Leadership Dialogue

In this episode, Tina Freese Decker, 2025 chair of the AHA Board of Trustees, talks with Lori Wightman, R.N., CEO of Bothwell Regional Health Center, in Sedalia, Mo., about the challenges that rural hospitals and health systems face.

Freese Decker and Wightman discuss working in a “family atmosphere” unique to a rural hospital and navigating the same pressures that face urban hospitals, including workforce shortages and the high costs of labor, supplies and drugs. Rural hospitals also experience severe underpayments by Medicare and Medicaid, and most have “razor-thin” operating margins.

Wightman describes leading annual advocacy days — where Bothwell board members meet with state legislators (and candidates in election years) — and emphasizes the importance of all team members telling the hospital story.