Health and Hospitals System Board Meeting January 28, 2011

As usual the meeting began at 7:30am at Stroger Hospital with public comment. Five of the seven speakers were concerned with staff morale and 3 people specifically addressed concerns with nursing shortages at Stroger Hospital with one speaker stating the ratio of nurses to patients was 12 to 1 and another speaker indicating the ratio was 7:1, and both indicating that patient care was suffering due to nursing shortages. The meeting then continued with approval of minutes of previous meetings and committee reports.

During the report from the Quality and Patient Safety Committee, Director Ansell discussed a systemwide process (Quality Dashboard) that is being used to look at quality measures. He thought perhaps a presentation on the process would be useful to the HHS Board for looking at patient quality issues. This provoked an outburst from one of the public speakers who accused the board of not listening to how nursing shortages are resulting in inadequate patient care, and accused the Board of not wanting to take care of poor people. The Board seemed quite stunned by the outburst which continued until the speaker was escorted out of the meeting. Another of the directors stated that since specific allegations had been made by the public speakers (a patient dying due to lack of decubitus ulcer care, and patients not being cleaned for entire shifts) that she would like Mr. Foley to investigate these charges and get back to the board with information about the incidents. Director Ansell acknowledged that nurse staffing is an issue and that the parameters on the quality control scale he was presenting indicate problems with nursing. He further stated that communication between nursing management and labor needs to be improved.

Ros Lennon, Chief Clinical Officer, was asked to address the board concerning the nursing shortage. She stated that there are nurse staffing issues particularly at Stroger Hospital. They have not hired nurses externally in more than 18 months due to "displacement" - the union requirement that nurses from within be moved to positions before there are hires from outside. The closing of Oak Forest and Provident Hospitals have resulted in a number of displacements and the goal is to finish the process by the end of February. Vacancies must first be filled by qualified candidates from within the system and the displacement process stops nurse recruitment. When asked by the board what was taking so long for the process to be completed they were told that the vacancy list has been hard to complete.

Deb Tate, from Human Resources, was asked about the problems with the vacancy list. She stated that it has been difficult to verify that positions are actually vacant. An inaccurate list has apparently resulted in some volatile meetings with the nurses union so HR is now trying to be sure the list is correct before calling another meeting with the union. The difficulty in obtaining the list is that the data from the employee tracking system that has been used does not correspond with actuality. The HHS Board thought it would be okay to take the risk of presenting an inaccurate list to get the process moving but Deb stated that frankly HR does not have a relationship with the nurses union that allows for negotiation.

The Board continued to discuss this issue, at one point considering a motion to expedite the process, but finally decided that they would make a "recommendation" that the administration complete the displacement process as soon as possible so that staffing levels can be optimized. Director Ansell summarized some of the discussion by stating that the Board is going to need to address issues of capacity - they want to say they can do it all, but the money is not there to do everything. Director Carvalho stated that perhaps it would be a good idea to include data on nurse ratios on the Dashboard. He also said that they have to be cautious with the language they use. The HHS is providing as much care as the money they have allows. When their budget is cut they move from not meeting the health needs of Cook County residents to meeting less of the health needs of Cook County residents. They will never have enough money to meet all unmet need.

Human Resources Committee - A compensation audit has been completed and will be discussed in closed session. Mr. Foley stated that the report indicates that the CCHHS administrative compensation levels appear to be comparable with other large urban public hospitals. Director Carvalho stated that in the future they should have the comparative information upfront, prior to hiring individuals, and not have to gather the information after the fact.

Deb Tate, Human Resources Director, was asked to comment on an incident at Cermak Hospital, where personal information on a nurse was obtained by an inmate. Comm. Steele, from the CC Board, was at the meeting and expressed great displeasure at the handling of the situation. Dr. Pisius, Director of Cermak Hospital, stated that the nurse has been moved to a different facility and the incident is being investigated by the Sheriff as that falls under his jurisdiction.

Finance Committee - Director Carvalho reported that they now have an internal auditor. He reported on a special earnings review that indicated significant funds being paid for moonlighting and shift differentials that lacked clear guidelines for who can receive such payments, as well as unclear guidelines for authorization of such payments. Price Waterhouse Coopers provided an update on their ongoing efforts as consultants within the HHS. Their projects include training CC employees to do medicaide authorizations; working on the supply side to reduce expenses; doing efficiency studies in the OR and the ICU; doing a process study on how a bill gets paid; working on standardization process for the clinics; and working on recruitment. Mr Ayres, CFO, was asked how the medicaide authorization backlog is going and he responded that they are still talking with the state about moving the process along.

Director Carvalho pointed out that at the present time increasing the revenues at the hospital will not increase the HHS revenues since all their revenue goes into the General Fund of Cook County. He made a motion that they seek a provision in the Cook County Budget Ordinance that increasing HHS revenues will allow HHS to increase expenditures. He said otherwise they have no incentive to increase their revenues if they are not going to be allowed to keep them. This year HHS decreased their subsidy from Cook County by $95m. The motion was approved.

Chamberlin Edmonds and Assoc. then gave an eligibility enrollment optimization report. Director Carvalho said that he wanted to get the information from both reports to the commissioners on the CC Board.

At 11:00am the meeting went into closed session and the observer left.