I. Attendance/Call to Order · Sister Sheila Lyne, RSM; Luis Muñoz, MD, MPH; and Andrea Zopp (10)...

Minutes of the meeting of the Board of Directors of the Cook County Health and Hospitals System held Friday, January 28, 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 David A. Ansell, MD,

MPH; Hon. Jerry Butler; David Carvalho; Quin R. Golden; Benn Greenspan, PhD, MPH, FACHE; Sister Sheila Lyne, RSM; Luis Muoz, MD, MPH; and Andrea Zopp (10)

Absent: Heather E. O'Donnell, JD, LLM (1)

Additional attendees and/or presenters were: Michael Ayres System Chief Financial Officer Cathy Bodnar System Chief Compliance Officer T. Ulrich Brechbhl Chamberlin Edmonds &

Associates, Inc. Patrick T. Driscoll, Jr. States Attorneys Office Jackie Edwards PricewaterhouseCoopers William T. Foley System Chief Executive Officer Hon. Jesus Garcia Cook County Commissioner Avery Hart, MD Chief Medical Officer, Cermak

Health Services Helen Haynes Office of the General Counsel Randolph Johnston States Attorneys Office G. William Luallen PricewaterhouseCoopers

Roz Lennon System Chief Clinical Officer Randall Mark System Director of Intergovernmental

Affairs and Policy Terry Mason, MD System Chief Medical Officer Michael Puisis, MD Chief Operating Officer, Cermak

Health Services Elizabeth Reidy System General Counsel Deborah Santana Secretary to the Board Hon. Robert Steele Cook County Commissioner Nita Stith System Supply Chain Management Deborah Tate System Chief of Human Resources Anthony J. Tedeschi, MD, MPH, MBA System

Chief Operating Officer

II. Public Speakers

Chairman Batts asked the Secretary to call upon the registered speakers. The Secretary called upon the following registered public speakers: 1. George Blakemore Concerned Citizen 2. Richard David, MD Physician (written testimony also provided Attachment #1) 3. Randy Ruff Concerned Citizen 4. Anne Scheetz, MD Physician 5. Leslie Curtis Midwest Director, National Nurses Organizing Committee 6. D.C. Tess Concerned Citizen 7. Cheryl Conner Resident Physician, UIC

III. Board and Committee Reports

A. Minutes of the Board of Directors Meeting, December 17, 2010

Director Lyne, seconded by Director Greenspan, moved the approval of the minutes of the Board of Directors Meeting of December 17, 2010. THE MOTION CARRIED UNANIMOUSLY.

Page 1 of 30

CCHHS Board of Directors Meeting Minutes Friday, January 28, 2011

Page 2

III. Board and Committee Reports (continued)

B. Minutes of the Board of Directors Special Meeting, January 3, 2011

Director Muoz, seconded by Director Lyne, moved the approval of the minutes of the Board of Directors Special Meeting of January 3, 2011. THE MOTION CARRIED UNANIMOUSLY.

C. **Minutes of the Audit and Compliance Committee Meeting, January 18, 2011

Director Muoz, seconded by Director Zopp, moved the approval of the minutes of the Audit and Compliance Committee Meeting of January 18, 2011. THE MOTION CARRIED UNANIMOUSLY.

D. **Minutes of the Quality and Patient Safety Committee Meeting, January 18, 2011 During the presentation of the minutes, Director Ansell noted that at this meeting, the Committee received the System Quality and Safety Dashboard. He suggested that the Dashboard be presented to the full Board at a future meeting. Director Carvalho requested that the Dashboard be expanded to include nurse staffing data. Director Ansell stated that he has asked Dr. Jeffrey Schaider, System Chair of the Emergency Department, to discuss the issue of capacity, and the Systems ability to manage it, at the next meeting of the Quality and Patient Safety Committee. Furthermore, with regard to the transition at Oak Forest Hospital, Director Ansell stated that at the next Committee meeting, he expects to have a discussion of any quality issues that may be related with the transition. The Board discussed public comments made during the provision of public testimony by Dr. Scheetz and Ms. Tess; these included specific concerns regarding staffing and allegations relating to two specific incidents involving patient care. Director Zopp stated that the specific concerns should be addressed; management should investigate and report back to the Quality and Patient Safety Committee. Director Ansell added that there needs to be a process for bringing these types of issues forward. The Board further discussed the issue of nurse staffing and current nurse-to-patient ratios. It was stated that problems have been experienced with the displacement process; issues with the accuracy of the position vacancy list, which is integral to the displacement process, were described. Director Lyne, seconded by Director Greenspan, made, and subsequently withdrew, a motion with regard to moving forward with the vacancy list and displacement process, while recognizing that there may be some data issues with the vacancy list. In lieu of a formal motion, the Board concurred on the following recommendation made to this effect: to urge management to take whatever steps possible to ensure that staffing is up to patient safety levels.

