Massachusetts Health Care Workforce Center

August 14, 2008

Rural Healthcare Workforce Activities

Understanding and Addressing Rural Workforce Needs

The Massachusetts (MA) State Office of Rural Health (SORH) has spent years examining the challenges of training, recruitment, and retention of a qualified healthcare workforce for rural Massachusetts communities gathering information through many different informal and formal mechanisms, from our rural communities, rural healthcare organizations, provider organizations, government and private agencies, etc. At this point we feel we have substantial information and some data on the rural healthcare recruitment and retention challenges and the potential strategies for addressing these needs at the local, state, New England, and national level. In addition to our rural work in Massachusetts we work with other SORHs, State Primary Care Offices, and State AHEC Programs, as well as national organizations so we have been able to gather information and many best practices and strategies from across the country. The MA SORH and our rural healthcare organizations are positioned to participate fully in the development of a stronger focus in our state on healthcare workforce efforts and a healthcare workforce center.

MDPH's Rural Health Advisory Council

The Massachusetts SORH provides staff support and coordination to the MDPH's Rural Health Advisory Council, as well as other Massachusetts and New England rural provider groups. These groups, as well as our ongoing visits to communities and healthcare organizations, have helped to inform the MA SORH. In addition, we have been able to produce some data on workforce and use additional data sources as we can.

State Rural Health Plan

This year the MA SORH is launching our initiative to develop an enhanced and updated State Rural Health Plan for Massachusetts. Because rural healthcare workforce training, recruitment, and retention is a very critical challenge for our rural communities at this point, and it has gotten worse over the past five years, we are sure that a key component of the State Rural Health Plan will be gathering more-up-to-date and focused data on the rural healthcare needs and developing a written action plan to address these needs in a more coordinated and focused manner.

National Organization of State Offices of Rural Health (NOSORH)

Pamela Smith of the MA SORH is Chair of the HealthCare Workforce Committee of the National Organization of State Offices of Rural Health (NOSORH). Through this committee she has been providing leadership and coordination bringing together the SORHs across the country to learn from each other and develop additional strategic support and capacity building for the SORHs across the US so that we can more effectively work on the priority issue of workforce recruitment and retention. They have put on a national conference and gathered information and resources on state level, regional, and local strategies for improving workforce recruitment and retention. Many State Primary Care Offices are also active in NOSORH and the Workforce Committee, so Pamela has also been able to learn a lot about the state level and local activities to improve rural recruitment and retention in other states.

National Rural Recruitment and Retention Network (3RNet)

The MA SORH uses SORH federal grant funds to support our state's membership in the National Rural Recruitment and Retention Network. Through their targeted national recruiting efforts, and their well known website, the 3RNet provides states with a national source of healthcare candidates interested in rural practice. Each member state maintains a webpage of information on the 3RNet website; we are still developing this for Massachusetts. This national Network has also brought us access to additional resources and technical assistance that we use to improve rural recruitment and retention for rural communities.

University of Massachusetts Medical School's Rural Scholars Program

The MA SORH is an active member of the advisory board for the U.Mass Medical School's Rural Scholars Program. This program brings medical and nursing students into rural healthcare settings for a variety of community and clinical experiences. The intent is to increase their interest in, and engagement with, rural healthcare organizations, to increase the likelihood they will practice in rural communities after their training. The SORH has been assisting U.Mass Medical School with the initial and ongoing development of the program, facilitating additional student placements as the program has grown, providing information and technical assistance to the rural scholars and their projects, providing technical support to the faculty member's research on rural providers, and providing linkages with other efforts in the state and region.

New England Regional Rural Health Workforce Initiative

The MA SORH has been a leader in the development of the New England Regional Rural Healthcare Workforce Initiative developed this year with the six New England SORHs and the New England Rural Health RoundTable. The group obtained grant funding from NOSORH (National Organization of State Offices of Rural Health) to fund the initial phase. Within each New England state, key organizations are making efforts to try to address rural workforce needs including loan repayment programs, recruitment centers, retention initiatives, and pipeline development programs. Among these key stakeholders there is an increasing awareness that within the New England region, states are competing against each other to recruit and retain health care professionals from the same limited pool of applicants. In order to reduce the extent to which this competition occurs and to improve our collective ability to develop, recruit, and retain healthcare professionals, we are developing a plan that engages partners in developing regional collaborative strategies.

