Introduction: Critical Access Hospitals (CAHs) are a vital part of the public health system, particularly in small rural counties where access to health promoting resources are limited. Thus, the public health system needs successful CAH employee recruitment and retention. Employee engagement is growing in importance for improving employee satisfaction and retention in all facilities that provide health care services.. The COVID-19 pandemic has only increased the growing recognition of the need for strong employee engagement in the healthcare workspace in order to increase retention.

Methods: Employees of four Georgia Critical Access Hospitals (CAHs) were surveyed in 2020 (n=589), and again in 2021 (n=487). Domains represented in the survey include organizational citizenship and processes, operational conditions, compensation, communication, human resources practices, leadership and supervision, employee traits, and COVID-19. In between surveys, the hospitals implemented action plans to address findings from the baseline survey.

Results: Hospitals saw improvement in overall employee engagement and outcomes, even in the midst of the COVID-19 pandemic. Specifically, these organizations saw improvements in areas where they implemented improvement plans. Communication was a consistent area of challenges for hospitals. Our findings may inform efforts by CAH leadership to improve rural health care.

Conclusion: As the challenge of maintaining a dependable and productive workforce has grown for healthcare organizations, maintaining high levels of employee engagement has become an organizational priority. Our study of CAHs in rural Georgia found that making employee engagement a priority can have a positive impact on it.