Cook County Health Board Of Directors Meeting
​March 22, 2024

Public testimony

• Michelle Gutierrez, Pres. California Nurses Assn, rep for CCH Nurses.  1200 nurses are owed back compensation, covering many years. Nurses worked overtime and extra shifts, supporting CCH through the pandemic and ongoing due to staffing shortages.  The CCHHS Board approved the payments in Oct 2023, but none have been made.  Delays occur in Human Resources, Finance and Payroll.  These “retro” payments are owed since Oct 2023 and “justice delayed is justice denied”.  

Board and Committee Reports

• Minutes of the Board and each committee were accepted and approved.  However, non-emergency medical transportation at an increased cost, not to exceed, $12 million, provoked Dr. Harrington to ask for customer survey data.

Report from Interim CEO, Erik Mikaitis, MD.

• Dr. Mikaitis reviewed the description of measles and emphasized the contagion risk of two hours for this airborne virus.  CCDPH is support partner at the new arrival shelters.  Vaccination rates for all new arrivals are very low.  All vaccinations are by appointment only but will examine and vaccinate walk-ins. Added availability of vaccination for measles to Covid Hotline.  1 case suspected in CCDPH jurisdiction.  50 doses of MMR (measles, mumps, rubella) vaccination allotted for each Affordable Care Health Network clinic.   Thru February 2024 there were 60 measles cases reported for the US against 58 in all of 2023.  In Illinois 17 cases were reported 15 of those in Chicago
• $44 million in grants to be awarded for Behavioral Health. Proposals accepted until 17Apr2024, 5pm.    Source of funds was not identified. 
• First robotic surgery was performed at Stroger in March 2024, and Stroger is now a Certified Stroke Center providing 25/7 care.  It must also provide tele stroke and be able to deliver vagus nerve stimulation.  The goal is to achieve certification as a COMPREHENSIVE Stroke Center.  However, half of the staff neurologists left in last 12 months which limits ability to complete expansion of stroke services such as home infusion.   More funds and more doctors are needed to complete goals.            

Employment Plan Officer, Semi-Annual Report.  Kimberly Craft 

• The Employment Plan (EP) is a manual containing structured processes for hiring and other employment actions applied system-wide.  It prohibits discrimination, contains proactive and requires transparent processes and requires collective bargaining agreements to be honored. 
• The Employment Plan Office which is part of HR added 2 positions and is now staffed at 4.  Investigations were behind, but are catching up: Carryover 78 (closed 46, new 4, pending 46).
• Board member concerns:​ When asked if this evaluation system was automated, the response: loading & sharing is automated.  However automated in this context means that the information is online.  All review is a manual process.  Policy updates are pending

Managed Care, Aaron Galeener

• CountyCare enrollment is 32% of overall managed care enrollment 426,395/1,319,686 through Dec2023.  Lower enrollment over 2022 is following all of managed care; main cause is redetermination.
• Actual enrollment in 2024 is 20-30% ahead of budget projections
• Call volume Dec-41,586; Jan-54,936; Feb-53,682
• 2024 acute admits much lower than 2023
• Percentage of claims paid in 30 days is returning to pre-pandemic levels

Human Resources Committee, Carrie Pramuk-Volk.

• Positions filled: 70% of offers made is 281 YTD, (57 net new hires); Overall time to fill 195 positions was 126 days.
• Accelerated nurse hiring during Aug2023-Feb2024 411 offers: 231 accepted (56%), 30 pending, 150 declined.
• completed an examination of the duration of the hiring timeline for one role: 85 days on average, 167 of external hire and 64 for internal against a goal of 45 days.

Quality & Patient Safety Committee Meeting
March 7, 2024

• OpEx dashboard expanded to include monthly scores As requested by the committee last meeting, the new rolling dashboard now includes monthly data. Last month Chair Bhatt requested that future updates include information on the actions being taken and timeline for improvement. This was referenced this month but actions being taken and timelines were not presented.
• For Stroger hospital, with the exception of the readmission rate of the same hospital the data did not show much improvement.
• For Provident, patient experience improved but clinical outcomes (hand hygiene and "left without being seen" rate are trending in the wrong direction)

Observer:  Victoria Cerinich

Cook County Health Board of Directors
Finance Committee Meeting
March 7, 2024

Attendance: Chair Robert Reiter, Directors:  Joseph Harrington and Sam A Robinson. Not present: Director Deer. 

