i. sb scan minutes.pdf · 2011. 4. 15. · minutes of the meeting of the board of directors of the...

Minutes of the meeting of the Board of Directors of the Cook County Health and Hospitals System held Thursday, February 24, 2011 at the hour of 7:30 A.M. at John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, in the fifth floor conference room, Chicago, Illinois.

I. Attendance/Call to Order

Chairman Batts called the meeting to order. Present: Chairman Warren L. Batts, Vice Chairman Jorge Ramirez and Directors Hon. Jerry Butler; David

Carvalho; Quin R. Golden; Sister Sheila Lyne, RSM; Heather E. O'Donnell, JD, LLM; and Andrea Zopp (8)

Absent: Directors David A. Ansell, MD, MPH; Benn Greenspan, PhD, MPH, FACHE; and Luis Muñoz,

MD, MPH (3)

Additional attendees and/or presenters were:

Michael Ayres – System Chief Financial Officer Robert Cohen, MD – System Chair, Department of

Pulmonary and Critical Care Medicine Patrick T. Driscoll, Jr. – State’s Attorney’s Office William T. Foley – System Chief Executive Officer Sharon Freyer – Oak Forest Hospital of Cook County Hon. Bridget Gainer – Cook County Commissioner Lucio Guerrero – System Director of Public Relations Aaron Hamb, MD – Provident Hospital of Cook County Robert Hamilton – Provident Hospital of Cook County Dan Howard – System Chief Information Officer Carmen Hudson-White, MD – Provident Hospital of

Cook County

Randolph Johnston– State’s Attorney’s Office Roz Lennon – System Chief Clinical Officer Terry Mason, MD – System Chief Medical Officer Elizabeth Reidy – System General Counsel Deborah Santana – Secretary to the Board Jeffrey Schaider, MD – System Chair, Department of

Emergency Medicine Deborah Tate – System Chief Human Resources Officer Anthony J. Tedeschi, MD, MPH, MBA – System Chief

Operating Officer Pierre Wakim, MD – Provident Hospital of Cook

County

II. Public Speakers

Chairman Batts asked the Secretary to call upon the registered speakers. The Secretary responded that there were none.

III. Board and Committee Reports

A. Minutes of the Board of Directors Meeting, January 28, 2011

Director Butler, seconded by Director Lyne, moved the approval of the minutes of the Board of Directors Meeting of January 28, 2011. THE MOTION CARRIED UNANIMOUSLY.

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CCHHS Board of Directors Meeting Minutes Thursday, February 24, 2011

III. Board and Committee Reports (continued)

B. Minutes of the Quality and Patient Safety Committee Meeting, February 15, 2011 i. Update on Transfers and Capacity

Dr. Jeffrey Schaider, System Chair of the Department of Emergency Medicine, and Dr. Robert Cohen, System Chair of the Department of Pulmonary and Critical Care Medicine, provided an update on transfers and capacity (Attachment #1). The Board reviewed and discussed the information.

Director Butler, seconded by Director Lyne, moved the approval of the minutes of the Quality and Patient Safety Committee Meeting of February 15, 2011. THE MOTION CARRIED UNANIMOUSLY.

C. Minutes of the Finance Committee Meeting, February 18, 2011

During the presentation of the Finance Committee Meeting Minutes, the Board discussed several of the proposed items that were considered and recommended for approval by the Committee. The following individuals provided additional information on the requests: Dan Howard, System Chief Information Officer; Lucio Guerrero, System Director of Public Relations; and Robert Hamilton, Interim Chief Operating Officer of Provident Hospital of Cook County.

Director Carvalho, seconded by Director O’Donnell, moved to approve the minutes of the Finance Committee Meeting of February 18, 2011. THE MOTION CARRIED. Director Carvalho restated his PRESENT votes on the following contained within the minutes: request numbers 1 and 2 (Illinois Department of Public Health), under the Contracts and Procurement Items; and Item III(E)-Proposed Amendment to the Intergovernmental Agreement between CCHHS, Cook County Board of Commissioners and the Illinois Department of Healthcare and Family Services. Vice Chairman Ramirez and Director Golden voted NO on request number 16 (ACS Healthcare Solutions), under the Contracts and Procurement Items contained within the minutes. Director Lyne voted PRESENT, and Directors Golden and Zopp voted NO on request number 25 (Torres Consulting), under the Supplemental Contracts and Procurement Items contained within the minutes.

IV. Action Items

A. Proposed Resolution – in appreciation of outstanding staff efforts during the Blizzard of 2011 (Attachment #2)

Chairman Batts read the proposed Resolution into the record. Chairman Batts, seconded by Director Butler, moved the approval of the proposed Resolution in appreciation of outstanding staff efforts during the Blizzard of 2011. THE MOTION CARRIED UNANIMOUSLY.

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IV. Action Items

A. Proposed Resolution (continued) Director Carvalho noted that the System has received criticism for management’s decision to reward those employees who were able to show up for work. He stated that this is an opportunity to defend the decision made by management to pay bonuses to those employees. William T. Foley, Chief Executive Officer of the Cook County Health and Hospitals System, stated that County Board President Toni Preckwinkle had declared a state of emergency, and County employees were ordered not to come to work; however, employees were paid regular time for that day. At the System, there was a large number of call-offs of scheduled workers, so the System was pressed in terms of staffing. Management made a decision to reward the staff who came in, and who made extraordinary efforts to do so. Vice Chairman Ramirez inquired regarding the results of the recent employee engagement survey. Deborah Tate, System Chief Human Resources Officer, responded that the results are expected to be presented at the March or April Board Meeting. The Board briefly discussed the purpose, expectations and response rate for the survey.

Chairman Batts, seconded by Director Zopp, moved to ratify management’s action to reward employees who came in to work during the storm. THE MOTION CARRIED UNANIMOUSLY.

