In Alaska , small rural hospitals are essential providers of preventive services and primary care, as well as links to emergency care and transport, and for this reason the quality of the care they provide is key to maintaining and improving the health status of their communities.

The Hospital and Nursing Home Association was moved to form a network of its smallest member hospitals because it understands that the essential interface of preventive and primary care services with acute care and specialties is improved by planning, networking and coordinating among all sectors of the health care system. Hospitals and nursing homes are involved individually and through ASHNHA membership.

Professional medical, nursing and dental associations participate in statewide planning efforts. These relationships cannot be taken for granted – identifying common interests is often a challenge. ASHNHA believes that the hospitals of this state must be active participants in the State's public health initiatives, and that the possibility of success will be greatly increased if its many small hospital members are working together on issues common to their hospitals and communities their size.

If Network hospitals are able to share resources to work on workforce development, their hospitals may resolve some of the consistent staffing issues and suffer less from the problems encountered by seasonal fluctuations in census (e.g., fishing seasons differ by region; the network could hire a number of traveling nurses, who would rotate to these community facilities as the various local shellfish, pollock, salmon, king crab, etc., seasons came on line). Reducing staffing shortages in these communities will ensure access to care and thus enhance the quality of their healthcare.9

If these hospitals, through collaboration, are able to develop and offer more affordable, timely, and appropriate training opportunities (via a long distance learning system of some type, whether conference phone or video- or web-based, or in-person), their staff will be able to more readily avail themselves of this education, something that staff are not able to do with any consistency at the present time.

Alaska small hospitals are located in remote communities 10 where round-trip air travel is expensive, travel budgets are low, and the weather decisive. Increased access to timely training and educational opportunities will mean improved patient care and increased staff satisfaction.

Communications systems collaboration by network members, to create or more effectively link their rural hospitals to each other (via telephone or videoconferencing), to other existing telehealth/telemedicine networks, and to healthcare providers (e.g., specialists, pharmacists) who can consult and advise local physicians and nurses, is a necessity if these hospitals are to improve the access to and quality of the care these medical centers provide. Indeed, these hospitals' very survival may well depend on their collaborative ability to achieve advantages from the connectivity that present telecommunications medium seeming allow.

If these hospitals develop a successful communications system that allow for multiple uses through multiple mediums, it will greatly reduce the feelings of isolation and provide significant quality and access benefits for patients and staff alike.

9 As Alan Morgan of the National Rural Health Association had the courage to say during his presentation at the recent HRSA/ORHP All Programs meeting in August in Washington , D.C. : “Let's remember that for many Americans, access is quality.”

10 Of the 10 Network members, practically speaking, seven can only be reached by plane, and all of them, even the three with road access, are isolated and travel in winter can cause travel delays of several days or more. All of these communities can also be accessed by water, but that form of transportation, for obvious reasons, is rarely employed for regular business travel.