Director Muoz, seconded by Director Lyne, moved the approval of the minutes of the Quality and Patient Safety Committee Meeting of January 18, 2011. THE MOTION CARRIED UNANIMOUSLY.

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Page 3

III. Board and Committee Reports (continued)

E. **Minutes of the Human Resources Committee Meeting, January 21, 2011 i. CCHHS Compensation Review by Cook County Auditor

The Board discussed an issue presented earlier by Ms. Curtis during the public testimony portion of the Board Meeting. This issue involves the allegation that a detainee at the Cook County Department of Corrections (DOC) was given personal information on a nurse who works at Cermak Health Services. Cook County Commissioner Robert Steele provided further information on the issue. Deborah Tate, System Chief of Human Resources, and Dr. Michael Puisis, Chief Operating Officer of Cermak Health Services, outlined the actions that have taken place since the incident took place. It was noted that the DOC is investigating this issue; the Office of the Independent Inspector General is also investigating. The subject of policies and procedures used to ensure the personal safety of employees was discussed. Commissioner Steele suggested that the System Board receive a full report from the Sheriff on the matter. Furthermore, Director Zopp suggested that the Sheriff be asked to provide short-term security for the employee.

Director Zopp stated that the Human Resources Committee should receive a report on the matter, to review how the issue was handled and resolved.

Action on this item took place following the adjournment of closed session. Director Ansell, seconded by Director Greenspan, moved the approval of the minutes of the Human Resources Committee Meeting of January 21, 2011. THE MOTION CARRIED UNANIMOUSLY.

F. Minutes of the Finance Committee Meeting, January 21, 2011 i. PricewaterhouseCoopers Update

ii. Chamberlin Edmonds & Associates, Inc. Update

William Luallen and Jackie Edwards, from PricewaterhouseCoopers (PwC), presented an overview of the update on performance improvement. The subjects reviewed included the following: sustainable CCHHS placemat; performance improvement economic plan; work effort; accomplishments to date; challenges; and next steps. During the presentation by PwC, the subject of the Systems current inability to spend additional revenues, over and above the budgeted appropriation, that are either secured or achieved as a result of performance improvement initiatives, was discussed. Director Carvalho stated that the System budgets conservatively on the assumption that only a portion of the savings and revenue improvements will be realized. If additional savings or revenues are secured or achieved, there is no mechanism in place for the System to devote these funds to health care services. He noted that this mechanism would need to be incorporated into the Countys Appropriation Ordinance.

Director Carvalho, seconded by Vice Chairman Ramirez, moved that, as part of the adoption of this budget, that the System Board be given the authority to spend additional revenues if they are accrued, for both the budget and capital budget. THE MOTION CARRIED UNANIMOUSLY.

It was determined that the Office of the General Counsel and the States Attorneys Office would draft the appropriate mechanism to convey the System Boards intent to the County Board.

Page 3 of 30


Page 4

III. Board and Committee Reports

F. Minutes of the Finance Committee Meeting, January 21, 2011 (continued) T. Ulrich Brechbhl, President of Chamberlin Edmonds & Associates, Inc. (CEA), provided an overview of the Eligibility and Enrollment Optimization. Information was provided on the following subjects: background; financial targets and staffing required; philosophical approach and key metrics; self-pay referrals projected and actual; accepted accounts projected and actual; planned staffing versus actual as of 10/31/10; pending account and application inventory growth; approved accounts; approved account aging; remit dollars; projected steady State net cash flow from Eligibility and Enrollment Optimization; and summary and next steps. Director Carvalho noted that management should make sure that the presentations given by PwC and CEA are forwarded to the County Commissioners, for their information. With regard to the Medicaid Reform Bill recently signed by the Governor, Director Carvalho noted that it will have two negative impacts: it will eliminate presumptive eligibility for adults, other than pregnant women; and will mandate managed care for 50% of the population. He requested that a future discussion take place on the potential impact to the System. Director Golden inquired regarding the issue involving the States backlog in processing the Systems eligibility applications. Michael Ayres, System Chief Financial Officer, stated that a meeting took place yesterday with representatives from the Governors Office, to discuss and try to resolve the issue. He stated that the draft Intergovernmental Transfer Agreement is in its final phases; this will allow the System to pay the State to fund positions that will process System eligibility applications. What may take some time is for the States Department of Management and Budget to release what are, in effect, temporary positions. Mr. Ayres added that all parties appear to be willing to move forward. With regard to the data provided on those self-pay patients who were not eligible for coverage, Director Muoz requested additional information on that population; this information should include factors that render the patients ineligible.

