Cook County Health (CCH) Board of Directors Meeting
November 22, 2024; 9 am   

Aaron Galeener, Chief Administrative Officer CountyCare, the County Health and Hospital System’s Medicaid managed care organization, responded to questions by Board Directors on how the incoming Trump  administration might affect the Hospital System.  Lots of concerns that the Hospital’s Medicaid block grants might be at risk noted Galeener.  CountyCare was founded utilizing a 1115 Medicaid waiver.  CFO Cassara added that CCH leadership would be conducting strategic discussions on possible impacts.  Governor Pritzker, Cook County Board President Preckwinkle and others will support CCH initiatives others commented.  Should CCH be concerned Director Robinson queried, with Galeener responding that they were hoping moderating influences would prevail.

Board Action: 

• Lyndon Taylor was re-elected unopposed as Chair of CCH Board by Directors.
• CC Commissioner William Lowry was elected unopposed as Vice Chair of CCH Board of Directors.
• Contract and Procurement items were all approved with: 

• Director Bhatt dissenting and voting “present” rather than “yes” on items 11 (Deloitte Consulting LLP: service-supply chain optimization consulting $598,095 extension of existing contract) and 20 (Deloitte Consulting LLP: service-human resources optimization, consulting and support services; $9,211,367 competitive bid RFP ).
• Likewise, Director Sorrell voted “present rather than yes for items 7 (Rush University Medical Center: service-clinical services agreement—no fiscal impact, extension of sole source contract) and 43 (Rush University Medical Center: service-renal biopsy studies, consults & conference moderation; $149,999, extension of contract--competitive bid RFP).  No discussion on reasons for dissent.
• Sept. 30, 2024 CCH Financials show $51,255,000 unfavorable variance to Budget for line item: supplies & pharmaceuticals.  This was attributed to increasing use of expensive biologic and genetic drugs, such as sickle-cell anemia gene treatment and others. 

Research and Grant Funding Discussion:

• Discussed the Life Science Department, newly established in 2024 to win research and other grants and contracts and manage them to increase a larger flow of extramural funds and expand the base of funders with the goal of supplementing revenue to CCH.

• Hektoen Institute has historically managed CCH’s grant solicitation and management.  Transition of Hektoen staff to permanent CCH positions is on-going with nearly 100 FTEs expected to transition by March 31,2025 at comparable salary & benefits.
• Directors posed numerous questions: 

• Institutional Review Board required to enroll human subjects— who will manage IRB, obtain informed consent, process research grant specimens? Answer: The program that sponsors the grant will manage IRB .  Clinical trial lab specimens will be processed at CCH.  
• Will participants recruited for clinical studies reflect CCH population? What about patients not eligible for study enrollment?  
• Grant funders have asked serious questions about the capability of CCH to manage their research grants. 
• Hektoen charges an 11% management fee—can CCH really provide services at this financial break point?  Will we generate more revenue than currently using Hektoen?
• How will we retain clinical investigators at CCH to be competitive?
• Director Reiter, Acting Board Chair in the absence of Lyndon Taylor, tabled the topic for further discussions at subsequent meetings.

Items to Watch for in the Future:

• Hektoen transition of grant management to new CCH Life Sciences Department status in 2025.
• Potential changes to Medicaid and healthcare provision impacting CCH in 2025 under new USA administration. 

Observer - Susan Kern, MD


Cook County Health Human Resources Committee Meeting
 November 14, 2024

Dr. Mikaitis introduced the newly hired Chief of Human Resources, Mr. Win Buren who joined the System just three days before on November 11.  The interim Chief, Carrie Pramuk-Volk was thanked for her leadership during the position search.

Metrics October 30, 2024:

• 1700 vacancies – 1200 of which are currently in the HR hiring/replacement process
•   113 days on average to fill positions and a 64% offer acceptance rate
• 1060 total filled positions of which 725 were external hires

December 1 – October 31 metrics:

• 290 Nurse hires and 173 separations:  117 net new nurse additions
•   107 days on average to fill positions
•   173 Retirements
•   216 Resignations
•     56 Discharges

September Agency Hires:  1,378                      October Agency Hires:  1,224

Recruitment Process Improvements: 40% reduction in positions not posted within 14 days of approval
Decision to Hire packets not completed within 14 days of submission also showed a 40% reduction.

