SORH Proficiencies

State Office of Rural Health Proficiencies and Self-Assessment

The SORH Proficiencies are a member-driven set of competencies and proficiencies which will help build the capacity of all 50 SORH and guide the educational strategy of NOSORH. The Proficiencies include a set of four target areas with their own rubrics, an instructional Proficiencies Guide that includes the rubrics and definitions, a self-assessment, and future Benchmarking Report.

Webinar: SORH Capacity Building Webinar: Overview of the Proficiencies and Self-Assessment (9-18-2018)

Webinar Recording

Webinar Slide

Target Area Rubrics
Target Area 1: Grants Management
Target Area 2: Information Dissemination
Target Area 3: Funding
Target Area 4: Organizational Structure

Instructional Materials
SORH Proficiencies Guide
SORH Proficiencies FAQ Fact Sheet

Assessing Your Office
SORH Proficiencies Self-Assessment

Weekly Radio Program Interviews Rural Health Leaders: Let’s Hear from Your SORH

i Jul 21st No Comments by

An up-and-coming weekly radio program is bringing attention to the work of rural health leaders across the country by providing an avenue to share ideas, success stories and lessons learned. Rural Health Leadership Radio, founded by Bill Auxier, is a free podcast featuring leaders of clinics, hospitals, organizations, and communities working to make a difference in rural health. State Offices of Rural Health are encouraged to contact Auxier to share their lessons in leadership and to connect their stakeholders to this great resource.

After moving to Florida, Auxier was having a conversation with the CEO of a Critical Access Hospital and asked what his greatest challenge is as a leader in rural health. His response was that it is hard to know what other rural health leaders are doing that’s working or not working, and what new things they are trying. He could learn these things by going to meetings, but that costs time and money that he didn’t have. He wished there was an easy, cost-free way for sharing that information.

“The next day, I was out for a run listening to my favorite podcast. In the middle of my run a light bulb went off! I wonder if anybody is doing a podcast focused on rural health?” When Auxier researched it, and couldn’t find anything of its kind, that’s when Rural Health Leadership Radio was born. The first episode launched in July 2016 and had 24 downloads.

“I was excited about that because I don’t have 24 people in my family, so I knew somebody other than a family member had listened to it.”

Since then, there have been over 6,000 downloads across 22 countries. And this is all without any formal promotion. Most guests come as referrals from other guests or from meeting people at events Auxier attends. When rural organizations have been recognized for their work, he will reach out to them as well.

“My whole goal is to share stories,” Auxier said. “It’s always good to hear success stories, but more importantly, it’s the lessons that we’ve learned from our failures. I always try to get my guests to share a lesson learned story. I think a lot of times those are the most powerful stories.”

Auxier grew up in the bean fields of Southern Illinois and at the age of 17 was introduced to rural health care when he got his first job as a nurse’s aide at a local rural hospital. After graduating from college, he worked in sales for a medical supply distributor and worked his way up to CEO of a surgical device company. Auxier has a Ph.D. in Leadership and provides coaching for healthcare executives. He strongly believes that leadership and communication are two of the most important aspects that affect the outcomes of any organization.

“I ask every guest what their definition of leadership is,” stated Auxier. “It’s always interesting to hear the different definitions. There are always commonalities, but also subtle differences. I find that fascinating. I also ask how they got into health care and how they got into rural health in particular. Everybody has a different journey in how they got to where they are and it helps my listeners get to know that individual better.”

Auxier recently applied for Rural Health Leadership Radio to become a 501c3, stressing that this is not a money-making venture; instead, it is his way of giving back. He would eventually like to offer scholarships for students who plan to pursue a career in rural health care or help practicing rural health leaders take advantage of leadership development programs.

“I’m totally humbled and delighted at the same time to be able to talk to some of the movers and shakers in rural health,” said Auxier. “Whether they are movers and shakers that anybody else knows about it is not the important part. It’s that they’re making a contribution. By sharing these stories, I’m hoping that somewhere in rural America, if someone can pick up one nugget that helps deliver health care in a rural part of the world, that’s what we’re trying to do.”

SORH colleagues, such as John Barnas, Executive Director of the Michigan Center for Rural Health, and NOSORH Executive Director, Teryl Eisinger, have been featured on the program. If you would like to be a guest on Rural Health Leadership Radio or if you would like to recommend a guest, please send an email to bill@billauxier.com

Visit www.Rhlradio.com to listen to the podcasts.

