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This process includes 5 steps, which we recommend you follow in order. As you work through the process, you may find it helpful to document your thoughts, questions and findings. You can use this process even when time and resources are tight, and you may consider involving key stakeholders in any of the steps.

Step 1: Clearly state the question to be answered

You need to clearly and specifically state the question you’re trying to answer or the decision you’re trying to make ― whether you’re addressing an issue or opportunity ― and the context in which the decision will be made.

Step 2: Quantify the need for services

Gather evidence to better understand the need for a service or service change, and use it to characterize and quantify the current and anticipated future service requirements.

Step 3: Identify potential service options

Once you have a good understanding of the population and the need for services, you can identify potential service options that you could feasibly employ to address the need.

Step 4: Assess viable service options

Once you’ve identified the viable options, the next step is to assess them, as well as the status quo, against 6 themes. The first 3 themes are outcomes you may wish to prioritize. The other 3 themes are inputs related to context and processes.

Themes to prioritize

Outcomes to achieve

• Quality and safety
• Patient experience
• Provider experience

Inputs to consider

• Internal capacity and context
• Funding and payment models, costs
• Engagement

Step 5: Summarize your results

Create a summary you can use to develop internal communications and to host discussions about the decision, as well as to support external communications with stakeholders.

Rural health frameworks

• (Child ºìÁì½í¹Ï±¨ BC, 2020): A planning tool to help inform which health care services can be safely performed in a given location
• (Making It Work, 2019): A framework to help recruit, train and retain rural health care providers
• (Centre for Rural ºìÁì½í¹Ï±¨ Research, University of British Columbia, 2016): A toolkit to guide to rural communities trying to establish or optimize maternity care
• (Dr. Emily Donato, 2015): A framework of the unique factors that affect the health of rural populations
• (Dr. Deanna White, 2013): A planning framework to inform rural communities on good practices for rural health programs

Other resources

• (Canadian Anesthesiologists’ Society, 2021): The official recommendations by the Canadian Anesthesiologists’ Society on clinical guidelines and equipment
• (Canadian Association of General Surgeons, 2020): A program that helps recruit and train medical residents

Members of CIHI’s Sparsely Populated Regions Advisory Group raised the need for this guide. This group of senior leaders from rural regions across Western and Northern Canada asked ºìÁì½í¹Ï±¨to create a comprehensive and systematic approach to support informed decision-making in these situations. The advisory group provided valuable input and helped inform the development of this guide and supporting materials. Rural health system leaders in Central and Eastern Canada provided further validation for the content of this guide. ºìÁì½í¹Ï±¨wishes to thank those who were involved in the development of this content.

CIHI’s Western Office