Provident Scholarships:
2022    31 scholars $348,000 awarded           
2023    60 scholars $900,000 awarded
2024    91 scholars $1.3million awarded 

Observer - Diane Edmundson     

Cook County Health Board of Directors Meeting
October 25, 2024   

After securing approval of the AFSCME31 and SEIU 73 contracts, Acting Chair of this meeting, Robert Reiter, JR. (also the Chairperson of the Finance Cmte) revealed that the number of nursing staff vacancies has been frozen at the request of the County Board.  Although the number of budgeted positions is fixed, there is an increased need for staff due to increased patient load, new services, etc.  In turn, there is increased utilization of registry, which continues to negatively impact finances and employee morale.

The first public speaker, Dominica Flanagan, RN, SANE (Sexual Assault Nurse Examiner) in Pediatrics, 

• expressed her concern for two pediatric victims of sexual assault because she was not called in to interview the victims and assist due to the Executive Order to not call her on her day off.  

Before recessing to executive session, a second speaker, Mr. Blakemore, stated that

• “Health is Wealth.” and wants all CCH employees to use CCH for their health care.  And, US citizens to go to the front of the line.

Board members drilled down into the data in the just received 2022 Public Health report.

• 12-month delay on producing an annual report.  
• Faster results, like those for Covid are less accurate, have duplication and incorrect locations: address of report vs actual location.
• Items discussed were rates based on income and race for: 
  • pre-term birth, stroke mortality, equity and health equity, language preference, sexual orientation, lead abatement.
  • using opioid deaths to focus on specific communities for distribution of Naloxone/Narcan to specific organizations and businesses.  

Discussion of the late addition to the agenda: VI Action Items E. regarding the proposed resolution regarding agency usage and strategies promoted discussion and was referred to Finance Committee for more conversations with the labor partners. 

• CCH Board wants to maintain control and not have the Commissioners take over. 
• The turnover rate is at 18% which is less than the national average of 20%.
• 1264 vacancies; 
• 50% are in interview/offer stages.  
• 38% decrease in resignations over 2022/2023, but December sees higher rate of retirements.  
• 98 net new hires as of now, was 23 last year at this time.  
• 18% utilization of agency (averaged across all Depts & roles).

Other Items of Note:

• New device:  CCH has acquired and deployed a new robotic Lung Cancer Biopsy tool.
• Leader Rounds: 2-3 CCH Board members will make “rounds” to departments.
• New Leadership: Dr. Erik Mikaitis was introduced as the new CEO.
• New Board members: Maya Green, MD, MPH, FACHE and Dr. Inger Burnet-Ziegler
• Departing Leadership: Robert Currie

Observer -  Victoria L Cerinich

CCH Managed Care Committee Meeting –
October 18, 2024

Metrics Reported:
Members as of September 5:                    417,175
ACHN Members                                             31,621
% of CountyCare Members that use CC Health     7.60%

​Highlights from the meeting:

• CountyCare achieved a 90% redetermination rate to continue to lead the Managed Medicaid Market in Cook County with 34.2% of the total market share as of 6/24
• CountyCare received an award for its Food Insecurity Program
• In August 100,000 transportation requests were received.  Previously, LWVCC reported that CountyCare has switched to a new and broader transportation program including public and for-hire options.
• To Increase the 7.60% cited above, CountyCare staff is working with Cermak inmates to build relationships and trust before they are released.in order to retain them for CCH services.
• CountyCare led in the 2024 NCQA Health Plan ratings with prevention and equity, earning a 3.5 Star with the highest measurers for adolescent immunizations, BME percentile assessment, and prenatal immunizations.
• CountyCare working on a TeleHealth RFP which would have the potential for on-demand care for those that need it.  Implementation for selected vendors in early 2025.  To date.  CountyCare has contracted with 10 telehealth providers, adding at least 84 practitioners to the virtual care network.  Behavioral health is the domain more generally available.

Observer:  Diane Edmundson

Cook County Health Board & Committee Reports
August 23, 2024

Board Meeting Discussion and Action:
Chairman Taylor and Dr. Erik Mikaitis, Interim CEO, began the meeting with the announcement that anchored by CCH’S Provident Hospital the Bronzeville Community Health Center will offer family medicine, behavioral health, and rehabilitation services including physical, occupational and speech therapy.  The 26,000 square foot center is projected to have 80-85,000 visits in its first year and will include 44 exam rooms and a gym space for therapy services providing care for patients of all ages and stages of life.    The family medicine and behavioral health practices are moving from Provident Hospital’s Sengstacke Health Center into Bronzeville which offers a larger, more modern environment to better serve patients.  The move will also free up more clinical space within Provident to allow for the expansion of hospital-based services.  Patients will continue to be able to receive comprehensive primary and specialty outpatient care at Sengstake.
 
