Infrastructure of a Canadian Rural Health Network: A Four-Year Longitudinal Survey Study

The International Journal of Health Planning and Management
Authors: Anshu Parajulee, Gal Av-Gay, Tom Skinner, Jude Kornelsen
Publication date: February 25, 2025
DOI: https://doi.org/10.1002/hpm.3898

Understanding What Makes a Rural Health Network Work: Insights from RSON

A new peer-reviewed study has shown that the Rural Surgical and Obstetrical Networks (RSON) — a collaborative initiative supported by the Rural Coordination Centre of BC (RCCbc) — improved its performance over four years across key areas like communication, leadership, and governance.

RSON was designed to strengthen surgical and maternity services in small rural hospitals across British Columbia. Through this network, rural hospitals received support in five main areas: clinical coaching, quality improvement, expanded operating room use, remote presence technology, and ongoing evaluation.

Between 2019 and 2022, RSON leaders completed an annual survey to reflect on how well the network was working. The results showed steady progress:

65% of indicators improved significantly, especially in communication, evaluation, and financial transparency.
Relationships across the network deepened, with increased trust and collaboration between rural and referral hospitals.
The Local Community Coordinator role was key in connecting local teams to the broader network and central leadership.

The study also identified opportunities for improvement, including a need for clearer processes, better inclusion of local voices in decision-making, and stronger integration with Health Authority systems. The researchers noted a tension between how the network operates and how the broader health system functions — a challenge unique to healthcare networks.

Still, the overall message is clear: RSON strengthened rural surgical and maternity care by building trust, improving coordination, and fostering local innovation. These findings can help inform similar efforts in other provinces and territories.

“RSON has been absolutely critical to maintaining a small town functional OR and building a highly valued OR team!” — 2022 survey respondent

Funding: The study was funded by the British Columbia Joint Standing Committee on Rural Issues.