Innovation in healthcare is often concentrated in large urban health systems and well-resourced academic medical centers. But a vivid and underappreciated part of the healthcare ecosystem is consistently overlooked: rural hospitals.
These institutions serve millions, and while they may lack the resources of their urban counterparts, they bring something just as valuable to the table—agility, practicality and a culture of creative problem-solving. For startups, rural healthcare systems offer not just a proving ground, but a receptive environment for innovation—one that moves faster, collaborates more directly and welcomes solutions that can immediately reduce provider burden and improve patient outcomes.
Healthcare’s performance improvement culture shares roots with the Lean Startup methodology
Healthcare is a famously conservative industry, slow to adopt new technology despite constant clinical advances. At the same time, the culture of iterative performance improvement continues to advance in healthcare, driven by organizations like the Institute for Healthcare Improvement and an increase in quality-based compensation incentives. At its core is the Plan-Do-Study-Act cycle, rooted in W. Edward Deming’s 1950s work. The Lean Startup methodology, developed by Eric Ries and adopted by many startups, shares that same lineage, with its corollary Build-Measure-Learn loop.
Both emphasize rapid iteration and learning, making rural hospitals—steeped in continuous improvement and operational pragmatism—an ideal proving ground for technology innovation.
What makes rural hospitals “different” is what makes them good partners
Rural hospitals, by necessity, are experts in working “lean.” They typically lack the resources of larger systems, but their experience of “doing more with less” makes them understanding partners for startups. Where academic hospitals may expect a polished end-to-end solution, rural hospitals recognize that not-yet-perfect approaches to a problem can still yield meaningful impacts. Rural hospitals’ performance threshold for that minimum viable product (MVP) loop may be lower, enabling startups to gather early feedback and minimize investment during the early stages of development.
Larger health systems may offer deep expertise, but it frequently comes entangled in layers of bureaucracy. Endless stakeholders and committee meetings can stall a pilot indefinitely. Rural hospitals operate with flatter hierarchies and faster decision loops. Startups can speak directly with CEOs or lead providers, gaining not just buy-in but genuine enthusiasm. IT teams are more nimble and less beholden to entrenched electronic health record (EHR) vendors, making them more open to collaboration.
Feedback loops also run deeper in rural settings. Providers and patients are used to more personal, face-to-face interactions—and often more generous with their time and insights. Though the volume of interactions may be lower, the quality is higher, offering sharper, more actionable feedback for startups refining an MVP.
What’s in it for rural health?
Rural hospitals rarely see technology built with their realities in mind. More often, they are offered stripped-down versions of enterprise systems or oversized hand-me-downs from their urban siblings. These tools may function, but they rarely fit. By collaborating with startups, rural health systems can shape solutions from the ground up to reflect the nuances of their communities, care models and constraints. Patient engagement, chronic illness management, and care coordination look different in rural communities, and require platforms rooted in the lived experience of those environments.
Recruiting and retaining skilled staff is a persistent challenge for rural hospitals, partly due to limited access to professional development and continuing education. But professional satisfaction isn’t just about credentials, it’s about purpose. Healthcare workers are deeply motivated by the desire to improve their patients’ lives. Embedding innovation into the fabric of rural care delivery not only elevates the quality of care, it gives providers a reason to stay.
What do startups need to know about rural communities?
In rural communities, relationships matter more. Successful startups quickly learn that trust and connection carry more weight than pretty slidedecks or flashy tech. That means showing up with humility and a deep commitment to understanding the challenges rural teams face. Rural clinicians often wear multiple hats, navigate limited infrastructure and manage care with fewer resources and less support. Solutions that require layered workflows, constant connectivity, or deep IT builds are likely to fall flat. Startups need to bring tools that are lightweight, practical and ready to plug into the realities of rural practice. That kind of thoughtful design begins with listening—innovation in rural healthcare must be grounded in real relationships and a genuine respect for the people doing the work.
Equally important is setting clear expectations—on timelines, roles, data needs and support. Transparency builds trust, especially where time and budgets are tight. Offering clear and easy to understand contracts, terms, outcome reporting and data governance lowers the barrier to engagement. Above all, approach with honesty and a desire to learn. Rural health systems are not simply “smaller hospitals,” they are agile, relationship-driven environments that punch above their weight and will engage wholeheartedly if you show up like an equal partner.
One of the best examples of rural innovation scaling to broader impact is Project ECHO, launched in my native New Mexico to address the hepatitis C crisis in underserved areas. Faced with long waitlists and limited specialist access, Dr. Sanjeev Arora developed a model that used simple videoconferencing technology to mentor rural clinicians in treating complex conditions.
Instead of centralizing care, it democratized it—turning primary care providers into specialists through case-based learning and ongoing support. What started as a rural solution became a global model, now used in over 40 countries to manage everything from cancer to addiction to COVID-19. Project ECHO redefined how knowledge moves through healthcare. And it all began by listening deeply to the needs of rural providers and designing something that worked in their reality first.
How can rural hospitals advocate for innovation?
Rural hospitals have a powerful role to play in shaping healthcare innovation. Developing in-house expertise across clinical, technical and operational teams helps rural systems become active co-creators. Creating space for innovation in rural conference agendas—like the AHA Rural Health Conference—and inviting startups into those conversations signals openness. So does stepping into the startup spaces, like digital health summits. Building innovation coalitions across hospitals can attract startups that need broader populations to develop their product. Innovation partnerships thrive on mutual readiness, and rural systems that show up informed, organized and curious can help steer solutions that work not just for them—but for everyone.
Rural health systems are more than just sites of care—they are rich environments with an opportunity to accelerate innovation for the entire healthcare ecosystem. Vendors that invest could learn and improve at a rate that urban and academic centers cannot match, and that’s good for patients, for hospitals and for vendors trying to solve today’s persistent healthcare challenges.
Jason Cohen, M.D., is the chief medical officer of inpatient at Qventus, a tech company providing AI-powered care operations automation software to improve health system efficiency. He was previously the chief medical officer of North Valley Hospital in Montana.
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