Better access to healthcare services in rural Newfoundland

The Challenge: Linking decision-makers and communities

Central Health is a relatively new organization that works to ensure health services meet the needs of a mostly rural population in central Newfoundland. It strives to make decisions that are in the best interests of the people it serves, and that are based on evidence rather than past practices. To improve how decisions were made—and to encourage interaction among various stakeholders—the organization needed a formal, evidence-informed decision-making process that would link the appropriate decision makers with one another and with the communities they serve.

The Improvement Project: A decision-making framework to improve communication

Heather Brown, Vice President, Rural Health, and Doug Prince, Director of Health Services for the Exploits Area—launched an EXTRA improvement project, working closely with senior leaders at Central Health to develop an appropriate decision-making model for the organization. The model would set out a process for including appropriate decision makers in all decisions; show how evidence should be used in analyzing and providing options; illustrate how decisions can be arrived at by consensus and, at the same time, reflect the values of the organization; and outline and approach for how decision makers should document the decisions they reach.

The Results: Expert surveys indicate a way forward

The project team completed a literature review about the best ways for patients to access health services in rural areas, the kinds of challenges organizations like Central Health face in making decisions, and the kinds of decision-making frameworks being used by other organizations. The team produced a survey to find out whether leaders at Central Health were satisfied with how the organization makes decisions (78 percent completed and returned the survey.) They then compared the findings of the literature review to the survey results and ran focus groups and interviews with leaders to learn whether Central Health was indeed committed to adopting a new model for making decisions.

The Impact: New decision-making model now used throughout Central Health

The EXTRA improvement team used the results to run focus groups with leaders and gain an even better understanding of where improvements could be made. The focus groups also gathered leaders’ opinions about how a new decision-making model should be structured so as to be most helpful. Using this information, the team developed a decision-making model that is now in use at Central Health to better allocate resources and deliver health services to rural populations.

Heather Brown image

“ The most significant outcome we have experienced is the increased use of evidence among decision makers to inform the decisions we make about health service delivery on a day-to-day basis. The fact that we look to the available evidence rather than relying on past practice has significantly impacted our organization and the ability to use our resources as effectively and efficiently as possible.” 

– Heather Brown, Vice President, Rural Health

Doug Prince image

“ The EXTRA project was a catalyst within our organization for discussion around those key decision-making factors essential to providing sustainable health care in our rural context. Integrating an evidence-based approach into our decisions has certainly been key, but equally important has been the growth in our awareness and understanding of how our organizational and community values impact the process”

– Doug Prince, Director of Health Services for the Exploits Area

To learn more about this project or the EXTRA program, visit or email us at