An Interview with Rebecca J. Davis, Ph.D.

by Beth Blevins

Rebecca DavisRebecca Davis is the Executive Director of the National Cooperative of Health Networks Association (NCHN), a role she has served since July 2006. NCHN is the only national level professional membership organization dedicated to supporting and strengthening health networks across the country. She is also the manager of Rural Health Network Resources, LLC, a for-profit company, wholly owned by NCHN. In addition, since 2003, she has held a faculty appointment in Rural Health Policy at the Virginia College of Osteopathic Medicine (VCOM).

Prior to her work at NCHN, she served as the Executive Director of both the Virginia Rural Health Resource Center and the Virginia Rural Health Association. She was the founding Chair of the Council for Rural Virginia and was appointed to the Board of Trustees for the Center for Rural Virginia by the Speaker of the House.

Davis has served on numerous boards related to rural health issues over the past 10 years. She has presented at both state and national meetings on board development, effective meeting management, stress management, network development and management, rural behavioral health, rural health and rural development topics. Davis earned a Ph.D. in Educational Leadership and Policy Studies from Virginia Tech.

In her spare time, she loves going to flea markets and auctions (past auction purchases include a car and a three-story Victorian house). She also collects hats and vintage costume jewelry and loves wearing jewelry every day. She and her husband, Michael, recently moved from Hardinsburg, Ky., to Montrose, Colo. They have one son, Logan Garner Davis, who works at Middle Tennessee State University.

What is a rural health network (RHN)?

RHNs may also be referred to as collaboratives, consortia, partnerships, and alliances. The definition approved by our Board of Directors last year states that a RHN “is a collaboration of at least three like-minded entities that join together to improve health outcomes for rural communities”… that “advance a common mission.” We believe that, by working together as a network organization, they are able to obtain a greater collective value.

I feel that the work of health networks across the nation is some of the most important work being done in health care delivery. The network leader and the network is the structure behind a large number of programs and services provided to patients that most people never know about! Rural health networks provide the opportunity for independent organizations to combine efforts and funding to provide more services, increase efficiency, improve quality, share information, and increase recruitment of health professionals. Networks are positioned to overcome many of the barriers to health access that are common in rural areas.

Are there different types of health networks? How many networks are in NCHN?

Each network is unique, but all networks have some core likeness. There are two broad categories: horizontal networks and integrated vertical networks. Put simply, a horizontal network is comprised of one type of provider and an integrated vertical network is comprised of different types of providers. Networks can be formed for behavioral/mental health, chronic disease prevention, EMS, quality improvement, workforce, group purchasing, etc. NCHN’s members represent regional and statewide networks, while some actually reach across state lines. We currently have approximately 60 network organizations as members. The networks consist of as few as three members, to more than 50. Some have been in existence for over 30 years and some are just forming!

What are the benefits of being part of a network?

The two core purposes are cost-savings and quality improvement, but other benefits include increased efficiency, reduced duplication, increased revenue, and reduced cost of health care. Another major benefit of NCHN membership is the wealth and breadth of network expertise and knowledge our members are so willing to share with each other.

In a 2000 study, Anthony Wellever and his colleagues found that one of their major functions included risk sharing—an acceptance of each network member of a portion of the risk, in addition to quality initiatives and professional recruitment. In his dissertation, Colin O’Sullivan, a former employee of a NCHN member, documented that networks have successfully saved member organizations millions of dollars.

Is there funding for network formation and development?

In 1997, funding for rural health networks became available from the federal Federal Office of Rural Health Policy (FORHP) through the Rural Health Network Development Grant and Rural Health Network Planning Grant programs, which explicitly fund rural health networks. Recently, FORHP expanded the funding to include two specific network function areas, health information technology and workforce. Twenty Workforce Network Development grantees were funded about a year and a half ago to address the rural health workforce crisis and in September 2011, 40 HIT Network Development grantees were funded. Some NCHN members were successful in receiving funds through these new specific network function grants. We are excited that FORHP recognizes the importance of networks in the delivery of health care to rural areas and that it has taken a leadership role in the funding and support of rural health networks.

What is the major barrier to networking for rural health care facilities?

I think the largest barrier is the fear of the potential network members of losing control of their program/facility. Networks bring organizations together that have a history of competing with each other! I know, it sounds crazy, but in reality health care has been competitive! Networks bring these competing entities together, sometimes for the first time, to discuss how as a collective group, they all can better serve the patients in their service area. The network leadership is the most important factor in overcoming the barrier.

