Reimagining rural with NRHA President Leslie Marsh
More than three decades ago, NRHA President Leslie Marsh came to rural Nebraska and fell in love with small town life. Since then, she’s become a vocal rural health advocate and leader, having served in leadership roles at Lexington (Neb.) Regional Health Center for more than 25 years and as the facility’s current CEO. She recently told NRHA more about her passion for health policy, her early experiences with NRHA, and why rethinking rural health care is on her 2023 presidential agenda.
What is your connection to rural America? Did you grow up in a rural place?
I was born in a rural place – Needles, Calif. I didn’t live there very long, but when I went to college I moved to rural Nebraska, and since then I’ve lived in rural communities. I got married and raised my children and stayed in Nebraska. I am passionate about the people who live in rural communities – the resilience, the grit, the willingness to come together toward a common goal. When your neighbor has something going on, everyone comes together to help that individual be as successful as they possibly can. They’re there to support them and see to their needs. That might not happen in an urban setting as often.
How long have you been working in rural health, and what inspired you to pursue a rural health career?
I’ve been working in rural health since 1986. I always wanted to be in health care – my older sister is a nurse, so I’m sure that had something to do with it. I’m a nurse as well, but the things I was passionate about and my skillsets and interests went beyond the bedside.
I wanted to be better prepared to serve as a leader in a health care organization, which meant I needed to pursue a business degree. I was hired at Tri-County Hospital (now Lexington Regional Health Center) as CNO in 1998. My roles over the years have included working in infection control during the height of the AIDS epidemic, focusing on community health and wellness as a lead organizer of a Community Health Olympics event, and developing a community fitness initiative focused on reducing childhood obesity, enhancing access to nutritious produce, and providing free access to a variety of activities. I realized I wanted to be more involved in health policy and potentially serve as CEO at a rural health care organization.
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That realization and personal strategic plan sent me back to school, where I focused on health policy leadership and management. I graduated in 2010 and began my job as CEO almost immediately. I have been CEO at Lexington Regional Health Center since 2010. My interest in politics, policy, and the regulatory environment has led to my being involved in various organizations in a variety of leadership roles.
In terms of a rural health career, I am blessed to be able to participate on a micro and macro level. The relationship-based work we do in rural is incredibly rewarding, and 2020 illustrated the heart, soul, competence, commitment, innovation, adaptation, and strengths of our rural health care heroes in Lexington and across the nation. It is truly an honor to work alongside incredible people who care deeply and passionately about those they serve and their community.
How long have you been involved with NRHA? What are some of the biggest benefits of membership?
In 2010, as I was completing my graduate work, I interned at NRHA. I got to be involved with NRHA CEO Alan Morgan, COO Brock Slabach, and the team just as the Affordable Care Act was being enacted – it was such an exciting time to be there. I got to know NRHA staff and quickly grew to admire them. That small but mighty organization is incredibly impressive. The work they do and everything about the organization really motivated me to engage at every level, allowing me to advocate for rural.
I got to know Brock in particular very well. He took me under his wing and became a role model. The best things I’ve ever accomplished have come from other people’s input shaping the way I lead and thereby more effectively operationalizing different initiatives. My involvement with NRHA continues to help me develop and evolve as a leader. I learn from every single person I interact with through my NRHA membership. The members and the leadership are fantastic. It’s a great organization full of smart, talented, kind, caring, and involved people.
What are your goals and priorities as NRHA president this year?
One of the things I would like to accomplish in terms of reimagining health care is taking all of the innovation, technology, and processes that were fast-tracked during the public health emergency and intentionally distilling that information. I want to look at driving health care delivery in a way that recognizes the honor, duty, and obligations we have as health care providers to ethically, competently, safely, and compliantly deliver high-quality care. With innovation and technology – as with all health care – there is an awesome duty to safeguard the privacy and security of the people who depend on us to take care of them through meaningful consent, deliberate conversations about the risks and benefits of treatments or procedures, and patients’ goals in receiving care.
Workforce shortages are also part of my platform. In the wake of COVID-19 it is obvious that health and recovery are paramount. I can’t remember a time when I’ve seen such across-the-board shortages and vacancies. In order to continue to heal, synthesize information from the past three years, and transform health care, we will need to work hard as an association to identify and respond to challenges and opportunities. We must amplify our voices as we advocate for the resources to reimagine high-quality, safe, secure, value-based rural health care delivery models.
What do you find most rewarding about working in a rural community?
You get to see what your work does for the people you serve. We can see the barriers to care and determine how we can help overcome those barriers by providing the right resources. Importantly, people may want something different than what we think would be best based on research and historical evidence. If we want to elevate the health of our patient populations, it will be imperative to understand what is important to them and create shared goals that recognize their preferences.
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My community is very diverse – 67 percent of the town is Hispanic, and we have a Somali population of about 14 percent. We have a lot of different elements that come into play, so building trust, making sure patients and their families are making their own decisions, and helping them optimize their health is really rewarding. There is a critical need to build trust and understand and respect cultural and individual differences as we seek to deliver the best health care possible. Our community health care workers are a vital part of our health delivery team.
Finally, COVID-19 underscored our ability to be nimble and pivot quickly. We are not very bureaucratic in our rural community, so we can quickly adapt. That inherent, adaptive characteristic will serve rural well as we innovate and continue our transformative delivery of care post-PHE.
What qualities do you feel are most vital for rural health leaders? Why is strong leadership so important?
Rural and urban leaders all have to demonstrate authenticity and understanding of internal and external factors. I don’t see true leadership as being vastly different between urban and rural settings. I think you have to be principled, have integrity and care, seek to understand, and be mission focused. You need to execute strategy and serve. Our roles as leaders may be different, but the characteristics of a leader are more similar than dissimilar.
We need strong rural leadership to gain support from key stakeholders locally, regionally, and nationally, enabling us to maintain financial and operational sustainability. Without strong and engaged leadership, there will be a diminished understanding of any situation and ineffective advocacy. Our challenges will be amplified, creating an economic ripple effect throughout the community. Without strong leadership in rural communities, health care organizations can fail. One big difference between rural and urban is once health care is gone, you see a dying community, literally and figuratively.
What about the future of rural health energizes and excites you?
I’m looking forward to NRHA’s Annual Rural Health Conference in May and Rural Health Clinic and Critical Access Hospital Conferences this fall. I’m also excited by all of the power and potential we have as a group of thought leaders. We can realize great things by working together to make a difference. I love NRHA’s slogan: “Your voice. Louder.” We really are a group of committed, dedicated people in NRHA, and together we stand a much better chance of transforming health care in a way that ensures our rural communities continue to have access to the same high-quality care as their urban counterparts.
This interview has been edited for length and clarity.