Essential Elements of Rural Health Innovation
By Janice Walters, M.S.H.A., CHFP, Chief Operating Officer, Rural Health Redesign Center
Have you ever asked yourself why innovation is so hard? Having the opportunity to lead the rural health innovation efforts within the Pennsylvania Rural Health Model (PARHM) as its Chief Operating Officer has given me firsthand insight into why innovation within healthcare is so difficult. Having considered myself a change agent for most of my professional career, leading this effort has provided deep insights into the difficulty, but not the impossibility, of innovating rural health. Solving the rural health crisis across the nation is a task that must be completed with determination and grit, and there is enough wherewithal within rural health leaders to accomplish this mission. The goal of this article is to provide insights for governance and organizational leaders to consider as they contemplate a journey of rural health innovation.
Innovation Building Blocks
When thinking about an innovation journey, the most important aspect required is effective planning. Change of significant magnitude takes time to achieve. Ensuring realistic expectations within timelines is part of an effective planning process. Effective planning is the foundation—it’s critical to achieving goals and successfully executing innovation efforts.
A second building block is appropriate data infrastructure. Timely and accurate data is essential to implement and measure the success of any performance improvement initiative. Rural health innovation is no exception. Adequate data by which to identify where there is opportunity for change, as well as to measure the success of change efforts, should be considered early in the innovation journey. A third building block is identifying competencies with the implementation team. Ensure that the individuals leading these efforts, both within your organization, as well as those leading collaborative efforts, have rural-relevant experience. Relevant experience helps to establish trust and rapport with necessary stakeholders, including rural healthcare executives, their teams, and their communities. Effective change management experience and expertise is also necessary to drive meaningful and lasting change.
Essential Leadership Soft Skills
While the building blocks identified above are essential to innovation, it is also important that specific soft skills are present within leadership. These include:
Humility: There will be questions that do not yet have answers, and one must be humble enough to admit that. No one person has all the answers.
Patience: Change of this magnitude takes time. It is a marathon not a sprint.
Resiliency: Innovation is hard, and there will be setbacks. Expect the difficulty, push through it, and don’t give up. Rural health innovation is not for the faint of heart; keep on keeping on.
Humor: The use of humor and not taking yourself too seriously is essential. Choose to laugh; it is good medicine. The effective use of humor can readily change a tense situation for the better.
Understanding: Understand that work of this nature takes the development of both new mindsets and skillsets. It will take time for healthcare leaders to grasp new concepts and adopt these into practice. Within the PARHM, hospital leaders needed to understand the new paradigm before they could fully strategically plan within it. This journey took several years.
Important Program Elements
In addition to the building blocks and soft skill requirements of leadership teams, there are essential program elements that must be present within the innovative process:
Transparent and honest communication within formal communication forums to ensure ongoing stakeholder engagement.
Relevant expertise that provides the ability to connect with stakeholders, especially related to the reality of what rural healthcare leaders are facing today.
Alignment of purpose, ensuring that everyone agrees on realistic desired outcomes, and a shared belief that everyone is working for the best interest of rural healthcare providers and keeping access to care in rural communities.
Stakeholder input. It is important to ensure that input is actively sought and heard from impacted stakeholders, and that a feedback loop is provided to keep all stakeholders informed.
These elements, when functioning together, produce the continual cycle required to maintain trust and keep forward momentum.
As boards and senior leaders of rural hospitals and health systems, there are questions that should be considered as you prepare to embark upon an innovative journey. These include:
If the answers to the questions posed are “we don’t know,” then the questions become “how do we get an understanding of the current state?” For example, what resources and planning are necessary to assess the current state or what is a reasonable timeline to begin assessment planning and implementation?
As I reflect upon the transformational journey happening within Pennsylvania and its Rural Health Model, there are a few key takeaways. Why is innovation so hard? Because change is hard. Even though the current rural health environment is not sustainable for most rural hospitals, adopting a new way of thinking to envision a new reality can be difficult for healthcare leaders, board of directors, community members, and clinicians. A new paradigm requires a different mindset, and it takes discipline to think differently. For most people, change is difficult, and some may even fear it. Having the understanding that overcoming fear of change takes time in and of itself is essential. Even when rural leaders want to adopt change, there are often other circumstances that prohibit them from doing so, such as competing priorities, bandwidth issues, and resources. Addressing these problems must be part of the solution for long-term meaningful change (innovation) and sustainability of rural healthcare.
There remains a crisis of healthcare equity and access in rural America. Solving this problem will take continued political and legislative attention to develop meaningful and lasting solutions in the near-term. My fear is that our inability to be proactive in driving needed change will result in perpetuation of the crisis. Personally, leading this work within Pennsylvania has been some of the most taxing, yet rewarding, work of my career. While not for the faint of heart, if you are looking for a rewarding and exciting journey, embrace rural health innovation and be part of the solution.