Running Head: ORGANIZATIONAL ASSESSMENT

North Sound Accountable Community of Health Organizational Assessment

James Skar and Lindsey Helms
Western Washington University

ORGANIZATIONAL ASSESSMENT

North Sound Accountable Community of Health Organizational Assessment

The following paper reflects the experience of two Western Washington University
(WWU) nursing students and their collaborative efforts to improve the North Sound Accountable
Community of Health (NSACH) community health assessment of the north sound region. Through

this practice experience, the need for an improved method of conducting a gaps analysis was
identified by both the NSACH project manager and the participating WWU students. This paper
will introduce the deliverables proposed to the NSACH, apply Lewins change theory to the
organization, evaluate the organizations readiness for change, and explore the likelihood that the
organization adopts the proposed interventions, as well as provide a summary of the
recommended next steps.
North Sound Accountable Community of Health
The NSACH is a program of the Whatcom Alliance for Health Advancement (WAHA).
WAHA is a community based organization funded by a state grant and private donors with a
triple aim to transform the current healthcare system into one that improves health, reduces costs
and improves the experience of care (WAHA, 2012). The NSACH encompasses San Juan,
Island, Skagit, Whatcom, and Snohomish Counties, and has similar goals as WAHA, which are
to transform the healthcare system into one that improves health, improves the experience of
care, increases access, and lowers costs for residents in the North Sound Region. The NSACH
will achieve this by focusing on community health, as well as promoting the integration of
physical, behavioral, and public health systems (WAHA, 2012).
The NSACH collected data and prioritized the needs of the five counties previously
mentioned. It was noted that the data gathered was not completely representative of the most
vulnerable populations in the region. The NSACH recognizes that there is a need to improve the

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gaps analysis in an effort to reach marginalized populations within the region and engage them in
community planning. Marginalized groups for the purpose of this paper include refugee
communities, aging populations, ethnic communities, individuals with HIV/AIDS, tribal
populations, low-income individuals, and lesbian, gay, transgender, bisexual, and queer
(LGTBQ) communities The following are the proposed interventions of two WWU students to
the NSACH in an effort to improve their gaps analysis.
Purposed Interventions to Improve the NSACHs Gaps Analysis
In an effort to address the numerous quality gaps in healthcare, the NSACH could develop a
better strategy to conduct a gaps analysis. In a recent report by the Agency for Healthcare
Research and Quality (AHRQ) it was noted that more than 60 percent of health related
disparities have either not improved or worsened for Blacks, Hispanics, Asians, and poor
populations (Umbdenstock & Lofton, 2011). It is evident that the NSACH is making an effort to
reach marginalized populations and fill in the gaps in data. Below are specific recommendations
for collecting data that is more representative of the actual population:
Diversify the governing board of the NSACH to include more community members
representing marginalized populations
Expand community surveys to areas of community where they can be easily accessed by
minority populations
Invest time and energy in creating trusting relationships within the community to
encourage participation in health planning from marginalized populations
Create listening sessions specifically for minority groups in areas that are comfortable
and convenient, at times that are accessible

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The following sections will examine Kurt Lewins theory of change, apply it to the current
state of the NSACH, examine the likelihood that the organization will adopt the proposed
interventions, and make recommendations for future WWU students to carry on this work.
Kurt Lewins Theory of Change
Kurt Lewin first developed his theory of change in the 1940s, which consisted of three
stages; unfreezing, changing, and refreezing (Sare & Ogilvie, 2010). The unfreezing stage is
characterized by patterns that promote a sense of security and reliability, essentially, the status
quo. The goal of this stage of Lewins theory is to use force-field analysis to find out what will
drive the change and what will restrict the change from happening. The priority of the unfreezing
stage is to release old patterns (Sare & Ogilvie, 2010).
During the second stage of Lewins theory, change is occurring. The change subjects are
using the forces identified in the first stage to create the desired change (Sare & Ogilvie, 2010).
Forces include patterns, beliefs, practices, and attitudes. The main goal of this stage is to involve
people to take action and make changes (Mitchell, 2013).
Finally, the third stage of Lewins theory, refreezing is characterized by establishing new
norms that have replaced the old ways of being (Sare & Ogilvie, 2010). The goal of refreezing is
to prevent the organization from falling back into old ways. In order for this to be successful, the
organization must have established new patterns, practices, beliefs, and attitudes about the norm.
It is imperative to understand that for change to be successful, none of the three stages can be
skipped over (Sare & Ogilvie, 2010).
NSACH and Lewins Theory of Change
As the NSACH is in the early stages of planning post gathering data, they are still
working through the unfreezing process. Although the NSACH has choosen six regional