B. Any items listed under Sections III, IV and VII

V. Report from Chairman of the Board

VI. Report from Chief Executive Officer

Update on proposed collaboration with University of Chicago Medical Center

Mr. Foley provided an update on the proposed collaboration with the University of Chicago Medical Center (UCMC) and Provident Hospital of Cook County. He stated that the consultants from Health Strategies & Solutions, who were jointly engaged by UCMC and the System to do Phase II of the study, recommended that Provident Hospital partner with UCMC by focusing on a set of services, initially pediatrics and other clinical services, going forward. Mr. Foley noted that there would be a focus on System plans to expand outpatient services at Provident Hospital with the Regional Outpatient Center. From the System’s perspective, Mr. Foley stated that there were some issues with the specialties that were suggested. He stated that the System’s resources for pediatrics are located at Stroger Hospital, and there are already contracts with Rush for some of the pediatrics services and resources. It was determined that the System will take a closer review of the clinical services that are needed by the patient population, in order to further examine and deliberate the proposed collaboration. Miscellaneous

Mr. Foley provided an update on the status of the conversion of the Student Lounge in the Polk Building to a multi-purpose meeting room. He stated that this conversion is expected to be completed in June.

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VI. Report from Chief Executive Officer (continued) Update on FY2011 Budget Mr. Foley stated that on February 25th, the Cook County Board’s Finance Committee is set to consider the President’s FY2011 Budget Recommendation and any proposed amendments. He reviewed information on some budget amendments that will affect the System. One amendment is expected to be presented that will address some corrections and inconsistencies for salaries that were found in the proposed budget. Commissioner Peter Silvestri has presented a proposed amendment that directs $1 million from the System’s budget for professional services to fund dental services. Commissioner Larry Suffredin has presented a proposed amendment that re-directs System funding to fund rape crisis center activities. Additionally, Mr. Foley stated that he anticipates several floor amendments to also be presented tomorrow at the meeting.

A. Update on Provident Hospital and Oak Forest Hospital Implementation Plans (Attachment #3)

Robert Hamilton, Interim Chief Operating Officer of Provident Hospital of Cook County, and Sharon Freyer, Chief Nursing Officer of Oak Forest Hospital of Cook County, provided an update on implementation plans for Provident and Oak Forest Hospitals. The Board discussed the subject of the marketing and communications plan for the implementation. Additionally, further information and discussion took place regarding receiving input from Provident Hospital’s community advisory council. Mr. Foley noted that during the strategic planning process, there were suggestions that other regional advisory councils be created, similar to the council at Provident Hospital.

VII. Closed Session Discussion/Information Items

A. Proposed Grade 24 Hires B. Discussion of Personnel Matters C. Provident Hospital Medical Staff Matter D. Review of Closed Session Board Meeting Minutes

Director O’Donnell, seconded by Director Golden, moved to recess the regular session and convene into closed session, pursuant to the following exceptions to the Illinois Open Meetings Act: 5 ILCS 120/2(c)(1), regarding “the appointment, employment, compensation, discipline, performance, or dismissal of specific employees of the public body or legal counsel for the public body, including hearing testimony on a complaint lodged against an employee of the public body or against legal counsel for the public body to determine its validity,” 5 ILCS 120/2(c)(2), regarding “collective negotiating matters between the public body and its employees or their representatives, or deliberations concerning salary schedules for one or more classes of employees,” 5 ILCS 120/2(c)(17), which permits closed meetings for consideration of “the recruitment, credentialing, discipline or formal peer review of physicians or other health care professionals for a hospital, or other institution providing medical care, that is operated by the public body,” 5 ILCS 120/2(c)(11), regarding “litigation, when an action against, affecting or on behalf of the particular body has been filed and is pending before a court or administrative tribunal, or when the public body finds that an action is probable or imminent, in which case the basis for the finding shall be recorded and entered into the minutes of the closed meeting,” and 5 ILCS 120/2(c)(21), regarding “discussion of minutes of meetings lawfully closed under this Act, whether for purposes of approval by the body of the minutes or semi‑annual review of the minutes as mandated by Section 2.06.”

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VII. Closed Session Discussion/Information Items (continued)

On the motion to recess the regular session and convene into closed session, a roll call was taken, the votes of yeas and nays being as follows:

Yeas: Chairman Batts, Vice Chairman Ramirez and Directors Butler, Carvalho, Golden, O’Donnell and Zopp (7)

Nays: None (0) Absent: Directors Ansell, Greenspan, Lyne and Muñoz (4) THE MOTION CARRIED UNANIMOUSLY and the Board convened into closed session. Chairman Batts declared that the closed session was adjourned. The Board reconvened into regular session. Director Carvalho, seconded by Director O’Donnell, moved to approve the Closed Session Minutes of the meetings held September 5, 2008; September 19, 2008; October 30, 2008; and November 13, 2008. THE MOTION CARRIED UNANIMOUSLY. Director Carvalho, seconded by Director O’Donnell, moved that, pursuant to Section 2.06(d) of the Illinois Open Meetings Act and based upon a review of the Closed Session Minutes of the meetings held September 5, 2008; September 19, 2008; October 30, 2008; and November 13, 2008, and the determination that the need for confidentiality still exists as to these minutes, the Closed Session Minutes of these meetings shall remain closed. THE MOTION CARRIED UNANIMOUSLY.

Director Lyne, seconded by Director Butler, moved to approve the Grade 24 hires presented in closed session, and urged management to consider the discussion held in closed session regarding the position of System Director of Case Management, prior to making the offer to the candidate. THE MOTION CARRIED UNANIMOUSLY. Director Carvalho, seconded by Director Zopp, moved to adopt the corrective action recommended by the Executive Medical Staff of Provident Hospital of Cook County with regard to the clinical privileges of the physician who is the subject of the medical staff matter referred to in Agenda Item VII(C) of today’s agenda; and to adopt the Report of the Provident Hospital Medical Staff’s Hearing Committee as the basis for the Board’s action in this matter. THE MOTION CARRIED UNANIMOUSLY.

VIII. Adjourn

As the agenda was exhausted, Chairman Batts declared the MEETING ADJOURNED.

