Rural Surgical Obstetrical Networks (RSON)

RSON Background

The closure of rural surgical and maternity programs in the past 25 years has increased the disparity in access to care between urban and rural residents. Rural Surgical and Obstetrical Networks (RSON) is a way to support safe and appropriate surgery, operative delivery, and maternity care closer to home for rural communities. BC’s Joint Standing Committee on Rural Issues has provided funding over five years (2018- 2022) to support RSONs in eight geographic communities in BC. The networks are supported by five inter-related pillars:

  1. Increased scope and volume
  2. Clinical coaching for rural generalists by regional specialists
  3. Remote presence technology
  4. Continuous quality improvement
  5. Evaluation

RSON Evaluation


The Centre for Rural Health Research at UBC will design and implement the evaluation of RSON in collaboration with key stakeholders. The evaluation framework includes four streams, all developed using a shared measures framework (Figure 1). This is the first time the RSON model of care is being applied in a Canadian context. For this reason, the evaluation of RSON is critical for iterative network development and improvement. Evaluation findings will also inform other Canadian jurisdictions interested in implementing a similar model of care.


Figure 1. Four evaluation streams developed using a shared measures framework.


The evaluation is rooted in the following four key values:

  1. Open systems: We respect that networks are dynamic, continuously learning, and self-adjusting.
  2. Context/difference: We will develop theories using local data that may be transferable to other similar settings. At the same time, we will respect local knowledge in the identification of problems and solutions. Learning will occur across networks and stakeholders.
  3. Shared measures: We will co-develop indicators with key stakeholders who have expertise in various areas. These stakeholders will also help us develop strategies to address evaluation challenges. Key stakeholders are pentagram partners (Figure 3).
  4. Pragmatism: We will work with “what is” and not strive for “perfect measures.” We will aim for quality and realistic measures that do not overwhelm health systems.

Figure 2. Social Accountability Partnership

Theoretical Approach

The RSON evaluation will be guided by the question, “What works, for whom, in what respects, to what extent, in what contexts/circumstances, why and how?” The program theory and evaluation framework will be modified using emerging evaluation data and feedback from local stakeholders. This will allow for the development of theories that will be specific enough to local networks while also broad enough to be relevant across networks.

Evaluation Phases

The evaluation consists of three overlapping phases (Figure 3).


Figure 3. Tentative timeline for implementation of RSON evaluation phases


Please email RSON Evaluation Coordinator Anshu Parajulee at with any questions, comments, or feedback.