Link to all documents/slides presented: https://cookcountyhealth.org/about/board-of-directors/board-committee-meetings-agendas-minutes/

Public Testimony: There was none

IV Items Under Chief Procurement Officer
Action Items:

• Contracts and Procurement (All Approved)
  • #1 Population Health Surveillance Program: Grant Funded project $856,000.00 from the Cook County Health Dept: Requested: Cook County Department of Public Health
    • The funding will be used to develop a comprehensive evaluation design that will evaluate impact, usage, process and overall impact of the Cook County Health Atlas which is housed at UIC School of Public Health. 
      • For background information on this program:  This link with Dr Hasbrouck explains the usages of the Atlas https://youtu.be/IzcyW2duuDg
  • #2 Beyond Green Sustainable Food Partners: Grant Funded project $230,000.00 Requested: Cook County Dept of Public Health
    • Audit and provide technical assistance to the 3 purchasing departments (CCH, Sheriff’s office, and Cook County Juvenile Temporary Detention Center). The vendor will build capacity and coach staff who are directly involved in food purchase and prepare food at these 3 sites. This grant supports implementation outlined in GOOD FOOD PURCHASING POLICY (18-1650 _5/16/18)
• #5 Kaizen Health Inc: Increase contract to a total for 2 years for $12 million covering FY24 and FY25. (Previous amount was $11,400,000.00 for total of 36 months from 7/1/23 to 6/30/25.). This service provides transportation for patients. 
  • Rationale: There has been a surge in their shuttle and ride service of about 4,000 to 5,000/month due to addition of New Arrivals and increase in County Care patients. 
• Report of Emergency Purchases 
  • As temporary stop gap CCH emergency purchase of Hematology/Oncology services for the Dept of Medicine for $1,137,800.00. 

Items under Chief Financial Officer

• Transfer of Funds: Transferred 13,479,000.00 from the Nursing Registry FY24 Budget to Professional FY24 Budget for services after termination of Hektoen Institute contract. 

Observer - Sue Avila

Cook County Health Board of Directors Meeting
February 23, 2024

Before the public testimony and the remaining agenda items, the Board recognized: 

1. a successful first Forum on Behavioral Health – over 700 participants from more than 300 organizations participated on 15Feb2024;
2. 2024 Press Ganey Horizon Award for High Reliability;
3. Other awards received by – Diabetes & Endocrinology, Corrections team;
4. four doctors are on the Chicago Magazine Top Docs list;
5. five members recognized by Commitment to Excellence
6. Civic Leadership Academy award to Gina Massuda Barnett, Deputy Dir, Public Health Programs.

Oral testimony:  Karen Rush, DuPage County Resident, in-person
Request Cook County HHS to recognize that the frequent flooding of parking lots and homes is a health hazard.  Asks that CCHHS examine the land owned by Cook County and if it contributes to the flooding that Cook County improve land management to mitigate the flooding. Submitted written information & photos.
Public Speaker had technical difficulties. (Recording is not available as of 28Feb2024)

Item IV. Board and Committee Reports.

• Minutes of the Board and each committee were accepted and approved. 
• Donna Miller, Cook County Commissioner 6th District, reported that since the last CCHHS Board meeting, a resolution supporting doula and social services support services aimed at improving maternal health outcomes was proposed by Cook County to the National Association of Counties was unanimously approved for presentation to all NACO members. 
• The Quality and Patient Safety Committee has reorganized their meeting agenda to put Action Items earlier in appearance to provide more time for discussion.  
  

Link to Slides on Managed Care Metrics.
https://cookcountyhealth.org/wp-content/uploads/Item-IVD-Managed-Care-Metrics-02-23-24.pdf
Board Member concerns:

1. Fewer CountyCare Managed Care (MCO) members over 2023: Board member asks for way to acknowledge MCO members who return to or renew with CountyCare.  (Loss of members due to resumption of redetermination: member must rejoin or pick new MCO annually fall when they validate their eligibility.) Reduced enrolment in CountyCare has a negative effect on income.
2. CountyCare members who do stay or return to CountyCare tend to need more acute care.  Outreach to existing and new members is focusing on a broad spectrum of profiles.