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priorities, the process itself is iterative, and the NSACH is still gathering and evaluating data to
update regional needs as they change. The NSACH has begun to identify challenges within the
region, which is usually associated with the unfreezing stage of Lewins theory. Because this
organization is working on such a large scale, improvements within the identified areas of care
coordination, behavioral health integration and access, prevention, dental and primary care
access, housing, and addressing health disparities, are likely to occur at a slow pace. Once the
NSACH begins to invest money into new programs targeting the regional needs, they will be in
the actual change phase of Lewins theory. Finally, the refreezing process in this organization
will be an ongoing long term goal. Engaging such a large and diverse group of stakeholders to
change their attitudes and practices at this level is not something that happens overnight or even
over a period of years. However, inspiring these stakeholders to shift the focus of their priorities
is necessary to improve health outcomes of marginalized populations in the region. One major
obstacle that WAHA and the NSACH will have to overcome is finding a way to motivate a
diverse group of stakeholders to adopt a common goal of improving health for those populations
who voices are underrepresented.
Likelihood of Adoptability
Identifying barriers is important when determining an organizations likelihood to adopt
proposed interventions. The proposed interventions that are previously stated have the goal of
improving the NSACHs ability to conduct an improved and throrough gaps anaylsis. The
current barriers to implementation include factors such as staffing changes, financial resources,
approval from the governing board, the organizations commitment to achieving set goals, and
the strength of the supporting community.

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Recent staffing changes include the elimination of eighteen positions due to WAHA
shifting its emphasis from systems innovation toward improving population and community
health. While this change may influence morale within the agency, in the long term it should
increase the organizations likelihood of adopting the interventions as they are in alignment with
the goal of improving population and community health.
During meetings with the NSACHs project manager it was expressed that there was a
need for increased accuracy of data. Data from the county community health assessments
(CHAs) did not accurately reflect the communitys marginalized populations. Without tapping
into this data, the NSACH will struggle to reach its goal of acheiving the triple aim as the
majority of healthcare costs are incurred by a small portion of the community which is not well
represented. Addressing regional health disparities is a multifaceted dilemma and requires a
multifaceted approach. The NSACH is committed to transforming the healthcare system and is
likely to implement interventions that will improve the strength of their gaps analysis and overall
lead to better health outcomes for the community (See appendix B).
Force Field Analysis
Many of the enabling forces influencing NSACHs likelihood to diversify the governing
board and create a better system for gaps analysis are driven by intrinsic factors. For the
stakeholders who represent marginalized groups, it is in their best interest to bring these
oppressed voices to the table. Unfortunately, intrinsic motivation is not always enough of a
motivating factor to create such a large change. However, the ability to show the fiscal efficicay
of following the moral compass in this situation is a major enabling force. The amount of health
care resources consumed by marginalized populations is a driving factor to creating a better gaps
analysis. The cost alone of providing care for these groups is enough to influence the NSACH

