Ask A Researcher

April 2022

One Health System’s Approach to Improving Community Health Understanding what the 2021 Community Health Needs Assessment Conducted by Sanford Health means for population health.

Andrew Wiese, Head of Strategic Intelligence at Sanford Health
Karen Olson, Research Specialist with the Center for Social Research at NDSU

Andy Wiese is the head of intelligence for the Strategic Planning team at Sanford Health. He has a bachelor's degree in political science from South Dakota State University and a master’s in business administration from the University of Sioux Falls. A lifelong resident of the Upper Midwest, Wiese is committed to advancing community health.
Karen Olson is a research specialist for the Center for Social Research at NDSU. In this role, Karen’s background in demographics and socioeconomics is used to facilitate the public’s access to data and information needed to make decisions, design and implement programs, and invest in communities across the state. Her efforts involve a wide range of topics including migration, characteristics of the aging population, community efforts to reduce poverty, housing needs, and the health and well-being of children and families.

The overall health of a community depends on the health of the individuals living in the community. While it can be argued a person’s health is a product of medical care and genetics, for many, health and the likelihood of becoming sick and dying prematurely are greatly influenced by factors such as education, income, social determinants and the quality of neighborhood environments. Differences in health along social, economic, racial and ethnic lines exist and often persist across generations.

Finding solutions and improving quality of life, from the perspective of a health care system, begins with understanding the communities it serves and the existing social, economic, and environmental factors that influence a person’s ability to choose paths leading to health.

To this end, the Patient Protection and Affordable Care Act (ACA), enacted March 2010, added a requirement that non-profit medical centers conduct a community health needs assessment (CHNA) every three years. The findings enable health care providers to prioritize the needs of the communities they serve for the purpose of implementing strategies to address those needs. As a result, hospital organizations across the country are actively and regularly engaged with community leaders and residents to explore community strengths and health needs and are held accountable for finding solutions for identified needs.

Sandford Health, one of the largest health systems in the United States, has embraced the community health needs assessment process. Headquartered in Sioux Falls, South Dakota, the organization includes 48 medical centers, 1,494 physicians and 170 Good Samaritan Society senior care locations in 26 states and 10 countries.

“Healthy people create healthy communities and vice versa,” said Dr. Jeremy Cauwels, chief physician for Sanford Health. “The more we know about individual and community health and wellness needs, the more targeted we can be in formulating strategies and allocating resources. Making sure that our resources and desired outcomes are aligned will improve the health of the entire population we serve.”

Throughout the past year, Sanford Health collaborated with multiple health systems, public health agencies, individuals, organizations, stakeholders, and residents in four states to identify the best strategies to improve the health of communities they serve. To assist in this effort, Sanford Health contracted with the Center for Social Research at North Dakota State University, an applied social science research unit, to analyze the information collected through the assessment process in order identify priority health needs specific to each community.

The following section outlines the process Sanford Health utilized to develop strategies and implementation plans addressing significant health needs over the next three years.

2021 Community Health Needs Assessment (CHNA) for Sanford Health – The Process

Consultation. Sanford Health, in coordination with local public health experts, community leaders, and other health care providers throughout the organization’s footprint, developed a multi-faceted assessment program designed to be comprehensive and inclusive. The process maximizes community input and decision-making opportunities, and is built on reliable, existing health data.

Community and Stakeholder Survey. An online survey, aligned to social determinants of health, was administered from December 2020 through February 2021. Invitations to complete the survey were sent to a sample of people within each identified community served. To further promote community involvement, the survey was also sent to community stakeholders and elected officials with knowledge and connections among medically underserved, low income, and minority populations. Stakeholders were asked to complete the instrument as a resident of the community and to forward the survey to their respective populations for greater involvement.

The survey included questions asking for perspective on community factors that may have influence on people’s health such as the quality of childcare and long-term care; access to nutrition, physical activity, and daily transportation; public safety; affordable housing; employment and economic opportunities; and environmental health. Other questions focused specifically on health care access, quality of care, barriers to care, travel to care, and health insurance. In addition, respondents were given the opportunity to follow up on their answers and provide additional feedback. The full set of questions is available in the appendix of each community report found here.

Secondary Data. The framework for the survey was aligned with the County Health Rankings. County Health Rankings, a program of the University of Wisconsin Population Health Institute, also served as the main secondary data source utilized for the community health needs assessment. Alignment of the survey and secondary data within the Rankings model allowed for greater connection of the data sets.

Health Needs Identified. Sanford Health contracted with the Center for Social Research at North Dakota State University to analyze the data gathered from the online survey as well as secondary data from County Health Rankings. 