Director Carvalho, seconded by Director Butler, moved to approve the minutes of the Finance Committee Meeting of January 21, 2011, with the exception of the following:

excluding request numbers 6, 9, 15 and 16 under the Contracts and Procurement

Items, which are being withdrawn at this time. On the motion, a voice vote was taken and the MOTION CARRIED UNANIMOUSLY.

IV. Action Items

A. Contract and Procurement Item (Attachment #2)

Nita Stith, Interim Deputy Director of Supply Chain, presented the request for the Boards consideration.

Director Carvalho, seconded by Director Butler, moved the approval of the proposed Contract and Procurement Item. THE MOTION CARRIED UNANIMOUSLY.

Page 4 of 30


Page 5

IV. Action Items (continued)

B. Approval of Cermak Cook County Department of Corrections Memorandum of Understanding (reviewed by the Quality and Patient Safety Committee on January 18, 2011)

Action on this item took place following the adjournment of closed session. Director Lyne, seconded by Director Butler, moved the approval of the Cermak-Cook County Department of Corrections Memorandum of Understanding. THE MOTION CARRIED UNANIMOUSLY.

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

V. Report from Chairman of the Board

Chairman Batts deferred his report to the next meeting.

VI. Report from Chief Executive Officer

A. CCHHS 4th Quarter 2010 Report (Attachment #3)

B. Patient Demographic and Service Statistics (deferred)

Mr. Foley deferred his report to the next meeting.

VII. Closed Session Discussion/Information Items

A. Discussion of Personnel Matters B. **Minutes of the Audit and Compliance Committee Meeting, January 18, 2011 C. **Minutes of the Quality and Patient Safety Committee Meeting, January 18, 2011 D. **Minutes of the Human Resources Committee Meeting, January 21, 2011

Director Ansell, seconded by Director Greenspan, 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, and 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.

Page 5 of 30


Page 6

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 Ansell, Butler,

Carvalho, Greenspan, Lyne, Muoz and Zopp (9) Nays: None (0) Absent: Directors Golden and ODonnell (2) 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 Lyne, seconded by Director Butler, moved to approve the Grade 24 salaries for the four positions presented in closed session. THE MOTION CARRIED. Directors Carvalho and Lyne abstained and voted PRESENT, and Vice Chairman Ramirez voted NO.

Director Lyne requested further information on positions currently filled on an interim basis.

VIII. Adjourn

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

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

XXXXXXXXXXXXXXXXXXXXX Warren L. Batts, Chairman

Attest: XXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary

Page 6 of 30

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

January 28, 2011

ATTACHMENT #1

Page 7 of 30

Testimony by Richard David, MD

Health and Hospitals System Board Meeting, January 28, 2011

I am speaking today as a member of the medical profession with growing concerns based on 20th century

history. A very disturbing episode in the history of medicine keeps coming to mind as I witness the events

unfolding in our public health system today.

Dr. Leo Alexander, a Boston neurologist and psychiatrist, was called as a special expert witness to testify

before the Nuremberg tribunal investigating the actions of German physicians during World War II. In 1949 he

published a summary of his testimony in the New England Journal of Medicine. He described how the most

advanced medical profession in the world was transformed into an appendage of the militarized state, how it

lost touch with its mission to care for the sick and infirm. Embracing the politics of the day with patriotic

fervor, doctors and other health professionals actively organized a program that was referred to as

euthanasia.

In the opening paragraph of his NEJM article Dr Alexander describes "a rapid decline fn standards of

professional ethics. Medical science in Nazi Germany collaborated ... in the following enterprises: the mass

extermination of the chronically sick in the interest of saving "useless" expenses to the community as a whole;

[and] the mass extermination of those considered socially disturbing or raCially and ideologically unwanted ..."

Care.