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Respectfully submitted, Board of Directors of the Cook County Health and Hospitals System

XXXXXXXXXXXXXXXXXXXXX Warren L. Batts, Chairman

Attest: XXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary

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Cook County Health and Hospitals System Minutes of the Board of Directors Meeting

February 24, 2011

ATTACHMENT #1

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QPS OutlinebFebruary 15, 2011

• Bed CapacityBed Capacity

• Safety of Transfers

l• Flu

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SH Med/Surg Midnight CensusSource – SH DCR–Dorothy Richardson

MedSurg Capacity – 240

January Inpatient Census is often higher Flu / Transfers from OFH/PH / ED with high censusJanuary Inpatient Census is often higher – Flu / Transfers from OFH/PH / ED with high census

DOES NOT INCLUDE PATIENTS WAITING IN ED FOR BED AT MIDNIGHT

ED 12am 16 22 16 1 8 0 * * * 25 0 10 13 * * 5 * * * 17

ED 8am 3 5 26 14 13 2 15 19 33 17 3 21 24 27 5 17 17 25 9 3

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SH ICU Occupancy after PH ICU Closure% of Total Beds (not staffed beds) ( )

Source – SH DCR–Dorothy Richardson

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Capacity IssuesCapacity Issues

• High ADC at SH in January – almost 90%High ADC at SH in January almost 90%– High flu season

Transfers from PH / OFH– Transfers from PH / OFH

– Highest SH ED volume since 2005

• Significant inpatient bed waits

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SH Bed Assignment after Requesth% Waiting > 6 hrs

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PH Bed Assignment after Requesth% Waiting > 6 hrs

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January, 2011SH ED‐# Patients waiting for AdmissionSH ED # Patients waiting for Admission

Source – ODA Surge Report

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There is an inpatient med‐surgflow and capacity issue

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Vision 2015 b dImpact on bed capacity

• OFHOFH– Average Med/Surg census

Current daily admissions = 8– Current daily admissions = 8

– Estimated daily transfers post conversion=4 / day

P id t• Provident– EMS runs stopping 2/15/11

– Reduced inpatient beds from 45 to 25

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PH ED Census ProjectionsPH ED Census Projections

• Past 12 months – 40 534Past 12 months 40,534 – CFD Runs – 4899

• Expected 2011 Census with loss of CFD runs• Expected 2011 Census with loss of CFD runs– 10% reduction

– 36,000

• In January, 30% of admissions (349) at Provident came via EMS

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PH Med/Surg Midnight Census

Assuming 30% reduction in census without EMS 80% ADCAssuming 30% reduction in census without EMS 80% ADC

Source Aaron Hamb

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PH Vision 2015 Bed Calculationsd /Census Reduction / No EMS

• 33/96 PH to SH transfers came in via EMS33/96 PH to SH transfers came in via EMS– 1 less transfer per day

• # additional PH to SH Transfers due to PH bed• # additional PH to SH Transfers due to PH bed reduction

1 f d– 1 more transfer per day (12.5% of estimated daily admissions)

• > 95% of the PH admissions in January would be able t b d itt d t th 25 b d itto be admitted to the 25 bed unit (Clark/Wakim analysis)

– 1 more transfer every 2‐3 days (0.5 increase)

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BalanceBalance

# Transfers/Day Ave LOS # SH Additional Med Surg Beds

OFH 4

PH 1

Balance 5 2‐3 10‐15Balance 5 2 3 10 15

Does not include future increase in outpatient capacity that may lead to either less or more inpatient needs.

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Solutions• Initiated Patient Thro ghp t Steering Committee• Initiated Patient Throughput Steering Committee

– More rapid inpatient/outpatient diagnostic testing/f/u– Rework Discharge process (Bed huddles, DC lounge/prescription writer/new pharmacy)Rework Discharge process (Bed huddles, DC lounge/prescription writer/new pharmacy)

– Weekly meetings to identify barriers / opportunities• Implementing case management – ED / Inpatient• Started bed placement flexibility

– ICU overflow, tele to CCU, trauma OBSI OBS it il bilit• Increase OBS unit availability– Opened ED OBS unit West on Weekends

• Increase number of SH Med/Surg BedsIncrease number of SH Med/Surg Beds – Utilize unstaffed 7 bed burn step down unit– Possibly convert 4th floor underutilized beds (12 beds)– Moving Family Medicine to SH to staff additional beds

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SH ‐ % Occupancy 4th Floor OB/PedsSH % Occupancy 4 Floor OB/Peds

Source DCR – Dorothy RichardsonPage 15 of 21 of 94

Provident TransfersJanuary, 2011

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PH Transfer SummaryPH Transfer Summary

One complication •ED to MICU transfer hypotensive due to propol drip•Hypotension resolved after stopping drip

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Number PH‐SH TransfersJanuary, 2011

Average = 3/dayAverage = 3/day

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Flu UpdateFlu Update

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Nov 11th 2009

May 2nd 2009

Stroger Hospital E.D ILI Rate

Jan 22nd 2011

Source – Ibrar Ahmad ‐ EM

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Stroger Hospital E.D ILI Rate

Source – Ibrar Ahmad ‐ EMPage 21 of 21 of 94

Update on PHCC pCritical Care

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Background Admissions suspended 12/27/10

Critical Care Physician On Duty 24/7 y yproviding critical care services

Patients in ED and Floors seen in consult and Patients in ED and Floors seen in consult and recommendations made.

