Top Challenges for Rural Health Networks
Developed by:
Community Health System Development Team
Georgia Health Policy Center
Georgia State University
- Fostering Effective Leadership
- Demonstrating Impact
- Finding Appropriate Staff
- Retaining Board Member Participation and Interest
- Finding Funding
- Dealing with a Constantly Changing Political Landscape
- Dealing with Conflict
- Building Community Support and Collaboration
- Developing the Network vs. Implementing Programs
Fostering Effective Leadership
Finding the right leadership can be a major challenge for a rural health network. During the origins of a network, due to limitations in time and resources, often the conveyors focus on getting the programs up and running without building the infrastructure for the success of such programs. The process of finding the right individuals who will provide administrative, organizational and clinical leadership and oversight is easily overlooked. At times, leadership is obtained from individuals who are available within close proximity and whom, though having the desire to serve, may not have the necessary skills to lead a social enterprise.
Tips for overcoming these challenges are:
- Define the characteristics you are looking for in a leader and who will help the network achieve its vision.
- Find a visionary individual who has exceptional communication skills, is politically savvy, and has a social and entrepreneurial vision to manage the network.
- Assemble a committed governing board that is open-minded, has strong leadership skills, and represents the diversity within the community.
- Find a leader among the community providers that champions the clinical initiatives of the network and actively engage peer providers in the supporting the network.
Demonstrating Impact
Evaluating the impact and outcomes that the network's activities have and creating value to the partners is often times an afterthought for rural health networks. Evaluation should be a constant since the inception of a network to determine achievement of goals; improve program implementation; provide accountability to stakeholders and funders; and increase community support.
Tips for overcoming this challenge:
- Become familiar with the evaluation process: ensure that it is simple, makes sense, and increases your potential for success.
- Include evaluation in the planning process.
- Start evaluating your network's activities from day 1 of funding; create a matrix with activities, measures of success, responsible parties, and timelines.
- Provide periodic feedback to your partners regarding successes, challenges, and changes in the action plan.
- Seek assistance to build internal capacity to develop the evaluation component of your network.
Finding Appropriate Staff
Recruiting and retaining qualified staff can be a major challenge for a rural health network. Often in the early development of a network, there are not enough financial resources to hire full time staff initially, nor to provide competitive compensation packages (combination of salary and/or benefits), or in smaller, isolated communities, often the skills needed to direct or manage a newly forming network are not readily apparent in those in the job market.
Tips for overcoming these challenges are:
- Start by identifying the key characteristics of the staff you want to hire.
- Look for untapped resources in the community (a person just returning to the job market; a part-time person at one of the partner facilities/programs; job sharing; perhaps someone considering retirement with key skills).
- Piece together a competitive package with contributions from the community or partners.
- Be bold about trusting the underlying skills of a person that fit your needs, even if the exact expertise for your health collaborative may not be apparent. Allow on the job training and growth.
- Provide sound guidelines and business protocols for staff to work under.
- Give direction to aid in their success.
Retaining Board Member Participation and Interest
Leadership provided by Board members and partners is vital to the success of a network. Keeping board members active in the organization and involved in program development is key as well. Oftentimes board members or partners are focused on the organization they represent- and can be distracted from the broad picture of the network.
Tips for overcoming these challenges are:
- Seek input and continuous feedback from board members and partners about what their needs, goals and ideas are for your success; keep lines of communication as open as possible.
- Find a win-win situation for each member - they don't always have to be a part of every program activity, but make sure at least one issue hits home with them, adds to their success or helps alleviate a problem for them.
- Demonstrate value to board members in order to keep people at the table.
- When seeking a contribution from board members (time or financial (in-kind or cash)) help them to see the value of their contribution and document their "gifts".
- Continue to show appreciation for their participation.
Finding Funding
Many rural health networks receive their initial funding through a grant combined with in-kind contributions from network members with the grant providing most of the funds. Since grants provide financial support for a defined period of time, networks are faced with the challenge of identifying sources of money to sustain the infrastructure and programs of the network. The tendency is to look for another grant, then another, and another. Networks that are most successful at sustaining operations over time are those that develop a variety of funding streams.
Tips for overcoming this challenge:
- Approach your network as a business. Develop a business plan to help evaluate the long-term feasibility and resource needs for network infrastructure and activities.
- Consider grants for what they usually are, start-up money.
