Abstract
The theme of this edition of Healthcare Management Forum is rural health.
Those of us who work in rural healthcare, whether in a remote location or in a small community in a more central area, experience professional fulfillment and challenges that differ from those in an urban setting—different advantages, different solutions, and different opportunities for innovation.
Isolation, small scale, low volumes, and transportation issues are just some of the challenges characteristic to rural settings. These are more than offset by flexibility and ease of communication. Collaboration is borne by necessity and often easier due to the small number of providers.
For these reasons, rural healthcare has long been recognized by many governments as requiring a unique policy approach. Whaley’s article assesses Ontario’s rural health policy initiatives implemented from 1969 to 2019 related to access, rationalization, restructuring, and integration. The article concludes with some important lessons learned about clarity, focus, advocacy, implementation, and prioritization.
One of the challenges of rural healthcare is building and maintaining sufficient scale to operate efficiently and attract and retain specialty services. Wilson Trider describes how two hospitals formed an alliance (as an alternative to a merger) to address these challenges and to produce additional benefits from integration. The article provides advice for others who might set out on this course of action.
Racette illustrates another example of partners forming a coalition. Leveraging the flat structure and spirit of collaboration in a rural setting, an initiative was launched to improve access to care and address healthcare issues that are specific to their local challenges, which include dispersed population, remoteness, lack of public transportation, seasonal population surge, and lack of clarity about the provision of Indigenous health services.
Du Mont and co-authors describe the development of a network that could apply to all communities—large or small. Establishing sexual assault against transgender persons as a complex public health issue, the article details planning for leaders from across health and social service sectors to collaborate to ensure trans-affirming care for sexual assault victims.
Because of remoteness and professional isolation, ongoing education can be challenging for healthcare professionals working in smaller communities. The article by Poulin and Skinner relates how the smaller, more integrated healthcare systems within these communities can be optimal for interprofessional education. They are ideal settings due to overlapping, flexible roles that are not typical to urban settings and can expose learners to team environments with enhanced communication and cooperation among different disciplines. The results include increased professional collaboration and improved outcomes.
Wenghofer and co-authors propose a pilot study for rural Ontario to provide rural physicians with access to high-quality continuing professional development. It is based on an initiative implemented and evaluated in rural Texas involving peer reviewers who are familiar with the conditions, scopes of practice, and resources available in small centres. It recognizes the unique challenges of these settings and overcomes professional isolation to improve medical knowledge and patient care competencies.
Whether in cities or small communities, the goal in healthcare is to provide high-quality services. Fyfe and Payne identify challenges in implementing clinical guidelines to enhance quality in rural communities and identify how adaptation occurs in those settings. They recommend that these should not occur on an ad hoc basis but, rather, systematically to ensure consistency and quality patient care.
Gazarin and co-authors describe a medication reconciliation program for chemotherapy patients that demonstrates how high quality can be achieved in a small hospital, despite the moderate patient volumes and limited resources. The article outlines success factors and a model that could be transferred to other rural institutions.
This edition of Healthcare Management Forum celebrates achievements in rural healthcare, identifies opportunities, and provides examples of successfully addressing rural challenges. I have spent most of my career working in smaller communities. Working in small organizations and collaborating with rural partners to foster innovation that impacts the health of entire communities has been rewarding and very fulfilling.
Thank you to all the authors for their contributions and to the Managing Editor, Laurie Wilson, for all her work in putting the edition together.
