Implementation Considerations

Each rural health program is different and there is no one-size-fits-all implementation strategy. Successful programs identify existing resources and best practices, and tailor them to address their community's needs. These resources are adapted based on program goals, model, and scope (See Adapting Interventions - Module 2). Depending on the health programs, required resources may include staff, space, and transportation.

There are some basic implementation tasks that most programs will need to consider. These include:

Relationships with community partners
Recruitment and supervision of program staff
Staff retention
Training for staff
Liability

Relationships with community partners

Many existing rural health programs form relationships with other community organizations. These relationships can grow to be partnerships that are vital to program success. Partners may provide funding for programs and guidance as a program is developed and implemented. Potential partners include:

Community service organizations
Foundations
Government organizations
Health and dental plans
Local hospitals
Multicultural alliances and associations
Public health organizations
State and local health departments
Universities and colleges
Volunteer groups

Recruitment of program staff

An important factor in recruiting entails how program staff will fit into an organization and community. It is often beneficial to have staff with some education, skills, and qualities specific to each rural health program, so that they are better prepared to contribute to program efforts. Since rural communities are typically highly connected, community health workers may be especially adept at building community capacity while delivering culturally competent services.

Generally, program scope and community needs should drive recruitment. For example, an organization may recruit volunteers to conduct outreach activities, or hire a certified professional to deliver screening services. The type of staff hired should align with the job expectations, time commitment, and compensation for the role. Hiring options to consider include:

Paid employee, via stipend, salary or hourly wages
Full- or part-time
Volunteer
Volunteer with stipend

Staff retention

Direct-care work can be very demanding and tiring for both clinical and non-clinical staff, which can lead to high rates of turnover. Senior management should be committed to supporting their staff, encouraging high quality work, and developing a sense of community in their organization. Staff that feel supported and appreciated tend to feel better about their work and their role in an organization. There are different ways to keep high levels of staff moral, including:

Staff orientation and training
Regular evaluation, constructive feedback, and merit-based wage increases
Sponsorship for continuing education
Employee recognition, for example “Employee of the Month”
Health benefits

Training for staff

Training is the one of the first opportunities that an organization has to create a strong, positive work environment. Newly hired staff may have little formal education or work experience, and it is important to consider what may need to be explicitly taught, like a professional code of ethics.

Trainings should aim to feel like a safe but creative space. For example, instead of presenting information in a traditional lecture-style, instructors can engage staff in role-plays, case studies, and team discussions to demonstrate direct connections between training content and job tasks. New staff can be partnered with current staff who can help mentor and provide individual attention to newly hired staff as they learn necessary skills for their job.

Liability

Certain rural health programs, such as those involving a range of medical providers or home visits, may consider developing a risk management plan to mitigate liability for potential issues. Risk management plans can also help programs determine the training needs of staff members. For example, programs that involve home visits or travel should provide safety training to staff members.

For implementation considerations for specific types of programs, see:

The Rural Philanthropy Toolkit identifies implementation considerations for establishing partnerships with funders.

Resources to Learn More

The Dynamics of Sustainability: A Primer for Rural Health Organizations
Document
Information about how to plan for organization sustainability at the beginning of a new program. It describes itself as a “starter guide” to help organizations and their partners think about preparing for sustainability activities.
Organization(s): Georgia Health Policy Center
Date: 2/2012

MAP-IT: A Guide To Using Healthy People 2020 in Your Community
Website
Mobilize, Assess, Plan, Implement, Track: A resource developed to align with the Healthy People 2020 initiative. This framework can be used to plan and evaluate public health interventions to achieve Healthy People 2020 objectives. Designed to help leaders, organizations and health professionals create their own path to a healthy community and a healthier Nation.
Organization(s): U.S. Department of Health and Human Services