He goes on to describe the system: liThe decision regarding which patients should be killed was made entirely

on the basis of [limited] information by expert consultants .... These consultants never saw the patients

themselves .... [Q]uestionnaires were collected by a "Realm's Work Committee of Institutions for Cure and 11

... The IICharitable Transport Company for the Sick" transported patients to the killing centers, and the

"Charitable Foundation for Institutional Carell was in charge of collecting the cost of the killings from the

relatives, without, however, informing them what the charges were for; in the death certificates the cause of

death was falsified."

When the County of Cook arranges transportation of undocumented patients to home countries where we

know they will not receive the treatments that are keeping them alive, I submit that that that policy should be

referred to as administrative euthanasia. When patients on ventilators are forced to move to nursing homes

with none of the resources or expertise needed to care for them properly and a track record of ext,remely high

mortality, that, too, should be labeled administrative euthanasia.

Dr. Alexander concluded, "Whatever proportions these crimes finally assumed,it became evident to all who

investigated them that they had started from small beginnings. The beginnings at first were merely a subtle

shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in

the euthanasia movement, that there is such a thing as life not worthy to be lived."

We must not allow the distorted values of that dark period in human history to direct policy in this health

system. "Vision 2015" will be no less a euphemism than the "Charitable Transport Company for the Sick"

should those twisted ideas prevail in our time.

Alexander, L. Medical science under dictatorship. New England Journal of Medicine, July 14, 1949.

Page 8 of 30


January 28, 2011

ATTACHMENT #2

Page 9 of 30

COOKCOUNTYHEALTHANDHOSPITALSSYSTEMITEMIV(A)

JANUARY28,2011BOARDOFDIRECTORSMEETINGCONTRACTANDPROCUREMENTITEM

Request# Vendor ServiceorProduct FiscalImpact

Affiliate/System

BeginsonPage

#

1

LincolnParkDialysisServices,Inc.d/b/aDaVita,Inc. Servicedialysisservices $230,400.00

CHSCC,PHCC,OFHCC 2

ExtendandIncreaseContract

Page 10 of 30

BOARD APPROVAL REQUEST

I DATE: PRODUCT I SERVICE: 01/17/2011 Service - Dialysis Services

I TYPE OF REQUEST: ~i~NDOR I SUPPLIER: Extend and I ncrease Contract 'ncoln Park Dialysis Services, Inc. dlbla DaVita, Inc., Chicago, Illinois SELECTION METHODOLOGY: BID I SOLE SOURCE IRFP I GPO I COMPARABLE GOVERNMENT BID RFP ACCOUNT#: FISCAL IMPACT: GRANT FUNDED AMOUNT: 891-360 Provident Hospital 891-360 $96,000.00 N/A 898-360 Oak Forest Hospital 898-360 $96,000.00 240-360 Cermak Health Services 240-360 38AOO.00

Total: $230,400.00 CONTRACT PERIOD: REQ # I CONTRACT #: 02/01/2011 thru 07/31/2011 09-72-01 REQUESTING DEPT I AFFILIATE: SPONSOR: ~ Department of Internal Medicine 1CCHHS Roslyn Lennon, Chief Clinical Officer, CCHHS

Robert Hamilton, COO, Provident Hospital Sylvia Edwards, COO, Oak Forest Hospital Michael Puisis, D.O., COO, Cermak Health Services

IS THIS REQUEST THE LOWEST DESCRIBE GPO IMPACT OR BEARING ON THE BIDDER I SUPPLIER? NIA PURCHASE? NIA

JUSTIFICATION:

This contract provides hemodialysis and apheresis services for Provident and Oak Forest hospitals, and Cermak

Health Services of Cook County. The extension and increase is needed to allow time to finalize a new contract.

An RFP will be completed and will be posted on March 15,2011.

I Contract No. Description Bd. Approval Start Date End Date Amount Months

I 09-72-01 Original 01/30/2009 02/01/2009 01/31/2011 $1,570,100.00 24 09-72-01 Extend and 02/01/2011 07/31/2011 $230,400.00 6

Increase I Contract

TERMS OF REQUEST:

This is a request to extend and increase contract 09-72-01 for a period of 6 months from 02/01/2011 thru 07/31/2011

in the amount of $230,400.00.

CONTRACT COMPLIANCE HAS FOUND THIS CONTRACT RESPONSIVE?

