A Path to Equity for Rural Health
By Darren Henson
Right before the COVID-19 outbreak occurred, AHA’s Institute for Diversity and Health Equity (IFDHE) convened more than 65 leaders, trustees and clinicians from rural hospitals across the country at AHA’s annual Rural Conference. We inquired about strategies for health equity in rural communities, as well as these communities’ most common areas of disparity or need.
Below, I've compiled key takeaways and lessons gleaned from this session.
Rural hospitals can lead in communities when they embrace their role as anchor institutions. Hospitals are often these areas’ largest employers — especially in smaller towns — and generally offer well-paying positions with benefits. Hospitals can also take the lead as the primary source of information on addressing common gaps in care through community health needs assessments (CHNA). By understanding what community members identify as their primary health-related needs, community health advocates/stakeholders can significantly influence how local health systems set priorities, allocate resources and build local capacity. As part of a recent case study by the University Of North Dakota School Of Medicine and Health Sciences' Center for Rural Health, 36 recently completed CHNAs identified 139 community health needs, ranging from substance abuse to transportation. A hospital doesn’t need to solve them all, but rather can seek improvements by biting off what they can chew.
Kearny County Hospital (KCH) in western Kansas, for example, sought to address its sustainability challenges and advance health equity by better understanding its community through initiating strategic data collection over the last couple of years (video). Not only were surveys and questions created to gain a greater understanding of general community health needs and resident behaviors, but KCH also remained committed to connecting with and gaining the trust of residents to encourage survey responses.
Leverage channels of communication throughout the community. Communications channels involving key hospital leaders and community partners, or “community connectors,” helped spread the word about the importance of KCH’s health survey and how the information collected would help identify specific community needs to be addressed. For KCH and in many other rural communities, communications channels are far more personal and far less technical – often relying on face-to-face meetings with prominent community members with the local chamber of commerce, school district officials, business owners and faith-based leaders, among others. Once responses were collected and analyzed, community health leaders then began pinpointing conditions that deserved primary focus.
Narrow your focus areas to gain immediate improvements. Better focus can lead to quick wins, as organizations capitalize on low-hanging fruit. These successes in turn build trust within communities and among stakeholders. Let the community identify primary focus issues, once the data has been collected, and act quickly. Some hospitals have organized community leadership boards, comprised of leaders of community organizations that are served by a hospital, such as social service agencies, faith community leaders, neighborhood coalition and educational institution leaders as well as leaders representing mental health, housing law enforcement and emergency preparedness initiatives, among others. Convening these organizational leaders on a regular basis can help get information out to the community as well as provide a feedback loop to the hospital leadership about the needs, concerns, and satisfaction from the community.
Identify Funding Sources
Identify funding sources. Rural America stands to benefit from stronger connections with community hospitals that can lead research opportunities to positively impact a variety of populations. The Coronavirus Aid, Relief and Economic Security (CARES) Act that became federal law in March, created $100 billion in new funding to assist rural hospitals. Additionally, the law created greater access to telehealth services for rural communities and temporarily eliminated Medicare sequestration through the end of 2020. (AHA CARES Act: Provisions to Help Rural Hospitals).
Sow the seeds of success. After seeing the fruitful outcomes of an improvement project, share it widely. State hospital associations are always sharing leading practices with the other organizations in the state. The AHA’s IFDHE and Rural Health Services webpages are great resources for case studies, member spotlights and webinars to share key learnings.
Drive policy reform to influence systematic change. Share the lessons learned with policy makers so that changes can be sustained through the policy-development process. AHA is working at the federal level to make certain waivers and flexibilities granted during the pandemic permanent or extended past the public health emergency. Adaptations in this unprecedented time can be solutions that last. Furthermore, let your state representative know of the positive impact local hospitals are making on their communities. Share stories of local hospital efforts and your opinions with congressional leaders, and ask them to enact the policy changes necessary for such initiatives to continue well into the future.