CEO Position: The Commissioners adjourned following the Public Testimony to a Closed Session.  Upon return, Chairman Taylor made a motion to entertain and approve, subject to the approval of the Cook County Board of Commissioners, the appointment of Candidate “A” for the position of Chief Executive Officer of the Cook County Health and Hospital Systems pursuant to the compensation package discussed in closed session.  Motion to approve carried.  

Report from Interim CEO:   Dr. Mikaitis presented a high-level review of ARPA hire and spend. The current spend of ARPA funds is $137M with a remaining obligation of $97M which must be obligated by the end of 2024 with spend through 2026.  Next steps will be to determine sources to continue funding after ARPA funds are spent i.e. post 2026.  Initiatives include Food as Medicine at Belmont-Cragin and an opportunity at Provident Hospital.  Housing for Health which has received a boost to its effectiveness with ARPA funds. This was followed by updates on all the various programs which have received ARPA funding.  
Dr. Hasbrook was requested to in the future provide information about the overlap between Public Health outreach and the programs and to report on the collective impact of the investment in dollars and resources of the various programs. A report on Branding followed with a presentation of the new tagline – “Accountable, Exceptional for All.”  Updates have been made to web sites and staff will have access to new materials for use with patients after launch in September.   
 
Finance Committee:  Director Reiter briefly outlined the three Finance Committee meetings and public hearings in which the FY2025 preliminary budget was presented in detail and the August 15 Finance Committee Meeting where the preliminary budget was approved and requested a motion to approve without another presentation by Pam Cassara.  The CCH approved budget for 2025 is projected at $5.1B for both income and expenses.     Motion presented and approved.   This projected budget will require the  approval of the Cook County Board of Commissions in October.

Audit and Compliance Committee:  Director Harrington reviewed the minutes of the August 2, 2024, meeting indicating that Nicole Emerald, Chief Compliance and Privacy Officer reviewed 1st and 2nd Quarters including system compliance program and Cook County Medicaid Health Plan Compliance Program as well as recovery and the privacy update.  Motion made to approve and carried.  The next meeting will be on Friday, October 18 at 9:00 a.m.

Human Resources:  Reported metrics on vacancies, separations and status of hiring efforts.  1,080 vacancies reported as of the end of July.

Public Speaker Testimony:  There were four in-person, and one written testimonies provided.  The four speakers providing testimony were Dr. Ngozi Ezike, President and CEO of Sinai Chicago Hospital; Lena Hatchett, PhD, Co-founder and Executive Lead for Proviso Partners for Health (PP4H); Jackie Burgess Bishop, CEO National Kidney Foundation of Illinois; and Esther Cook, CEO Alevio FQHC serving Hispanic populations.  All four spoke in strong support of the preliminary Cook County Health and County Care budget for the coming fiscal year.  Each speaker provided an example of how their partnership with Cook County Health has had a positive impact on the goals and objectives of their organizations and a positive impact on the people they serve. 

Observer: Peg Moster

Quality and Patient Safety Committee: 
August 15
The Stroger Hospital and Ambulatory Clinics Joint Commission Triennial Accreditation and Primary Care Medical Home Certification survey was successfully completed in June 2024:

• The overall compliance was 97% for all standards and elements of performance. 
• Corrective actions were established for the findings identified and evidence of compliance will be submitted to the Joint Commission this month.
• Departments will report compliance data at the Hospital Quality and Patient Safety Committee meetings monthly August 2024 – December 2024, then quarterly thereafter thru 2025.
• A compliance dashboard has been developed for reporting and to track ongoing compliance.