ATTACHMENTS:

BID TABULATIONS: N/A

CONTRACT COMPLIANCE MEMO: Pending

CCHHSCOO: 0 ~ Anthony Tedeschi, Chi'1);11f:" Officer

CCHHS CF~ "- ,,,dlU

pAPPROVED

JAN 282011

BY BOARD OF

DIRECTORS OF THE COOKCOUNTY

HEALTH AND HOSPITALS SYSTEM

Michael Ayres, ChiiinanCial Offf;:er

CCHHSCEO: ~ Request # William T. Foley, ~E;~cutiveOfficer ~ 1

( Ambulatory & Community Health Network Cermak Health Services Department of Public Health

John H. Stroger, Jr. Hospital of Cook County Oak Forest Hospital Provident Hospital Ruth M, Rothstein

CORE Center

We Bring Health CARE to Your Community Revised 01/05/2011 Page 11 of 30

http:230,400.00http:230,400.00http:38AOO.00http:96,000.00http:96,000.00


January 28, 2011

ATTACHMENT #3

Page 12 of 30

COOK C'OUNTY HEALTH & HOSPITALS ,SYSTEM

QUARTERLY REPORT ON THE STATUS

OF OPERATIONS AND FINANCES

- FY 2010 FOURTH QUARTER

SEPTEMBER 1, 2010 - NOVEMBER 30, 2010

WILLIAM T. FOLEY CHIEF EXECUTIVE OFFICER

COOK COUNTY HEALTH & HOSPITALS SYSTEM

SUBMITTED JANUARY 12, 2011

Page 13 of 30

January 12,2011

The Honorable President and Members Cook County Board of Commissioners County Building 118 North Clark Street, Room 567 Chicago, Illinois 60602

Dear President Preckwinkle and Commissioners:

In accordance with Chapter 38, Article Y, of the Cook County Code, the following report of the Cook County Health & Hospitals System appears on the agenda of the January 19, 2011 meeting of the Cook County Board of Commissioners:

Sec. 38-81 (e) Quarterly Report on the Status of Operations and Finances

This report is for the Fourth Quarter of FY201 0 which covers the months of September, October and November. We have noted when more current information subsequent to the fourth quarter frame has been included. Please feel free to contact my office should you have any questions or concerns.

Thank you.

Sincerely,

William T. Foley, Chief Executive Officer Cook County Health & Hospitals System


QUARTERLY REPORT ON THE STATUS OF OPERATIONS AND FINANCES

4Q - SEPTEMBER 2010 THROUGH NOVEMBER 2010

PAGE 2

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INTRODUCTION

Section 38-81(e) of the Ordinance establishing the Cook County Health & Hospitals System states that the CEO shall provide, through the System Board, quarterly reports to the County Board concerning the status of operations and finances of the CCHHS. To meet the provisions of this reporting requirement, I am submitting the FY2010 & 2011 Goals of the System Leadership which are both financial and operational. The fourth quarter status report reflects the progress of each of these goals for the period from September 1, 2010 through November 30, 2010.

CCHHS MISSION

To deliver integrated health services with dignity and respect regardless of a patient's ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies which promote and protect the physical, mental, and social well being of the people of Cook County.

CCHHS SYSTEM LEADERSHIP GOALS

GOAl #1 ApPROVE STRATEGIC PLAN INCLUDING 5-YEAR FINANCIAL PLAN

Status - Complete

On June 25, 2010, the CCHHS Board of Directors unanimously approved the Vision 2015 Strategic and Five-Year Financial Plan. The Health & Hospitals Committee of the Cook County Board of Commissioners approved the plan on July 14, 2010 and the County Board approved the plan on July 27, 2010.

GOAL #2 COMPLETE AND ACHIEVE CCHHS BOARD APPROVAL OF 5-YEAR IMPLEMENTATION PLAN

Status - Complete

The Implementation Plan identifies the action steps necessary to execute the Strategic Plan, along with timelines and assignment of responsibilities. The Implementation Plan was presented to the CCHHS Board of Directors on October 28, 2010.

The major focus of implementation planning involves the re-alignment of services at Provident and Oak Forest Hospitals. The plan calls for Provident to be downsized to 25 short-stay beds in February, 2011. In October, 2010 obstetric services were suspended redirecting patients to Stroger Hospital. In December, 2010 intensive care services were suspended. Effective January, 2011, ambulance runs to the Provident Emergency Department will be suspended. Planning is also underway to expand services through the




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development of a Regional Outpatient Center (ROC) at Provident. The goal of the ROC is to expand access to care by expanding primary care, specialty care, outpatient surgery, and urgent care services.

