Transcript
Andrew Nelson: Welcome to Exploring
Rural Health, a podcast from the Rural Health Information
Hub. My name is Andrew Nelson. In this podcast, we’ll be
talking with a variety of experts about providing rural
healthcare, problems they’ve encountered, and ways in
which those problems can be solved.
Today I’m talking to Alycia Bayne. Alycia is a researcher
with the NORC Walsh Center for Rural Health Analysis.
Alycia, you recently contributed to a resource entitled
Practical Guide to Supporting Innovation in Rural Health,
which was published on RHIhub’s website in June. Can you
tell us what inspired the development of the guide?
Alycia Bayne: In developing this guide,
we wanted to shine a light on the innovative work
happening every day in rural communities. We know that
they are innovating in terms of using their unique
assets, also while addressing some really complex
challenges: workforce shortages, resource constraints,
access issues. And so, the guide was developed to provide
a practical resource and a roadmap that can help rural
leaders move from a creative idea to implementation,
using strategies that do fit rural context and realities.
Andrew Nelson: In the context of this
guide, how is innovation defined?
Alycia Bayne: So, innovation takes many
forms in rural communities, and so I think it’s helpful
to start with what innovation is, and what it’s not.
Rural innovation is thoughtful, purposeful change that’s
realistic in rural communities, and that can be sustained
over time. It is adapting evidence-based and promising
practices, and then also ensuring that they fit the
context of the community. And it’s incremental change.
It’s not always large-scale change. Sometimes it’s
small-scale improvements. What it’s not is, rural
innovation isn’t limited to technology. It’s not a
one-off project that can’t be sustained. It’s not
implementing an evidence-based practice without really
giving thought to how to adapt it to the context of the
community. I also think it’s important to talk about some
of the features of rural innovation. Rural innovation is
very context-driven and place-based. It’s focused on
solving problems. It’s adaptive. It’s asset-focused, so
assets-first. It’s community-engaged, sustainable, and
then also supportive of the workforce within rural
communities.
Andrew Nelson: Yeah, it’s important to
have a framework that’s tailored to the communities
you’re trying to serve. Why is it that innovation tends
to look different in rural communities versus urban?
Alycia Bayne: Well, I think rural
communities are different. So rural communities are not
simply smaller versions of urban communities. They differ
from other communities in many important ways. So, both
population size and density, in terms of health status,
economic conditions, and access to services. And so,
while I think sometimes when we think about innovation as
being a huge technology advancement, rural innovation is
often driven by community relationships, partnerships,
local assets, rather than a large tech budget or a new
tech implementation.
Andrew Nelson: You mentioned
community-centered design; could you go into a little
more detail about why that specifically is so important?
Alycia Bayne: Sure. So successful
innovations are designed with the communities at the
center. Community-centered design really focuses on
reflecting the local priorities, the culture, the values,
the experiences that everyone brings to the project. And
I think cross-sector community engagement is key to rural
innovation. We want everyone to be at the table when
talking about innovations. And this includes local
residents, government partners, local service providers,
faith communities are a big important partner in rural,
payers, employers. So, bringing them all to the table,
having everybody there builds trust, it improves the
relevance of the innovation, and it also helps us to
ensure that innovations are sustainable, if everybody
buys in and is really engaged.
Andrew Nelson: When you were going
through the process of contributing to this resource,
what was the biggest misconception you encountered about
rural innovation?
Alycia Bayne: The biggest misconception,
I think, is that it’s related to technology. So,
innovation is not synonymous with technology, and I think
sometimes that’s right where our minds go. Many of the
most impactful rural innovations that we see through our
research are actually low-tech or even no-tech. In rural
communities, those types of innovations are partnerships.
They are workflow redesigns within health systems.
They’re integrating health and human services in new
ways. They are community-based approaches. And so, I
think we have to get beyond thinking about technology as
the only form of innovation. And I think we see that in
rural communities. Innovation is so much broader than
that.
Andrew Nelson: We certainly heard a lot
about telehealth in the last few years, but that’s really
just one tool that providers can use to improve outcomes
for people in rural areas. What do you want rural leaders
to be able to take away from this guide?
Alycia Bayne: I hope rural leaders and
practitioners see themselves and their communities in
this guide. I also want them to take away that innovation
does not need to be large and expensive and disruptive.
We don’t want it to be disruptive, for innovation to make
a meaningful impact. So, the best innovations start with
what the local needs are, what problems do we need to
solve, and how can we be creative about doing that? And
then what kinds of strengths do we have at the community
level that we can bring to bear? And how can we evolve
over time, perhaps starting small and then adapting and
learning and growing, and then hopefully sustaining new
innovations? So, I hope rural leaders take away that
process and also that it doesn’t need to be this large
undertaking.
