Cook County Health & Hospitals System Board Meeting October 28, 2010

Stroger Hospital, 5^th floor Conference Room, 7:30 am

Board and Committee Reports

Finance Committee reported on the operating budget submitted to the County for public hearings. It requests appropriations of $817 million (a reduction from 2010 of about $48 million). Based on the revenue and expense projections, the required subsidy from Cook County would be approximately $217 million (almost 30% less than in 2010). The Board position has been to seek a cut in subsidy rather than across the total appropriation. The reduction will result in a loss of services of approximately 1000 Full Time Equivalent (FTE) positions. The budget process is anticipated to last until February.

Meanwhile, the CCHHS intends to proceed with implementation of its Strategic Plan.

Audit and Compliance Committee noted several policy revisions in process, notably the gift policy. Many departments are involved. Resolution is expected by December.

Quality and Patient Safety Committee reported on several services. With no in-patient psychiatric services at Stroger, the ER is inundated with cases. Obstetrics (OB) services at Provident have been suspended. Other improvements were noted with recognition that quality depends on staffing.

Resolutions were passed celebrating the 100^th anniversary of Oak Forest Hospital and the 50^th anniversary of Provident Hospital's Women's Auxiliary Board.

CEO Foley reported on progress on Leadership Goals. Under performance improvements, the Knowledge Web on the Internet has established a webpage for each department for internal use. Among operational improvements, lab consolidation has occurred, bringing testing from the clinics to Stroger, with anticipated savings of $5 million over 3 years, as well as more efficiency. Nursing professional development has streamlined 20 affiliation agreements to 10 at all levels, with better schedule monitoring and ability to assess competency.

The Strategic Plan proceeds with 14 teams addressing 350 tasks. The Cook County Ambulatory and Community Health Network (ACHN) team will address computer needs, regional outpatient services at Oak Forest and Provident, and potential expansion of Cicero and Palatine clinics. The consultant, Fantus, is involved in program planning for a new facility which involves County Capital Planning and Requests For Proposals with a target of Certificate Of Need (CON) approval in 2012 and construction in 2014.

The Oak Forest team has a March deadline for CON approval of a closure of inpatient beds in May, with inherent marketing and communications needs. They will also address an expansion of Building E to regional outpatient and specialty services, the development of ER to Urgent Care, and meetings with local hospitals.

The Provident team will address the downsizing of inpatient beds and suspended OB services, along with inherent communications needs, ER transition, the relationship with University of Chicago and collaboration with Federally Qualified Health Centers (FQHC) for primary care.

Overall goals continue: Access (which addresses barriers regarding phone, referral, and staff development), Quality, Service Excellence, and Cultural Competency. Specialized areas will continue to be examined, including ER/Trauma, Urgent Care, Maternal/child, Perioperative, Stroger capacity/length of stay, Staff development and training, and Staff satisfaction.

The meeting adjourned at 9:45 am. The next meeting will be on November 19 at 7:30 am.

--Submitted by Nancy Staunton, Observer

CC Health & Hospitals System Board Meeting Sept. 30, 2010

7:30 am, Stroger Hospital 5^th floor conference room

The Finance Committee Minutes noted a projected shortfall in revenue partly due to delays in State of Illinois payments for Medicaid patients. Illinois' proposed move to an HMO model for Medicaid reimbursement threatens to undermine a previously established "special" relationship that the County had enjoyed.

HHS also has an issue with the Cook County Board regarding an across-the-board reduction in appropriations that does not recognize the revenues generated by HHS. They seek a reduction in subsidy rather than in total appropriations. A communiqué from the Office of the County Board's President identifies an 11% reduction. HHS questions whether dialog should be with the President or the Board of Commissioners who established HHS.

CCHHS Financial Statements and Audit Management Letter were discussed. The latter identified errors but shows improvement.

The HHS Budget for 2011 will go to the Finance Committee for discussion.

The Board Education presentation was devoted to National Healthcare Reform. Many questions remain unanswered, e.g., about Exchanges, Waivers, Partnerships. Rules are in process.

Implementation of the HHS Strategic Plan will be discussed at the October meeting with timetables for various stages. Meanwhile, necessary steps are underway for Certificate of Need (ON) approval for the closure of in-patient beds at Oak Forest Hospital and the suspension of Obstetrics at Provident Hospital as of October.

Discussion with University of Chicago regarding Provident Hospital continues.

Work-force rebalancing and staff reductions of 400 FTEs are underway. Unions have been notified.

Several management initiatives are underway. One addresses long wait lines at Fantus Clinic. The Website is being redesigned to be more consumer friendly. The General Medical Clinic has implemented changes in its internal reporting structure that has improved outcomes regarding access and patient satisfaction.

The meeting adjourned at 9:30 am.

--Submitted by Nancy Staunton, Observer

CCHHS Board Presented with Options in Delivery of Care

Cook County Health and Hospitals System Board Meeting

April 30, 2010 7:30 am to 4:00 pm

This was an all day meeting which covered regular Board agenda matters and a review of the Strategic Plan. The regular meeting spilled over its projected two hour time frame because of lengthy public comments, a protracted discussion of a contract for laundry linen services and a closed session regarding personnel matters. The current provider of laundry services was underbid by the GPO (Group Purchasing), a mechanism which had been approved several months ago to seek the lowest bidder for all services. Proponents of the current provider and losing bidder spoke of jobs lost by local residents to an out-of-state company. But Board members responded with arguments that the $2 million saving over 3 years of the contract could not be ignored. They recognized that use of GPOs represents change that may be hard on previous vendors and asked for a report on the efforts of the GPO to mentor small vendors to encourage their participation. The contract was approved with one negative vote.

