Supporting health care decision-making in rural communities

4 May 2009

How does maternity care help sustain a rural community? That’s what Dr. Michael Klein and his research team set out to explore in four northern BC communities, funded in part through an MSFHR Health Services and Policy Research Support Network operating grant.

Their findings reveal a complicated but unmistakable relationship between maternity care and a community’s economic and social conditions – one that should be taken into account in decisions about health services, says Klein, a pediatrician and family practitioner as well as senior scientist emeritus at the Child & Family Research Institute.

“Maternity care is a good example of how a single health care decision can profoundly affect rural communities,” explains Klein, presenting a cascade of effects that can result when a service is no longer offered: Women have to travel to a different community for care, leaving behind family and personal supports; the number of premature infants and newborn complications increases due to delays in transfer and lack of support, causing increased health care costs; doctors and nurses stop providing maternity care in the community; healthcare recruitment and retention become difficult; and the lack of medical services makes the community less desirable to families and businesses, leading to reduced economic viability.

It’s not a straight line cause and effect situation,” stresses Klein. “But the evidence underlines the need for health care administrators and staff to consider a large number of factors.”

Based on their findings – which involved more than 50 interviews and 12 focus groups with community leaders, women of childbearing age, health care providers and administrators, First Nations members, business owners and other community representatives – the research team developed a manual to support the making of difficult decisions about maternity care services.

“Despite the ideal situation of giving birth in your own community, we realize health care managers are dealing with the reality of staffing and funding and other issues,” says Klein. “The manual presents a structured, objective process for making decisions that involve these complex factors.”

Titled “Informed Decision Making: The Interaction Between Sustainable Maternity Care Services and Community Sustainability,” the manual was developed in partnership with Ecoplan International, collaborators from the SFU Centre for Sustainable Community Development, and decision-makers from Northern Health. It presents nine steps in optimal decision-making, all aimed at “distilling the underlying objectives behind the decision, identifying the many actions that can meet those objectives, and bringing forward the most viable actions into a strategic plan.”

Klein emphasizes the transparency of the process, where all issues and values are on the table for everyone to discuss. “The reasoning behind the decision becomes very clear, for the decision-makers as well as those in the community,” he says. “Even though people may not like the decision, they can see why it was made.”

The manual is already assisting decision-makers in Northern Health. “They’re really pleased, and they want us to look at adapting it for other issues,” says Klein. “One of the benefits of this research is its relevance beyond maternity care services, to general surgery, rehabilitation, mental health care and more – any service that is more difficult to sustain and provide in a rural or smaller urban community.”

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