After routine committee reports, Chief Information Officer Dr.
Das reported on the Adverse Event
(i.e., an injury or harm due to medical care, unrelated to the underlying
disease or condition of the patient) Reporting System now being implemented at
CCHHS. 48,000-98,000 deaths annually are
due to medical errors, 50% preventable.
New expectations: Disclose error to patients; report error to Hospital Compare. "Never events"
that can't be billed include infection in catheters.
CCHHS has a higher percentage of patients in
burn units and high risk settings, so CCHHS error percentage may look higher
but in fact is close to the norm. Error types include violation, slip or error,
or mistake. About 10% of errors result
in adverse events. Common types include
adverse drug reactions, procedural complications, and hospital-acquired
infections.
Dr. Das reported that to
find errors, nurses review charts to look for non-reported events, and staff
are rewarded for reporting "near misses." Board members expressed concern regarding
rewarding staff for reporting errors, which Dr. Das defended as making it possible to use root cause analysis,
creating a "just culture" approach to assign accountability in a
structured fashion. Lerner pointed out
that payments are reduced for negative events.
Chief Business Officer Anthony Rajkumar introduced lots of
discussion on the proposed use of 10 acres of property owned by the Illinois Medical District Commission (IMDC), a zoning agency
created in the 1940s, delegated by the state and overseeing 560 total acres
including UIC, Rush and Stroger, and roughly extending from Ashland to Congress
and south of Roosevelt. Through
acquisition of tax delinquent properties, the IMDC also owns some
property. IMDC's 7-member board meets
monthly to discuss how to best use and develop the 560 acres it oversees.
The CCHHS board was asked to vote to approve
an intergovernmental agreement to allow IMDC, the Office of Capital Planning
and Policy (OCPP), and CCHHS to collaborate on redevelopment opportunities
within the IMDC, to better account for existing and future needs of the County
and CCHHS as well as the IMDC. Dr. Raju
strongly supported the agreement, saying CCHHS needs a medical laboratory that might serve the whole
district, and Fantus Clinic needs to
relocate. Lerner also supported the
agreement, saying it would be good to collaborate and talk about other
possibilities, including biotech investment. Gugenheim felt CCHHS was giving
IMD power by agreeing; Carvalho pointed out that CCHHS is a "small
fish", and now we could sit with the "big fish" and have our
voice heard at the table. Velasquez
voiced reservations due to CCHHS history with IMDC, but Dr. Raju said this
board is new, we should join the conversation.
Gugenheim felt more information should have been provided to the board
beforehand for review. As a result of
these and other concerns the issue was tabled, but the county board may vote to
move ahead on the matter without CCHHS input.
A $14m new
"clean steam" heat system was
approved to be installed at Stroger after the failure of the first system installed
when Stroger was built in 2002. (Two steam systems are required, one a
"clean steam" system to sterilize medical instruments. After failure of initial system, it was
"cobbled together" to keep it functioning. A lawsuit against initial construction company
yielded $17m, some of which is being used for the new system.) Collens asked
whether CCHHS board had power over capital expenditures and was told NO, the full County board retains power over
capital decisions, but CCHHS approval is usually sought anyway. Lerner
requested that in future a member of buildings and grounds be present to
provide a fuller explanation of such proposals.
More discussion of timing of meetings, the idea of combining
several on the same day. No decision.
Dr. Raju said CCHHS budget has been approved and will be
included in the full county budget to be voted on and to go into effect
December 1. 22 FQHCs ("Federally Qualified Health Centers") are now recruiting
enrollees for CountyCare, with outreach planned for 100 churches this Sunday. As
of September 26 there are 103,000 applications for Countycare; Dr. Raju
expects to exceed the 115,000 goal.
Oak
Forest opened officially as an intermediate care, regional ambulatory care
center after a $6m investment.
CBO Anthony Rajkumar explained his job: standardize work
processes, redefine roles, renegotiate contracts, evaluate real estate, assess
life safety of patients, staff and facilities.
His challenges: contract oversight, electronic procurement system, aging
infrastructure, replacement of aging medical equipment. Lerner asked how many patients were
undocumented immigrants and pointed out that the ACA will not cover these persons. Munoz said there
will be 30 million without insurance.
Meeting adjourned to closed session at 11:10.
-submitted by Linda Christianson