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
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
- 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 with stipend
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.
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:
- Aging in Place
- Access to Care for Rural People with Disabilities Toolkit
- Care Coordination Toolkit
- Community Health Workers Toolkit
- Diabetes Prevention and Management Toolkit
- Food Access Toolkit
- Health Networks and Coalitions Toolkit
- Health Promotion and Disease Prevention Toolkit
- HIV/AIDS Prevention and Treatment Toolkit
- Obesity Prevention Toolkit
- Oral Health Toolkit
- Prevention and Treatment of Substance Use Disorders Toolkit
- Services Integration Toolkit
- Tobacco Control and Prevention Toolkit
- Transportation Toolkit
The Rural Philanthropy Toolkit identifies implementation considerations for establishing partnerships with funders.
Resources to Learn More
Steps for Creating a Culture of Retention: A Workbook for Home and Community-Based Long-Term Care
Workbook offers 12 steps to guide agencies in developing excellent recruitment, selection and retention practices necessary to manage long-term care organizations.
Organization(s): Paraprofessional Healthcare Institute (PHI)
The Dynamics of Sustainability: A Primer
for Rural Health Organizations
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
MAP-IT: A Guide To Using
People 2020 in Your Community
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