Western provinces call for rural networks, interprofessional collaborative practice to support rural maternity and surgical services

A white paper issued by the Western Provinces Collaborative on Sustainable Rural Maternity and Surgical Services (WPC) is calling on rural providers, planners, and other health care stakeholders to curb and reverse the loss of rural maternity and surgical services through the development of geographic rural health service delivery networks that are built on interprofessional collaborative relationships.

“The white paper – Patients at the Centre: Sustaining Rural Maternity – It’s All About the Surgery! – focuses on the needs of women and families in rural areas,” says Kim Williams, Provincial Executive Director for Perinatal Services BC (PSBC). “From a maternity care perspective, this strategic vision is designed to meet local needs for delivering care as close to home as possible.” From a broader perspective, says Williams, the vision also includes looking at ways to retain and/or repopulate operative delivery along with other appropriate surgical procedures in rural and regional contexts. The two services are interdependent as (usually) low volumes of Cesarian section in rural settings need to be available alongside other surgical services to maintain the necessary nursing, anesthesia, and surgical staff. This also provides depth for dealing with any form of major trauma—a key element in narrowing the gap of health outcomes between urban and rural Canadians.

The key themes of the strategic vision outlined in the white paper include:

  • Purposeful upstream and downstream alignment of providers and services
  • Local delivery of rural health services is a part of a cohesive system of regional programs
  • Planning of rural networks is based on geographic catchment and population need
  • Promotion of a transdisciplinary culture of lifelong learning and quality improvement
  • Development of a competency-based curriculum to train and support rural providers

The development of rural health service networks is important for more reasons than localizing access to services, and reducing the economic and social burdens faced by rural residents who must otherwise travel to and live in larger centres, far away from family and community supports when they are recovering from health challenges. Per the white paper:

Beyond equity in access, networked rural maternity and surgical service teams enhance local medical capabilities, and ensure critical care, emergency, and trauma response services are sustainable (Iglesias et al., 2015). At the same time, distributive health service delivery networks increase a community’s capacity to recruit rural providers and they stimulate rural health services education, research, and training (Iglesias et. al., 2015).

The strategic vision in Patients at the Centre would not have been possible without the dedicated work of a diverse group of stakeholders, including patients, community leaders, researchers, policy makers, and health professionals, says Lee Yeates, Primary Maternity Care Lead, PSBC and author of the paper. Participants from British Columbia, Alberta, and Saskatchewan developed key principles that can be applied to improve the delivery and quality of rural health services in all three jurisdictions, despite provincial policy and environment differences. The unprecedented momentum generated by The Joint Position Paper on Rural Surgery and Operative Delivery and the collaborative commitments championed by the College of Family Physicians of Canada (CFPC), the Society of Obstetricians and Gynecologists of Canada (SOGC), the Canadian Association of General Surgeons (CAGS) and the Society of Rural Physicians of Canada (SRPC) will “enable advancement of the principles articulated in the white paper on national, provincial, and local scales,” says Yeates.

With the completion of the white paper, conversations about possible collaborations and actions are now taking place at several levels. Collaboration at the national level is focusing on credentialing and education and was discussed at the CFPC’s Advancing Rural Family Medicine summit in Ottawa on February 22. Within individual provinces, there are some existing geographic rural networks already in place in BC and Alberta, while other provinces are busy engaging with stakeholders to prepare the way for network development. Dr. Brian Gellar in Saskatchewan, is asking questions, planting seeds, and encouraging rural communities in Saskatchewan to shape rural maternity initiatives in their own way so that services meet their needs. “I think we need to tell the stories of rural women – across Canada and across the world – of safe births taking place in or near home communities, where women are surrounded by family,” says Gellar. “We know that negative outcomes happen more frequently when rural women travel great distances to deliver. We need to get the word out that delivering in a small centre can be a great experience, and safe, too.”

How you can get involved in a rural health service delivery network

If you would like to become involved in and/or start a rural health service delivery network in your geographic area, Yeates suggest connecting with other practitioners. “Start talking to each other, start building relationships. There doesn’t have to be an agenda in place about networks.” Dr. Robert Woollard, Associate Director, RCCbc encourages rural providers to “look around – something is probably happening. If there isn’t [any activity], get it happening using the principles that are elucidated in Patients at the Centre.”

For rural practitioners seeking to acquire or build more experience with generating collaborative competencies, PSBC and Shared Care [LINK To: http://www.sharedcarebc.ca/] are working jointly to offer an Interprofessional Collaborative Practice Development Workshop for primary maternity care providers in May 2017. “The workshop is just the first step,” says Yeates. “It will also serve as the launch pad for a robust Community of Practice centered around interprofessional collaboration in maternity care.” As part of these projects, PSBC and Shared Care will be developing a shared tool box that will be a resource for rural practitioners who would like to engage in this work, including those who may be unable to attend the workshop.

For more information about interprofessional collaboration in British Columbia, contact Lee Yeates via email.

To learn more about the upcoming Interprofessional Collaborative Practice Development Workshop, email pmc.ipc@phsa.ca for details.