The group developed a survey tool and interviewed six to ten key stakeholder organizations in each state about rural recruitment and retention challenges, current activities, and future possibilities and opportunities. We had 100% participation by the ten Massachusetts stakeholder organizations in the survey. The survey results were then used to inform the discussions at a regional rural workforce summit held in July. The Summit was very successful with great participation and enthusiasm from the stakeholders from each state. The Summit participants identified key priority focus areas and future workplan strategies the group would like to work on together. Our project consultant is now writing our report on the interview and Summit results for us to continue into the next action phase of the initiative.

Collaboration with MDPH Primary Care Office and Office of Oral Health Programs

The MA SORH collaborates with the MDPH Primary Care Office and Office of Oral Health on their workforce activities. Key roles of the MA SORH include providing additional outreach and stronger linkages with rural healthcare organizations to promote greater use of state and federal workforce programs in rural communities. We also assist the development of shortage designations helping to identify communities in need, facilitating community relationships, assisting with additional information for the applications, and assisting communities with understanding how they can utilize the shortage designations in their communities. We also provide a rural perspective to the continued development and evolution of healthcare workforce programs in our state and comment on federal proposals for regulatory change.

Special Commission on OB/GYN and Neurological Care in Western Massachusetts

The MA SORH is participating in the data collection and development of the report for the Special Commission on OB/GYN and Neurosurgical Care in Western Massachusetts providing staff support, as well as funding, for the consultant hired by the project.

Rural Pharmacists

The MA SORH has developed a very successful collaboration with the MA College of Pharmacy and Health Sciences/Worcester Campus with engagement from various additional experts, including but not limited to, the MDPH's Bureau of Healthcare Quality. Through this collaboration we have developed a MA Rural Hospital Pharmacy Network which is a statewide effort linking hospital pharmacists from isolated rural communities in order to share best practices, expertise, resources, as well as to consider joint solutions to mutual challenges. Nearly all of the 12 hospitals participating only have from one to two pharmacist FTEs, so these are particularly isolated healthcare professionals in our facilities. Connecting similar facilities around the increasing number and complexity of pharmacy concerns provides opportunities to achieve simultaneous efficiencies in cost, quality, staffing, communication, and educational strategies. One of the priority concerns, we are working on is recruiting and retaining appropriate staffing, back-up staffing, and 24/7 after-hours pharmacy management. Similar to the U.Mass Medical School Rural Scholars Program, we are working with the MA College of Pharmacy to increase student placements in rural hospitals and other rural healthcare settings. We are also working on current hospital pharmacy issues such as anti-coagulation therapy administration and monitoring programs, keeping current on MRSA, new sterile compounding regulations, and assisting them with better use of technology to support the Pharmacy Departments and clinical hospital staff more effectively.

Pre-Hospital Emergency Medical Services

Western Mass EMS Council Workforce Study and Summit

The Rural Hospital Flex Program has been working with the State EMS Office and the Western MA EMS Council over the past few years to examine and begin to address rural EMS workforce needs more effectively. We provided federal Flex Program grant funds to the Western MA EMS Council to conduct a regional rural EMS workforce study and convene a Rural EMS Workforce Summit. The results of the workforce study have been very informative and useful at the state, regional, and local level for planning. The Summit was well attended (over 100 people with 100% of all rural local EMS services represented) and successful according to the evaluations and verbal feedback. Based on this model, we intend to provide Flex Program funds to an additional Regional EMS Councils with large rural areas to conduct the same EMS rural workforce study and a Summit. Similar to western MA, all of our rural areas of the state are having a very significant and growing challenge with recruiting and retaining an EMS workforce, volunteer or paid.

Rural EMS Management Training Curriculum

This past year the 6 New England SORHs, including Massachusetts, provided federal grant funds through the New England Rural Health RoundTable to the New England Council for EMS to develop and pilot an EMS management training curriculum for rural EMS providers. The group had determined that one of the most pressing issues facing rural EMS today is a lack of formal training for managers. The project resulted in a standard curriculum divided into 8 modules to support flexible delivery of content material in single day or multi-day offerings. The module topics are based on the system components identified in the Rural EMS Agenda for the Future and include topics such as overall management practices, human resources management including staff/volunteer recruitment and retention practices, financial management, quality improvement programs, public relations and public information, etc.

