Community Health Needs Assessment

Community Health Needs

Assessment

2023-2025

Table of Contents

Introduction………………………………………………………………………….3

Community Description…………………………………………………………4

2020 CHNA and review ……………...…………………………………………5

2023-2025 CHNA Process and Methods……………………………..... 7 

Community Input and Prioritization of needs……………………….. 8

Implementation Plan…………………………………………………………… 9

Introduction

This Community Health Needs Assessment was compiled for Grays Harbor County Public

Hospital District #1, dba Summit Pacific. Summit Pacific is a municipal corporation organized

under chapter 70.44 RCW. It owns and operates a 40,000 square foot 10-bed Acute Care

Hospital and three Medicare-certified Rural Health Clinics. Summit Pacific replaced its original

facility and relocated to its existing location in 2013.

Summit Pacific is a vibrant and expanding public hospital district that operates a Critical Access

Hospital with a level IV trauma designation, three rural healthcare clinics and a seven day a

week urgent care clinic and the wellness center. Our vision is that “Through Summit Care, we

will build the healthiest community in the Nation.” Our facilities are unique due to their size

and accessibility. The patient experience and functional modalities are enhanced by the

following key Summit Pacific attributes:

 Critical Access Hospital

 24/7 Emergency Department

 Inpatient Acute Department

 Level II Cardiac Center

 Level III Stroke Center

 Level IV Trauma Care

 Three Rural Health Clinics

 Wellness Center

At Summit Pacific, we stabilize and provide advanced trauma life support to critically injured

patients within our 10-bed Emergency Department (ED). If a higher-level trauma center is

needed to provide the patient with the best care, we are equipped to transfer by ambulance

or helicopter. Summit Pacific is essential for stabilization and has saved countless lives for

heart attack and stroke victims as well as those with traumatic injuries.

Summit Pacific currently has a 10-bed Acute Care unit but is licensed for up to 25-beds. Part of

the acute care program allows for a Skilled Nursing and Rehabilitation Program, where we care

for patients who are recently out of surgery or recovering from illness who need a bit more

recovery time before returning home.

In 2019 the campus was expanded with the addition of an award winning 60,000-square-foot

Wellness Center funded by revenue bonds through USDA. This additional space has allowed us

to dramatically increase access to primary care and preventive wellness services within our

community.

Grays Harbor County currently ranks 37 out of 39 Washington counties for Health Outcomes

(length and quality of life) and 36 in overall Health Factors on the County Health Rankings and

Roadmaps compiled by the Robert Wood Johnson Foundation (RWJF). To address these

challenges, Summit Pacific has passionately embraced the guiding principles of the Quadruple

Aim – focusing on improving the health status of our community, redefining the patient

experience, improving the work life of health care clinicians and staff, and creating a system of

efficient and effective healthcare spend. Through identification of socioeconomic barriers that

impact health, individual health needs assessment, and customization of the health care

experience, Summit Pacific supports the residents of Grays Harbor County to achieve a state of

health and wellness.

OUR MISSION

In partnership with our community, we passionately advance the health of all individuals

with an emphasis on quality, access, and compassion.

OUR VISION

Through Summit Care, we will build the healthiest community in the Nation.

OUR VALUES

Passion – Respect – Integrity – Compassion – Excellence -Service

Community Description

Grays Harbor is a rural county in western Washington State, bordered by Jefferson County to

the north, Mason and Thurston counties to the east, Pacific County to the south and the

Pacific Ocean to the west. The county is 2,224 square miles and there are three major

highways that run through Grays Harbor County: State Route 101 runs north/south along the

coast and Highways 8 and 12 run east-west providing access to Interstate 5. Grays Harbor

County Public Hospital District #1 covers the Eastern portion of the county, including the cities

of Elma and McCleary.