Last year, NCHN conducted a survey to determine the necessary components for a successful network. Besides effective leadership, it identified: engaged and/or involved network members; a well-defined mission; an ability to adapt to changing conditions; practical strategic planning; an effective communication system; collaborative process; and, formalized structure. I recommend that anyone looking to form a network and concerned about barriers use these eight common components as a roadmap for your network development journey.

How does your organization help its members develop leadership skills?

We have offered a number of workshops and special training sessions over the years at our annual educational conference on leadership development and skills—the sessions were developed and led by experienced network leaders!

In September 2011, we introduced our new Transformer Leadership Learning Community concept at the first ever NCHN Leadership Summit, which we plan to host annually, where network leaders can discuss specific challenges and share best practice models. The first class started with 14 network leaders from across the country. Since the Summit in Kansas City they have been meeting by conference call and working through the Transformer Leadership Workbook. Dr. Mary Kay Chess, a former NCHN member, is leading the group and the first class will end with a face-to-face session at the 2012 NCHN Annual Educational Conference in Denver in April. A second year of curriculum is being developed for the 2011 Transformer Leadership Learning Community to further explore the leadership skills needed to manage a successful health network. In addition, a new group of Leadership Learning Community will begin with new members.

We are also planning to offer a half-day session for board members of networks. Based on the research, after the network leader, the board members are the most important components of a successful network. We were not able to identify a Leadership program specific to health network board members, so have undertaken the task of developing such a program. We are excited to be able to roll out this new service later this year.

You are both Executive Director of NCHN, which is non-profit, and the manager of Rural Health Network Resources, LLC, a for-profit company, wholly owned by NCHN. What is the difference between them and how do those two positions correspond?

NCHN formed Rural Health Network Resources, LLC (RHNR) in 2009 because it was suggested that a for-profit, rural small business organization might be more competitive in receiving federal contracts. RHNR is wholly owned by NCHN and the NCHN Board serves as its Directors. Its purpose is to develop products and services that support the mission of NCHN. RHNR completed a small contract with FORHP in September 2011 that focused on supporting Rural Health Network Development Planning grantees, which included an extensive literature review on health networks, the development of the taxonomy used to conduct a survey of health networks, training sessions with network grantees, and developing the definition of rural health networks.

RHNR’s newest project is the development and implementation of a Health Network Consulting Group. Again, there is no specific training program for network leaders, it is really an on-the job training program! The goal is to develop a pool of experienced network leaders that are willing to serve as consultants. RHNR will serve as the clearinghouse—kind of like a dating service for networks!

We hold the RNHR management meetings at the end of the quarterly NCHN Board of Directors meetings and so far, the two organizations have operated beautifully together. We are exploring other opportunities for RHNR that will support NCHN’s mission, which is to support and strengthen health networks.

You recently moved to Colorado. Why did you make the move? And does the move affect how NCHN is run?

I moved because my husband changed jobs! He is a federal employee and switched from the U.S. Forest Service to Bureau of Land Management as a Fire Management Officer. We both love the West and this opportunity came up. I work from home—NCHN is a virtual office—so it was easy to move the headquarters! That and thanks to a wonderful board that I am fortunate to work with!

Are you a one-person operation?

No! Christy Sullenberger is our director of Member Services. She handles communications including the Weekly Digest and monthly eNews. I would be lost without her. (She also works virtually and is located in rural Wirtz, Va.) In addition, each spring semester, we have an Occupational Business Student help us part time and, in the summer, an intern through a youth program.

Will you continue your position as an Assistant Professor at VCOM?

Yes. I have been on faculty since the school was formed! The Dean, Dr. Dixie Tooke-Rawlins is a strong rural health supporter and offered me office space for the Virginia Rural Health Resource Center—I was operating it from home at the time and it included a faculty appointment with the office space! I served as an advisor to 10 students in the first class at VCOM, was available to do guest lectures related to rural health policy and issues, worked with the students to form the Student Rural Health Association, and represented the college and Dr. Rawlins at the state level. When my husband switched jobs and we moved to Hardinsburg, she continued my appointment. I worked as a grant writer and represented the college when needed. Then when I obtained the NCHN job, we formed a partnership between VCOM and NCHN. NCHN has a contract with VCOM for payroll services and, under the contract, I serve as the Program Coordinator for this project on VCOM’s faculty. Also, I am still available as a guest lecturer if needed.

Earlier in your career, you taught Home Ec, managed school food service operations, and worked as a state-level supervisor with the New Mexico State Department of Education. How did those experiences propel you to your work in rural health? And do you draw on them now in your current work?