Planning is also underway for development of a Diabetes Center on the Provident campus similar to the Diabetes Center which has been operational for more than 10 years in the Fantus Health Center. While Diabetes will be the initial focus, the plan calls for expanding the Center to address other chronic illnesses common to Southside residents such as obesity, asthma, heart failure, and hypertension.

The Implementation Plan includes efforts to pursue a clinical collaboration between Cook County Health & Hospitals System (CCHHS) and the University of Chicago Medical Center (UCMC) at Provident Hospital. The relationship would entail an academic relationship with UCMC through which UCMC would extend its clinical and teaching programs to Provident. The consulting firm Health Strategies & Solutions, Inc. was jointly engaged by both institutions to conduct a feasibility study and business plan. Phase I of the study which involved market analysis and feasibility was completed in April, 2010. Phase II of the study is in process and involves the development of a business/operations plan and census management. A Joint Ad Hoc Working Group consisting of selected board members from CCHHS and UCMC was convened in November, 2010. The study is expected to be completed by the end of January, 2011.

With regard to Oak Forest Hospital, a Certificate of Need (CON) was filed with the State in November, 2010 to close inpatient services. A public hearing will be held in January, 2011 and a decision on the CON is expected in March, 2011. If the CON is approved, closure of the inpatient services would occur by May, 2011. Concurrently, planning is underway for development of a ROC on the Oak Forest campus in the New E Building. The Oak Forest ROC will be similar to the Provident ROC in terms of services provided. The urgent care center would replace the existing Emergency Department in the Hospital. We are also working on plans for the transition of patients to other providers including the long-term ventilator patients, rehab patients, and long-term care patients.

Another major area of focus in our implementation planning is the upgrade and expansion of our Ambulatory and Community Health Network (ACHN) clinics. This includes replacement of the Fantus Clinic on the Stroger Hospital campus and developing it as a third ROC, expanding the Cottage Grove Clinic, relocating and expanding the Cicero Clinic, redesigning and expanding the Logan Square Clinic, and planning for a new site in Northwest Cook County around the Des Plaines area.

The other areas of activity in our implementation planning are focused on strategic initiatives such as quality improvement, service excellence, cultural competency, employee/staff satisfaction, and staff recruitment, training, and development.

Finally, the Implementation Plan also includes the development of a comprehensive marketing and communications plan to educate internal and external constituencies about the Strategic Plan and enhance CCHHS' image in the market. Efforts are underway to meet with various elected officials, community groups, providers, and internal staff. In addition, a long term communications plan focusing on the long term impact of the Strategic Plan, Health Reform, and CCHHS' image in the market is currently in development.




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GOAL #3 COMPLETE ENTERPRISE RESOURCE PLANNING (ERP) SYSTEM IMPLEMENTATION INCLUDING GENERAL LEDGER, PAYROLL, MATERIALS MANAGEMENT AND HUMAN RESOURCES

Status - General Ledger complete

Remaining implementation on hold pending County's ERP decision

The Health System completed the installation of the general ledger portion of the Lawson ERP system on December 1, 2009. The Health System is currently downloading monthly expense data from the County's JD Edwards System and performing accrual adjustments. Revenue has been posted to the general ledger through interfaces with each of the relevant patient accounting systems. The Health System has suspended implementation of the other modules of the ERP - payroll, materials management, and human resources - pending the County's decision on its ERP System. The County Board approved a contract with the Government Finance Officers Association on October 19, 2010 to assist with the preparation of a Request for Proposal for system integration services related to the countywide enterprise resources planning system. Until a decision is made by the County Board on the countywide ERP, the Health System is unable to move forward with the other components of the ERP System.

GOAL #4 DESIGN AND IMPLEMENT A MANAGEMENT RESTRUCTURING AND DEVElOPMENT PLAN

Status - Complete

In April, 2010, a management assessment was completed for over 350 management positions throughout CCHHS. All managers were evaluated and ranked utilizing a standard assessment tool. The assessment process indentified opportunities for leadership development which will be incorporated into a system-wide leadership development/service excellence program.

In August, 2010, restructuring of System management was completed which involved centralization of system-wide functions and responsibilities and streamlining of management. As a result, 70 management positions were eliminated.