Census Bureau statistics for 2021 list the population of Grays Harbor County at 76,841, a 1.6%

increase from 2020 census. The median household income is $50,665 compared to the

national average of $57,652. The population density of the county is 39.8 people per square

mile resulting in a largely rural area. Just 88.7% of residents in Grays Harbor County aged 25

and older are high school graduates, compared to the state average of 90.8%. The average

annual unemployment rate in Grays Harbor County has been on a decline year after year since

2010, when it reached 13.9%. In 2019, the figure was 7.2 percent. The pandemic brought a

jump to 11.7 percent in 2020. As 2021 ended the annual rate of unemployment fell to 7.7

percent.

According to the United States Census Bureau 14.5% of the population in Grays Harbor live in

Poverty compared to 10.2% in Washington state. The most recent report published in 2020

United Way ALICE report based on 2018 information states that 46% of Grays Harbor County

households were living below the ALICE threshold. ALICE is an acronym for Asset, Limited,

Income, Constrained and Employed – households that earn more than the Federal Poverty

Level, but less than the basic cost of living for the county (the ALICE Threshold). Combined,

the number of ALICE and poverty-level households equals the total population struggling to

afford their basic needs. This includes 45% of households of families with children, and 49% of

senior households (65 & older). In McCleary, 38% of households fall below the ALICE

threshold; in Elma, the number jumps to 44%.

2020-2022 CHNA Review

Summit Pacific is committed to understanding and addressing the health needs of the East

Grays Harbor County community, as evidenced by its vision to “build the healthiest community

in the Nation.” This commitment is demonstrated by many years of growth and development

of healthcare services and programs, including expanded primary care, pharmacy, laboratory

and radiology services, a new hospital in 2013, new clinic in McCleary in 2016 and Wellness

Center in 2019.

Additionally, as an early adopter of advanced payment models like Accountable Care

Organization and Value-Based Care contracts, Summit Pacific has dedicated significant

resources toward the prevention of disease and advancement of wellness, which will

ultimately reduce healthcare spend and benefit the community for generations.

A review of the District’s 2020-2022 CHNA and CHNA Implementation Plan and actions taken

to-date validates that significant progress is being made with regard to:

Encouraging Healthy Behaviors & Improving Health Literacy and Nutrition

In 2019, Summit Pacific opened a 60,000 square-foot Wellness Center. This center continues

to serve as a hub of wellness that encourages and supports overall health and well-being.

Unfortunately, the 2020 Covid-19 pandemic limited our ability to offer the full range of

community programs and services the facility was designed to offer. However, with pandemic

restrictions decreasing in 2022, the Wellness Center has again resumed offering community

education, support groups, and healthy eating options. Our campus fitness trail has expanded

to now offer additional walking paths to encourage physical activity for the community as well

as a “Story Trail” as a partnership with Timberland Library to promote youth literacy. We host

many community groups in our meeting spaces to facilitate community engagement,

welcoming our community into our healing environment.

Summit Pacific has a yearly Peak Health Wellness Fair that provides different vendors and free

health screenings for our community members. Other community events include a bike ride

and a golf outing.

Although small, some health measures have shown slight improvement in Grays Harbor

County with the percentage of the community with diabetes falling from 12% in 2019 to 10%

in 2022. Obesity rates also fell slightly, going from 37% of our population in 2019 to 36% in

2022 according to

www.countyhealthrankings.org

Clinical Care

Summit Pacific has been successful in recruiting new providers to the district. Improved access

is reflected in the strong improvement in the Robert Wood Johnson Foundation’s County

health ranking for Clinical Care, which showed Grays Harbor County improving to 34th in 2022,

up from 37th of all Washington Counties in 2018.

To further address the shortage of providers, Summit Pacific developed a Family Medicine

Residency Program. In 2020 the Residency welcomed its inaugural class of residents and has

continued to welcome a new class of residents each year. This program provides much-needed

rural training opportunities. It is also expected to directly improve the local provider shortage,

as providers commonly choose to practice in the community where they complete their

training. There are six residents in the Summit Family Medicine Residency Program for 2022,

and we anticipate our inaugural class will graduate and enter the workforce in June 2023.

