The New Rural Health Professions Campus Collaborative

Transcription

1 A Rural Health Professions Campus Network A 501(c)(3) Organization and board directed entity with individual program and organizational memberships, financial sponsors and income-generating service lines Concept Paper Randall Longenecker MD December 13, 2011 Name: The Rural Training Track Campus Collaborative ( The RTT Collaborative or RTTCC ) Purpose: The purpose of this organization is to sustain medical education in rural places. The collaborative will initially focus on establishing and growing a viable membershipdriven and service-oriented organization, extending in time and scope the efforts of the RTT Technical Assistance Program: 1. Providing technical assistance to established and developing rural training track residency programs in various configurations, 2. Increasing the number of students who enter such programs, 3. Maintaining a database of program demographics and outcomes 4. Establishing new means and standards of accreditation, and 5. Generally promoting excellence in rurally located community-embedded medical and health professions education through (a) faculty, organizational, and network development, (b) video-conferencing and in-person meetings and conferences, (c) peer consultation, (d) financial analysis, (e) innovation, (f) research, and (g) elaboration of inter-professional academic connections and joint initiatives. Enhancement of existing programs and organizational structures, integration, alignment, and collaboration will be the guiding principles for this new organization. It will develop in a manner that is economically and organizationally sustainable over decades; deliberately expanding it s scope as it is able to medical specialties other than family medicine, and eventually to the education of other rural health professionals. Background As a strategy for creating a sustainable rural physician workforce, the RTT Technical Assistance Program was established through a grant from HRSA s Office of Rural Health Policy in September of ,2 The program is a consortium of organizations and individuals committed to sustaining rural training track residency programs as a key strategy in rural medical education. 3 As a result of this grant, the first ever meeting of the 1 The RTT Technical Assistance Program is a consortium funded under a cooperative agreement with HRSA s Office of Rural Health Policy. (Accessed ) 2 WWAMI Rural Health Research Center Policy Brief, January (Accessed ) 3 Longenecker, R. Graduate Medical Education for Rural Practice, Position paper jointly sponsored by the NRHA and the AAFP, Approved AAFP Board February 2008, Approved NRHA Board May 2008.

2 2 nation s RTT Program Directors occurred in Columbus, Ohio, in February This meeting generated remarkable enthusiasm for transforming what has been a cottage industry in medical education into a thriving and organic network of support for the distributed efforts of these relatively autonomous programs. In the past year conversations with the leadership of the allopathic and osteopathic accrediting bodies, with representatives of Community Health Centers and Critical Access Hospitals, with the Academic Council of the Association of Family Medicine Residency Directors, and with a multitude of other stakeholders point to the need for alignment, integration, and collaboration among these parties in addressing a growing rural physician workforce crisis in family medicine, general surgery, and other generalist specialties in primary care. No entity other than the current RTT Technical Assistance Program is singularly dedicated to meeting the goals listed above, and establishing a non-profit entity to carry on this critical work is essential to sustaining rural health professions education and the health of rural communities. (Accessed )

3 3 Business plan Administrative core: Co Directors (One of whom serves as executive VP; part-time or full-time as the organization grows) with the following responsibilities: Organizational Development Operations and finance Research coordination 4 Distributed/branch offices with regional directors beginning with at least two Ultimate staff (likely distributed among the regional offices) Financial manager Web developer and graphic designer Administrative assistants (at least one at each branch office for communications, meeting and travel support, data entry, report preparation) Tele communication and information systems specialist Grant writer (Coordinate both grant application, administration, and preparation of reports) Initial board composition: A member-elected board to include 5 rural program directors or coordinators and 5 institutional affiliate representatives, at least two of whom would be from a sector outside of healthcare, i.e. representing a community or cross-sector perspective Facility Needs: At least one office location with easy access to Washington DC and the Office of Rural Health Policy and located within an academic campus in a relatively rural community setting, e.g. a small college or university, with easy access to the human and technical resources to accomplish the purposes of the organization; preferably not a medical school Office space for at least one Co-director and several administrative staff, approximately 750 to 1,000 sq.ft., with access to a videoconference room for participants (See attached specifications) and a general purpose meeting room for Financial structure: 1. Membership, partner, and sponsorship fees according to the following categories: Category I Individual rurally located educational program members, e.g. an RTT (Program charged a membership fee, gets one proxy vote on general membership matters; receives reduced conference fees for a set number of 4 Possibly someone with expertise as a qualitative researcher/ethnographer, with special interest in small area analysis