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governing board to make the appropriate changes to better identify the health needs of this
region. In addition, a better gaps analysis will ultimately lead to a healthier community, which is
the NSACHs overarching goal.
As with the enabling forces, finances are also a huge restraining force. It will require
more resources in the form of time and money to reach minority populations in a way that can
positively impact the gaps analysis for the NSACH. Currently WAHA is under a great deal of
stress due to changes in the organizational structure, which is creating a barrier to implementing
new changes. Finally, the current governing board of the NSACH would need to agree to the
plan to diversify its leadership, which could mean some current members losing their positions,
and affecting the bottom line of their home organizations (See appendix A).
Next Steps for NSACH
The process in which the NSACH assesses community needs and addresses health
disparities is iterative and multidimensional. Once accurate assessment data has been collected
and interpreted, the NSACH can move toward interventions that positively impact priorities
identified in the CHAs and community health needs assessments (CHNAs). Although the
NSACH project began two years ago, it is still very much in the early stages.
A proposed next step for the NSACH is to continue their relationship with Western
Washington University and have the next cohort of nursing students focus their efforts on
addressing the gaps that have been identified in the data. There are a number of ways in which
the relationship between WAHA and WWU can serve the north sound region. As was discovered
during this process, the resources available to the NSACH for data collection are limited. WAHA
has a great opportunity to utilize the knowledge and creativity of BSN students to help achieve
the goals of the NSACH. Congruently, having the chance to work on such a revolutionary

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community improvement effort is an invaluable experience for any nurse continuing their
education. Success for the NSACH is determinant on a continued dedication to improving health,
improving the experience of care, and increasing health care access for all residents in the north
sound region.

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References
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing
Management, 20, 32-37.
Moore, E. (2015). Accountable community of health readiness proposal. North Sound
Accountable Community of Health. Retrieved from http://whatcomalliance.org/policy2/north-sound-accountable-community-of-health/resources/
Sare, M. & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health
care. Burlington, MA: Jones and Bartlett Learning.
Whatcom Alliance for Health Advancement (2012). What we do. Retrieved from
http://whatcomalliance.org/what-we-do/
Umbdenstock, R. & Lofton, K.E. (2011). Eliminating health disparities: Why its essential and
how to get it done. American Hospital Association. Retrieved from
http://www.aha.org/advocacy-issues/disparities/issues-overview.shtml

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Appendix A
Force Field Analysis
Enabling Forces

Equilibrium

Restraining Forces

Economic stability> -Effective governing board <Financial resources

Healthier communities> -Continued momentum
Satisfied consumers> toward triple aim
Social justice/moral -Accurate representation
influence> of minority populations
Mitigation of high reflected in CHAs and on
utilizers> governing board

<Deadlines
<Governing body
approval
<Restructuring of agency
<Policy and legislation

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Appendix B
Basic Logic Model
Statement of need: Improved method for the North Sound Accountable Community of Heath to
conduct a gaps analysis in order to better reach and serve the needs of marginalized populations
Resources/Inputs

Activities

Outputs

Outcomes

Impact

In order to

In order to address

We expect that

We expect that

We expect that

accomplish our set

our problem or

once

if

if

of activities, we will

asset we will

accomplished

accomplished

accomplished

need the following:

accomplish the

these activities

these activities

these activities

following activities:

will produce the

will lead to the

will lead to the

following

following

following

evidence or

changes in 1-3

changes in 7-

service delivery:

then 4-6 years:

10 years:

*Lee Che Leong

*Review of literature

*Better gaps

*Accurate data

*Better

*North Sound

to identify effective

analysis

that highlights

resources for

Accountable

ways to conduct

*Having

health

marginalized

Community of

gaps analysis to

representatives

disparities

populations

Health (NSACH)

reach marginalized

from

experienced by

*Better health

governing board

populations

marginalized

marginalized

outcomes

willing to engage in

*Gaps analysis

populations on the populations

active listening and

*Review current data governing board

*Public

marginalized

respectful dialogue

and make up of

planning that is

populations

with the community

NSACH governing

focused on

*Programs in

*Community

board

improving

place to address

involvement

*Make

healthcare for

issues of social

*Time

recommendations

marginalized

justice among

populations

marginalized

*Research
*Funding

of NSACH

experienced by

groups