All modules were delivered, evaluated and updated based on the evaluations during the 07-08 year. Offerings were made in program venues identified by the State EMS Offices and/or SORHs in each New England state. The EMS Council of Western MA piloted the human resources module in November 2007 and it was well received. The complete course is a total of about 40 hours of delivered training. Subject matter experts are being identified in New England to continue the deployment of the curriculum. The goal is to build a cadre of qualified individuals who deliver consistent content based on the standardized course and their own expertise. Now that the full curriculum has been developed and piloted, the MA SORH will continue to support offerings of additional modules for rural EMS providers in our state, coordinated with the other New England States in an effort to make the program accessible to candidates throughout the region.

Rural Hospital Management Training

Department managers at small rural hospitals are often good staff, with leadership ability, that has been promoted into management positions without management skills training. Collaborating with the other three Rural Hospital Flex Programs in New England, the MA SORH has been using federal funds to develop and offer three-day management skills training for department managers on-site at small rural hospitals and a one-day refresher course held regionally for those that have been through the multi-day training. These have been very well received with extremely positive evaluations from our hospitals. We have held these trainings at three of our small rural hospitals to date with the goal being that we hold these at all 10 of our small rural hospitals. For the participating hospitals so far, we have connected these management skills trainings to the launching of hospital-wide Balanced Score Card performance improvement programs. We have also used federal rural health funds to pay for consultants to provide technical assistance and health information technology support to the implementation of Balanced Score Card programs at three small rural hospitals.

The MA SORH is in discussions with key quality improvement directors and physician leaders from our small rural hospitals, U.Mass Medical School, the Hospital Association, MassPRO, etc. about the potential for the development of a physician quality leadership institute which our hospital quality directors believe is needed in order to more fully engage the physicians practicing at their hospitals in their quality programs. We have begun some initial outreach and informational meetings with small rural hospital physicians and the SORH and MassPRO to discuss quality programs from the physician's viewpoint and gather information useful to the development of an Institute.

Telemedicine and Long-Distance Learning

The MA SORH has used Rural Hospital Flex Program resources to assist small rural hospitals with developing improved capacity for telemedicine, so they can access medical specialists such as neurologists, tele-stroke services, dermatology, interpretation for the deaf, etc. We have provided educational forums, resource materials, project funding, and assistance with accessing other federal funding sources.

The MA SORH has been in discussion with U.Mass Medical School and others in the New England region about ways to increase the long distance learning and rural provider networking opportunities to reduce the isolation of rural medical providers and improve their access to other physicians and colleagueal support.

Health Information Technology

We have used multiple educational, networking, technical assistance, and funding strategies to assist our rural healthcare facilities including community health centers, rural hospitals, and group practices, with the development of health information technology systems (HIT) to support their informational and clinical needs. We have made some progress, but the needs are still great and we still have very far to go to truly have the systems that are needed in today's healthcare setting. We have used our Small Rural Hospital Improvement and Rural Hospital Flex Program funds to support many HIT projects among our 10 small rural hospitals and helped with access additional state and federal funds for HIT development. We have created forums for rural hospitals to learn directly about HIT initiatives of the MA Technology Collaborative including CPOE, e-prescribing and broadband access, and the MA E-Health Collaborative including details of the North Adams rural community EMR pilot. We have also facilitated opportunities for our rural healthcare organizations to join regional networks to reduce HIT and tele-health costs where appropriate.

The MA SORH also co-facilitates the MA Rural Health Forum with the MA Health Data Consortium. This group, comprised mostly of western MA healthcare organizations, meets to identify common challenges and develop more coordinated approaches to addressing the HIT needs in western Massachusetts. One of the key issues we have been working on is to increase the supply of HIT technical staff available to healthcare organizations and the need for more training for current clinical and administrative staff in HIT. The group is actively exploring collaborative options for making on-line HIT training, as well as undergraduate and graduate level HIT/IT programs available to rural and western Massachusetts organizations to further support hospital administrative and clinical staff.


This information is provided by the State Office of Rural Health within the Department of Public Health.