Observer - Lisa Slankard

Managed Care Committee: 
August 2 
Metrics: 426,239 total members [well above budget projections].   32,928 ACHN Members [7.7%].  It continues to be the leading Managed Medicare Plan in CC with a 34.2%.  BC/SH is next with 27.2% market share. The CountyCare staff received kudos for its 88.9 Redetermination Rate and its marketing and outreach efforts including billboards along the expressways.  
CountyCare Access (health benefits for immigrant adults and seniors):  Effective January 1, 2023, Immigrant Medicaid members residing in CC have been auto-assigned to CountyCare except for those with a family member in another plan.  Through April of 2024, a total of 35,000 HBI immigrants have come into the plan.  
Healthy Choice Illinois RFP: The RFP by the State has been delayed for a year.  The new expiration date for the State’s approval of CountyCare is December 2026, and a new contract would start January 1, 2027.
Quality and Equity Choice Campaign:  Primary care engagement strategies will focus on adults 18-24.  Equity efforts will start with smoking cessation via education and prevention.  Other efforts center around the food care project, the flexible housing pool with a goal to provide permanent housing and wrap around services to 58 participants.  Clinical Services will focus on accomplishments particularly with behavioral health participants.
Other Successes, Goals, Strategies, and Metrics:

• Won three National Association of counties awards for Addressing food insecurity [Best in Category], engaging members during redetermination, and improving member demographics. It also won an Aster Award for healthcare marketing, advertising, and communications.
• HEDIS scores improved in all but one category [follow up after ED visit for mental illness in 7 days  dropped 3%]. Opportunities for improvement for 2024-25 include behavioral health, living with illness and chronic disease, and maternal and child health.
• CCH’s Illinois Healthcare Transformation 1115 Waiver [promotes the objectives of the children’s CHIP program] was approved as of 7-2-24 and ending 6-30-29.  However, within the request, 3 specific waivers were not approved, a leadership grant program, the redirection of DSH funding to create a pool of funding for strategies and intervention in underserved communities, and training community health workers.
• Food care strategies started in 2023 include emergency meals, general nutrition programs, and medically tailored food. A Total of 7,800 members have been engaged as of the August 2, 2024 report.
• A new non-emergency medical transportation vendor [ModivCare] will start on August 1. ModivCare maintains a network of providers providing multiple levels of transportation services, including public.
• In 2024, CCH and County-Care entered into a new value-based payment arrangement with the State including pay-for-performance incentives tied to key quality outcomes.

​Observer - Diane Edmundson

Cook County Health Board Meeting
June 28, 2024

Challenge of Monitoring 53 Separate Behavioral Health Grant Awardees

• Grants of either $500,000 or $1 Million of ARPA funds under the Stronger Together Behavioral Health initiative have been awarded to 53 different community-based organization  The purpose of the grants is to address behavioral health inequities across the region’s system of care through increased systems alignment, enhanced system quality, and the expansion of access to early intervention and prevention, treatment, support, recovery and crisis assessment and care.  Grant awards were made  to those communities in greatest need and will begin  September 2024. Commissioners were concerned with how the Department would accomplish gathering granular data, given the diversity of grantee organizations to be able to measure effectiveness. The Department recognizes  the challenge and is working on and dedicated to setting measurable and quantifiable goals and objectives. 
• The Commissioners also engaged in a discussion on the use of the term  “mental health” vs. “behavioral health” indicating that each may create stigma. The Department indicated that both terms are in use but are dependent on circumstances and level of comfort with who they are addressing at any time. Commissioners requested an update on goals and objectives in six months.

Report from Chairman of Board:  

• Chair Taylor asked for a moment of silence in recognition of the passing of Commissioner Dennis Deer and announced that there would be a formal recognition of his contributions with Commissioner Deer’s family present at the next scheduled Board meeting on July 26, 2024.  There were Commissioners who chose to reflect on their friendship with Commissioner Deer at this meeting as well.

Finance Committee Report: 

• A total of thirty-four contracts received approval from the Finance Committee on June 14th and subsequently received approval by the Board. Six had no fiscal impact, two were ARPA funded and two were grant funded. Of the remaining contracts, ten exceeded $1 million with the majority of those between $1 and $3.6 million except for a three-year contract for 3rd Party Administration of dental and vision benefits awarded to Avesis for $9.9 million; and a 2-1/2 year contract for telephone triage and referral services for mental health and substance abuse awarded to NAMI of Chicago for $7.9 million.   
• Questions were raised by Board regarding an amendment and increase to the contract with In His Hands Resource Center for $46,150 (ARPA funded) as to impact on homeless families with children and a request made to drill down to all levels of need - singles, families with children under 12, bi-lingual, etc. and further, how this service would be funded after ARPA funds are exhausted.