Appropriate patients are transferred to SHCC Appropriate patients are transferred to SHCC ICU, CCU, or in some cases ED for further evaluationevaluation

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Critical CareC t ca Ca eCurrent Data as of 2/14/11 (50 days) 111 Critical Care Consults – 2.2/day

80% of Consults to critical care were from ED20% f th fl 20% were from the floors

46 Patients transferred by CC service to SHCC 0 94/d 0.94/day 34 Patient transferred to MICU 7 Patients transferred to CCU 7 Patients transferred to CCU 5 Patients transferred to SHCC ED

1 Patient transferred to U of C MICU 1 Patient transferred to U of C MICU

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Patients Transferred by Critical Care toPatients Transferred by Critical Care to SHCC N=46

28 (61%) Arrived at PHCC by EMS 18 (49%) Arrived at PHCC on their own 37/46 (83%) of patients transferred to SHCC

by critical care came from EDby critical care came from ED 9/46 (17%) of patients transferred came from

floorsfloors

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Outcome Data on Transferred PatientsOutcome Data on Transferred PatientsN=41

34/41 (83%) Improved

1/41 Discharged AMA 1/41 Discharged AMA

6/41 (15%) Died 4/6 Died after family/service withdrew support

2/6 had end stage disease

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Outcome Data on Transferred PatientsOu co e o s e ed e sN=41

2/6 Died within 24 hours of transfer 63 y/o with end stage COPD and sepsis – 6 hours

82 y/o with metastatic lung cancer and sepsis – 14 hours

No deaths or complications related to the transfer

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Monitoring Transfer Process Average of 9 minutes between time called and

time accepted Range 0 to 40 minutes

Time to Transfer (time called to time leaving ( gPHCC) 2:23 (Range 1:05 to 5:00)( g )

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Moving Forward 60% of transfers came from EMS runs

Number of Critical Care transfers should be reduced at least by half. One every other dayy y

Critical Care consults should be reduced similarly – one per daysimilarly one per day

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Mortality Data MICUMortality Data MICUMICU Mortality

100120140

14161820

AdmissionsMortality

406080

4681012 Mortality

% MortalityUnexpected%Unexpected

020

024 %Unexpected

April May June July August

September

October

Admissions 132 110 105 89 104 90 67

Mortality 12 11 16 17 23 8 14

% Mortality 9 10 15 19 22 9 21y

Unexpected 1 1 3 3 3 0 1

%Unexpected 8 9 19 18 13 0 7

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February 24, 2011

ATTACHMENT #2

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R-11-01

COOK COUNTY HEALTH AND HOSPITALS SYSTEM BOARD OF DIRECTORS

RESOLUTION

Sponsored by

WARREN L. BATTS, CHAIR, JORGE RAMIREZ, VICE CHAIR,

DAVID A. ANSELL, M.D., THE HONORABLE JERRY BUTLER, DAVID CARVALHO, QUIN R. GOLDEN, BENN GREENSPAN, Ph.D., SISTER SHEILA LYNE, RSM,

LUIS MUNOZ, M.D., HEATHER E. O’DONNELL, AND ANDREA ZOPP DIRECTORS

WHEREAS, on February 2, 2011, Chicago’s third largest blizzard on record crippled traffic, caused severe disruption in public transportation and made traveling in and around the City and its Suburbs extremely difficult; and WHEREAS, the Cook County Health and Hospitals System (Health System) operates three hospitals and a correctional health facility, each providing critical care for patients twenty-four hours a day, seven days a week, including providing emergency services; and WHEREAS, throughout the storm, those individuals in the Health System providing direct patient care for our patients, as well as those individuals providing essential support services, once again demonstrated their unwavering commitment and dedication to the safety and well being of our patients through their hard work over extended periods of time; and WHEREAS, throughout the storm, administrative staff and management provided invaluable assistance and support to the individuals on the front lines who were providing direct patient care and essential support services; and WHEREAS, throughout the storm, individuals in the Health System’s non-hospital Affiliates stepped up to lend a hand in any way they could; and WHEREAS, throughout the storm, the Health System’s volunteers, consultants and other contractors pitched in to assist by, among other things, helping man the 24-hour Command Center or delivering critically needed supplies, such as food and linen, in a timely manner despite the difficult travel conditions; and WHEREAS, the Health System overcame staffing challenges and supply demands during the storm through ingenuity and innovative solutions as well as through the tenacity and perseverance of all involved; and

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WHEREAS, in response to the massive storm, the Health System’s emergency preparedness plans were successfully implemented, and there were learning opportunities which will allow the Health System to be even better prepared to meet these types of challenges in the future; and WHEREAS, there were countless extraordinary acts of devotion to our patients, as well as a sense of camaraderie and mutual respect among the staff and volunteers working throughout the storm. NOW, THEREFORE, BE IT RESOLVED, that the Board of Directors of the Cook County Health and Hospitals System, on behalf of the more than five million residents of Cook County served by the Health System, does hereby gratefully acknowledge and commend the staff, volunteers and contractors of the Health System for their remarkable performance during the memorable Blizzard of 2011 ensuring continuity of quality care for our patients.

Approved on February 24, 2011 by the Board of Directors of the Cook County Health and Hospitals System

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February 24, 2011

ATTACHMENT #3

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Vision 2015 – Transforming Our System Through Growth and EfficiencyManagement Quarterly UpdateFebruary 23, 2011

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Introductory RemarksWilliam Foley, CEO, CCHHS

Provident Hospital Project UpdateRobert Hamilton, COO Provident Hospital

Oak Forest Hospital UpdateSharon Freyer, CNO Oak Forest Hospital

Tom Dohm, Associate Administrator Oak Forest Hospital

PricewaterhouseCoopers Update

Bill Luallen

Jackie Edwards

Budget Overview 2011Michael Ayres, CFO, CCHHS

Upcoming Events and Announcements

Agenda

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Provident Hospital Vision 2015 Update

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Programming Planning Design Implement

Tasks Start End

Downsize inpatient services OCT 2010 FEB 2011

Develop and implement marketing and communications plan

OCT 2010 DEC 2011

Transition to standby ED DEC 2010 FEB 2011

Develop and implement ROC FEB 2011 DEC 2011

Continue to explore collaborative opportunities

OCT 2010 DEC 2011

Executive Sponsor: Tony TedeschiTeam Lead: Robert Hamilton

Provident Hospital

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Provident Hospital Status Inpatient Down-sizing/ED Transition

1) ICU suspension/Inpatient downsizing- To be completed by 3/1- Notice sent to IDPH of ICU suspension

2) Ambulance run elimination- Completed 2/15- Meetings/data with South Side hospitals- Notice sent to IDPH & EMS Commission

3) ‘Low-Acuity’ Diagnosis List/Proactive Management- Completed 2/1- Diagnoses & potential for critical care intervention- Patient conditions & complexity that are unstable for PH Med/Surg unit