GOAL #5 ACHIEVE THE CCHHS FYl0 OPERATING BUDGET

Status - Complete

The FY 2010 approved budget included an unallocated $106.7M cost reduction -- $80M in projected expense reductions based on our performance improvement initiatives and an additional $26M related to the half-cent sales tax rollback and mandated holdback. The goal was to target areas for expense reduction and implement changes to ensure the Health System would be equal to or below the approved appropriations for the fiscal year. Management has identified expense reductions of


QUARTERLY REPORT ON THE STATUS OF OPERATIONS AND FIN.ANCES


PAGES

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approximately $132.7M annually including a reduction in force of 1350 positions (889 vacant and 461 filled). In addition, expense categories related to pharmaceuticals, medical surgical supplies, strategic planning and other operational accounts were reduced. As a result, the Health System concluded FY2010 below the FY 2010 appropriated budget of $865.7M by approximately $28.7M .

However, revenues were unfavorable by $44.4M, therefore requiring an additional county tax subsidy of $13.6M. A number of initiatives are in place to offset the continued loss including efforts with the State to expedite the processing of backlogged Medicaid claims which are estimated to be in the $35M range.

GOAL #6 COMPLETE WORKFORCE REBALANCING PLAN .

Status - Complete

The Workforce Rebalancing Initiative (reduction in force) was designed and implemented in two phases. Phase I is complete and resulted in the elimination of 940 positions (272 filled and 668 vacant). Phase II consisted of two components, the first component involved management restructuring which identified 70 positions for elimination. The second component of Phase II included the elimination of a total of 340 positions (approximately 116 filled and 224 vacant). All of the position reductions have been completed with the exception of approximately 10 of the filled positions that are still in process. Upon completion of these reductions the health system will have achieved the targeted reduction of 1,350 positions.

GOAL #7 IMPLEMENT SYSTEM-WIDE QUALITY, PATIENT SAFETY AND RISK MANAGEMENT STRUCTURE.

Status - Complete

Barbara Farrell was recruited as the first System Director of Quality & Patient Safety. Ms. Farrell is a Registered Nurse with an MS in Nursing and MJ in Health Law and has extensive experience in quality. This position was created to provide a system-wide focus on quality, patient safety, accreditation and regulation. Ms. Farrell is currently in the process of developing a system-wide quality and safety dashboard.

Melinda Malecki was recruited as the first System Director of Risk Management. Ms. Malecki is an attorney who has significant experience establishing and maintaining risk management programs in healthcare settings. Ms. Malecki is working on the development of an electronic occurrence reporting system that will replace the paper system currently used at all System sites. Ms. Malecki is also working with County Risk Management in an effort to decrease insurance expense primarily related to medical malpractice premiums and claims. Subsequent to fourth quarter: Ms. Malecki has recruited risk managers for John H. Stroger, Jr. Hospital, Nancy Jarasek, BSN, RN and Cermak Health Services, Kristine Mueller, JD, LLM who assumed their positions on January 3, 2011.

COOK COUNTY HEALTH 8. HosprrALS SYSTEM



PAGE 6

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The Quality and Patient Safety Committee of the CCHHS Board of Directors vigorously oversees quality and patient safety activities throughout the System.

The Health System continues to strive to maintain accreditation status at all member organizations and to meet or exceed national benchmarks. In FY2010 John H. Stroger, Jr. Hospital was awarded full accreditation by The Joint Commission, the Hospital was also awarded certification as a Primary Stroke Center by The Joint Commission Oil June 10, 2010, and the Cancer Program was awarded certification by the Cancer Commission on June 22, 2010.

GOAL #8 DEVELOP AND IMPLEMENT A SERVICE EXCELLENCE PROGRAM WITH FOCUS ON: EMPLOYEE SATISFACTION, PATIENT SATISFACTION AND CULTURAL DIVERSITY. 1

Status -In process

Miriam Gonzalzles was recruited as the first System Director of Diversity and Multi-Cultural Affairs. Ms. Gonzalzles leads the development and implementation of programs and education initiatives designed to strengthen diversity and inclusion strategies for all System affiliates. She is responsible for working collaboratively to create, cultivate and communicate the Health System's diversity, inclusion and cultural competency across the organization and in the community. The first system cultural competency survey was conducted in December, 2010. The survey serves as a baseline to identify opportunities to improve cultural competency system-wide. Subsequent to fourth quarter: The cultural competency survey is complete. Preliminary results will be received mid January, 2011.

