An Interview with Kristine Sande
Kristine Sande is a program director at the Center for Rural Health (CRH), University of North Dakota School (UND) of Medicine and Health Sciences. In that role, Sande directs the activities of the Rural Assistance Center (RAC) and the Health Workforce Information Center (HWIC). Sande manages the development of the programs’ products and services and acts as a liaison to the project partners, advisory boards and stakeholder organizations, as well as the funding agencies.
Sande has been with the Rural Assistance Center since its inception in 2002, serving first as the project coordinator, and as the program director since 2004. Previously, she worked as a project coordinator for the North Dakota Rural Hospital Flexibility Program at CRH. Prior to that, she worked for electric cooperatives in Minnesota and North Dakota.
Sande serves on several national committees, including the National Center for the Analysis of Healthcare Data Advisory Board, the Rural Health Clinic Technical Assistance Series Steering Committee, and National Organization of State Offices of Rural Health Workforce Committee. She is the recipient of a 2010 University of North Dakota Meritorious Service Award. She received her MBA and Bachelor’s degree from UND.
In her spare time, Sande enjoys spending time with her husband, Hans, and son, Curtis, four. She also enjoys UND hockey, cooking and baking, and reading mysteries.
Do you think that growing up on a farm, and living in North Dakota, has given you a deeper perspective on rural issues?
I think that growing up on a farm gave me a deep appreciation for the rural way of life and a strong desire to preserve it. I think it also gave me a real understanding of rural issues that you don’t get from reading about it. That said, rural communities and the issues they face vary a lot across different regions of the country and I think it’s important to understand that, too.
I also was fortunate to have family that was very active in the community and state, which helped me to appreciate the importance of community. Both of my parents were in the North Dakota Legislature at different points during my childhood, so I spent a lot of time at the state Capitol. As a child, I was fascinated by the legislative process and actually enjoyed attending committee hearings—I was such a nerd! But the understanding of the political process that I gained has been really helpful as an adult.
My position with the RAC has given me the opportunity to work on rural and policy issues at the national level and still live in North Dakota. North Dakota feels like home to me. I can relate very well to the people here and I’m close to family. I really appreciate the way of life and the quality of life here. Of course, the winters are tough sometimes, but I grew up with that so it’s—tolerable. You have to have a sense of humor about it, and I do think there a lot of stubborn people here!
How do your previous jobs feed into your work at the RAC?
I started working at an electric cooperative when I was 22 and I really enjoyed it—that’s where I began to recognize how strongly I believed in rural issues. I think electric cooperatives are a neat model—it’s a great example of how rural people came together to address their own needs when other utilities wouldn’t serve them. That sort of determination and level of collaboration is necessary in so many ways in rural communities because the economics are very different. The economies of scale that exist in urban areas just aren’t there in rural areas, making service provision harder and more expensive, whether it be health care, transportation or whatever.
I also worked for about eight months as a nursing assistant in my hometown hospital during my breaks from college. While at the time it was just a summer job, it is an experience that has been tremendously valuable to me not only on a personal level, but also in my current career. I remember when I first interviewed at the Center for Rural Health and how I played up that experience—I thought at the time I was maybe stretching it, but now I realize that those few months really shaped my thoughts, opinions and general frame of reference about rural health care.
My other college job was working nights and weekends at the Grand Forks Public Library. Now I find myself supervising librarians. I’ve managed to unintentionally end up in a job that combines the rural, the health care and the library components of my previous jobs. I certainly never thought I’d end up being the program director of a federally funded information portal on rural health and human services—that’s just not one of those job titles that you dream about as a kid, but I’m glad I ended up where I did.
You’ve been with the RAC from the beginning and helped lay the groundwork for it. Can you describe that process?
Getting RAC off the ground once we received funding was intense. We had to get a website up in a matter of a couple of months and we had no staff. In the beginning, we had this tremendous vision of what RAC could be that was developed by Mary Wakefield, Chuck Fluharty and Keith Mueller. My challenge as project coordinator was to figure out the details of how to actually make it happen. Working with our information specialists made that a lot easier—they were so knowledgeable about things like copyright laws and organizing information.