4 4 attendees at meetings, up to one in-person technical assistance visit or internal review every other year by a relevant peer, access to members-only portion of the website) RTT member programs ("1 2" RTTs and IRTTs with >6 months rural immersion or 24 months of rural continuity clinic experience) Category II Institutional partners with rurally located programs 5 (Institution charged a partnership fee, gets one proxy vote, reduced conference fees for a set number of attendees at meetings, access to members-only portion of the website) a) Multiple rural residency program sponsors (in a multiple rural program sponsor, each rurally located program gets one vote) b) Regional residency networks with rurally located programs (e.g. OPTI, each rurally located program gets one vote) Category III Affiliate partners with or without contractual relationships or other financial support (no membership fee and no vote, invited to send representatives to annual meetings, and invited to nominate members to the board), for example: a) ACGME b) Graham Center c) 3RNet d) AFMRD/AAFP e) RME/NRHA f) NOSORH g) National Association of Health Education Centers h) American Hospital Association, Section for Small or Rural Hospitals i) National Association of Community Health Centers j) Research centers or networks k) USDA especially rural development l) Cooperative Extension m) Ranching, farming, and dairy associations n) Chambers of Commerce o) Walmart p) Rural-focused foundations or family of foundations q) Other Category IV Micro sponsors individual community contributors (Voluntary contribution; no vote; receives regular communication) Category V Macro sponsors corporate and foundation sponsors and social investors (With graded levels of sponsorship) 2. Meetings with the expectations that meetings pay for themselves through registration fees or external financial support 5 Rurally located program means programs with at least 6 months of training in a rural place as defined by either RUCA or RUCC

5 5 3. Grants possibly a continuing grant from ORHP, as well as other grants 4. Contracts 5. Other specific income-generating services offered À la carte Implementation: Year 1 Interim executive director to establish a 501(c)(3) corporation or other non-profit vehicle; recruit a board; develop a detailed business plan; obtain corporate and foundation sponsors for start-up capital; initiate outside contracts Year 2 - Hire co-directors and staff, secure office space, write for grants (e.g. continuing ORHP grant and/or HRSA rural health network planning and development grants), recruit members and partners, and finalize outside contracts Year 3 Fully implemented and self-sustaining

6 6 Potential income-generating service lines (through direct service fees or grants, and in addition to membership fees) Extended program support and technical assistance (possibly Institutional Cosponsorship - an innovation, not yet formally proposed to the ACGME or AOA) Peer visitation and peer coaching (collaborative learning - our skills and experience complement each others' needs) Tele-consultation Web resources Evaluation portfolio development and management Internal review and ACGME or AOA site visit preparation Crisis intervention, conflict mediation, and remediation for programs in difficulty Strategic planning Coalition-building and community development for sustainable health care (Community APGAR) Grant writing Other Faculty and staff development NIPDD R Residency Coordinator Network and Training Curriculum development Conflict mediation Other Meetings Annual Conclave for annual business meeting, ongoing network development, sharing innovation and strategizing for the future Topical conferences or pre-conferences in association with already established meetings Conference planning services Rural recruitment and retention for "the 4 th R" (Regeneration) residents, faculty and program staff; possible a placement service in collaboration with 3RNet, CMDA, and other non-profit placement services Collaborative Research (with specific grant or other external support) Maintenance of an RTT database, including demographics and program outcomes Scholarly activity network for residents and faculty Research in rural medical education N of ONE research methods, qualitative research, appreciative inquiry, mixed methods, and other tools for small area analysis

7 7 Rapid cycle performance improvement Participatory action research in rural communities Innovation incubation (with specific grant or other external support) Innovation pilots, networks and/or refinement (e.g. growing out of annual Conclave or upon referral from the ACGME or specialty-specific RRC) Construction and validation of competencies for rural practice as a measure of rural program outcomes Education Maintenance of a student oriented web portal Rural Health Scholars network development and support High school, college, and medical student programs Videoconferencing Network e.g. funded by a USDA Information Technology/Distance Learning grant (or in collaboration with an existing program like Missouri or Alabama) Informing policy in rural health professions education and workforce planning Strategic planning Ethics Expert facilitation Preparatory information gathering and post-meeting summary Rural healthcare ethics conferences and consultations Studies and colloquiums in social justice, e.g. disparities in both health care and health professions education Other Eventual expansion over 10 years to include rural health professions of all types in all rural settings, including rural training in traditional medical residency programs in all specialties ( all things rural, inter-professional education); i.e. begin with a singular medical division with the intention of adding additional health professions divisions as appropriate