Back to July/August Branch

Margaret Brockman – February 2017

i Feb 17th No Comments by

Margaret Brockman
Nebraska Office of Rural Health


How did you get to where you are now with the Nebraska SORH?
Most of my career has been in nursing. I started out doing hospital work and taught nursing courses at the University of Nebraska at Kearney and the University of Texas at Tyler. I was then a rehabilitation consultant and started my own company doing consulting work for insurance companies. When I first went into business, case management was in its infancy. I developed a lot of nurses in that role and did a lot of speaking on it. I’ve gone between teaching and consulting work for several years and still occasionally teach case management and nursing administration classes at Nebraska Wesleyan. I started at the Nebraska Office of Rural Health 3 ½ years ago under Dave Palm and moved into the position of administrator for the Office when he left. The entrepreneur in me has been perfect for my role at the SORH because I have been able to develop pilot programs and come up with new ideas to try in the state. That’s the part I love!

What is the most important thing you are working on right now?
We are working hard on integrated care, which includes building patient-centered medical homes, dental and oral care, and the mental health aspect of it. Because we are a large state with 64 CAHs and over 140 RHCs, we must rely on telemedicine because we just don’t have the number of providers needed in the state. This includes the recruitment and retention of healthcare providers.

It’s also important to know what’s going on nationally. The opioid crisis hasn’t hit Nebraska as strong as other areas, but it doesn’t mean we must wait until it gets here. How do we keep ahead of it? Being involved in national organizations helps me do that. Our Department recently applied for a SAMHSA grant we have been part of and we have started on a pilot project where we will have a rural hospital be the hub for opioid patients. I’ve been working with our prescription drug monitoring program as they have been identifying where our “hotspots” are. Communities can send patients to this hub with a provider and nurses on staff who are trained to care for those individuals, supplementing with telehealth. What I hope to do is use swing beds if patients need to go through withdrawal. We will be bringing these parties together and using a facilitator to help build the infrastructure. Right now, I have momentum with the behavioral health providers and a payor on board who are willing to participate. It will take all of us.

What is the biggest challenge facing SORH leaders today?
As a newer SORH Director, my challenge has been to get myself out there so people know what’s available through our Office and how we can assist them. How do you build those collaborations and include everyone, especially in a large, mostly rural state? How do I let those hospitals know that they don’t have to do things all by themselves? I am trying to make our website more current and interactive so people are aware of what we have to offer and can easily access our resources. We’re also working on moving from paper to electronic applications and resources.

What are you doing to ensure you continue to grow and develop as a SORH leader?
I’m always making sure my team has the ability to attend classes and conferences to increase their knowledge of current issues. I want to give them opportunities to grow and develop in areas they want. I challenge them to take on new things and look at how we can do things differently. If it sounds crazy, that’s okay! I have a lot of crazy ideas, but I’m willing to try them. I hope as a leader that I lead by example; that they see me come up with these ideas and actually get them up and running.

Temi Oshiyoye – January 2017

i Jan 13th No Comments by

Temi Oshiyoye
Maryland State Office of Rural Health


How did you get to where you are now?
I went to school in Indiana where I got my bachelor’s in psychology and master’s in public health with a concentration in behavioral and community health. I started working with the Maryland Department of Health and Mental Hygiene in January 2014 as the SORH Program Administrator. After 6 months of working, the SORH Director at the time got another offer and I applied for the position of the Maryland SORH Director.

What inspires you or excites you most about working for a SORH?
The breadth of impact I can make across the state. When I took over the position, I traveled across the state and went to all 18 rural counties to develop a relationship and understand each county’s unique rural health needs. During my visits with the key healthcare players, I realized that partners are excited to work collaboratively to make a change within their communities. My current partnership with other state agencies has given me an opportunity to advocate for initiatives and funding to address rural issues in Maryland. One of SORH’s partners, the Rural Maryland Council, was awarded state funds to provide grants to the rural communities. Based on my relationship with the organization, I was able to write the grant requirement for rural health based on what partners have informed me during my visits. This grant opportunity allowed us to award $324,937 to 8 rural health community organizations. This has given me drive and inspiration to find more statewide initiatives that can improve access to care in rural Maryland.

