Recruiting Rural Executives: The Board’s Role, Responsibilities, and Mindset

By Beth A. Nelson and James U. King III

“Rural hospitals and health systems often face a leadership catch-22. They need strong leaders to overcome the well-documented challenges facing rural healthcare – limited resources and dwindling populations, for example – but struggle to recruit strong leaders because of these challenges.”

This is how our recent article in Trustee Magazine begins. It is never easy to recruit CEOs and other executives for rural hospitals and health systems. Trustees, we have found, are often the “difference makers” if they are committed and able to engage with executive candidates and sell them on a vision for their organization’s future.

Witt/Kieffer's Beth Nelson

Beth Nelson

“When I feel pride from the board, I know we are starting in a great place,” says Ed Freysinger, who recently became chief administrative officer at PeaceHealth Ketchikan Medical Center in Ketchikan, Alaska, and was one of the leaders that we spoke with for the article.

Gerald R. Cayer, MPH, who signed on last summer as CEO at Lewis County General Hospital in Lowville, New York, also looked closely at the board. “I was looking for enthusiasm and engagement,” he says. “As the recruitment process continued I was evaluating ‘healthcare IQ’, the presence of safety and quality language in our discussions, the willingness to govern vs. micromanage, and personality compatibility.”

Four Areas of Focus

Jim King

In the article we outline four strategies that underpin a rural board’s ability to recruit top-notch executives:

  1. Connect with candidates on mission and values . . . and vision.
  2. Promote your medical staff, including its role in CEO and C-suite success.
  3. Make sure the board is at its best.
  4. Show candidates how you will support their transition.

A key is “open and transparent communication between the Board and management with a goal of advancing and evolving the organization’s mission,” says Pamela Robertson, who was recently hired as CEO at Kalispell Regional Healthcare in Montana. Robertson believes that board members’ commitment to “quality, safety and engagement” is a must to the organization’s long-term success.

Finally, says Cayer, the board must remind executives that rural health is a meaningful calling. “We have the opportunity to make a difference,” says Cayer. “How cool is that!”

Read “Recruiting Rural Executives”


Based in Oak Brook, Illinois, Beth Nelson is a principal in Witt/Kieffer’s Healthcare practice, specializing in recruiting for rural and community-based organizations. Jim King is a senior partner and chief quality officer with the firm and is based in Shakopee, Minnesota.

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