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Necessity Is the Mother of Innovation

A Message from Kate Vaughan, MSW
NICHQ’s Associate Project Director

June 2012


I grew up in a rural community in mid-coastal Maine- the kind of place where you wave to every car that passes you in the street because you inevitably know the driver. The town where my parents still live and work is home to around 850 people. This is not a unique existence for the Northeast, or most of the US: sixteen percent of our country’s population now lives in rural communities. People who live in rural America have a very different experience in the healthcare system than much of the country, one that forces them to create systems and customized solutions that work for the entire community.

When thinking of healthcare systems, I often look through the lens of my family. A brief experience on a recent visit with my parents brought everything into focus. My father had a small accident which, for many, would have meant a quick drive to the emergency room. However, the emergency room and the ambulance are well over half an hour away. While this is not a long distance by rural standards, my father, a life-long resident of this town, relied on some finely tuned home remedies (no doubt perfected through his own small tests of change) and moved on with his day.

People living in rural areas have a shared interest to improve health systems for their communities. The rural healthcare system is often fractured and understaffed. As practitioners reach the age of retirement, it is hard for rural communities to attract new medical professionals to take their place. Building a sustainable system of care for rural communities can also be challenging: rural populations are often older and use public insurance at a high rate.

Despite these challenges, rural systems have a potential advantage over urban ones in the arena of quality improvement. Smaller independent systems are more nimble and allow more room for change.

“You can get a change in a rural hospital in two days that would take you two months to get in a unit of an urban hospital. It’s just a lot easier, simply put, to turn a canoe around than it is to turn a battleship,” Mary Wakefield, the Administrator for the Health Resources and Services Administration (HRSA) at the U.S. Department of Health and Human Services, was once quoted as saying.

The realities of the rural healthcare system have driven innovations in models such as telemedicine, mobile clinics and community health workers. In rural communities, innovation is a necessity. As the saying goes, “Necessity is the mother of invention.” This is certainly the case for rural healthcare.

At NICHQ, I work on two projects that have shown me that many commonsense changes to our system will benefit all who access care. Working to Improve Sickle Cell Healthcare, or WISCH, is the umbrella project for two multi-year HRSA-funded programs that focus on improving the care and outcomes for individuals living with sickle cell disease and improving the follow-up of those who are detected through newborn screening to have sickle cell disease, sickle cell trait and other blood disorders.

I also work on the CHIPRA Medical Home Project, a five year initiative that works with thirteen Massachusetts-based pediatric practices to implement a medical home model of care.

Many of the solutions we focus on in these projects might seem obvious: coordinate patient care among different providers; plan for and focus on times when patients are at risk for losing healthcare or getting sicker, such as the transition time between pediatrics and adult care; help patients to become better managers of their health and wellness. But in our complicated and uncoordinated system of healthcare, these simple issues demand our attention. Fortunately, for all of us, there are innovators around the country who are conducting small tests of change to quietly change healthcare for the better. We are lucky to work with and learn from so many of these powerful innovators through our projects.

NICHQ is about making our healthcare systems better – be they urban, suburban or rural – one thoughtful small change at a time. In Maine, we might call it “Yankee Ingenuity.” At NICHQ, we call this Quality Improvement.

- Kate

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