A therapist works with a patient at the Grant Regional Health Center in Lancaster, Wisconsin.

[imgcontainer] [img:4d1243c3e3201.preview-1024.jpg] [source]Photo by the Wisconsin State Journal[/source] A therapist works with a patient at the Grant Regional Health Center in Lancaster, Wisconsin. [/imgcontainer]

Those of us who work for or live in rural communities have two unique opportunities: advocacy and collaboration.

For me, advocacy means acting to have others share your vision. For rural health, that often means confronting the multiple myths embedded not too far below the surface of many opinions. Here are some of my “favorites”:

  • Rural residents don’t care about local care.
  • Rural folks are naturally healthy and need less.
  • Rural health should cost less than urban care.
  • Or rural health care is inordinately expensive.
  • And finally, rural quality of care is lower. Urban is better. Rural hospitals and clinics are just Band-Aid stations.

These stereotypes should make your blood boil, and that is good. Advocacy needs passion to fuel it over the long haul that is needed to make a difference. Use that energy to work in your community and with others who have earned your respect for standing up for rural health.

There are many opportunities to advocate for rural health. Pick an issue you care about, commit to making a difference and seek partners with the same passion.

In a similar way, we all have opportunities to collaborate in the work we do or lives we lead. I find that opportunities for collaboration in rural health fall into three buckets:

  • Providing local patient-centered care that is team-based and outcome-focused.
  • Collaborating regionally to emphasize the value of care over the volume of care.
  • Partnering locally and regionally to foster healthy communities.

When I started out with Rural Wisconsin Health Cooperative 35 years ago, in some ways it was easier to talk about collaboration. It was rare enough an idea to be almost exotic. If you found anyone talking about it, it was fairly safe to assume they were sincere. And if they didn’t have much experience (like me) they were willing to start learning.

Today the idea of collaboration has become fashionable. In many areas it has become a requirement for funding or moving an initiative forward. And that is good. But it also means we have to be even more deliberate in conversations or planning. Too many are using the word without much appreciation or commitment to what it means in terms of behaving differently.

Collaboration can co-exist with competition and can be part of traditional organizational structures. But it is a way of working that is different and is not a way that many of us existing leaders were trained in or educated about. For my part, here is are some of the characteristics I look for as signs of effective collaboration:

  • There is an understanding that collaboration is not easy, as demonstrated by the current state of affairs in most State capitals and in particular Washington. To be clear, this isn’t a new problem, it’s just recycled.
  • The work follows a mutually agreed to strategic plan not dominated by one entity.
  • The strategies use both art and science to employ political, economic and social forces to a common advantage.
  • Partners listen as allies–they work to understand before evaluating. I find myself strongly agreeing with an unexpected source, Newt Gingrich, a former Republican House Speaker. “Look to work with people willing to say ‘Yes, if …’ rather than ‘No, because…’ ”

We will achieve our vision for a healthy rural America if we use our passion to advocate for it and do the hard work of working together.

Tim Size is executive director of the Rural Wisconsin Health Cooperative in Sauk City.

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