The Oregon Office of Rural Health (OORH) has learned that the simple act of listening can be a powerful tool for change. With Listening Tours conducted in 2014 and again this year, OORH has met with Oregon rural facilities to see what their most pressing challenges are, and has brought together stakeholders who can help them.

“In the first Listening Tour, we invited our rural hospital association (the Oregon Association of Hospitals and Health Systems, OAHHS) and the Oregon Health Authority’s then Chief Financial Officer to go with us to rural hospitals to discuss concerns around their financial sustainability,” said Meredith Guardino, OORH Director of Field Services. The focus, Guardino said, was going to be on the recent change from cost-based reimbursement to an alternative payment methodology for some rural hospitals. But the meetings became more open-ended, she said, and OORH realized the focus could be much broader and the results used in a variety of ways.

The resulting report from each Listening Tour is distributed to state and federal legislators, in addition to organizations and offices across the state. “We want to make sure that our constituents’ voice is out there,” Guardino said. “We distribute the reports as widely as we can so that everybody in the state is aware of what is going on and can respond appropriately.”

In 2016, the state legislature invested a one-time $10 million to rural hospitals to implement rural hospital transformation and sustainability recommendations. The first report, , was used to develop the projects funded by this state investment.

This year, OORH has a new Field Services Program Coordinator, Rebecca Dobert. One of her primary responsibilities is coordinating the tour, which has expanded to encompass other types of rural facilities, including tribal clinics, Rural Health Clinics, and Federally Qualified Health Centers (FQHCs), in addition to rural hospitals. A big change this year was that each facility was asked which stakeholders they wanted OORH to bring to the meetings. “This way, they can explain their challenges to all the relevant stakeholders at one time,” Dobert said. The tour, to date, has included 16 stakeholder organizations including Oregon’s Legislators, Coordinated Care Organizations, multiple offices within the Oregon Health Authority, the Oregon Medical Board, OAHHS, and local housing authorities. Coordination became a challenge since the stakeholders were required to appear in person—no one could simply call or Skype in.

“It’s important for these stakeholders to be on-site and have the context of the facility, and it’s important for the facilities to see the stakeholders coming to them,” Dobert explained. “We are incredibly fortunate to have dedicated partner organizations in Oregon with people who have traveled all over the state with us.”

Going forward, Guardino said, OORH has three goals with the Listening Tours. “We want to make sure that the facilities have a platform to talk to everybody at once and explain what their challenges are, so that they aren’t regurgitating the same challenges year after year, depending on who is in the room,” she said. “We want to make sure we are documenting those challenges. And, most importantly, we want to make sure we are all collaboratively helping to address those challenges.”

According to Guardino, the next steps following the Listening Tour site visits are to compile key challenges of all the facilities, and to find data to back up what rural facilities have shared anecdotally. Some of the key challenges identified in the first Listening Tour report included the availability of mental health care and long-term care, and the sustainability of health reform. “This year,” Guardino said, “we hope to improve the data component and to make sure that we talk about what is already being done around those challenges. We want everybody on the same page with what the issues are and what various people are doing to address them so that everyone knows what the gaps are, and what we need to focus on to move forward.”

OORH has used three sources of funding for the Listening Tours: a designated part of their FLEX grant was used for the Critical Access Hospitals that participated; the clinic portion was built into their SORH grant; the rest (e.g., professional publication of the final report) is funded by the Oregon Rural Health Association.

According to Guardino, the Listening Tour has had additional, unexpected benefits. One is that it offers an easy way to publicize their office. “We created a of what our office does and we brought it to everyone on the tour to make sure they knew what our office could provide—so there’s a marketing component,” she said. In addition, she said, “Listening offers a unique way to develop stronger partnerships with your state stakeholder organizations. We now have partnerships with people who didn’t know we existed and we didn’t know existed. Traveling to facilities together and listening to these challenges has sometimes enabled a level of collaboration that didn’t exist before.”