Health care assessment highlights issues with trust and services offered
North Shore Health CEO Kimber Wraalstad and Sawtooth Mountain Clinic CEO Kate Surbaugh joined Rural Health Innovations for a series of presentations on April 29 and 30 regarding the clinic and hospital’s findings from a health care assessment conducted in the fall of 2024.
Rural Health Innovations (RHI), a subsidiary of the National Rural Health Resource Center, is a non-profit organization and was contracted by North Shore Health (NSH) to conduct the health care assessment.
Main concerns from the community, outlined in the assessment included a lack of transportation and remoteness of the community, in addition to care for the elderly, mental health, and substance use disorders.
The report identified two additional themes addressed in RHI’s presentation to the community. The first was cultural misunderstandings, lack of knowledge, and a lack of sensitivity to the beliefs and traditions of the Ojibwe people.
The second theme was an issue of trust, stemming from a need for North Shore Health and Sawtooth Mountain Clinic to work collaboratively for the community’s benefit.
Rural Health Innovations recommended that the two health care institutions collaborate on a community project involving other county stakeholders, including service agencies, tribal groups, and other relevant organizations.
After receiving the report, Surbaugh and Wraalstad organized a community working group comprising 26 members to address two key goals. The first was developing a communication plan regarding health resources. The second was streamlining care coordination and the documentation process.
The working group broke apart into subcommittees that have been exploring ideas, such as a website that lists all services provided between the clinic and hospital. However, the details about these projects remain vague.
“We’re still really early in the process,” Surbaugh said during the presentation.
Surbaugh and Wraalstad were impressed by the working group’s turnout and the attendance at both presentations in Grand Portage and Grand Marais.
“I really appreciate that you’re working together on this,” a community member told the CEOs in response to the presentation, “and that you have gone through this process, and you’ve set these two priorities. I think this is a really good start, and thank you for doing all of this work.”
Report Details
The health care assessment was conducted through focus groups and key informant interviews. In both cases, the interviewees were asked eleven questions about their experiences and the services Sawtooth Mountain Clinic and North Shore Health offered.
Residents interviewed were then asked to provide a score of how likely they were to recommend Sawtooth Mountain Clinic or North Shore Health to a friend or family member.
In focus groups, North Shore Health scored an average of 7.1 among interviewees while Sawtooth Mountain Clinic scored 8.6. A smaller gap was found in key informant interviews, where NSH scored 8.8 while SMC scored a 9.2.
North Shore Health was mentioned explicitly for issues with its emergency department and a lack of trust with providers.
One comment in the report said, “Trust issues and especially with ED [emergency department] providers and the inconsistency in care, prior negative experiences, medication errors and lack of cultural competency.”
“We have had two incorrect diagnoses in ED,” another comment said when giving a score for NSH.
A third comment read, “I have encountered some awful locum doctors in this ED who have treated me poorly or wrote injuries off when they ended up being serious.”
“[RHI’s] findings reinforced much that we were already aware of and are working to address,” Wraalstad told WTIP regarding the report.
Feedback for Sawtooth Mountain Clinic concerned difficulties booking appointments and the availability of services at the clinic.
Multiple comments called for better communication between Sawtooth Mountain Clinic and North Shore Health.
“Sawtooth Mountain Clinic and North Shore Health do work together behind the scenes quite a lot,” Surbaugh told WTIP, “in a way that I think the public doesn’t always see. And so I think that’s been one of the things that clearly needs to be communicated more, is like what we do work on together.”
Small Segment of the Community
Rural Health Innovations’ report calls out its limitations, saying, “The information is based on comments from a small segment of the community.”
Only 53 people gave feedback in focus groups and interviews. The number represents about 0.01% of the population in Cook County, which relies on North Shore Health and Sawtooth Mountain Clinic.
“[RHI] are putting together a little bit more information on that qualitative data,” Surbaugh said. “They actually do have a way of measuring that, and they said that was a good sampling for a rural community our size.”
The demographics of the assessment are also worth examining. The report states that Cook County’s median income is $58,600. However, 60% of those interviewed made more than $60,000 annually, and over a third had a household income of more than $100,000 annually.
Nearly a third of those interviewed were retired, and 40% had graduate or professional degrees. Meanwhile, the report stated that those who are underemployed and under the age of 25 were not interviewed for the survey. Only one seasonal worker was interviewed.
When asked about the cost of the survey, Wraalstad told WTIP the hospital budgeted “$25,000 – $50,000” in 2024. The amount was split with Sawtooth Mountain Clinic.
“Hospitals that are designated as 501(c)(3) are required by the IRS to conduct a Needs Assessment every three years. RHI has worked with many of those organizations,” Wraalstad told WTIP.
Rural Health Innovations declined to be interviewed for this article.
Rural Health Innovations’ full report is available on Sawtooth Mountain Clinic’s Website.
WTIP’s Kalli Hawkins spoke with Kate Surbaugh about the April 28 board meeting, which included questions about the Health Care Assessment. The audio of the conversation can be found below.
Josh Hinke May 8, 2025