VI. Recommendations, Discussion/Information Items

1. Quarterly report from the Cook County Dept of Public Health.

• Lowest childhood vaccination coverage in 10 years.
• As low as 10% in some jurisdictions.
• Three exemptions identified: medical, religious and philosophical.  Presenter said that Illinois permitted all three types of exemptions.  (This Observer researched and Illinois Public Health only recognizes medical and religious.)
• Illinois and Cook County are at risk for cluster outbreaks; measles cluster outbreak is possible.
• CCHHS expanded the public education spend to $310K in 2023 and will continue the spending trend.  Media includes Face Book, Instagram and Snapchat, broadcast media (purchased and invited as subject matter expert source), bus ads on PACE routes, print (community media in English and Spanish, Lawndale Citizen, local vaccination clinics.
• HPV is included in marketing but this is a smaller, targeted group
• https://cookcountyhealth.org/wp-content/uploads/Item-VIA-Q1-CCDPH-Report-02-23-24.pdf​

Board member concerns:

1. Causes for very low rates 55% or less in some school districts.
2. Asked staff to use “Boost Up” metrics to report on potential correlation between data and vaccine rates.
3. Schools must request visits by public health nurses (PH RN). Presently, only 24 PH RNs on staff.
4. PH RN role and trajectory is different than traditional clinical RN, but must have changed over time.
   1. Focus is on case management of lead poisoning, premature infant care and expanding vaccination rates.
   2. Will need more PH RNs if asked to expand roles.
5. COVID clinic visits can engage persons who need other vaccines, but capacity/time is limited.
6. Outside contracted RNs provide home health visits and can give vaccines.
7. Board members suggested connecting with other MCO’s which also have financial incentives to maintain healthy members and vaccinations are a tool.

Item VII. Resolution/Recognition and Board Member testimony on contributions of Director Otis L. Story, who is leaving the CCHHS Board.  Mr. Story was directly appointed by Pres. Preckwinkle.

VIII. Interim CEO Report

1. https://cookcountyhealth.org/wp-content/uploads/Item-VIII-CEO-Report-02-23-24.pdf
2. Nursing Update.
   https://cookcountyhealth.org/wp-content/uploads/Item-VIIIB-Nursing-Update-02-23-24.pdf
   1. First ever CCH Nursing School Summit: 50 Participants.
   2. Contract Labor decline from total of $12.7M for 2022 down to $7.5M for 2023.
      1. Board wants these savings to be used to meet long term goals for patients & staff. 
      2. 17% of Nurses are expected to retire in next three years.
      3. FTE needed = 2179, filled =1282, Vacancies = 896 (41%)
      4. Six Nursing Workforce Strategies 
         1. Innovative Staffing Models
         2. Mentorship/Professional Development Program
         3. Focus on Self Care & Personal Development
         4. System & Workflow Redesign
         5. Virtual Nursing – Research & Evidence Based Practice
         6. Transformational Leadership

ITEMS TO WATCH FOR THE FUTURE

1. 1. Qualification for Magnet Award in Nursing excellence in 2024.  Will use a consultant for next steps toward Magnet Award.
2. Strategic Deployment goals were consolidated from 250 to 60 and finally 27.  These 27 were further grouped into seven pillars;
   1. Patient Safety, Clinical Excellence & Quality
   2. Health Equity, Community Health & Integration
   3. Workforce: Talent & Teams
   4. Human Experience: Employee Wellness and Engagement; Patient Satisfaction
   5. Fiscal Resilience
   6. Optimization, Systemization & Performance Improvement
   7. Growth, Innovation and Transformation

Virtual Observer - Victoria L Cerinich

Cook County Health Board of Directors
Finance Committee Meeting
Feb 15, 2024

Attendance: Chair Robert Reiter, Directors:  Joseph Harrington and Sam A Robinson. Not present: Director Story and Director Deer. 
Link to all documents presented: https://cookcountyhealth.org/about/board-of-directors/board-committee-meetings-agendas-minutes/
Public Testimony

• Several members of the registered nurses’ union (NNOC) testified that they have not received retro check for work done during the COVID epidemic which was promised in Nov 2023. 

