Are rural hospitals "strategic"?

This article focuses on strategic management of rural hospitals from an evolutionary perspective, using logistic regression models to examine the environmental/organizational pressures that induced rural hospitals to be more active in strategic changes (high changers versus low changers) in two 5-year consecutive intervals between 1983 and 1993. Findings suggest that these pressures had inconsistent effects and high changers were more sensitive to organizational pressures than environmental pressures.