It’s amazing to me when I think about how much was accomplished in the first year. An incredible amount of content was created on the website and a substantial collection of resources was identified and indexed. That was a really fun time, but we also realized the importance of maintaining the information on the website, which takes a lot of our staff time now.
What was the original vision for the RAC?
The overall vision of the RAC has not changed from the time that the first proposal was written in 2002—it is to be an information portal that can help rural communities and other rural stakeholders access the full range of available programs, funding and research that can enable them to provide quality health and human services to rural residents. We knew that having up-to-date information is very important for rural communities for so many reasons—to make informed decisions, to communicate their need, to effectively network, to take advantage of opportunities.
The reality is that rural communities and facilities just don’t have the same resources that their urban counterparts have. People in rural organizations have to wear many hats—and time is always at a premium. Because of that, opportunities might be lost, both for the providers, but also the communities that they serve. We hope that RAC’s services save our users time, keep them informed, help them make good decisions and ensure that they don’t miss out on important opportunities.
What do you think are RAC’s biggest accomplishments since that time?
I think that our biggest accomplishment is that we are consistently available to provide current information for rural folks. We’ve been able to create a network of experts who have been willing to help us create and review web content, as well as help people who call or e-mail us looking for information. The expertise and networks of the RAC partners were critical in identifying those experts early on. It’s heartwarming to see the commitment of so many of those experts that they would give their time to help us create quality information resources. Plus, I think that’s really leveraged and stretched ORHP’s investment in RAC. One of the many things that I learned from my former boss, Mary Wakefield, was to be frugal and make the most of the resources available, so I like to see that we can stretch ORHP’s resources in that way.
The existing rural health networks definitely make our job easier. Rural human services has been much more difficult because of the relative lack of networks and research.
Other accomplishments along the way have been the addition of State Resources pages to help people find information about their state as well as the Success Stories section of the site, which is intended to help people and communities find model programs that might spark ideas about programs that might work for them. We know there are tons of success stories in rural communities across the nation and we’d love to see many more of them submitted for inclusion on the website.
How many people use RAC services annually?
We had over 900,000 visits to the website last year, and we help about 1,000 people each year who call or e-mail our information specialists for individual help finding information, funding, resources, or experts. We also have three different electronic mailing lists, with a combined 13,000 subscribers.
What are some of the most popular topics for which people request information?
Funding is always popular. We also see a lot of interest in information pertaining to specific types of health care facilities like Critical Access Hospitals, Federally Qualified Health Centers, and Rural Health Clinics—the types of information people are looking for there can vary widely, such as regulations, reimbursement issues, how to start or convert to one, etc. Other topics that are popular include What is Rural?, Teen Pregnancy, Mental Health, Health Care Workforce issues, Housing and EMS.
What services or projects would you like to see the RAC add in its next five years? And, what do you envision the RAC will be like five years from now?
It can be a challenge to project what will happen in five years in a technology-based project, but we did just complete our work plan for the next five years—we’ll just have to adjust it to make sure we stay up-to-date with technologies as they emerge and evolve.
We are actually just completing a major upgrade to the website that should be live in the next month. First, it breaks each Topic Guide and state page into a series of smaller subpages. We hope that will make those resources easier to use and less overwhelming. Second, and I think this is very exciting, the site will allow users to select resources to add to a clipboard or to their own saved lists. This will let users easily collect and share lists of resources, complete with the links and RAC’s descriptions of them. This is the first of several initiatives that we’ll take on in the coming years to allow users to customize their experience with the RAC site.
In the next year, we’ll be working to highlight some of the findings of the evaluation team for ORHP’s Outreach programs. While that sounds a little dry, I think people will find that it provides some really useful tools.
We’re looking to upgrade our search capabilities and Internet mapping functionality. Also, we’ll be working on making the site work better with mobile devices. We plan to start hosting informational webinars several times a year. Our partners at RUPRI will be instrumental, developing products related to rural data considerations, helping us to analyze and address the information needs of our rural communities related to health reform, and establishing a rural human services research and data needs framework.