Quality and Patient Safety and Audit and Compliance Committees:  

• Due to a lack of a quorum, the Quality and Patient Safety meeting was cancelled. The Committee submitted reports for informational purposes and later consideration.
• Although the Audit and Compliance Committee had rescheduled its meeting to the hour before today’s Board Meeting, it went into a closed meeting and never reconvened into an open session. 

Report from Interim Chief Executive Officer:

• In addition to the Behavioral Health Grant awards, Dr. Mikaitis reported successful audits including a Joint Commission survey, and  an IDPH compliance audit for a sickle cell grant. Cermak developed a comprehensive resource guide for individuals leaving Cook County Jail. CCDPH continues to participate in the 100-day challenge to end homelessness in Suburban Cook County.

Informational Reports:  

1. Human Resources Committee Metrics: Second quarter vacancies at 1,821 with 1,435 at various stages of fulfillment from posting of position to offers made. Separations and retirements trending down, and one-third of  ARPA funded positions filled with permanent staff. The accelerated Nursing hire between August 2023 and May 31, 2024,  had 564 offers made with three hundred accepted and twenty-eight pending for a 57% acceptance rate. There were declines from applicants who had applied for multiple positions and could only accept one.
2. Managed Care Committee Metrics: County Care had 429,217 members as of June 5, 2024, and 33.7% of the managed Medicaid Market in Cook County. CountyCare’s enrollment increased 1.3% in March in part due to an 83.7% retention rate over projections. Retention through redeterminations has been helped by the presence of DHS staff at dedicated redetermination events hosted by County Care. 

​Observer - Peg Moster

CCH Quality and Patient Safety Committee 
April 19, 2024 

• The Operation Excellence (OpEx) workgroups from Stroger, Provident and Ambulatory and Community Health Network (ACHN) provided updates.  At Stroger, progress is being made on both lowering central line and catheter infections and decreasing Pulmonary Embolism and Deep Vein Thrombosis occurrences. Provident Hospital has also shown improvement in their goals. Sepsis occurrence has decreased and hand hygiene has improved. 
• The Stroger OpEx readmissions workgroup reported lowering the readmission rate for Congestive Heart Failure and Chronic Obstructive Pulmonary Disease patients. Since these diagnoses are common, they were chosen to start this goal. The work will also be extended to less common but high readmission rate diagnoses.
• The various factors identified as problematic were presented along with changes made to ameliorate them. The Ambulatory services (ACHN) have explored how to get patients’ blood pressure under control. It was found that there were inconsistencies in how blood pressure readings were determined. The standard for ACHN is to take the reading 3 times and average it. The procedure is to make sure the patient is comfortable and positioned properly. It was found that newer staff in the specialty clinics were not aware of the procedure and have now been trained. They also developed an algorithm that allows the nursing staff to change doses.
• ​Both hospitals are due for the Joint Commission on Accreditation of HealthCare Organizations (JCAHO) surveys later this year and are preparing. Mock surveys were done in January. There were very few comments from committee members and no closed session. Items to Watch for in the Future: JCAHO preparation.                                                                            

Observer: Lisa Slankard

​Managed Care Committee
April 19, 2024

• Metrics - 442,652 total members [well above budget projections].     13,849 ACHN Members [5.4%]  
•  It continues to be the leading Managed Medicare Plan in CC with 32.3%.  BC/SH is next with 27.6% market share. The CountyCare staff received kudos for its 80% Redetermination rate and its marketing and outreach efforts including billboards along the expressways.  
• ​CountyCare Access (health benefits for immigrant adults and seniors) - Effective January 1, 1013, Immigrant Medicaid members residing in CC have been auto-assigned to CountyCare except for those with a family member in another plan.  To date, a total of 34,679 have been enrolled.  79% are in the adult category [vs seniors].
• Healthy Choice Illinois RFP  - The RFP by the State has been delayed for a year.  The new expiration date for the State’s approval of CountyCare is December 2026, and a new contract would start January 1, 2027.
• Quality and Equity Choice Campaign  - Primary care engagement strategies will focus on adults 18-24.  Equity efforts will start with smoking cessation via education and prevention.  Other efforts center around the food care project, the flexible housing pool with a goal to provide permanent housing and wrap around services to 58 participants.  Clinical Services will focus on accomplishments particularly with behavioral health participants.

Observer:  Diane Edmundson

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