I have been very fortunate to have a wide variety of experiences, mainly due to my husband’s career. He has moved around and I have moved with him. With each move, I was fortunate to find an exciting job opportunity.

I majored in vocational home economics way back when because I loved to sew. I must say that my vocational home economics education has served me well. I learned time management, and how to be organized, flexible, creative, compassionate and resourceful—all traits and skills that network leaders use every day! I taught grades 7-12, coached junior high cheerleaders, served on curriculum committees and loved every minute of the teaching experience.

Looking for a change and something different, I moved to Albuquerque, and worked as the Food Service Manager at a boarding school. I have never worked so hard—for the first three months I worked from about 5:00 AM until about 8:00 PM, every day without a day off. I learned a lot about people and the importance of food! When the opportunity came available to serve as State Supervisor of Home Economics, I jumped at the chance. I loved traveling around the state of New Mexico. This position also probably provided my first professional contact with health care. I worked closely with and traveled to the schools with the Occupational Health Supervisor.

My husband and I moved back to Pulaski, Ky., (my home county) in 1988 and I secured a job as a Regional Vocational Supervisor and worked with all the vocational teachers in a 14-county region. This allowed me to travel throughout South Central Kentucky and serve the teachers and students. While in this job, I also heard about the health care needs of students in these rural areas and worked with the occupational health programs.

In 1991, we moved to Hot Springs, Va. While serving as a Coordinator in the Educational Talent Search Program, I visited every single college campus in the state of Virginia! I also completed my Ph.D. program. After I graduated in 2000 from Virginia Tech, my first real job in health care was as a program coordinator for a behavioral health project for the Southwest Virginia AHEC. I had to gain the trust and cooperation of the medical professionals in a rural county in Southwest Virginia and develop a method for cooperation between the medical field and the behavioral health field. The outcome was the development of a flow chart that showed the various behavioral health providers in the service area and how and when to refer a patient from the medical side. It reminded me of working with the academic and vocational teachers to develop the best program of studies for the vocational student.

In 2001, I was approached by some of the founding Directors of the Virginia Rural Health Resource Center and asked if I would like to revive the organization. I have always loved a challenge. They had about $400 in the bank when I started! About six months later, we also took on the challenge of reviving the Virginia Rural Health Association and I served as Executive Director of both organizations. Today both organizations are strong and serving the rural health needs of the citizens of Virginia.

Have you lived in rural areas? If so, how has that affected your view of rural health care?

I have always lived in rural areas, was raised on a farm in Nancy, Ky. My memory of my first visits to a “doctor” was to Dr. Burton, a rural primary care physician that practiced from his home. I can still remember the smell of his office, must have been the medicine—and seems like I always got a shot! He also made house calls and delivered my younger brother and sister at our home. I remember my Dad saying that he had really gone up in his prices, as he charged $25 to deliver my brother and then four years later he charged $35 and a pony for my younger sister!

I was diagnosed with cervical cancer in 2007 and had to seek medical services and follow-up treatment in Louisville. I experienced, first-hand, the challenges and barriers that rural residents face with dealing with a major illness or medical condition. After surgery, I had to make several trips into Louisville, a three-hour round-trip (in good weather), to visit the oncologist while they decided what to do next. Once the decision was made, I then had to make daily trips for five and half weeks (28 radiation treatments) to Louisville. Unfortunately the treatments were in February and March of 2008—we actually got stuck in a snowstorm the very first day and were not able to get home that night! I was lucky, as my husband had plenty of sick leave and could go to work early and come home to drive me each day and on the few days that he couldn’t, members from our church drove me. It was expensive to make the trip each day—it cost us $20 just for the gasoline—and it was difficult to coordinate schedules. I can understand how some people might elect not to take the treatments because of the hardship of the distance to the treatment facility. This experience benefited me. Now, when I hear of someone facing cancer, I immediately wonder about their treatment plan and how he or she will arrange the transportation to the services.

What is your favorite part of your job?

I love all parts of my job but I think the best part is the Annual Conference—getting to see everyone and hearing about what their networks have been doing over the past year! We are in constant touch with the NCHN members—we provide a Weekly Digest and a monthly electronic newsletter, and I manage the committee meetings each month, post questions to the listserv and receive questions and request for information on almost a daily basis from members. We really have a lot of contact with our members! The willingness of this group of professionals to share their knowledge and expertise is absolutely amazing!

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.

Back to: Winter 2012 Issue