The Maine Rural Health Research Center (MRHRC) is one of six rural health research centers participating in the National Rural Hospital Flexibility Program (Flex Program) Tracking Project. As part of this comprehensive review of the Flex Program, MRHRC researchers have a lead role in exploring the role of state policies in the Flex Program, staffing and workforce issues, and factors related to the success of Critical Access Hospitals (CAHs). In collaboration with researchers from the other centers, MRHRC researchers will use a combination of primary and secondary data to evaluate the impact of the program. During 2002-2003, MRHRC will conduct the following projects:

• In collaboration with the North Carolina Rural Health Research and Policy Analysis Center, MRHRC will survey all 47 state Flex Coordinators to explore issues related to: the goals adopted by the states for their Flex Programs; the resources (including Flex grant funds, staff, relationships with other state agencies/departments and external organizations, and other state funds) necessary to accomplish these goals; and the impact of the Flex Program on the development of state capacity. In addition, MRHRC researchers will conduct key informant interviews in 8-10 states that have successfully implemented the Flex Program and have used their Flex Programs to develop additional state rural health initiatives.
• MRHRC researchers will expand upon their earlier work on CAH staffing patterns by focusing on issues related to staffing efficiency and staffing strategies used by CAHs to develop, recruit, and retain staff. This project will use Medicare cost report data and data from the survey of CAH administrators conducted in Year 3 of the Tracking Project to explore and develop measures of efficiency based on measures of inpatient and outpatient volume and staffing levels. They will also conduct telephone interviews with administrators of 20 CAHs to identify and explore innovative staffing strategies and best practices.
• In collaboration with the WWAMI Rural Health Research Center, MRHRC researchers will explore the determinants of success for CAHs through comparative case studies of six CAHs using a balanced scorecard framework. Site visits will be conducted with three financially successful and three financially challenged CAHs to explore the strategic and management issues undertaken by these facilities related to: patient satisfaction; clinical utilization and outcomes; financial performance and human capital support; and system integration and change. Researchers will compare the extent to which these two categories of CAHs differ in terms of the types and range of strategic and management initiatives undertaken and implemented.

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