System Interventions to Support Rural Access to Maternity Care: An Analysis of the Rural Surgical Obstetrical Networks program

Abstract

Background: The Rural Surgical Obstetrical Networks (RSON) project was developed in response to the persistent attrition of rural maternity services across Canada over the past two decades. While other research has demonstrated the adverse health and psychosocial consequences of losing local maternity services, this paper explores the impact of a program designed to increase the sustainability of rural services themselves, through the funding of four “pillars”: increased scope and volume, clinical coaching, continuous quality improvement (CQI) and remote presence technology. Methods: We conducted in-depth, qualitative research interviews with rural health care providers and administrators in eight rural communities across British Columbia to understand the impact of the RSON program on maternity services. Researchers used thematic analysis to generate common themes across the dataset and interpret findings. Findings: Participants articulated six themes regarding the sustainability of maternity care as actualized through the RSON project: safety and quality through quality improvement opportunities, improved access to care through increased surgical volume and OR backup, optimized team function through innovative models of care, improved infrastructure, local innovation surrounding workforce shortages, and locally tailored funding models. Conclusion: Rural maternity sites benefited from the funding offered through the RSON pillars, as demonstrated by larger volumes of local deliveries, nearly unanimous positive accounts of the interventions by health care providers, and evidence of staffing stability during the study time frame. As such, the interventions provided through the Rural Surgical Obstetrical Networks project as well as study findings on the common themes of sustainable maternity care should be considered when planning core rural health services funding schemes.

Evaluating the scope of rural general surgery in British Columbia

“…Losing elective work at smaller sites has implications over the long term for rural patients' access to a surgeon in a timely manner, as a base line volume of elective work is required to maintain deliv ery of care, such as cesarean deliveries. 36 Furthermore, the BC privileging dictionary, which defines scope of practice in BC, limits general practitioners with enhanced training in anesthesia in elective situations, but not in emergency situations. 37 The BC privileging dictionary also has clauses regarding enhanced training and surgical volumes for gen eral surgeons to provide care beyond the classic scope of the specialty.…”

“…For example, when local surgical services were available, 47% of women were able to deliver locally compared with only 15% when local cesarean delivery services were not available. 36 Patients have been shown to prioritize receiving surgical care closer to home for not only their social supports and ease of E97 transportation, but also the community and shared cultural understanding between the patient and health care provid ers. 40 Patients have expressed the importance of familiarity with the professionals they are receiving care from to be more important than the quality of care they receive.…”