Items under Chief Procurement Officer Charles Jones 

• Cook County Department of Public Health
  • Grant Funded contract continue to provide staffing for call center for unhoused prevention for suburban Cook County
  • Grant Funded for lead risk assessments for CCDPH’s Lead Hazard remediation program. Dr Hasbrouck in response to question from one of the Director’s regarding cost of remediation, the rough estimate of cost of remediation/home is around $40,000 to $50,000. 
• Report of Emergency Purchases
  • Contract with Alivio: Provides bilingual patient community facilitators: Extended contract from 5/23 to 4/24 Not to exceed increase: $317,886
  • Favorite Health Care Staffing: Contract for new arrivals staffing clinical services: Extended to 4/24 Not to Exceed Increase: $682,135.97
• Revenue Cycle Transformation Plan
  • Reviewed status of Revenue plan transformation: Has added ability to bill/collect through vendor with international ability. Has contract with Salud and Meduit to work with patients on payment plans. 
• Contract Vaya for nursing registry service
  • Question from Director Reiter: time to hire for RN’s is estimated now around 71 days. Human resources will report figures at next finance meeting. 
  • Extensive discussion with the Directors regarding what is the recruiting points for RN’s coming to the Health System around raw salary vs salary and benefits and professional goals. 
  • Registry usage from 9/23 to 12/23 reported FTE’s showed little variance. 

​Observer - Susan Avila 

Cook County Health Board of Directors
Human Resources Committee
Feb. 15, 2024 

Oral testimony:   

Angelica Moore (Family Nurse Practitioner in Burn Unit since fall 2023)

• Scheduled shifts denied w/o notice create unsafe working conditions & negative impact on patient care.  
• Nurses, such as speaker, are not allowed to pick up overtime shifts.  Request changes.

Brenda Langford [National Nurses Organizing Committee (NNOC) Bd Mbr] 

• Slow implementation of negotiated pay rises due to lack of staff in Finance & Payroll.
• Denial of overtime to employee nurses.
• Submitted copy of her statement.

Written testimony: 

• NNOC submitted separate written statement, included with Board packet, but not displayed on video.

Committee Agenda::
Interim Chief HR Officer presented report on employee census (with details on nursing) for 2023 and projections for 2024.

• Filled overall in 2023 - 179 positions
• External Hires in 2023 - 132 Positions
• Net new Hires Trending up - 291 Positions
  

Accelerated hiring of Nursing positions - Firm contracted for 08/07/2023-08/06/2024
08/07/2023-01/31/2024

• Offers made in first six months  - 365
  
• Accepted external (Cmte asked @ categories) - 143
• Accepted internal (Cmte asked @ categories) - 61
• Pending - 21
• Rejected (Cmte asked why? Many rejected     due to shift offered; Answers next meeting) - 140

HR contract ended on 02/06/2024 extension for six months was requested and granted evidently externally to this meeting.  HR Interim Chief wants to tweak contract, (detect vacancies earlier & start hiring process before shortage is critical) review again in three months and make permanent if success continues.
Items to watch for in the Future:  

• Nurse hiring and retention (including retired vs resigned) reports and answers to Cmte’s questions.
• Examination of nurse retention by “Prime Vision to Practice”.  New nurses have clear goals for their professional future; i.e.: in two years!  These goals must be identified and addressed.
• Cook County Learning Institute is up & running.  New curriculum for 2024 is based on surveys from all levels of staff and exit information.  Invited are:  All managers, staff, Teams, Affiliates and Departments. 

Cmte expressed great satisfaction with HR data, yet public comments revealed disquiet among nurses.

What items prompted the most discussion?

• Cmte members prefer and requested graphic style presentations, such as “Tableau”.
• Cmte wants automation of HR data versus manual tracking to continue, but questioned cost/benefit of external vendor versus in-house.  Vendor “Slalom” starting in two weeks. 

 
Virtual Observer - Victoria L Cerinich

Cook County Health Board of Directors
Quality and Patient Safety Committee 
February 15, 2024   

As requested by the board last year, a roadmap has been developed to implement the recently revised reporting method using rolling 12 month reporting. The status of the various workgroups was reported. Most workgroups are still completing the first stage of developing the workgroups.

The discussion on reducing length of stay included an explanation of outliers who will not be included in the data because their reason for overly long stays are due to factors beyond the hospital’s control. i.e. Prisoners who are in need of care that can’t be given to them at the prison but are healthy enough to have home care instead of hospitalization.

The turnaround time for radiology services was discussed as part of the goal to reduce length of stay. The directors were looking for clarification on what factors go into delaying this turnaround time.

The following indicators are currently trending in the wrong direction and should be watched:

•     -Provident Hospital left without being seen
•     -Stroger and Provident Hospitals survey response rate for HCAHPS
•     -Provident Hospital hand hygiene compliance

Observer: Lisa Slankard