Can you name a person who has had a tremendous impact on you as a leader?
My mom. She has a strong, dedicated, and determined. Whatever she sets her mind to, she gets done. She went back to school to get her PhD at 50. She had so many discouragements, but she had her mind set on it and she did it. Her strength inspires me.

What is one characteristic that you believe every SORH leader should possess?
It’s important to be a “peacemaker”—a person who tries to create peace and foster collaboration. Our counties have unique needs, but their needs are also very similar. Many are working in silos, so it’s important for a SORH leader to be able to build relationships and encourage collaboration because in the end we are all working towards one goal.

What are some great things about rural health in Maryland?
The uniqueness of rural health in Maryland. Maryland isn’t a typical rural state, which sometimes makes me feel like we get the short end of the stick, but with new leadership within the state, there has been a lot of focus on rural health needs in different statewide initiatives. I’m pulled in on these meetings and discussions which helps to voice these needs. This year SORH is involved in a couple of initiatives: Tax Credit Preceptor Program- this program authorizes a credit against the State income tax for individuals who have served as a preceptor in healthcare workforce shortage areas of the state. Preceptors receive $1000 tax credit for each student they precept for 160 hours of clinical rotation. The idea is to expose students and encourage physicians to stay in rural and underserved communities. In addition, the SORH and other partners are currently writing a new rural health plan, which will come later this year.

Jody Ward – September 2016

i Dec 22nd No Comments by

Jody Ward
Senior Project Coordinator
North Dakota Center for Rural Health

How did you get to where you are now?
I have a master’s degree in Advanced Public Health Nursing from the University of North Dakota and a bachelor’s degree in nursing from Minot State University. Before joining the Center for Rural Health in 2008, I was a Health Care QI Project Coordinator for our state’s QIO and was an ICU registered nurse. I currently coordinate activities of the ND Flex Program. I have led the ND CAH Quality Network(Network) in a number of quality and patient safety initiatives and serve as a liaison to statewide stakeholders, facilitating the exchange of information and network development.

What are 3 great things about rural health in your state?
1. The Network serves as a platform for CAHs to share best practices, policies and processes to improve quality improvement and safer patient care.

2. ND CAHs have strength in numbers!  100% (36/36) participate in the Network to share ideas or topics. Through collaborative work of the Network, ND Flex Program, SORH and other stakeholders, a statewide stroke system of care was developed.

3. The ND Flex Program provides an opportunity for CAH staff to learn from their peers.The Rural Healthcare Peer Exchange Program provides travel support for individuals or small groups to meet with similar entities from other areas of the state and share information and successful approaches to improving quality and access to healthcare services.

What is the most important thing you are working on right now?
The Network recently completed an update to a  CMS Conditions of Participation CAH regulations checklist that has been created using Flex funding. The checklist highlights conditions that require policies and processes in place to meet the regulation. The technical assistance provided has been identified by our CAHs as a top priority area. In addition to the checklist, the Network hosts quarterly webinar meetings, which all ND CAHs join with their teams to discuss their state survey experience, and deficiencies, along with their plans of correction.

What are you doing to ensure you continue to grow and develop as a leader?
I stay engaged in rural topics and always look for opportunities to learn from what others are doing. I regularly attend meetings offered by our project officers and national technical assistance center, attend education opportunities, volunteer to be on committees (a good way to meet other state programs), and read as much as I can. Engage other state programs and ask how they had success on something and learn from them.

What do you do when you are not working?
Make memories with my husband of 33 years and 2 daughters. We also have 2 little dogs that I groom and walk. I am a movie-goer, enjoy reading, and attend Aqua Dance and Aqua Exercise 3 days a week.

Pat Justis – August 2016

i Dec 22nd No Comments by

Patricia Justis
Director, Washington State Office of Rural Health

How did you get to where you are now?
I have a Master’s in Counseling Psychology and got into healthcare on an inpatient psychiatric unit where I worked for 14 years. The hospital was doing Total Quality Management and I ended up working another eight years in quality improvement at a semi-tertiary center that served five rural counties. I tried my own business for a few years doing consulting, writing and photography. I’ve now been with the Washington State Department of Health (DOH) since 2009 and in my current position for two years. In my first six years at the DOH, I ran statewide and regional PCMH collaboratives. The last one was in a rural area, which got me very hooked!