Survey data were organized into three groups based on the population size of each community: large urban/metro communities, medium-sized communities, and smaller rural communities. Data from each community were analyzed individually and in relation to the group to which they belonged based on population size, for comparison purposes. Data from County Health Rankings (using the same organizational method) were used to augment the findings of a particular community health need – and in some cases used to highlight other priority health needs not identified in the online survey results. 

The analysis of data from both the online survey and County Health Rankings resulted in an initial list of priority health needs specific to each community served by Sanford Health.

Community Asset Mapping. Following the initial assessment, Sanford Health conducted asset mapping to locate the various community resources available to address the identified needs. This process helped to identify the gaps in services available for each community.

Community Stakeholder Meetings. After the community health needs and gaps in community resources were identified, community stakeholders were invited to attend a presentation and discussion of the CHNA research findings specific to their community. The meetings brought together a range of community leaders with knowledge of medically underserved, low income, or minority populations. Members of the local public health agencies and Sanford Health were also invited. A list of attendees can be found in the introduction section of each community assessment. 

Participants were asked to consider the community health needs that should be further addressed through implementation strategies. The meeting was also intended to serve as a catalyst for future collaboration. The facilitated discussion sought to inform on several aspects:
• What are the biggest challenges/health needs facing your community?
• Does your community have gaps in services, access, or outreach?
• What are the opportunities for having the greatest impact in addressing these health needs?
• Which health needs are most urgent in nature?
• Is there any work currently being done to address these needs?
• Are there existing, yet underutilized resources within the community that could address these needs?
• Which needs fall within the purview of the health care system and which needs do not? Can the non-health care needs be shared with other entities or organizations in the community?
• Is there anything you consider an urgent need that has not been discussed? 

Implementation Plan. The community stakeholder meetings identified specific health needs to be addressed within the final implementation plan for 2022-2024. Identified needs were based upon all factors, including primary and secondary data, input from the community stakeholder meeting, and scalability of current hospital programs and resources to address the identified needs efficiently and effectively. Each implementation plan identifies the top two priorities to be addressed, along with the existing activities in place to address them. Goals for each of the priorities are identified along with the additional activities needed, desired outcomes, resources needed to accomplish the activities, leadership, and potential collaborations.

The 2021 Community Health Needs Assessments and 2022-2024 Implementation Strategies for the Sandford Health System are available online. In addition to the implementation plans, the reports also highlight the many strengths, support, and resources available to residents in the communities served. The reports also include a section detailing progress made on the implementation strategies established in the previous needs assessment completed in 2019.

While the resulting strategies and implementation plans are unique to each community, there were some common themes shared throughout the Sanford footprint. Two of the issues receiving most attention involved mental and behavioral health. Concerns for mental health and substance use were a prioritized health issue identified in nearly every community. This health need is acknowledged as one of the most pressing concerns in communities served by Sandford Health.

The purpose of a community health needs assessment is to develop a global view of population health and the prevalence of disease and health issues within a community. Findings from this assessment serve as a catalyst to align expertise and develop a plan of action. There is great intrinsic value in a community health needs assessment when it serves to identify and address public health issues from a broad perspective. A community health needs assessment identifies the community’s strengths and areas for improvement and is vital to investment strategies and programs that build on community assets, promote collaboration, improve community health, and promote innovation and research.

Ask a researcher archive

Grace Njau. ND SHIP - Guiding Public Health Strategies in North Dakota
July 2024

Faye Seidler. A New Horizon for LGBTQ+ Population Data
June 2024

Iyobosa Sonia Omoregie and Kendra Erickson-Dockter. Exploring Suicide Rates Among Youth
May 2024

Dean Bangsund and Nancy Hodur. Sugarbeet Industry in the Northern Plains: Economic Contribution in Minnesota and North Dakota.
April 2024

North Dakota Compass. North Dakota Compass Releases the 2024 Compass Points
March 2024

Nicholas Bauroth. City Governance: Commission or Council for Fargo, North Dakota?
February 2024

Ina Cernusca. 2024 Brings a NEW Visualization Tool and Data Updates to the North Dakota State Legislative District Profiles.
January 2024

Samuel Faraday Saidu and Chelsey Hukriede. Strapped for Safety: Exploring Insights into Car Seat Knowledge Among North Dakota Mothers.
December 2023

Debarati Kole and Kendra Erickson-Dockter. A Comprehensive Look at the Multifaceted Risk Factors of Postpartum Depression
October 2023

Valquiria F. Quirino and Avram Slone. COVID-19 pandemic in North Dakota: Significance, progression, and government response.
September 2023

Karen Olson. The Lasting Impact of Maternal Childhood Trauma
August 2023

Avram Slone. The Social Variability of COVID-19 Mortality in North Dakota between March 11th, 2020 and February 13th, 2022
July 2023

