Monitoring State Flex Program Financial and Operational Improvement Activities

Document Type

Policy Brief

Publication Date



MRHRC, rural, critical access hospitals, financial, operational, performance improvement, evaluation, Flex Monitoring Team


Researchers from the University of Southern Maine's Flex Monitoring Team present findings from a qualitative evaluation of State Flex Program interventions conducted under Program Area 2: Financial and Operational Improvement (FOI), a mandatory area of State Flex Program (SFP) activity.

They provide an inventory of all SFP FOI initiatives during FY15-18 and a more detailed analysis the interventions undertaken by a subset of 14 SFPs. The authors explored the types of project proposed by these 14 SFPs and the challenges they faced in monitoring the impact of their interventions on Critical Access Hospital (CAH) financial and operational performance. They conclude by recommending several efforts to document the impact of SFP initiatives.


Rural hospitals, Evaluation, Financial and Operational performance


For more information on this study, please contact John Gale,

This study was conducted by the Flex Monitoring Team with funding from the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS), under PHS Grant No. U27RH01080. The information, conclusions, and opinions expressed in this document are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Funding Organization

Federal Office of Rural Health Policy

Grant Number