What is the most important thing you are working on right now?
We are getting ready to launch a palliative care integration project with the idea that no rural community can stand up a free-standing palliative care service. We’re working on a Project ECHO type service of case consultation and exploring the feasibility of using board certified palliative care to provide direct patient telemedicine to rural communities. We want to create rural Centers of Excellence and integrate a training and technical assistance package to clinical teams to help with the culture change and how to think differently about this aspect of care. The overall goal is to minimize the use of long-term care beds and decrease transfers to tertiary centers for people who are not going to get better. We want to help people stay in their communities for care so they have the support of loved ones, which everybody needs when they are vulnerable and sick. We also consider site visiting as one of the most important things we do. Rural constituents would say we are visible and attentive and that we show we care by going to them.

What are some great things about rural health in your state?
We are a super diverse state with strong leadership and a lot of wonderful supports out there. We have only had one CAH closure. The University of Washington Research Center is near to us and we get a lot of interaction with the researchers. We also have strong partnerships with the Hospital Association and the Washington Resources Group, which is made up of the DOH, our Primary Care Association and both AHECs. We meet and lay out a calendar of residency visitations and canvas every residency across the state.

You recently hired new staff. What skill sets do SORH staff need?
I look for a sense of passion and empathy for rural communities. I look for staff who get along with others and are resilient when faced with a challenge. Instead of saying something’s too big and we can never get it done, what can we say “yes” to? We are a relatively new team, which gives us the ability to see things in a new way and make changes thoughtfully and with respect for how things have been done. We can step away from “we’ve always done it this way” and really try some new things. They are all very dedicated professionals.

Mary Winar – July 2016

i Jul 18th No Comments by

Mary Winar
Manager of the Connecticut State Office of Rural Health

How did you get to where you are now?
I’m a nurse and worked in various health care settings, and I was looking for a different employment opportunity. I responded to an ad in the newspaper for a rural health assistant. I thought it sounded interesting, so I applied and got the job in July of 1999.

What are three (life or work) lessons you would like to share?
1. Be honest and sincere 2. Organization leads to efficiency 3. Stay focused, but be willing to adapt to change

What are you doing to ensure you continue to grow and develop as a SORH leader?
I read and research as much as I possibly can and ask questions if there is something I don’t know or understand. It’s important to learn from other people and to always be looking for resources and opportunities to share information.

What is the most important thing you are working on right now?
Promoting telehealth services in the state. Recent CT legislation will allow for telehealth services to be provided for Medicaid recipients. This provides an opportunity to create more awareness and potential to increase telehealth services in the state. Another priority is the opiate crisis, which is a tremendous strain on rural resources. I’m looking to support educational programs for rural providers. I sit on an Opiate Task Force that was created two years ago. The CT-ORH is assisting them with strategic planning and data collection to provide direction and substantiate the need for more resources and services.

What are some great things about rural health in your state?
Strong collaboration. Everybody learns to work together quite well because there are less resources. You’ll see so many partners working together on the same projects. We are a small state. You can get to one end of the state to the other in about 2 ½ hours. There are many great initiatives and trainings that occur with a very small amount of money. The office has funded very successful trainings for Narcan (Naloxone) community awareness and administration and SMART triage training for EMS providers. Another initiative was community CPR training for participants of a healthy heart program. Four rural volunteer EMS organizations conducted the trainings. EMTs who were training to be CPR instructors were utilized as part of their training experience. It was a great collaboration that benefited so many.

What do you do when you are not working?
I like to sew and love spending time with my family, especially my 29 month old grandson who lives about 2 ½ hours away in Wilton, NY.

Adrienne McFadden- June 2016

i Jul 6th No Comments by

Adrienne McFadden, MD, JD
Director of the Virginia Office of Minority Health & Health Equity (since January 2014)

How did you get to where you are now?

I was a clinically practicing emergency physician who had additional skill sets from a legal education, in addition to my medical education. I was looking for opportunities within the health realm and happened upon a job in Richmond that would allow me to utilize my additional skill set and pursue my passion in health policy. We are the only state that has all three state-designated offices (SORH, Primary Care and Minority Health) under one roof.

What inspires/excites you most about working at the Virginia Office of Minority Health & Health Equity?
Working among passionate people and knowing at the end of the day we do make a difference in multiple communities and individuals’ lives.