4) Coordination- Clinical Leadership Interaction (PH/SH)- Worked on ICU transfer process & consultations (PH)- Worked on ED to ED, ED to I/P bed, bed to bed (PH to SH)- Impact on patients, nurse staffing, bed capacity- Family Medicine Residency accommodation/inclusion

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Regional Outpatient Center1) Create/Prioritize space use for ROC

- In process (40-50% completed, Phase 1)

2) Centralized Registration- Space in Sengstacke, 1st Floor for registration and waiting

- Developing site plan and facility rehab/remodeling budget

3) Sengstacke service/support staff improvements - New session creation- primary care access, subspecialty expansion

- Resources identified/budgeted for increase of needed services

- Specialists identified and budgeted

Center of Excellence (COE)- Space identified on campus- Developing acquisition & facility modification plans, and budget

Provident Hospital Status

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Provident Hospital Marketing & Communication Telling the ‘Provident Health Center’ Story & Status

Provident in ‘Open’, Changing, Growing – Community focused

Regional Outpatient Center- New and in-demand subspecialties, more PCP

Center of Excellence for Chronic Disease - Diabetes, CHF, COPD, Obesity

GI Service/Procedures – Five days’ per week

Outpatient Surgery Program - Double the procedural volume

Diagnostic Imaging Services - Comprehensive, referral destination, PACS

Emergency Services - ‘Standby’, comprehensive services, no ambulances

Customer Service & Complaint Resolution-In process: Improved customer service, staff behavior, timeliness of access- scheduling, registration, financial counseling

-To Be Determined: Improve patient experience7

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Provident Hospital Collaborative Opportunities UCMC

− Joint programs, branding, scarce resource recruitment

Access− Specialty referrals, OB patients, diagnostic utilization (lab, rad.)

Southside Collaborative− Primary Care Network, specialty referrals, diagnostic utilization

FQHCs− Primary Care Network, specialty referrals

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Provident Hospital Issues and Challenges

Developing and sustaining a Communication Plan that consistently and continually tells the PH story- not closing, providing services needed and desired by the community, improving access, and customer service

Changing the view of the ‘county’ health system- embracing our mission but also proving that based on our quality, service, and efficiency that we are a destination of choice

Having staff embrace our change and Vision so that their knowledge and support positively influences our patients and community

Enough time to get it all done the right way- thoughtfully, involving stakeholders, and proper communication of impacts!

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Oak Forest HospitalVision 2015 Update

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Programming Planning Design Implement

Tasks Start End

Complete CON process Oct 2010 Mar 2011

Implement marketing and communications plan

Oct 2010 May 2011

Close inpatient services Oct 2010 May 2011

Develop and implement ROC Dec 2010 Dec 2011

Executive Sponsor: Tony TedeschiTeam Lead: Sharon Freyer

Oak Forest

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Milestone Date Status

CON filed to cease Inpatient Services

Nov 4, 2010 Complete

CON deemed complete by Review Board

Nov 23, 2010 Complete

Public Hearing held atOak Forest City Hall

Jan 22, 2011 Complete

Review Board-Final Determination

Mar 22, 2011 In Progress

Oak Forest- Complete the Certificate of Need(State of Illinois Health Facilities and Service Review Board)

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Milestone Date Status

External- Identified Stakeholders and development of Message

Jan 1, 2011 Complete

Internal- Flyer created for internal distribution

Feb 1, 2011 Complete

System- Roll out CCHHS Marketing and Communication Initiative


Oak Forest- Communication Plan

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Milestone Due Date Status

RFP- Posted by Purchasing Jan 17 2011 CompleteVendor Conference Jan 28, 2011 Complete

Proposals Received Feb 7, 2011 Complete

Re-bid Acute Rehab March, 2011 In ProgressEvaluation* and Selection Mar 21, 2011 In ProgressApproved by CCHHS Board Apr 29, 2011 In Progress- On trackServices Begin June 1, 2011 On Schedule*Includes comparing vendor cost to providing service in-house

Oak Forest- Close Inpatient Services Request for Proposal- Vent Care and Acute Rehab

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Complete Scope of Services Feb 9, 2011 CompleteCreate Staffing Model Feb 9, 2011 Complete

Develop Urgent Care Policies for Treatment/Transfer of 1’s and 2’s


Services Begin June 1, 2011 On Schedule

Oak Forest - Close Inpatient Services cont.

Service in Transition- ED to Urgent Care

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Coordination of Efforts with ACHN

Dec 31, 2010 Complete

Develop the ROC Business Plan Mar 31, 2011 In Progress

Design and Build ROC Space Dec 31, 2011 Pending

Evaluate and Allocate Existing Space for Interim ROC Operations

Jun 1, 2011 In Progress

Open-Regional Outpatient Center Jun 1, 2011 Capstone

Oak Forest -Develop the Regional Outpatient Center

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Oak Forest- Issues and Challenges

Successful implementation of Staff Displacement Plan

Budget hold− Capital Planning− Capital projects

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PricewaterhouseCoopersUpdate

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Agenda

Sustainable CCHHS Placemat

Performance Improvement Economic Plan

Work Effort

Accomplishments to-date

Challenges

Next Steps

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Sustainable CCHHS Placemat

Sustainable CCHHSPerformance Improvement Implementation

Total 24 Month Opportunity $313.8M

GovernanceCook County Health & Hospital

System Board of Directors

LeadershipCCHHS – William FoleyCCHHS – Mike Ayres

CCHHS – Tony Tedeschi, MDPwC – Bill LuallenPwC – Joe Albian

1. Operations - $30.0MCCHHS – Roz Lennon

PwC – Deedie Root

4. Physician Effort and Funding Plan - $76.5M

CCHHS – Terry Mason, MDPwC – Jeff Booth

PwC – Courtney ShowellPwC – Pam McCarey

5. Implementation Support for ACHN - $15.8M

CCHHS – Tony Tedeschi, MDPwC – Deedie Root

PwC – Pam McCarey

5.1 Implementation Support for ACHN

CCHHS – Tony Tedeschi, MD /Enrique Martinez PwC – Deedie Root/Pam McCarey

6. Revenue Cycle Performance Improvement - $150.0M

CCHHS – Mike AyresPwC – Jackie EdwardsPwC – Neida Rosario

3. Supply Chain – $41.5MCCHHS – Tony Tedeschi, MD

CCHHS – Nita StithPwC – Ryan Siemers

3.1 Distribution and WarehousingCCHHS – Dan RuizPwC – Marty Ferguson

3.2 ERP/Supply Chain IT MaxCCHHS – Nita StithPwC – Anish Parekh

3.3 Non Labor Cost ReductionCCHHS – Tony Tedeschi, MDPwC – Tim Mangione

3.4 GPO OptimizationCCHHS – Nita Stith/Tony Tedeschi, MDPwC – Lindsey Armstrong3.5 Organization Development &

Process ImprovementCCHHS – Nita StithPwC – Jerry Olszewski

3.6 Inventory ReductionCCHHS – Dan RuizPwC – Marty Ferguson

3.7 Accounts PayableCCHHS – Dorothy LovingPwC – Emma Fluker

3.8 Outsourcing & Shared Services

CCHHS – Jim DeLisaPwC – Dan McGowan

Project Coordination and IntegrationCCHHS – Jeanene Johnson

PwC – Larry Patrick

Change Management & CommunicationsCCHHS – William FoleyCCHHS - Lucio Guerrero

CCHHS – Deb TatePwC – Larry Patrick

4.1 Clinical Productivity and Rev CCHHS – Maurice Lemon, MDPwC – Pam McCarey

4.2 Physician AdminCCHHS – Maurice Lemon, MDPwC - Pam McCarey

4.3 ResearchCCHHS – David Barker, MDPwC – Anthony Armstrong, Ph. D.

4.4 TeachingCCHHS – John O’Brien, MDPwC – Barbara Walsh

4.5 Strategic FundsCCHHS - Terry Mason, MDPwC – Robert Splawn, MD

4.6 Centers of ExcellenceCCHHS – Terry Mason, MDPwC – Courtney Showell

4.7 Medical School AffiliationsCCHHS – John O’Brien, MDPwC – Margaret Stover

1.1 Perioperative ServicesCCHHS – Roz LennonPwC – Kristi Kawamoto

1.2 Nursing ServicesCCHHS – Roz LennonPwC – Janice Buckner

1.3 Emergency ServicesCCHHS – Roz LennonPwC – Sharon Spreitzer1.4 Care Management & Patient

ThroughputCCHHS – Roz LennonPwC – Wanda Pell

CCHHS – Gina Goodson-AllenPwC – Mark Atkinson/Steven Slutsky

1.5 Labor Productivity / SolucientCCHHS – Roz Lennon PwC – Heidi Pandva

6.1 Patient AccessCCHHS – Claude CarterPwC – Edwin Hartai

6.2 HIMSCCHHS – Keith OlenikPwC – John Ruth

6.3 CDM / Charge CaptureCCHHS – John Morales/John CookinghamPwC – Jane Moh

6.4. Regulated PaymentsCCHHS – Bob VaisPwC – Jose Robles

6.5 Patient Billing & CollectingCCHHS – Matt KirkPwC – Leonard Mandel

6.6 Specialized Pharmacy BillingCCHHS – Marty GrantPwC – Betty Kaczmarek

6.7 Rate RationalizationCCHHS - John Morales/John CookinghamPwC – Rick Wichmann

7. Public HealthCCHHS – Stephen Martin, Ph. D.

PwC – Courtney ShowellPwC – Sonia Alvarez-Robinson

7.1 Public HealthCCHHS - Stephen Martin, Ph. D.PwC – Courtney Showell

8. CermakCCHHS – Tony Tedeschi, MD

PwC – Deedie RootPwC – Pam McCarey

8.1 CermakCCHHS – Michael Puisis, MDPwC – Deedie Root / Pam McCarey

3.9 Supply Chain Staff Augmentation

CCHHS – Nita Stith/Jerry OlszewskiPwC – Nita Stith/Jerry Olszewski

2. Recruitment, Retention and System Wide Compensation Structure

CCHHS – Deb TatePwC – Deedie Root

2.1 Recruitment and Retention

3.10 KPI Dashboard & RealizationCCHHS – Jeanene Johnson/Laura Lindeman-LorenzPwC – David Cooperburg

2.2 Compensation CCHHS – Paris Partee/Gladys LopezPwC – Mark Atkinson/Steven Slutsky

6.8 Physician BillingCCHHS - John Morales/John CookinghamPwC – Clara Kridle

6.9 Managed CareCCHHS – Bob VaisPwC – Clara Kridle

6.10 Siemans IT MigrationCCHHS – Donna HartPwC – Neida Rosario

6.11 Staff AugmentationCCHHS – Mary BuzasPwC – Neida Rosario

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Transformation Economic PlanKey Challenges to Driving Organizational Change

24 MONTH VIEW 2010 VIEW

Workstream 24 Month Value Proposition

ACTUAL BenefitThrough 12/31/10

Budgeted CY2010 TARGETED BENEFIT1

ACTUAL 2010 Benefit -6 Months

Through 12/31/10

Revenue Cycle $150M $38.4M $7.2M $38.4M

Operations $30M $0M $3.3M $0M

Public Health $0M $0M $0M $0M

Cermak $0M $0M $0M $0M

Supply Chain $41.5M $0M $12.8M $0M

ACHN $15.8M $0M $1.3M $0M

Physician Effort and Funding $76.5M $0M $6.8M $0M

Total $313.8M $38.4M $31.4M $38.4M

1 Budgeted target for CY201021

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Transformation Benefits Dashboard - OverallProgress Status vs. Plan - As of December 31, 2010

- Shading indicates budgeted benefit goal

T

- Blue arrow indicates actual benefit achieved

- Green hash indicates total benefit confirmed but not yet realized

All dollar amounts are in Millions.

