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Unconventional Wisdom: Healthcare Quality, Constraints, and the Unique Rural Opportunity

Unconventional Wisdom: Healthcare Quality, Constraints, and the Unique Rural Opportunity. A. Clinton MacKinney, MD, MS U of Nebraska Medical Center Stroudwater Associates Researcher Senior Consultant clintmack@cloudnet.com

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Unconventional Wisdom: Healthcare Quality, Constraints, and the Unique Rural Opportunity

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  1. Unconventional Wisdom: Healthcare Quality, Constraints, and the Unique Rural Opportunity A. Clinton MacKinney, MD, MS U of Nebraska Medical Center Stroudwater Associates Researcher Senior Consultant clintmack@cloudnet.com February 23, 2004

  2. Rural’s chronic illness • Stereotypes • Understaffed facilities • Outdated medical technology • Poorly trained providers • Worse yet, rural may believe the stereotypes A. Clinton MacKinney, MD, MS

  3. The painful consequences of erroneous perception • Rural is caught running behind the quality improvement movement • Rural asks for a place at the quality improvement table, but yet wonders if it even deserves a voice • No! We must explode the myth that rural cannot deliver high quality healthcare A. Clinton MacKinney, MD, MS

  4. Beyond traditional definitions of healthcare • Health: The capacity to fulfill dreams and aspirations – unfettered by disease and disability • Health and healthcare must be considered within a context of: • People • Place A. Clinton MacKinney, MD, MS

  5. Rural is People • Unique perspectives of health • Unique expectations of the healthcare system A. Clinton MacKinney, MD, MS

  6. Rural is Place • Diverse human resources and capacities to deliver healthcare • Diverse infrastructure (facility, equipment, information technology, etc.) to deliver healthcare A. Clinton MacKinney, MD, MS

  7. Acute myocardial infarction:urban setting • Urban setting • Relatively resource-rich environment • Protocols, staff, technology, etc. readily available • Urban medical decision-making is relatively straight-forward A. Clinton MacKinney, MD, MS

  8. Acute myocardial infarction:rural setting • Rural setting • Multiple constraints • May have fewer clinical protocols, specialized staff, and decision-support equipment • Rural medical decision-making is more complex • Policy question: How do we compare healthcare quality when system resources and capacities are so different? A. Clinton MacKinney, MD, MS

  9. Lesson: people and place define the experience • People is the diversity of patient, family, community, and cultural expectations • Place is the extent of healthcare system resources and capacities • The healthcare experience, defined by people and place, matters to our patients • Yet challenging to quantify for healthcare quality improvement comparisons A. Clinton MacKinney, MD, MS

  10. The fundamental challenge of delivering quality of healthcare • Balancing the ever-present constraints of costs and resource capacities • Constraints are multiple and varied • Opportunity costs • Information technology • Personnel and staffing • Policies and procedures • Knowledge diffusion • Communication failures • Cultural issues A. Clinton MacKinney, MD, MS

  11. No one knows better than rural • How to balance constraints • How to use flexibility when applying new programs • How to innovate with ease • How to engage the local community • Rural should be the platform for change A. Clinton MacKinney, MD, MS

  12. No one knows better than rural • How to collaborate with the community • How to provide comprehensive, longitudinal, and coordinated care • How to triage and transport • How to deliver a breadth of knowledge • Rural should be the platform for quality A. Clinton MacKinney, MD, MS

  13. Crucibles for healthcare quality improvement • Rural Clinics and Critical Access Hospitals (and other providers) represent an unmatched platform for healthcare improvement • Rural can drive quality improvement faster than ever before • Rural can become the ultimate healthcare quality improvement network A. Clinton MacKinney, MD, MS

  14. Crucibles for healthcare quality improvement • Critical Access Hospitals represent nearly 800 opportunities for inpatient healthcare improvement • CAHs and rural clinics now represent a powerful opportunity to improve community health across the nation • Can politics and self-interest be put aside? A. Clinton MacKinney, MD, MS

  15. Rural should take the lead • The Opportunity – The Responsibility • To support rural healthcare professionals • To address the nation’s greatest healthcare challenge: constraints • To enhance quality healthcare everywhere • Tap the undiscovered opportunity to advance the healthcare quality agenda A. Clinton MacKinney, MD, MS

  16. Healthcare quality agenda Don’t wait for an invitation. Rural must lead. – Thank you – A. Clinton MacKinney, MD, MS

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