Challenges Facing Rural Hospitals Case Study Analysis

CASE STUDY ANALYSIS

Case Study Analysis

Introduction

The selected case study details the challenges that rural hospitals faced during the 2020 Covid19 pandemic. The case focuses on two hospitals under the larger Oregon Health Services serving the rural town of Oregon that is located 80 miles from Salem in Oregon State. Upon confirmation of the Covid19 outbreak in Oregon in April 2020, the hospitals initiated an emergency disaster plan in anticipation of surging patient numbers. They, however, experienced several problems managing the effects of the pandemic, including lack of equipment and personal protective equipment (PPEs), staffing limitations, and poor cultural awareness. This analysis proposes the adoption of the all-payer global budget financing model for rural hospitals and implementation of cultural training programs for staff to address these challenges.

Background

Oregon Health Services is a general term for a large healthcare system that serves three counties in Oregon State. Immediately the positive covid19 cases were confirmed, the health services launched a massive testing campaign targeting residents with suspected symptoms, including chest pain, fever, breathing difficulties, fatigue, and persistent cough, among others. As part of the campaign, the hospitals offered free drive-through testing upon production of a clinician’s order. However, the effectiveness of the campaign was limited by insufficient supply of PPEs and equipment, including test kits, M4 viral transport media, and nasopharyngeal swabs. Further, the hospitals lacked the equipment to carry out the testing themselves at first and were forced to transport collected samples to urban centres, incurring additional transport costs.

Hispanics and indigenous Guatemalans accounted for the largest percentage of positive Covid19 cases. The health system attributed this to cultures that encouraged congregate housing, carpooling and walking together in groups, all of which were common among Hispanics and Guatemalans and made it difficult to keep social distancing requirements. Unfortunately, the hospital staff lacked cultural awareness to effectively educate the population on the same. Cultural awareness entails being sensitive to the differences and similarities between cultures and being able apply this sensitivity when communicating with members of different cultures (Jongen et al., 2018). Cultural awareness makes it easier for healthcare staff to effectively handle and relate better with patients from different cultures because it helps them love and appreciate others who hold different beliefs and perspectives from them (Jonen et al., 2018).

Finally, the hospitals were not adequately staffed to cater for the high demand for services. For instance, hospital managers were forced to share staff between hospitals to serve the high patient numbers and some staff such as the chief nursing officer had to hold multiple roles due to the large workload. This resulted in fatigue among healthcare staff and work-related stress that was exacerbated by the fear of infecting their families.

Alternatives

There are various alternatives for addressing each of the healthcare concerns identified in the preceding section. To strengthen the technical capacity of rural hospitals for future pandemics, one of the proposed strategies is to invest in well-equipped mobile clinics that could be transported to rural areas in times of crises to boost the existing healthcare facilities. Such clinics could be adequately equipped with all relevant equipment, supplies, and healthcare professionals to offer all needed care to the served communities. Alternatively, the Department of Health could choose to boost the technical capacity of the rural hospitals themselves by increasing funding to State Offices of Rural Health (SORHs) as a means to ensure that they have adequate resources to support the purchase of equipment, supplies, and hiring of enough staff to serve the community (Segel et al., 2021). SORHs are present in each state and are tasked with coordinating healthcare activities in rural areas through offering technical assistance, recruitment of healthcare workers, and sharing resources (SORHs). SORHs provide an effective platform for channelling development funds to rural hospitals due to their presence in all states and the fact that they are easier to monitor than individual healthcare organizations.

To enhance their cultural competencies, healthcare organizations could consider providing interpreter services as a means of identifying with the communities they serve (Nair & Adetayo, 2019). In this case, the hospitals could hire Hispanic and Guatemalan interpreters to assist in communicating with the served population on ways of minimizing their risk of exposure. Alternatively, the hospitals could hire staff from the minority groups they serve who would be responsible for handling patients drawn from the specific groups (Nair & Adetayo, 2019). This would minimize the risk of conflict between patients and healthcare providers resulting from cultural differences. Another strategy would be to use community health workers to offer continuous context-based training to healthcare workers as a means to improve their appreciation of the people they serve and enhance their cultural awareness (Nair & Adetayo, 2019).

Proposed Solutions

Due to resource limitations, healthcare organizations may not have the capacity to undertake all the alternatives discussed above at a go. The proposed solution to the challenge of inadequacies in equipment, supplies, and staffing would be to channel more funding to rural hospitals. Fried et al. (2020) express that this is the most plausible way to sustain rural hospitals better than the recovery programs such as Paycheck Protection and the Economic Security Act that all only provide short-term relief. The authors recommend the adoption of the all-payer global budget as the financing mechanism for rural hospitals (Fried et al., 2020). In their view, the current transactional nature of the healthcare system that equates volume to revenue contributes to the financial struggles of healthcare providers (Fried et al., 2020). An all-payer global budget administered through SORHs would ensure that rural hospitals have higher and more predictable income streams that they could use to source for equipment and supplies, as well as maintaining adequate staffing levels.

On the concern of cultural insensitivity, cultural education and training serves as the most plausible strategy. Jongen et al (2018) found employee training to be more effective than other strategies in increasing cultural awareness among healthcare staff. Their study concludes that “the effect of interventions beyond practitioner knowledge and attitudes is unclear” (Jongen et al., 2018, p. 1). They recommend that cultural training programs are complemented with professional development interventions such as supervision and mentoring to increase their effectiveness (Jongen et al., 2018).