$38.4M in benefit has been realized (exceeding the budget by $31.2M).

No benefit has been realized.



No benefit budgeted for Public Health & Cermak. No benefit realized for ACHN.

- Yellow hash indicates total benefit with confirmation in progress but not yet realizedT

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Work Effort

• 70+ PwC professionals

• 40+ sub-contractors

• 20,000+ hours to support the daily operations of the organization.

• More than 78,000 hours through 11/30/2010, of which approximately 24,000

hours worked by professionals representing minority and / or woman owned

business enterprises (MBE/WBE) and have been paid approximately $4M.

• Staff Augmentation for:- Deputy Director of Supply Chain

Management- Director, Capital Buyer- Manager of Contract Management- Director of Patient Accounting- Director of Strategic Sourcing- CDM Coordinator

- Senior Director of Revenue Cycle- HIM Director- HIM Manager- Director of Patient Access- Manager of Patient Access

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Accomplishments To-Date

Revenue Cycle• Reduced coding backlog from $35M on 8/1/10 to average

less than $10M• Enrolled all physicians in PECOS to enable physician fee

billing • Facilitated the process for all physicians, including

residents, to obtain their NPI number• Implemented OR charge capture focused on implants and

new technology devices and an overall Endoscopy charge capture process. Associated new revenue improvement is anticipated to be $3.5M

• Continue to reduce billing backlog, perform focused AR follow-up and provide guidance to CCHHS staff and temps to more effectively bill and follow-up. As of 12/31/10, the cumulative collections from these efforts total $38.4M

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Accomplishments To-Date Revenue Cycle – continued• Successful implementation and migration of the Siemens

platform• Developed future state Revenue Cycle organizational

structure and management job descriptions• Completed rebilling of chemotherapy / infusion accounts

with an estimated net revenue impact of $1.5M• Commenced system-wide charge capture improvement

efforts and roll out of charge capture reconciliation procedures.

• Conducted Superuser and Enduser training on Siemens INVISION Browser Enhanced Patient Accounting (BEPA)

• Implemented Pre-Processing Center, now pre-registering patients with planned roll out to all facilities.

• Conducted focused training in patient access, billing, coding, charge capture

• Implemented consolidated CDM for all three facilities 12/1/10

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Supply Chain• Proposed guaranteed savings agreement with UHC for

$18M in implemented savings over 2 years• Issued RFP for med/surg distribution to enhance

relationship and maximize programs available• Market testing pharmacy wholesaler agreement for

additional value and better support of Pharmacy strategy• Completing final negotiations for Lab Distribution with

significant savings and process improvements for obtaining supplies for the Lab

• Completed analysis of several RFPs totaling over $3M in savings for decision and execution

• Beginning roll-out of Value Analysis program to improve supply selection and utilization

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Current CCHHS Requisition to Pay Process

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Lean Requisition to Pay Process

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Operations• Developed and implemented a nursing service quality

dashboard.• Developed a Labor and Productivity indicator dashboard.• Developed organizational structure and model to support

system wide Case Management.• Conducted Dialysis Operational Assessment and developed

implementation plan.

Physician Effort and Funding• Completed Physician Effort survey with over 90% response

rate.• Targeted $50M of additional federal grant sponsorship.• Designing best practice future state research model to support

growth.• Collaboratively designed a framework for

developing/growing the Centers of Excellence.29

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ACHN• Developed operational model to facilitate patient

throughput.• Established standardized operating model to allow for more

predictable operations and improve patient throughput and access to care for ambulatory care.

• Established core measurement for physician and staff productivity standards to enable workforce efficiency to support future growth of services for ambulatory care.

• Facilitating the formalization of the Medical Home Model for primary care by integrating established processes to include physician directed care model, coordination and continuity of care through case management, improving access to care, and establishing and monitoring quality and safety measures.

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Accomplishments To-DateCermak• Leadership organizational chart structure completed.• Medication administration procedure developed for divisions

IV and XVII.• Assisted with completing updated responses to DOJ

initiatives status report.• Assisted with design of new ER log based on DOJ

recommendations.

Public Health• Developed and populated a local health department

benchmarking list of five suggested cities and county health departments for CCDPH for comparison.

• Held several Strategic Plan Steering Committee meetings to discuss CCPDH’s mission, vision and values.

• Attended WePLAN Executive Team meetings to review and discuss the Community Themes and Strengths Assessment and developed a framework for CCPDH’s role in health improvement.

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Recruitment, Retention and System Wide Compensation Structure• Developed the 100 Nurses in 100 Days recruitment

campaign.• Designed and facilitated nursing leadership training.• Creating a cultural competency assessment.• Analyzed market-competitive compensation levels for

newly defined/key positions.

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Challenges

• Critical positions need to be filled with permanent staff

• Integrating operational and technology challenges over the next six months to create a technologically enabled health system.

• Transition from County hiring system to Taleo.

• Inadequate staffing in recruiting department and complexities withinposition control.

• Infrastructure Misalignment

• Implementing future state process and organizational structureimprovements.

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Next Steps

Transition project teams to implementation of the “sustainable” future state CCHHS

Successful recruitment and placement of permanent CCHHS staff in the interim roles

Stabilize the technology infrastructures supporting both current operations and enhancing the information technology infrastructure to support future state CCHHS

Finalize Cerner and Siemens application enhancements and ensure stability of applications and network/response time

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CCHHS Transformation

Revenue Cycle PerformanceGraphics

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Patient Access Transformation: Transformational redesign and implementation efforts begin in January 2011 for the Emergency Departments, Centralized Scheduling, Outpatient Registration, and Inpatient Admissions/Bed Control.

Pre-Processing Center (PPC): The PPC was launched in the fall of 2010 at Oak Forest and will expand to include the remaining hospital-based services (Professional & Rehab services). Provident inpatient and hospital-based outpatient services are planned for first quarter of 2011with services at Stroger to follow.

Patient Access Redesign

Services included in the PPC pilot include Ambulatory Surgery, Oncology, Respiratory Therapy, Radiology, Ultrasound and Colonoscopy. Tracking commenced 11/1/10.

