Addressing Rural Health Access Inequity by Assessing Potential and Organizational Readiness for Antifragile Electronic Health Project Design in Rural Communities

There is a rural health access equity gap within Canadian and international universal healthcare systems. Electronic health (eHealth) interventions can address that gap, but intervention pilot projects rarely scale to other contexts, or sustain in their original settings. Antifragile design and complexity informed principles can improve pilot project lifespans, where antifragile entities gain stability from uncertainty, rather than lose integrity. Operators of antifragile projects include optionality, non-linear evaluation, hybrid leadership, starting small, and avoiding suboptimization. The greater the presence of these antifragile operators, the greater the likelihood a project succeeds in its initial context and successfully scales to others. The antifragile design portfolio (ADP) developed through this dissertation is an organizational readiness tool and evaluative framework which promotes integration of antifragile operators into rural eHealth projects. There are two central outputs of this dissertation: Output 1: Composite Design Cycle Theory - organizational readiness tool for antifragile eHealth deployment. Output 2: Matrix of Scale - evaluative framework to assess antifragility and institutional investment of an eHealth project. Together, these outputs can support rural eHealth interventions to sustain beyond the pilot project, scale-up from small local implementations, and contribute to addressing the rural health access equity gap. Further, these outputs reinforce placed-based health policies, where strong patient partnerships and care tailored for the needs of patients and communities can improve individual outcomes as well as overall health system functions. The antifragile design portfolio is uniquely situated as a mid-level theory to inform policymakers and decision makers and help reform rural health policy