Hello again, RHT Community!
As RHTP moves further into implementation, I have been thinking about something we may not see on our project plans:
The relationships through which transformation will actually happen.
We can identify initiatives, timelines, funding, deliverables, and accountable leaders, but implementation rarely moves through formal structure alone. It also moves through relationships. Who do people trust when something changes? Who do they call when a new process does not work as expected? Who connects clinical, operational, technology, and community partners? Who has influence across departments, or even across organizations, without necessarily having the title? And who is quietly becoming the person everyone depends upon?
This is where I believe Organizational Network Analysis (ONA) could offer an important lens for rural health transformation. ONA helps make visible the informal networks through which trust, information, collaboration, knowledge, and influence actually move.
Imagine being able to see, during implementation:
This is not about replacing traditional workforce data, surveys, or project management. It is about seeing another layer of the system. We can design an excellent transformation strategy on paper and still miss the human network required to make it work in practice.
Perhaps one of our RHTP implementation questions should be: Do we know who is actually carrying the transformation?
Perhaps equally important: Do we know whether the network around them is strong enough to sustain it?
I would love to hear whether others are thinking about the relational side of RHTP implementation.
Thank you! Happy Friday Eve!
Sincerely, Ava
Ava, your question about who is carrying the transformation is the one I would bring into implementation reviews.
In a hospital, I would trace one new workflow from the clinical decision through operations, technology, and reporting. At each handoff: Who do people actually call when it breaks? If that person is unavailable, can the work still move?
That would make ONA especially useful alongside the usual milestone measures. It could show where an initiative appears on track because a few trusted people are holding it together—and where those people need support before the model can last.
Hello, Augusta! Yes! Thank you! “If that person is unavailable, can the work still move?” What an important question.
Augusta, you have captured exactly what has been on my mind. An initiative can appear to be progressing beautifully according to traditional milestones while, beneath the surface, a few trusted people may be carrying an extraordinary amount of the relational and operational load. Regrettably, sometimes we do not discover just how essential those individuals were until they are unavailable, overwhelmed, or gone.
I especially appreciate your idea of tracing a workflow across the handoffs. That moves the conversation from simply asking whether implementation is on track to asking whether the human network supporting implementation is resilient enough to sustain it.
Thank you for adding this perspective, Augusta. You have given me even more to think about!
There is a difference between visible implementation success and hidden network vulnerability. Whoowee! Yes!
Sincerely, Ava
Ava, this is an important distinction: an initiative can meet its formal milestones while remaining vulnerable because too much knowledge, trust, or coordination is concentrated in a few people.
A practical way to use ONA alongside RHTP implementation reviews may be to map one critical workflow end-to-end and ask:
That creates a useful bridge between network insight and measurable implementation risk. It may also help teams identify where they need cross-training, clearer escalation paths, shared documentation, or stronger partner relationships before a hidden dependency becomes a service disruption.
The question “Can the work still move if that person is unavailable?” may be one of the clearest tests of whether an implementation model is truly sustainable.
Thank you, RCJ Team! Yes! You have taken this exactly where I hoped the conversation might go from seeing the network to strengthening it.
I especially appreciate the connection to cross-training, escalation paths, shared documentation, and stronger partner relationships. That is such an important point. The value of identifying a critical connector is not simply knowing who that person is. It is understanding what their position in the network may be telling us about the system around them.
Are they a strength we should learn from? Are they carrying knowledge that needs to be shared? Are they bridging two groups that otherwise have little connection? Are they becoming overloaded? And perhaps most importantly, what happens to the work if they are not there tomorrow?
That is where I believe ONA becomes especially actionable for RHTP. It can help move us from:
“Who is carrying the transformation?”
to:
“How do we strengthen the system so transformation does not depend upon a few people carrying it?”
In rural healthcare, where one vacancy or disrupted relationship can have an outsized effect on access and continuity, that distinction matters.
Perhaps sustainability is not simply whether the new model works. It is whether the work can keep moving when the people, circumstances, and demands inevitably change.
Thank you for continuing this conversation. You have given me another question to carry forward!
Sincerely, Ava