Evaluating the multiple impacts of the Rural Surgical and Obstetrical Networks in BC’s Interior

An RSON Series


The Rural Surgical and Obstetrical Networks (RSON) is an initiative that seeks to stabilize, support, and enhance the delivery of quality healthcare to vulnerable rural BC rural populations, including Indigenous populations. It provides sustainable local/regional surgery programs “closer-to-home” in geographic areas served by Enhanced Surgical Skills Family Physicians (ESS FPs) or a solo General Surgeon through enhancing existing care networks shared with referral centres. Through this work, these rural surgical and obstetric networks support enhanced critical care, emergency, and trauma services while also supporting closer-to-home maternity care, including vaginal birth and Caesarian section.

The local/regional RSON model seeks to improve both patient and provider experiences of care by:

  • understanding holistic risk and cost associated with travel so mitigation strategies can be put in place;
  • supporting networks of high quality, highly effective maternity and surgical teams to provide the right care at the right time by the right providers
  • supporting rural providers to practice full-scope of rural generalist medicine
  • enhancing and supporting relationships between team members within the geographic network
  • providing a robust evaluative framework for quantitative and qualitative metrics applied to both maternity and surgical care
  • providing culturally and rurally appropriate care closer-to-home


The work of RSON is split out into five pillars: Clinical Coaching, Continuous Quality Improvement, Remote Presence Technology, Evaluation, and Maternity. Over the next year, BC Rural Update will be featuring the work of each of these pillars, and will engage the providers leading each pillar to discuss the ongoing work taking place within these RSONs.

Evaluation is increasingly being used by healthcare organizations to measure not only financial and patient outcomes, but is also being used to focus on quality and safety from the perspective of multiple stakeholders. For innovative projects such as RSON, evaluation was intentionally built into the fabric of the work from the beginning to collect evidence of the impacts these networks have on rural healthcare provision in British Columbia.

Jude Kornelsen, PhD is a long-time healthcare researcher on rural maternity and surgical services and transport. She is leading the evaluation of RSON with the support of her team at the Centre for Rural Health Research (CRHR). Dr. Kornelsen is working closely with RSON Co-directors Dr. Nancy Humber and Kim Williams, and other Pillar Leads to implement an evaluation framework that will provide insight into the function, outcomes, and cost-effectiveness of RSONs. The evaluation framework is rooted in four evaluation streams looking at Facilities outcomes, Population Health Outcomes, Network Structure and Function, and Cost-Effectiveness. All four evaluation streams are being developed using a Shared Measures Framework, which prioritizes the co-development of measures by key stakeholder groups including providers, patients and families (see Figure 1 below).

Figure 1. RSON evaluation streams

Evaluation of the RSON project within Interior Health has already started and will run until the end of project funding. During the period from April 2018 to June 2019, Dr. Kornelsen and the CRHR team started laying the foundation for the evaluation process by conducting literature reviews, and developing an evaluation plan with the input of providers, patients, and administrators. The group also began collaborating with the Ministry of Health and Population Data BC to develop a data access plan for administrative, health services, and patient outcome information. During this time, the evaluation team also initiated data collection and conducted its first field visit to RSON Interior Health communities of Creston, Fernie, Golden, and Revelstoke as well as Vernon Jubilee Hospital, a referral centre. CRHR has since analyzed the findings from interviews and focus groups and is sharing back this information with patients and network members. The team is also co-developing shared measures for evaluation with patients and their families, and is continuing to develop relationships with Indigenous communities.

 “The RSON evaluation is designed to maximize methodological fidelity; that is, the evaluation approach reflects the core values of RSON,” says Dr. Kornelsen. “This is rooted in the acknowledgment of health system complexity and the understanding of networks as ‘open systems’ In this way we acknowledge that the networks are dynamic and self-transformational rooted in the ethic of a learning health care system. In bringing together key stakeholders to developed the measures most important to them, we are ensuring we are measuring the things that matter. The CRHR team is delighted to be working with the real-world challenges of ensuring robust quality data in rural settings.”

Over the long term, leaders for the RSON initiative hope that comprehensive evaluation of the project will provide new insights, specifically into the areas of surgical and obstetrical quality, network level health outcomes, cost-effectiveness, and the care experiences of the diverse patient population. As RSON expands to communities in Northern Health, it will continue to be assessed and evaluated with input from local and regional providers, patients, and administrators, allowing the networks to both individually and collectively deliver the best contextually appropriate health care possible closer-to-home.

RSON is an initiative supported by the Joint Standing Committee on Rural Issues (JSC) that is operationalized through the Rural Coordination Centre of BC working in collaboration with the health authorities, the Ministry of Health, UBC Rural Continuing Professional Development, and the Centre for Rural Health Research