Additionally, our ambulatory clinics are piloting a Nurse Practitioner Fellowship model that

allows newly graduated and licensed nurse practitioners an opportunity to gradually build

their practice and rotate through multiple Summit Pacific locations before settling into their

final clinic home. Our initial class in this program is underway, with completion and full-time

entry into primary care anticipated in summer of 2023.

Many patients in our area forgo routine colonoscopies due to barriers to access. In response

Summit Pacific’s Medical Center PMC is increasing specialty care access through the addition

of Gastroenterology services. These services went live for clinic visits in July of 2021 and began

serving our community with endoscopy procedures in September 2021. The program will

expand to full-time, from part-time operations in October 2022 to serve the community need.

Summit Pacific hopes to see this program enhance access and improve the health of our

community through early detection of colorectal cancers and other diseases.

Summit Pacific has offered a Medical Assistant Apprenticeship Program beginning in 2022.

This is a 12-month program that prepares students to take the Certified Clinical Medical

Assistant (CCMA) test through the National Health Care Association. It has been approved by

the state of Washington as an equivalent to an MA-C program at a community or technical

college. The first candidate will have 2000 hours of one-on-one, hands-on training with their

MA coach, learning all skills necessary to become a certified MA.

Between 2020-2022 Summit Pacific’s Medical Center has added four primary care physicians

and two Behavioral health providers. Summit Pacific’s Medical Center has also added two

Gastroenterology specialists, with plans for other specialists being put on hold during the

COVID pandemic.

For Summit Pacific Wellness Clinic, the wait time for new patient visits is 53 days out and for

existing patient routine visits are about 50 days out. For Summit Pacific’s Medical Center new

patient wait time is 115 days out and for existing patient routine visits its about 25 days out.

Addressing Substance Abuse & Mental Health Issues

Summit Pacific continues to operate an open access Medication Assisted Treatment (MAT)

clinic. Summit Pacific is directly addressing the opioid crisis and expanding access to care for

this underserved population. The clinic has received grants to help assist with harm reduction

and overdose prevention. In recognition of the high-quality care delivered by the MAT clinic,

the team was selected as the 2020 Every Day Extraordinary Quality Award from the

Washington State Hospital Association.

Ongoing efforts to expand and integrate mental health services include the addition of a

Psychiatric-Mental Health Nurse Practitioner (PMHNP) and Licensed Mental Health Counselor

(LMHC) in the primary care clinic as well as renovations to a new facility to expand the clinic’s

capacity to meet community needs.

Grays Harbor County has high rates of mental illness and substance use. Summit Pacific’s

strategies to improve mental health include increasing the number of behavioral health

providers and support staff and supporting community and regional efforts to expand access

to behavioral health services. Summit Pacific also has a goal of increasing access to its

Medication Assisted Treatment Team (MAT) program by increasing the number of MAT

waivered providers. MAT provides support services for individuals with substance abuse

disorder and offers Suboxone, Vivitrol and other support medications to help clients

accomplish their goals related to substance reduction and abstinence. 12 out of 14 of Summit

Pacific’s adult/full spectrum primary care providers and the residency program are waivered to

provide Suboxone to eligible patients. The MAT clinic had 306 patients in 2019 for a total of

1720 visits, in 2021 they had 153 patients with a total of 2516 visits. As of September 2022,

Summit Pacific Medical Center, has had 84 patients with 3467 total visits.

In 2021 Summit Pacific Medical Center created the East County Crisis Response Team which

has grown to 36 members across the community in 2022. The team’s current focus is to

provide a youth program for East County youth, giving them a safe place to go for the

resources they may need.

Grays Harbor Opioid Consortium is a diverse group of invested partners (Summit Pacific

Medical Center included) with a vision to influence healthy and safe lifestyle for the residents

of Grays Harbor County. They provide compassionate and equitable opportunities that will

prevent and reduce opioid use disorder (OUD) and substance use disorder (SUD), improve

health behaviors through education, environment, food security, employment, and harm

reduction, with increased access to all social determinants of health services. Current projects

are community contracted transportation services for treatment, recovery, primary care, and

legal services.

