Professor Emma Watson, MBChB FRCPath FRCP
Professor Emma Watson, MBChB FRCPath FRCP was a 2021- 2022 UK Harkness Fellow in Health Care Policy and practice. She is currently the Executive Medical Director at NHS Education for Scotland and the Director of the National Centre for Remote and Rural Health and Care Excellence in Scotland. A Consultant Medical Microbiologist by background and a senior clinical systems leader in Scotland, she is an expert in quality improvement and in medical education and workforce planning. Prior to her fellowship Emma was Deputy Medical Director in NHS Highland and held the clinical leadership for 4 acute hospitals (3 of which are small rural hospitals); she was also a senior medical adviser in the Scottish Government. In both these roles her focus was on developing innovative approaches to ensuring equitable access to high quality health care services with a sustainable health and care workforce, particularly in remote and rural areas. Emma has led several major change programs including the development of Scotland’s first graduate entry medical school. Emma previously held a post in the Scottish Government as Clinical Lead for the Scottish Patient Safety Program during which time she ensured quality improvement methodology translated from the development of health policy and strategy through to implementation across the entirety of the Scottish healthcare system. Scotland was the first country in the world to implement a patient safety program on a whole system basis at national level. As Director of Medical Education in NHS Highland she focused on the delivery of high-quality medical education as a tool to increase recruitment and attract young doctors to the region and established a programme to encourage young people from the area to go to medical school. During the COVID-19 pandemic she led the clinical response in her region and ensured there was a whole system approach to manage the impact of the virus.
Emma’s Fellowship project, based in Cecil Sheps Rural Research Centre, University North Carolina, Chapel Hill, NC, with the mentorship of Prof George Pink and Kristie Thompson, was to learn from Rural Hospital Bright spots to develop a framework for sustainable healthcare in rural and underserved communities. Delivering high-quality, rural health care is a challenge internationally. Post the Covid 19 pandemic, delivering high quality healthcare will be a challenge everywhere. The United States is facing a significant delivery challenge with high numbers of rural hospital closures. In the U.S., many small rural hospitals struggle with profitability compared to their urban counterparts. There is also a perception that the quality of care in rural hospitals is less than their urban equivalents. Rural environments often struggle to recruit providers, nurses and other staff members. Rural hospitals have lower patient volume, which equates to less patient revenue. These persistent challenges make it difficult for U.S. rural hospitals to remain financially viable. However, many rural hospitals succeed despite these pressures.
In her study, a positive deviant approach was utilized to identify successful rural hospitals and establish if these rural hospitals have any common cultures and behaviors that other rural hospitals or fragile health systems could learn from and implement to improve sustainability. Semi structured interviews were undertaken in “Bright spot “Rural Hospitals across the USA. Interviews were conducted with 32 individuals in 8 sites and were a mix of administrators, frontline staff, and community members. Transcribed interview data was managed in MaxQDA software and analyzed thematically.
As a result of this work, three main themes were identified that characterized aspects of organizational culture and practices in these hospitals. Each of these themes and sub themes are described below.
|Deeply embedded focus on the community||Community is core to mission; supported by structures and processes; reflected in workforce; manifests in emphasis on population health|
|Servant or compassionate model of leadership||Empower the front line, invest in relationships; model vulnerability|
|Organizational culture that supports autonomy and accountability||Value belonging/knowing; cultivate psychological safety; celebrate successes and failures|
It is often said there is not a playbook for successful rural hospitals. However, this study suggests that the structural factors that are important in large urban high performing hospitals are also important in “bright spot” rural hospitals.
A framework for success might be to prioritize community engagement and approach it with authenticity and openness; to ensure that the governance of the organization has community and service user engagement; to ensure the workforce are developed and supported; to develop a supportive leadership network across peer institution and within the institution and finally to ensure both the community and the hospital leadership are focused on the future and are deliberate about the longevity of the institution.
The Implications of this work are that when considering interventions to sustain rural healthcare delivery, organisations, funders and governments should be intentional around developing leadership that have the skills to work collaboratively and compassionately.