- Set network goals and objectives and then look for grants to start your initiatives.
- Look for ways to sell network program services to private and public entities to generate revenue.
- Explore joint contracting and shared services opportunities for network members and retain a portion of the savings for network administration costs.
- Develop value for network members so that they will be willing to provide increased financial support to the network via membership dues cash or other in-kind contributions.
- Be creative and develop diverse sources of funding and revenue to reduce the risk of losing all funding.
- Work toward reduced dependence on grants and increased self-sufficiency.
Dealing with a Constantly Changing Political Landscape
Initiatives to provide public funding of networks at both the state and federal levels come from political support. The willingness of local government, hospitals, businesses, network partners and other stakeholders to contribute their time, efforts and resources to your network also comes from political support. Politicians and other key people come and go and the issues that are important to them can go as well; you can help ensure your network's viability is not in jeopardy in the midst of changing political environment.
Tips for overcoming this challenge:
- Be aware of the current local, state and federal political environment as it relates to your network.
- Keep your community, legislators, state regulators, funding organizations, and other stakeholders informed about the health issues your network is addressing, how you are addressing them, and the progress you make. Do not wait for the legislative session before telling your story.
- Know the agendas of those that help generate political support for you and look for ways to partner with them and help meet their goals as well.
- Be sure you have political support from a range of individuals and organizations. "Do not put all your eggs in one political basket."
- Build broad-based support for the issues that are important to your network and the programs you develop.
- Develop informational and public relations tools to educate others.
Dealing with Conflict
Networks by definition include multiple organizations that come together to address a common issue or goal. Some networks have diverse member organizations, creating opportunities for conflicting interests and goals. Even horizontal networks comprised of more than one of the same type of entity (i.e. hospitals) are subject to conflicting individual organizational goals or issues of competition. Regardless of the types of organizations in a network, there will always be diverse personalities that represent them. It is inevitable that conflict will arise out of network efforts and deliberations. The key is to ensure that conflict does not debilitate the efforts of the network to achieve the common goals.
Tips for overcoming this challenge:
- Recognize that not all conflict is bad. Conflict can be used to generate discussion and sharing of ideas if dealt with constructively.
- Work on building open communication and trust among network members.
- Avoid hidden agendas. Get issues out on the table where they can be addressed.
- Do not assume there is conflict with another network partner. If you think there may be a conflicting issue, ask.
- Gather relevant data to support dialogue over a specific issue.
- Pursue training in conflict resolution.
- Seek the assistance of an external mediator if you cannot resolve major conflicting issues among yourselves.
Building Community Support and Collaboration
Community support and collaboration are not only critical for successful health networks, but they go hand-in-hand in the development of a strong foundation for a network. Community support involves invitations to all sectors of the community for equal participation, which equates to a vested buy in, by all parties involved. Collaboration means simply to work together towards a common goal. However, when the science of community support is combined with the art of collaboration, a synergy is developed that propels a network to the commitment of fulfilling its mission, purpose and objectives.
Tips for achieving community support and collaboration:
- One organization must take the lead in convening the collaborative and helping build relationships among potential partners.
- Develop a map of the assets in your community.
- Find a driving force that motivates and inspires each of your potential partners.
- Engage in individual conversations with all potential partners and ask them to refer you to other sources known to them.
- Define goals that benefit everyone in the collaborative and the community.
- Try to formalize relationships with your potential partners by signing a memorandum of agreement that lays out everyone's responsibilities and commitments.
- Maintain the community abreast of the successes and needs of the collaborative.
Developing the Network vs. Implementing Programs
Network development is crucial to the success of any health network's intervention. Community groups quickly form a collaborative to implement an intervention without dedicating much attention to the development of the relationships within network and other elements that need to be in place prior to the outgrowth of programs. The success of the implementation of the intervention is dependent upon the success of the network and the success of the network is dependent upon the time and energy invested into the development of the relationships and partnerships of the network.
Tips to ensure proper and comprehensive network development:
- Find active and effective leaders to provide oversight of the network.
- Find the most competent personnel to staff the day to day operations of the network.
- Develop a common vision that is owned by each member of the network.
- Develop a work plan that will ensure the viability of the network down the road.
- Develop programs that are based on the needs and assets of the community.
- Evaluate and communicate the successes and impact of the network's activities.
- Seek external technical assistance to help you fill any void in expertise when developing your network.