Nancy Hodur and Dean Bangsund. Agriculture a Key Driver in the North Dakota economy
June 2023

Karen Olson. Health and Well-Being in North Dakota. Understanding how the five social determinants of health are impacting the ability of North Dakotans to thrive
May 2023

Kendra Erickson-Dockter. North Dakota Compass: 10 years of Measuring Progress and Inspiring Action.
April 2023

Hannah Hanson & Grace Njau. Every Dad Counts: North Dakota Fatherhood Experiences Survey
March 2023

Nancy Hodur. Housing Market Conditions and Declining Homeownership Rates
February 2023

North Dakota Compass. 2022 Recap: Data highlighted throughout the year
January 2023

Kendra Erickson-Dockter. A Look into a Chronic Condition and Pregnancy: Preexisting Diabetes PRAMS Points 2022
December 2022

Nancy Hodur and Karen Olson. Lower-income households and baby boomers, main drivers for North Dakota housing needs in the near term
November 2022

Avram Slone. The Impact of COVID-19 on Group Quarters in North Dakota
October 2022

Chelsey Hukriede. Safe Sleep PRAMS Points 
September 2022

Kendra Erickson-Dockter. Gestational Diabetes PRAMS Points – A NEW Dashboard Format!
August 2022

Aastha Bhandari, Debarati Kole, Dr. Nancy Hodur. Mission Of Mercy: Giving hope through a smile.
July 2022

Ina Cernusca.Households with children have been disproportionately affected by the COVID-19 pandemic, especially in the first year of the pandemic.
May 2022

Andy Wiese and Karen Olson. One Health System’s Approach to Improving Community Health. Understanding what the 2021 Community Health Needs Assessment Conducted by Sanford Health means for population health
April 2022

Mariel Lopez-Valentin and Grace Njau. North Dakota Title X, Family Planning Needs Assessment
January 2022

Nancy Hodur and Dean Bangsund. North Dakota Lignite Energy Industry Workforce
December 2021

Ina Cernusca. Vaccine Acceptance and Hesitancy in North Dakota
October 2021

Nancy Hodur and Karen Olson. Rural Communities Will Benefit from a New Cooperative in Walsh County
September 2021

Matt Schmidt and Grace Njau. COVID-19 Trends Among North Dakota Children, March 2020 – March 2021
August 2021

Kendra Erickson-Dockter and Ina Cernusca. COVID Hardship on North Dakota Households: New study on the impacts on North Dakota households that lost employment income during the pandemic
July 2021

Chelsey Hukriede and Kendra Erickson-Dockter. NEW! PRAMS Points – A Brief Infographic using North Dakota PRAMS Survey Data
May 2021

North Dakota Compass: A look inside the 2021 Compass Points
April 2021

Ina Cernusca: Households with children are disproportionately affected by the COVID-19 pandemic
March 2021

Ina Cernusca: Differences in COVID-19 Risk Factors at District Level
February 2021

Kendra Erickson-Dockter, Chelsey Hukriede, and Grace Njau: An Introduction to the North Dakota Study of Associated Risks of Stillbirth (SOARS)
October 2020

Karen Ehrens: North Dakota Families are Facing Food and Other Hardships in the Wake of COVID-19 Pandemic, and Helpers Respond
September 2020

Ina Cernusca: Taking the pulse of North Dakota households during the COVID-19 pandemic.
July 2020

Nancy Hodur:Challenges of Grocery Stores in Rural North Dakota
May 2020

North Dakota Compass:2020 Compass Points: Measuring progress. Inspiring action.
March 2020

Amy Tichy:Student Veterans in the College Classroom.
February 2020

North Dakota Compass:North Dakota Compass launches the 2020 State Legislative District Profiles
January 2020

Grace Njau, Nancy Hodur:&Chelsey Hukriede: Risk Behaviors among Women with a Recent Live Birth in North Dakota: Findings from the 2017 North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
November 2019

Ina Cernusca:& Karen Olson: Behind the scenes – The story of the North Dakota State Legislative District Profiles
October 2019

Ina Cernusca: Key demographic trends in North Dakota.
August 2019

Karen Olson: The 30th edition of the Annie E. Casey Foundation’s KIDS COUNT® Data Book finds that 175,772 children will shape the future of a more diverse North Dakota.
July 2019

Shweta Arpit Srivastava & Dr. Ann Burnett: “Giving rope and pulling it back”: Parental dilemmas to prevent adolescent substance use
June 2019

Ina Cernusca: 2019 Compass Points: Setting direction for improving the quality of life in North Dakota
May 2019

Joshua Marineau and Onnolee Nordstrom: Learning from Fargo -- An Exploration of the Fargo-Moorhead Entrepreneurial Ecosystem
March 2019