Customer service training has taken place or is scheduled to take place at each of the CCHHS facilities. Oak Forest Hospital completed basic customer service training in early 2010. The Ambulatory and Community Health Network (ACHI\J) clinics have completed basic customer service training. Provident Hospital and the Ruth M. Rothstein CORE Center completed basic customer service training for approximately 85% of their staff in 2010. John H. Stroger, Jr. Hospital, the Ambulatory Community Healthcare Network Administration, Fantus Clinic and the Specialty Clinics anticipate completion of training by the end of the first quarter of FY 2011.

The first system-wide employee engagement survey will be conducted in January, 2011. Previously, the hospitals and clinics conducted their own surveys which were not consistent in terms of the survey tool, frequency, and timing. The system-wide survey will serve as a baseline to identify opportunities for improvement and develop tools for managers to enhance employee satisfaction. This effort will be spearheaded by the Director of Development and Training, Tiffany Dotson. Subsequent to fourth quarter: The employee engagement survey went live January 12, 2011.

The CCHHS Diversity Hiring FY 2010 Fourth Quarter Report for the months of September, October and November 2010 is attached as an appendix.




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Page 19 of 30

GOAL #9 DEVELOP AND IMPLEMENT COMPREHENSIVE INTERNAL AUDIT AND CORPORATE COMPLIANCE FUNCTIONS

WITHIN CCHHS.

Status - Complete

The System Chief Compliance Officer, Cathy Bodnar and the System Director of Internal Audit, Tom Schroeder have developed charters, polices, procedures, organizational plans, and work plans that have been approved by the CCHHS Audit & Compliance Committee as well as the CCHHS Board of Directors. 23

GOAL #10 COMPLETE ASSESSMENT OF GRADUATE MEDICAL EDUCATION (GME) PROGRAM

Status -In 'Process

The Graduate Medical Education (GME) Program involves relationships between CCHHS and a number of medical schools and teaching programs. The assessment of this program and recommendation for changes is an important component of the Hea'lth System's performance improvement project. PricewaterhouseCoopers (PwC) is charged with the responsibility for conducting the assessment which includes a cost/benefit analysis of the GME Program. The assessment will be completed in January, 2011. Subsequent to fourth quarter: A draft report has been received and is currently under review by senior management.

GOAL#l1 COMPLETE AND RECEIVE APPROVAL OF FY2011 PRELIMINARY BUDGET WHICH INCORPORATES STRATEGIC PlAN IMPLEMENTATION AND PERFORMANCE IMPROVEMENT TARGETS IDENTIFIED IN PwC SCOPE OF WORK.

Status -In process

The FY2011 Preliminary Budget includes the anticipated expense reductions and revenue increases that will occur during FY 2011 as a result of the performance improvement project currently underway with PricewaterhouseCoopers (PwC). The FY2011 Preliminary Budget is also driven by those actions required to implement the first phase of the Strategic and Five-Year Financial Plan including discontinuation of inpatient services at Oak Forest Hospital, the re-alignment of services at Provident Hospital, the potential impact of these changes on John H. Stroger, Jr. Hospital, the development of enhanced outpatient services, operational modifications to increase volumes and improve customer service throughout the organization, and the effect of personnel and expense changes in order to accomplish these goals.

2 Dashboard regarding Internal Audit Activity is attached as an appendix. 3 Dashboard regarding Corporate Compliance Activity is attached as an appendix.

COOK COUNTY HEALTH 8. HOSPITALS SYSTEM


40 - SEPTEMBER 2010 THROUGH NOVEMBER lOlO

PAGES

Page 20 of 30

Following public hearings that where held in November, 2010, the CCHHS Board of Directors approved the FY2011 Preliminary Budget on November 19, 2010. Subsequent to fourth quarter: The FY2011 Preliminary Budget was submitted to the County Board and referred to the Finance Committee on December 14, 2010. In order to comply with the directive of the County Board President that the FY2011 Budget incorporate a 21% reduction from the FY2010 appropriation, the CCHHS Board of Directors approved a Revised FY2011 Preliminary Budget on January 3, 2011. The Revised FY2011 Preliminary Budget was submitted to the County Board on January 4, 2011 and referred to the Finance Committee. The budget hearing is scheduled with the Finance Committee on January 24, 2011.

ApPENDIX

1 The CCHHS Diversity Hiring FY 2010 Fourth Quarter Report for the months of September, October and November 2010

2 Dashboard regarding Internal Audit Activity

3 Dashboard regarding Corporate Compliance Activity




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I. Attendance/Call to Order · Sister Sheila Lyne, RSM; Luis Muñoz, MD, MPH; and Andrea Zopp (10)...

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