Rural–Urban Differences in the Incorporation of Workforce Planning and Development in the Strategic Planning Process of US Hospitals

Background: The effectiveness of healthcare systems relies on how well workforce planning and development strategies align with organizational goals, given the detrimental impact of workforce shortages on patient safety and healthcare quality. This study examines the determinants and rural–urban differences in the integration of workforce planning and development into strategic planning in US hospitals. Methods: Data for this study were obtained from the 2022 American Hospital Association Annual Survey and the 2021 Medicare Hospital Cost Report. The study outcome was measured with a composite score, calculated as the count of workforce planning and development activities incorporated into strategic planning. A Poisson regression analysis was conducted to identify the determinants of strategically aligned workforce planning and development, and to assess rural–urban differences. Results: Of the 2749 hospitals analyzed, most were urban, non-profit, and system-affiliated, with an average of 170 beds. Factors such as system affiliation and organizational size were positively linked to the incorporation of workforce planning into hospitals’ strategic planning efforts. Conversely, for-profit ownership, critical access hospitals, and locations in the South were associated with less integration of workforce planning and development into strategic planning. Conclusion: Structural, institutional, and regional factors may influence the extent to which hospitals incorporate workforce planning and development in their strategic planning processes. Efforts to align workforce planning and development with strategic planning across US hospitals may require interventions to enhance institutional capacity and foster a culture of long-term planning for sustainability.