2023-2025 CHNA Process and Methods

Summit Pacific’s 2023-2025 Community Needs Health Assessment (CHNA) was developed over

several months, using internal and external data and community feedback.

Data was compiled, reviewed, and interpreted by the Summit Pacific Care Administration

departments. Where possible, data was collected specific to the district, and where not, Grays

Harbor County level data was used.

Primary Data Sources

 U.S. Census Bureau

https://www.census.gov/quickfacts/graysharborcountywashington

 U.S. Bureau of Labor Statistics

https://data.bls.gov/lausmap/showMap.jsp;jsessionid=8DE3ABE5D80E3E3677FA2B4073A1A5CF

 County Health Rankings & Roadmaps 2022 Robert Wood Johnson Foundation

 United Way ALICE Report – Washington

https://www.dropbox.com/s/lbwkwhmcnlcvte7/18UW_ALICE_ReportCountyPages_Wash_8.16.18.pdf?dl=0

 Grays Harbor County Public Health & Social Services

http://www.healthygh.org/

 Washington State Employment Security Department

https://esd.wa.gov/

 U.S. Department of Health and Human Services

https://www.hhs.gov/

 Washington State Department of Health

http://www.doh.wa.gov/Portals/1/Documents/5500/GHS-HOSP2014.pdf

Health Factors Data and Statistics

Life expectancy in Grays Harbor is 3.5 years less than the rest of Washington and a review of

the Robert Wood Johnson Foundation’s 2022 County Health Rankings & Roadmaps for

Washington State shows that Grays Harbor County currently ranks 37 out of 39 counties for

overall health outcomes. There are many factors contributing to this overall ranking, including

health behaviors, nutrition, clinical care, social & economic factors, and physical environment

Source: County Health Rankings 2022 Robert Wood Johnson Foundation

Name Measure 2012 2013 2014 2015 2016 2017 2018 2019 2020

Ranking

Change 2011-

2020

Health

Outcomes

Mortality and Morbidity 36 36 36 36 34 35 35 36 37 -1

Length of

Life

Premature death 33 37 37 35 36 35 36 36 37 -4

Quality of

Life

Poor or fair health, Poor physical

health days, Poor mental health

days, Low birthweight

34 33 36 33 29 30 33 33 34 0

Health

Factors

Health Factors 39 39 38 38 38 36 36 35 36 3

Clinical

Care

Uninsured adults, primary care

providers rate, preventable hospital

stays, diabetic screenings

37 38 37 38 39 35 34 26 34 3

Health

Behaviors

Adult smoking, adult obesity, binge

drinking, motor vehicle crash

deaths, Chlamydia, Teen Birth Rate

38 38 37 38 39 38 38 38 37 1

Social and

Economic

Factors

High school graduation rate,

college degrees, children in

poverty, income inequality,

inadequate social support

38 39 39 38 38 33 36 35 36 2

Health Behaviors

Grays Harbor County ranks low when it comes to health behaviors (37/39) Grays Harbor

County has higher rates of smoking and obesity and lower rates of physical activity compared

to other counties.

Community Input & Prioritization of Needs

Summit Pacific is governed by a publicly elected Board of Commissioners. The Commissioners’

ongoing role is to ensure that the district serves the needs and interests of the community.

The Commissioners set strategic priorities for the district and provide input on both short and

long-term strategic planning.

In addition to monthly public board meetings, Summit Pacific periodically holds open

Community Forums to share information, and to collect feedback from the community.

Summit Pacific’s leadership team develops a one to five-year strategic plan annually. This work

is completed over multiple work sessions, with input from commissioners, executives,

directors, managers, and staff. The Community Health Needs Assessment is referenced

throughout this process. Ultimately the strategic plan is presented at a public board meeting

and formally approved by the Board of Commissioners.