Nancy Hodur: Improving Oral Health for Older Adults in North Dakota
November 2018

Rachelle Vettern: Engaging Volunteers across Generations
October 2018

Karen Olson: The 2018 KIDS COUNT® Data Book reveals strengths and challenges for children in North Dakota – and emphasizes that an inaccurate census in 2020 threatens to worsen existing challenges for North Dakota youth
July 2018

Lori Capouch: Is food access a concern in rural North Dakota?
May 2018

Deb Nelson: Williston Basin 2016: Employment, Population, and Housing Forecasts – An Overview
January 2018

Karen Olson: North Dakota among Top 10 States in Country for Child Well-Being
July 2017

Nancy Hodur: SEAL!North Dakota: A School Dental Sealant Program
June 2017

Grace Njau: A Brief Introduction to the North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
April 2017

Ina Cernusca: North Dakota’s Women study: A brief overview
March 2017

Dean Bangsund: Effects of Fargo-Moorhead Area Diversion on Spring Planting for Producers
February 2017

Deb Nelson: Vision West: Leading, Educating, and Collaborating to Mobilize the 19 Western North Dakota Counties Towards Resilience and Prosperity
December 2016

Nancy Hodur: North Dakota Statewide Housing Needs Assessment: A Brief Overview of the Population and Housing Forecast component
November 2016

Social Isolation: Experiential Narratives of African Refugee Women in the Fargo-Moorhead Community
September 2016

Sean Brotherson: Father Involvement and the Future of Children and Families
July 2016

Carol Cwiak: Bakken Oil: What Have We Learned and What Will We Do Differently Next Time
June 2016

Jessica Creuzer: The Changing Face of Western North Dakota: What are the Effects of Increased Travel from Energy Development
April 2016

ND Compass: City Profiles
February 2016

ND Department of Health: Making Change Happen
January 2016

Jennifer Weber: A Bold New Direction for the North Dakota University System - The NDUS Edge Dashboards
December 2015

Wendy Troop-Gordon: What Has Science Taught Us About Bullying?
November 2015

ND Compass: A Look at the Youngest North Dakotans
October 2015

Kendra Erickson-Dockter: Growing Older in North Dakota
September 2015

Michael Ziesch: Data You Can Trust: The Labor Market Information Center
August 2015

Malini Srivastava and Troy Raisanen: efargo: City Scale Sustainability
July 2015

Kevin Iverson: The State Repository of Census Information- The North Dakota Census
June 2015

Wonwoo Byun: Reducing Sedentary Behavior is a Key for Obesity Prevention in Children
May 2015

Kathryn Gordon: The Science of Suicide Prevention
April 2015

ND Compass: Tell a Story with Data! The Importance of Crade-to-Career Success
March 2015

Abby Gold: Community Food Systems: Food Charters and More
February 2015

Heather Fuller-Iglesias: The Importance of Recognizing the Role of Social Support in Human Development Across the Lifespan
January 2015

Michael Carbone: Using Data to End Homelessness
December 2014

Randal Coon: Tribal Colleges Contribute to the State's Economy
November 2014

Deb White: Women's Representation in Elected Office
October 2014

Randal Coon: Pull Factors Measure Retail Trade Performance
September 2014

Karen Olson: North Dakota ranks Well Nationally with Regard to Overall Child Well-Being; However, Substantial Opportunities for Improvement Exist
August 2014

Julie Garden-Robinson: Guard Against Grilling Gaffes: Healthy Grilling and Food Safety Tips
July 2014

Michael Noone: Extreme Weather Patterns- North Dakota Has It All
June 2014

Kathleen Tweeten: Why All Community Development Decisions Should Use the Community Capitals Framework
May 2014

Clayton Hilmert: Stress effects on pregnancy: The impact of the 2009 Red River flood on birth weight
April 2014

Karen Ehrens: Food Deserts and how they impact North Dakota
March 2014

Gretchen Dobervich and Kendra Erickson-Dockter: New Geographic Profiles: How they can work for you
February 2014

Compass Staff: "New Compass Team Brings Changes in 2014"
January 2014

Donna Grandbois: "Fargo-Moorhead American Indian Community-Sponsored Health Needs Assessment"
November 2013

Karen Olson: "North Dakota KIDS COUNT - why it counts for you
October 2013

Nancy Hodur: "Western North Dakota School Administrators Face Challenges"
August 2013

Megan Chmielewski: "Annual population estimates tell interesting stories about North Dakota's growth patterns"
July 2013

Ramona Danielson: "Learn how to make the ND Compass website work for you"
May 2013

Karen Olson: "About the American Community Survey (ACS)"
February 2013

North Dakota Compass

Center for Social Research
North Dakota State University

Compass created by:
Wilder Research

© 2024. All rights reserved.