What is the most important thing you are working on right now?
Making sure health equity is always at the forefront of our decision makers’ and leadership’s minds. This goes for rural health equity as well as health equity with regard to racial and ethnic groups, socioeconomic groups, and other underserved groups in the Commonwealth.

What are you doing to ensure you continue to grow and develop as a SORH leader?
Maintaining humility and making sure you hire really great people you can continue to learn from as well. We are always looking at what’s going on not only in this state, but with our colleagues in other states and at a national level to see if we can learn best practices or learn from missteps or other things that are happening elsewhere.

What is the biggest challenge facing SORH leaders today?
Maintaining focus on the issues that impact rural health because the number of individuals that reside in rural Virginia communities is shrinking, but that doesn’t make their challenges any less important.

Brad Gibbens- May 2016

i Jun 8th No Comments by

Brad Gibbens
Deputy Director, North Dakota Center for Rural Health

How did you get to where you are now?
I had an attraction to the general idea of rural; it wasn’t my academic background. I grew up on a durum wheat farm in rural North Dakota. As a farm boy, rural was something I could relate to. I’m now in my 31st year at the Center for Rural Health. I started in 1985 out of grad school as a program assistant and then became a program coordinator. When the Center got their first rural health research center grant, I became a policy analyst. I was named Associate Director in 1991 and remained in that position until becoming Deputy Director in 2010.

What inspires/excites you most about working at the Center for Rural Health?
It’s the same thing in 2016 as it was in 1985 – an opportunity to try to make a difference. I want to be intellectually challenged, take what I learn and turn it around to help other people…help the people I grew up with. It makes a difference if you’re working in the state you grew up in because you truly understand the culture, norms, values, people and have a sense of the topography.

What is the most important thing you are working on right now?
I’m working with our Flex Program on a new round of Community Health Needs Assessments. I started 31 years ago by getting in a car in my first week and going to a small town to do interviews for recruitment and retention. What I enjoy more than anything is going to a rural community and doing something that directly benefits that town. I want to help them think through where they are now and where they want to go.

What is one characteristic that you believe every rural health leader should possess?
Flexibility. People who don’t understand rural health think of it as being simple, especially because of small areas and populations. They think it can’t be as complicated as urban issues. Rural has complex issues because of a small population spread out over a large area with unique access issues. SORHs have to know a little bit about a lot of things. Anybody interested in rural health should definitely spend part of their career as a generalist. Learn how to do a lot of different things. In the process you will figure out what stimulates you and what you’re good at. The more different things you can do, the more value you are to an organization.

What are you doing to ensure you continue to grow and develop as a rural health leader?
I operate from assumption that I don’t know everything. I go directly to rural communities to learn, attend conferences and talk with colleagues. I like to ask people what they are doing and learning. I want them to share it with me to keep me fresh. Never allow yourself to quit learning!

Keith Clark- March 2016

i Jun 8th No Comments by

Keith Clark
Director, Rural Programs
Nevada Office of Rural Health

Keith recently joined the NOSORH Board as a first-time Workforce Liaison. He is also our “Chief Photographer” for the group photo at the Annual Meeting each year. You can look for him photo shopped into last year’s group photo. Keith has an extensive background in photography, but lucky for us, he has a strong connection to his rural health colleagues.

How did you get to where you are now?
I have been with the University of Nevada School of Medicine for about 10 years, serving in many roles, including AHEC Director. I am also currently serving as the President of the Board of Directors for 3RNet.

What is 3RNet working on these days? 
If you haven’t seen 3RNet lately, you haven’t seen 3RNet! We are looking at new and innovative ways to attract healthcare providers to rural areas, offer value-added benefits, and be an education source to members.

What is the most important thing you are working on right now?
We have the opportunity to really make a difference in people’s lives. If you can bring one provider to one community, you have changed people’s lives.  I live in a rural area of Nevada, so I know firsthand how long it takes (500 miles roundtrip!) to get some of the healthcare my kids need. You can’t deliver a baby in my town.

I’ve been working under the leadership of Gerald Ackerman to expand rural residencies in the state. We have developed one of the first rural residency programs based out of CAHs. We need to increase and duplicate this where we can. We found that if we educate someone in the state and they do residency training here, we keep 80% of them in the state. We need to find places for them!

Check out the University of Nevada School of Medicine Rural Residency Video from National Rural Health Day 2015.