Andrew Nelson: You mentioned a couple of
minutes ago how when people think about innovation, often
their mind just immediately goes to technology, and
that’s often kind of presented as a silver bullet for
rural health challenges. So that’s part of the picture,
absolutely. What have you identified as guidelines for
when technology can be useful related to innovations and
when caution should be used?
Alycia Bayne: I think technology can be
really important, but only when it’s fit for purpose.
Meaning that it’s capable of doing what we want it to do.
And so, technology can support innovation in rural if the
infrastructure is there to support it. So, if a
technology requires infrastructure that doesn’t exist, if
it adds to the workload that people already have, and if
people are already very stretched, or if it’s difficult
for patients to use, or perhaps they don’t trust it, then
technology can create new and different barriers and
challenges. So, I think successful rural innovation
really does start with the problem, and then whether the
technology is the right solution, and not the other way
around.
Andrew Nelson: And I guess to look at it
another way, you just want to make sure you don’t want to
have systems of care that are dependent on some form of
technology, that not everybody is going to have access
to. Another form of technology that we hear a lot about
every day is AI, of course. In the paper, you briefly
mentioned AI as an emerging tool for rural providers, but
you don’t spend a lot of time on it. What’s your
assessment of where AI and similar technologies could
genuinely benefit rural health, and where might it
actually cause harm?
Alycia Bayne: This is a really
interesting question, and we do touch on it in the
innovations guide, but we’re also working on a toolkit
focused on AI in rural healthcare. And so, what we’ve
learned through both of these projects is that rural
leaders should actually start by saying, “What problem
are we trying to solve?” rather than, “How can we use AI?
How should we implement AI? Where should we bring in AI?”
Starting with a clearly defined problem is where to
begin, and that might be a workforce shortage, or
clinician burnout is an issue, or perhaps there’s long
wait times, and there aren’t enough people to schedule,
limited access to specialty care. There’s so many
different problems that might exist, and then
determining, “Is AI actually the right tool? Is AI where
we want to begin?”
So, I think when we look at rural, there are a lot of
opportunities with AI, and there’s also so many different
tools and use cases. Some of the really interesting
examples that we’ve seen through our research are using
AI to reduce documentation burden, to support care
coordination, to identify patients who may need earlier
intervention. They’re using AI with medical image
interpretation, in some ways with telehealth and remote
patient monitoring to make that faster and more
efficient. And I think what we see in rural is using AI
to try to help clinicians spend less time doing
administratively burdensome things and more time actually
caring for their patients. But AI isn’t going to solve
every problem that we have, especially if it’s a problem
where technology isn’t the issue, it’s actually a
training issue, or the best solution is a new
partnership, or a redesigned care model.
So I think we always need to start with the problem and
then figure out if AI is the right solution. You are
right to think about the risks. AI can introduce bias. We
have concerns about privacy, and of course, the need for
governance councils. Some rural communities lack
broadband access, which may create issues. There’s the
need for training and technical assistance, so not just
bringing AI in, but how do you maintain it? How do you
sustain it and ensure people know how to use it? There’s
the importance of patient trust. And then certainly, the
concerns around AI may not adequately reflect rural
populations depending on how the tools are trained and
what kind of data they’re trained on. So, I think rural
leaders should approach AI, with a careful assessment of
whether it’s truly the best solution and how it can
support them.
Andrew Nelson: There’s this recurring
idea that I see popping up that if you’re not shoehorning
AI into every facet of your organization, then you’re
going to be left behind. Sometimes it seems like people
might be using AI as a solution in search of a problem,
and that’s just not always going to be appropriate or the
best way to accomplish a goal. I really like the
framework you’ve provided on how to evaluate when AI can
be useful and effective. What are some other examples of
rural innovation that you highlight in the guide?
Alycia Bayne: There’s so many great
examples that are highlighted in the guide. There are
some workforce pipeline programs that get at that
recruitment and retention challenge that we see in rural
communities. So, bringing local students in for rural
health careers and trying to retain them. There are great
examples of community health worker programs that expand
access to care for community residents and really do
bring that trust. There’s Project ECHO, which is
telementoring to connect specialists with rural
providers, mobile clinics and home-based models that
bring services to patients, and integrated care models
where we see the combination of primary care, behavioral
health, oral health, and social services, really looking
at the person and their health as a whole. So, there are
many different examples, and many of these don’t have
anything to do with technology. I think it’s important to
just see the vast array of examples of innovation that
are happening.
Andrew Nelson: Something else you
identify in the guide is the role of community health
workers as crucial partners. What role or roles do you
see CHWs playing in the next decade of rural health
innovation? And what kind of support do they need in
order to thrive?
Alycia Bayne: Community health workers
are among some of the most important drivers of rural
health innovation, and I think that will continue to be
the case. They are the trusted connectors between
healthcare systems and communities. They know the
community, and so they are able to work really
effectively with partners in the community to break down
barriers that would otherwise not be possible to address.