In November of 2022, two community sessions will convene specifically to provide input on

community health needs. At these sessions, health rankings and other related information will

be reviewed, priorities discussed, and the community’s input will be solicited. This information

will be considered in the final preparation of Summit Pacific’s 2023-2025 Community Health

Needs Assessment.

Selected Priorities

After reviewing the data and trends and with careful consideration of the district’s resources,

mission and vision, the Summit Pacific Board of Commissioners and executive leadership

selected to stay focused on the following priorities for 2023-2025:

1. Health Behaviors: Support Healthy Lifestyle

a. Reduce the occurrence of nutrition-related chronic disease and obesity

b. Improve mental health status and reduce the rate/impacts of substance abuse

2. Clinical Care: Healthcare Access and Utilization

a. Increase access to primary care, behavioral healthcare, and specialty care

3. Built Environment: Social, Economic & Physical Environment

a. Address socio-economic and physical environment issues to support a healthy

and vibrant community

These priorities will be the focus of the district’s 2023-2025 Community Health Needs

Assessment Implementation Plan.

Health Behaviors: Support Healthy Lifestyle

Issue

Needs

Strategies

Measures

Grays Harbor

County ranks

low in healthy

behaviors

related to

nutrition and

has high

incidence of

diabetes.

Increased

understanding of the

impact that diet has

on overall health,

awareness of healthy

alternatives, access to

nourishing foods, and

food preparation skills.

Provide education around food

storage and preservation,

menu planning and meal

preparation.

Expand medical nutrition

programming.

• Rate of diabetes.

• Obesity rates.

• County ranking on

nutrition-related

behaviors.

• Number of nutrition

classes and class

participants.

• Number of patients

receiving medical nutrition

counseling/support.

Grays Harbor

County has high

rates of mental

illness and

substance

abuse.

Increase access to

behavioral health and

substance abuse

treatment options;

reduce the stigma

associated with such

care to encourage and

support those in need

to see and/or continue

treatment.

Increase the number of

behavioral health providers

and support staff.

Increase care coordination

services for behavioral health

patients.

Support community and

regional efforts to expand

access to behavioral health

services.

Increase access for the MAT

program; increase the number

of MAT waivered providers.

Operationalize a Behavioral

Health Clinic

East County Behavioral Crisis

Exploring access with

development of mental health

clinic

• Number of empaneled

behavioral health patients.

• Rate of ED visits related to

behavioral health and/or

substance abuse.

• Number of patients treated

in MAT clinic.

• Number of providers MAT

waivered.

Clinical Care: Healthcare Access and Utilization

Issue

Challenge

Strategies

Measures

Healthcare

Access: timely

access to the

right level of

care.

Shortage of primary

care and mental

health providers in

Grays Harbor County.

ED/Acute Access,

Outpatient Specialty

Increase the number of primary

care and behavioral health

providers.

Explore ways to support dental

care services.

Successfully recruit students

for a Rural Family Medicine

Residency program.

Increase partnerships with

specialty clinics and providers.

Master Facility Project to

include expanding Acute Care,

Imaging and ED services

• Number of employed

primary care and mental

health providers.

• Number of empaneled

patients.

• Wait time for new patient

visits.

• Wait time for existing

patient routine visits.

• Recruit physician students

for residency program.

Built Environment: Social & Economic Factors and Physical Environment

Issue

Challenge

Strategies

Measures

Social,

economic, and

physical

environment

factors are

drivers of overall

health and well-

being.

High rates of poverty,

and shortage of

housing impact the

health and vitality of

the community;

solutions require input

and involvement of

many.

Work with community

members and partners to build

a shared vision for health and

well-being that will lead to

measurable improvement in

health factors in District #1.

Explore the possibility of a Blue

Zones (or other similar

program) project for Grays

Harbor County.

Partnership with the City of

Elma and City of McCleary

regarding community planning

• Number of partners and

community members

involved and actively

engaged in this work.

• Improvement in Overall

County Health Ranking.