Data is populated based on manual PPC staff reporting of accounts worked on a daily basis, and calculation is the percentage of pre-registered accounts for the services included.

-10%

5%

20%

35%

50%

65%

80%

95%

8/6/

108/

13/1

08/

20/1

08/

27/1

09/

3/10

9/10

/10

9/17

/10

9/24

/10

10/1

/10

10/8

/10

10/1

5/10

10/2

2/10

10/2

9/10

11/5

/10

11/1

2/10

11/1

9/10

11/2

6/10

12/3

/10

12/1

0/10

12/1

7/10

12/2

4/10

12/3

1/10

1/7/

111/

14/1

1

Percentage of Scheduled Services Pre-Registered by Week

Target Percentage = 98%

Baseline Percentage = 0%

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Metrics: Key Performance Indicators (KPIs) have been collected across several Patient Access areas where changes have been implemented and are being routinely tracked and reported. Below are some of the Key Performance Metrics for Clinic C at Stroger Hospital. KPIs, and registration Quality Assurance, will be expanded across all Patient Access areas during the first quarter of 2011.

Definitions and Calculations

1. Productivity includes average minutes for a complete registration process over the total number of registrations2. Total Registrations by Month includes total number of registrations in Clinic C

3. Average wait time - average wait time from time of check-in to time registrar commences registration process.

0%

20%

40%

60%

80%

Average of < 7 Min

Average of 7-12 Min

Average of >12 Min

62%

34%

4%

75%

22% 3%

74%

22%4%

Registrar Average Registration Time Oct-Dec 2010

Oct

Nov

Dec

4.0

4.5

5.0

5.5

Oct Nov Dec

5.4

4.74.6

Clinic C Average Wait Times by Month 2010 (min)

Patient Access Redesign

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Note: ED dollars not available - charges manually entered subsequent to coding

Coding Backlog Reduction Dollars (Excludes ED – charges currently entered post coding)

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Coding Backlog Reduction Volume(Includes ED)

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Coding Backlog Reduction Dollars (Excludes ED – charges currently entered post coding)

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Coding Backlog Reduction Volume (Includes ED)

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Charge Capture

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Aug - 2010 Sep - 2010 Oct - 2010 Nov - 2010 Dec - 2010

Vol

ume

Stroger Patient Days in relation to Pharmacy Inpatient Charge Capture Cumulative Volume

Patient Days

Pharmacy

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$-$200,000 $400,000 $600,000 $800,000

$1,000,000 $1,200,000

Sep-2010 Oct-2010 Nov-2010 Dec-2010

Dol

lars

Stroger Cummulative Gross Revenue for OR Implants

Total

Inpatient

Outpatient

-

1,000

2,000

3,000

4,000

Sep-2010 Oct-2010 Nov-2010 Dec-2010

Vol

ume

Stroger Cummulative Total OR Case Volume

Total

Inpatient

Outpatient

Stroger Implant Charge Capture Performance

$-

$100

$200

$300

$400

$500

$600

Sep-2010 Oct-2010 Nov-2010 Dec-2010

Dol

lars

Stroger Cummulative Average Implant Charge Per OR Case

Total

Inpatient

Outpatient

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$-

$50

$100

$150

$200

$250

$300

Aug-2010 Sep-2010 Oct-2010 Nov-2010

Stroger Average Charge Per ED Encounter

Sep-2010

Go-Live

Stroger ED Charge Capture Performance

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Patient Financial ServicesBenefit Tracker Summary (Cumulative)

$210,000,000

$220,000,000

$230,000,000

$240,000,000

$250,000,000

$260,000,000

Aug-Sept Oct Nov Dec

Total Focused Accounts Receivable

Total Placements

$249M

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

Aug-Sept Oct Nov Dec

Total Collections

Total Collections

$38.4M

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Preliminary Budget Overview FY 2011

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Strategic Plan: Vision 2015FY 2011BudgetRevenuePayer 2010

Budget2010

Actual2011

PreliminaryBudget

2011 Preliminary to

2010 Actual

Medicare $53.6 M $56.3M $54.0 M $(2.3M)

Medicaid $227.5 M $168.7M $176.0 M $7.3M

Pvt. Payers $17.0 M $16.4M $21.3 M $4.9M

Medicaid IGT $131.3 M $131.3M $131.3 M $0

DSH $150.0 M $158.1M $140.0 M ($18.1M)

PWC Revenue Enhancement

$0 $0 $70M $70M

Other $6.9 M $6.9M $6.9 M $0

Total $586.3 M $537.7M $599.5 M $61.8M

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Estimated Net Subsidy

Budget 2010

Estimated Actual 2010

Prelim 2011

Budget

Prelim 2011 Budget to

Actual 2010

Health Fund $865.7 $835.7 $815.2 ($20.5)

Fixed Charge $108.2 $112.8 $97.5 ($15.3)

Total Approp. $973.9 $948.5 $912.7 ($35.8)

Revenue $586.3 $537.7 $599.5 $61.8

Subsidy $387.6 $410.8 $313.2 ($97.6)

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*In millions

Strategic Plan: Vision 2015FY 2011 BudgetSubsidy comparison

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Upcoming Events and Announcements…

Knowledge Web Training Course for Managers February 23, preregistration required

Managers communicate Transformation Update and policies distributed at department meetings by March 4

2011 Budget Approval February 28 Quarterly Leadership Development Program

begins March 9 hosted by Human Resources

Next Quarterly Management Meeting - May 18, JSH Cafeteria, 8 AM to 9:30 AM

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Appendix

Reference Support

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CCHHS Board Approved June 25, 2010 - Cook County Board Approved July 27, 2010

Overview of Strategic Plan

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PwC Project LeadershipMichael Ayres, [email protected]

Implementation Plan LeadershipCarlo Govia, [email protected], 312.648.4288

Project Management, Office of Performance ImprovementJeanene Johnson [email protected], 312.864.6841

Knowledge Web, Office of Performance ImprovementJohn Hughes, [email protected], 312.864.0525

Questions…

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mailto:[email protected]




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