Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

Brit Doty, MPH¹, Stephen E. Olson, MD², Randall Zuckerman, MD¹, and Steven Heneghan, MD¹. (1) Department of Surgery, Mithoefer Center for Rural Surgery, One Atwell Road, Cooperstown, NY 13326, 607.547.4607, brit.doty@bassett.org, (2) Department of Surgery, Harney District Hospital, 557 W. Washington, Burns, OR 97720

BACKGROUND Comprehensive surgical services are often unavailable in rural American communities. As a result, many people living in outlying areas must travel to receive surgical care. Small rural hospitals frequently have difficulty providing surgical services despite potential benefits for the hospital and community. Financial resources are limited so funding may not be available to add new services. Surgical programs commonly make a substantial financial contribution to a hospital's overall fiscal health. Frequently, the ability to provide surgical services is seen as critical to the survival of rural healthcare facilities.

PURPOSE The purpose of this project is to describe how Harney District Hospital, a rural critical access facility in Burns, Oregon, is developing a broadly based surgical program. Since there are few models illustrating the process, this account will be valuable for those considering offering expanded surgical services in a rural setting.

METHODS This project employed a case study design. During two site visits in 2005 qualitative information was gathered from semi-structured interviews, a focus group, reviews of historical documents, and informal observations. Quantitative data sources included financial and utilization records from Harney District Hospital, US census records, and economic and demographic statistics from the state of Oregon, Harney County, and the city of Burns.

RESULTS Harney District Hospital is learning many lessons as it develops the rural surgical program. They have found that during the preparation phase, it is important for the community to be involved in the decision-making process. Additionally, the hospital should be both financially and administratively stable. Several challenges occurring during the implementation phase included hiring a qualified surgeon and support staff, training employees, and acquiring the physical materials necessary to operate the surgery program. The refinement phase is a process of adjustment for both the hospital and the new surgery program as it is incorporated into the existing system. Early financial results show that the hospital had a significant increase in revenue from surgical services.

CONCLUSIONS While starting a rural surgery program is a complex and difficult undertaking, there are significant benefits for the hospital and local community. Many rural hospitals lack the resources needed to accomplish this undertaking. In working with related organizations to address funding, staffing, management, and community involvement issues, a small rural hospital can successfully provide this valuable service to the community. Collaboration and adaptability are two key components of the process for a rural hospital to achieve this mission.

Learning Objectives: