Quebec-based research initiative explores innovations in rural health care

In this stock photo, a doctor examines MRI scans of a brain. (Anna Shvets / pexels.com)

Although research on rural health care in Canada is limited, a 2018 study published by Laval University researchers showed that Canadians who suffer a stroke are 20 per cent more likely to die if treated in a rural hospital compared to an urban one.

Additionally, a separate study published in the British Medical Journal Open in 2019 showed that trauma patients in rural Quebec are three times more likely to die pre-hospital or in the emergency department. In that province, as well as many others, short staffing has led some emergency rooms to close altogether for hours or days at a time.

Dr. Rick Fleet, the research and innovation chair in emergency medicine at Laval University, believes local innovations can help improve access for patients and support health-care workers. At Living Lab Charlevoix he’s working with two hospitals in small-town Quebec to introduce medical students and residents to the realities of rural health care – and train them in “design thinking” to prioritize and prototype solutions.

Design thinking is rooted in empathy, and involves observing and talking to the people affected by a problem, making it an iterative, collaborative approach to solutions. The idea, says Fleet, is to “foster an environment where you involve many disciplines and stakeholders, including local citizens and patients, in developing and testing solutions to your local challenges.”

“We think teaching leadership and design thinking principles actually empowers students to reimagine the future of health care,” he says, “to be more audacious.”

Participants of Living Lab Charlevoix (LLC) spend half their time on clinical rotations at hospitals in the Quebec towns of Baie-Saint-Paul and La Malbaie. The rest of their time is spent on leadership and innovation. So far, there have been 70 “graduates” of the project, including senior residents and medical students, as well paramedics and other health professionals.

The Canadian Medical Association (CMA) is one of the Living Lab’s national collaborators. “Innovation and shifting how we deliver services in rural and remote regions will be required to improve patient access to care and take the unrelenting pressure off rural health workers. We need to think outside of the ‘status quo’ box,” says CMA President Dr. Kathleen Ross.

One way LLC is looking to challenge the status quo is by harnessing technology. For example, students introduced physicians to an app called TREKK, which provides ready access to clinical resources for pediatric emergencies. The team is also exploring artificial intelligence tools to cut down on the time ER doctors spend taking notes.

But understanding the limitations of technology is equally important. To address delays in patient transfers caused by physician shortages, LLC deployed a telemedicine platform to support nurses on board ambulances. However, testing performed between 2018 and 2022 revealed that gaps in cellular service during transport meant communication was frequently severed, and ultimately, the platform was scrapped.

Some of Fleet’s other technologically advanced ideas, such as the use of drones to transport blood products and defibrillators in emergencies, have fallen by the wayside in lieu of on-the-ground, human-centred solutions. To quickly source personnel to address the local workforce shortage during the COVID-19 pandemic, for example, participants at the Living Lab Charlevoix tapped Quebec’s medical schools. With some basic instruction, they realized some 3,000 students in Years 1 through 3 could support their hospitals’ overstretched nurses in the ER.

After putting the idea through design thinking methodology, a trial was launched last summer. Fleet says nurses “felt honoured and respected,” and the medical students “became more empathetic and knowledgeable about what nurses do.”

On their own, experiments like these won’t close the access-to-care gap in rural communities. National health workforce planning and providing tools for professionals to do their jobs effectively is also critical. According to 2022 data from the Canadian Institute for Health Information, only eight per cent of Canada’s physicians serve 18 per cent of the country’s population living outside urban centres.

Additionally, a 2018 paper published in the journal PLOS One showed that, among rural hospitals in all provinces excluding Quebec, only one per cent of emergency departments had magnetic resonance imaging (MRI) and 11 per cent had a CT scanner, vital for diagnosing critical conditions. The study also found that more than three-quarters or rural hospitals did not have an intensive care unit.

Dr. Jessie Warren, a family physician in rural Saskatchewan, recalls a patient with a severe headache and high blood pressure. The symptoms strongly suggested an intracranial hemorrhage, but before she could airlift the patient for neurosurgery in Regina, an 85-kilometre trip to the nearest centre with a CT scanner was required to document the bleed. “It’s just so frustrating,” she says.

Fleet has called for a CT scanner in every rural hospital. But Living Lab Charlevoix has shifted some of his thinking about local-level fixes. At the outset, Fleet’s goal was “to develop the most scalable model for optimal rural care.” Now, he’s a firm believer in the adage, “If you have seen one rural hospital, you have seen only one rural hospital.” A hospital in remote British Columbia will have different challenges than one in Ontario’s cottage country, so imposing one-size-fits-all solutions is less likely to drive meaningful, sustainable change than approaches rooted in place and developed with local stakeholders.

The biggest contribution his team can make, says Dr. Fleet, is to show other rural health-care systems how to create their own “living labs” – with solutions tailored to each region’s unique circumstances and facilities. He’s excited by the potential Living Lab Charlevoix holds to help others improve their creative thinking and leadership skills.

“We are training people to be innovative and how to unleash this power that is within everyone.”

This piece is part of a partnership between the Canadian Medical Association (CMA) and CTV News. For more information on the CMA, visit www.cma.ca.