They help people address social needs, get access to
social services. They help to focus on care coordination,
health education. To thrive in the future, community
health workers need sustainable financing and
reimbursement pathways. I think they also need training
programs, career advancement opportunities, and support
in their careers. And that’s something we’ve seen through
our research on community health workers.
Too often, what we see are community health worker
programs that depend on short-term grant funding. And
then, when that grant funding disappears or ends, then
the program is over, and we lose that part of the
infrastructure. So, if we want community health workers
to be a permanent part of the rural health infrastructure
in communities, then programs need to consider policy and
payment methods that recognize and support their value so
that they can keep doing that work.
Andrew Nelson: In rural areas, maybe to
a much greater extent than in urban areas, partnerships
are an important thing to consider. What role do
partnerships play in rural innovation?
Alycia Bayne: Partnerships are central
to rural innovation. What we find is that no single
organization in any community has all the resources that
it needs to address the very complex challenges that
exist. Innovation often depends on those partnerships
among providers, schools, public health agencies,
businesses, faith organizations, and others. And it
really needs to be a cross-sectorial group. One theme
that emerged repeatedly in our guide is that successful
innovation really does depend on those trusted
relationships and partnerships, having an alignment of
priorities and shared goals, and consistent coordination
and action across sectors. And we want those partnerships
to be sustainable, because that does help to sustain
innovation.
Andrew Nelson: In another section of the
guide, you talk about ethical considerations that can
emerge in various contexts, including digital divides and
staff burnout and so forth. How can rural leaders balance
the pressure to innovate with the risk of overwhelming
teams that are already being pushed to their limit?
Alycia Bayne: This is an important
question. I think the guide really encourages leaders to
pursue innovations that are supportive of the workforce,
rather than creating more work for everyone. Innovation
should be focused on reducing extra work. So, it should
be about improving efficiency or addressing a clearly
defined challenge and supporting folks. I think to
balance that pressure of wanting to do so much at once,
rural leaders can start small with some creative ideas,
pilot those ideas, collect feedback, make sure it’s not
putting too much burden on specific groups that are
already stretched, and adapting. A successful innovation
is not about doing more; it’s about doing things
differently, and hopefully more effectively.
Andrew Nelson: Rural innovation involves
coming up with new and exciting ideas to improve outcomes
for folks, but those new and exciting ideas need to be
sustainable as well. Can you talk about the importance of
focusing on sustainability in rural environments?
Alycia Bayne: Absolutely. Sustainability
is so important, and it’s important to think about it
right at the beginning of the project. When everybody’s
at the table, how are we going to sustain this work?
Unfortunately, many promising innovations disappear when
the funding ends. And if we don’t think about
sustainability until after implementation of a new idea
or project, it often is at risk of going away. So, I
think rural communities should think about what types of
sustainability strategies or approaches make sense for
the work they’re doing. Perhaps it’s reimbursement.
Perhaps it’s partnerships, sharing the burden or sharing
resources for the program. Perhaps it’s staffing. But if
an innovation can’t be maintained, then it’s unlikely to
create lasting changes within the health system or the
community. So, we really do want folks to think about
sustainability upfront.
Andrew Nelson: Imagine it’s 10 years
from now, and the rural health landscape looks radically
better than it does today. What specific changes do you
think would need to happen for us to get there? And what
gives you hope that we’re on that path?
Alycia Bayne: Well, I think through this
work, we’ve heard directly from rural communities, and I
think several things would help. Certainly, reimbursement
models that support innovation. New models of payment for
many of our rural hospitals, particularly our low-volume
rural hospitals. You get paid less and have less volume,
which doesn’t cover fixed costs, and then you end up with
other challenges. So, thinking about payment, stronger
rural broadband infrastructure helps us get to the next
decade. Sustainable investment in workforce. How do we
recruit and retain people in careers to help rural
communities continue to flourish and to be vibrant?
Continued efforts to align healthcare, public health, and
social services around shared priorities. I think all of
these things help to get us there, to that next version
of rural communities and rural community health.
What gives me hope is that rural communities are
innovation incubators.They are already doing many of
these things in their unique ways within their own
communities. And across the country, we’re seeing so many
examples of innovative partnerships, like hospitals
partnering with different organizations or community
programs building workforce pipelines, or investing in
transformation initiatives, or telehealth being thought
of in new ways. So, I think there’s a lot of hope here,
and there’s a lot of promise. And I think we just need to
continue to support innovation and to support rural
communities and helping their efforts to succeed and to
spread and to watch and evaluate and explore how they are
innovating.
Andrew Nelson: You’ve been
listening to Exploring Rural Health, a podcast from RHIhub.
In this episode, we spoke with Alycia Bayne, a researcher
with the NORC Walsh Center for Rural Health Analysis. Look
in our show notes for more information about their work and
visit ruralhealthinfo.org for all things pertaining to
rural health.
