North Shore Health board sets ‘big rock’ goals in updated plan

North Shore Health has identified four major initiatives — dubbed “big rock items” — as part of an updated strategic plan aimed at ensuring the hospital’s long-term stability.

The North Shore Health Board of Directors has had a strategic plan in place for several years but spent a day last fall refining new goals intended to guide the organization in the coming years. The term “big rock items,” introduced by consultant Steve Underdahl during that meeting, refers to the board’s highest priorities — goals that will be revisited regularly at board meetings.

The term “big rock items” originated in last fall’s meeting and was used by consultant Steve Underdahl.  The term is used to help the board detemine it’s biggest goals in the coming years, that they will touch routinely in board meetings.

Board Chair Randy Wiitala said the first priority is to “establish the most effective and useful strategic partnerships and relationships.”

“We’re going to take a look at our current relationships and potentially identify new ones that can help North Shore Health thrive,” Wiitala told WTIP.  “That’s a pretty big priority right there, because our relationships in healthcare, as in our personal lives and business lives, relationships are key.”

Wiitala did not specify which partnerships the board or administration may pursue. North Shore Health works closely with Sawtooth Mountain Clinic on day-to-day operations and broader initiatives. The two organizations partnered on a community health assessment last year and engaged other county stakeholders to implement its findings.

The second priority is exploring a new electronic health record platform.

“Our current electronic health record is still very functional,” Wiitala said. “However, there’s some opportunities for upgrading it in the future.”

Wiitala said preliminary research has been conducted, though a transition to a new platform may not occur until 2027.

North Shore Health updated electronic medical records for its nursing home last summer, transitioning to the PointClickCare platform.

The third objective focuses on attracting and retaining staff while developing succession plans.

“We all agreed that this is something that we really have to have memorialized and in place as people move on, things change, markets change,” Wiitala said.

Some efforts to accomplish this goal are already underway. North Shore Health purchased property last year to provide temporary staff housing and conducted employee engagement surveys that showed improved satisfaction.

The fourth initiative is updating the safety net plan for the hospital’s nursing home.

In 2025, CEO Kimber Wraalstad worked with local congressional representatives to pass “Swing Bed Legislation,” which changes the designation of certain hospital beds and is expected to improve the hospital’s financial outlook.

Although the legislation has passed, additional steps remain before it takes effect.

“Our friends at the Minnesota Department of Human Services had to write a state plan amendment that they submitted to the Center for Medicare and Medicaid Services,” Wraalstad told WTIP.  “The way that the Minnesota Department of Human Services and the state and the federal government are getting along, you know, I’m not going to hold my breath. I’m just going to keep looking and thinking positive.”

The Centers for Medicare & Medicaid Services must approve the amendment before the changes can be implemented.

Amid shifts in Medicaid reimbursement and broader financial pressures, Wraalstad has previously described rural health care as facing a “real threat.” Wiitala said the board the newly identified priorities are intended to help position North Shore Health for long-term stability

“For a facility like ours, you may be doing well, but survival is not guaranteed,” Wiitala said in December. “It’s a reminder that not only do we have to focus on the day-to-day, we have to focus on what do we look like a year from now, five years from now, 10 years from now.”

WTIP spoke to Wraalstad and Wiitala about North Shore Health’s early 2026 financials, the board’s strategic plan, and other topics from the February Board Meeting.  The audio of that conversation can be found below.

Josh Hinke March 3, 2026