Summative evaluation of the rural surgical obstetrical networks initiative: Findings from a five year retrospective qualitative study

Background The Rural Surgical and Obstetrical Network (RSON) initiative was originally funded for five years to support, enhance, and sustain rural surgical and obstetrical services in British Columbia (Canada). Interviews and focus groups with healthcare providers and administrators from 10 rural communities were conducted annually, to document the implementation of RSON, understand challenges and gains, and to inform network improvements. To supplement this information and enable participants to reflect on the project’s full duration, we conducted a summative evaluation of RSON to understand the extent to which the program achieved its objectives. Methods Data were collected in two phases: annual interviews and focus groups with rural healthcare providers and administrators in the final project year and through a real-time interactive, anonymous platform, ThoughtExchange, in the context of a day-long, annual virtual meeting. Data from both sources were analysed using a process of thematic analysis. Findings Across both data sources, common themes highlighted the benefits of RSON, including the stabilization of local procedural care through increased local scope and volume, support for clinical coaching and other ongoing educational initiatives, quality improvement efforts, team-oriented care, increased administrative support, and appropriate staffing levels. Themes unique to the summative interviews included those addressing the limitations of RSON funding, particularly constraints on funding and contextual factors limiting participation. Conclusion Findings underscore the importance of a wrap-around approach to health service interventions to reflect the complexity of healthcare delivery and the importance of coordinated, context sensitive efforts that work in synergy with other initiatives. The RSON initiative precipitated a cultural change in key determinants of stability at individual site levels, a necessary precursor to long-lasting change. The combination of this retrospective assessment of RSON and the program evaluation findings suggest the need for long-term funding to support rural surgical and obstetrical services.