The meeting resumed with a presentation of the current state of the Strategic Plan and the challenges inherent in it. Integrated Clinical Solutions, Inc., the consultant team, provided an in-depth assessment of community needs and related access factors, an overall evaluation of the System's current state, and key issues and a framework for the System to reach its goals. Four staff physicians then reported the progress of certain service lines whose development they are responsible for shepherding.

A few key issues drove the discussion: (1) There are significant unmet healthcare needs in Cook County. The community areas with the lowest health rankings – near south side, southland, east southland – have the least health resource coverage. Access to health care is a major issue in these communities. (2) System access points are not aligned geographically with patient populations having the greatest healthcare needs. There has been a significant geographic redistribution of the vulnerable population over the past 20+ years. (3) The current system configuration does not support a population/patient-centered approach to healthcare delivery. CCHHS is disproportionately skewed toward the provision of acute inpatient services, while evolving healthcare models are placing increased emphasis on primary care/prevention and comprehensive case management/care coordination. A greater proportion of CCHHS' traditional patients will have a choice in selecting their providers as national health care reforms. (4) CCHHS' current cost structure is not sustainable. Its cost per inpatient day is high, its losses are projected to increase; there is a significant opportunity to modify these by reallocating dollars.

Proposed scenarios would develop Regional Outpatient Centers that provide specialty services and are accessible to geographic areas with greatest needs – South, DT/West, and North, formalize partnerships with existing FQHCs (Federally Qualified health Centers) and other providers. The options include considerable detail regarding existing inpatient facilities, emergency services and long term care.

The final hour or so was devoted to four Service Lines which are considered critical to the Plan; Outpatient, Emergency, Maternal/Child Health and Surgical Services were scrutinized. The status and needs of each was detailed by the lead Physician especially as to how each fits into a long term plan.

The Board had many questions and will continue to peruse the mass of information that was provided. They hope to come to closure on a direction by their June meeting.

--Submitted by Observer Nancy Staunton

Health & Hospitals System Board Meeting March 26, 2010

A speaker in the public comment period related his bad experience which involved duplicate dental x-rays and a prolonged wait for dental services which in the end were not available, which information should have been known prior to referral. The Board recognized it as indicative of poor quality service and referred the issue to the Quality Committee.

Chairman Warren Batts reported on his visits to four Ambulatory & Community Health Network of Cook County ("ACHN") clinics. He found one adequate and the others very limited. Among deficiencies were few computers to expedite record keeping.

His remarks coincided with this month's Board Education, which was on the status of Information Technology. There has been progress, but equipment is still not adequate to implement Electronic Medical Records. The capital investment would be ~ $1.2 million. CCHHS would now have a rating of 4, having moved from a 1 in 2007; the ideal would be 6 to 7. About 50% of U.S. hospitals are below the ideal rate. December is the target date to eliminate paper documentation. Nursing is lagging and needs an advisory committee to expedite. With all hospitals now on one system, scheduling and billing should improve.

CEO William Foley discussed progress on leadership goals. There has been a delay in moving accounts payable and payroll functions to the CCHHS from the County. Using two different systems delays action, but a resolution appears near. Assessment of manager restructuring should be complete by July 1, leading to workforces changes. The goal is a reduction in costs of $106 million. He referenced the recently passed Health Care Reform legislation and noted one downside in its reduction in DSH allocations by the State. He also anticipates that public hospitals will have to compete with private hospitals for the increased number of Medicaid eligible patients. He projects a need to address clinics and primary care and a new demand for specialty care, better regional access, and the need to improve quality and manager accountability. The Strategic Plan continues to be refined.

In the Strategic Planning process, the consultant sees uncovered populations, more demand and a competitive marketplace. Overall goals continue to be accessible care, ease of entry, accountability, quality, continuity and cost-effectiveness. The big issues are potential re-configurations, ACHN clinics, Fantus Clinic, partnerships and community engagement. The next meeting of the Board on April 30 will be primarily a Retreat session to focus on the Strategic Plan.

With regard to partnerships, a joint consulting project with University of Chicago regarding use of Provident Hospital was discussed. Thus far a 5 week process has included a market assessment to determine the community need. It revealed a very fragmented market in the service area with more than 50% of inpatients out-migrating. Questions remain regarding the need for inpatient services at Provident. Both parties want to postpone furthur consideration until issues, including governance and capital improvements are resolved. The future of Provident Hospital is an important piece of the Strategic Plan.

Committee minutes were approved.

--Submitted by Observer Nancy Staunton

CCHHS: Strategic Plan Still in Play

Cook County Health and Hospitals System February 26, 2010 Board Meeting

As part of its on-going education, the Board heard details of the Internet Referral Information System, or IRIS, that has been implemented in recent years. It tracks patient visits and referrals. Visits decreased in 2007 with budget constraints and are resuming growth at about 10% per year.

Delays in referrals within the CCHHS reflect a need for more specialty services. Even nationally, referrals are disorganized, but the use of electronic records expedites the process. In Cook, there is a no-show rate of 40%, which wastes resources. Some problems can be attributed to an unstable patient population, some of whom do not have phones to receive reminders of appointments. An automated phone system calls with reminders 10 and 2 days before appointments. The backlog for colonoscopy referrals is especially high.

CEO Foley reviewed the progress in meeting Leadership Team goals. The assessment of management restructuring will be completed by the end of March. Centralization of functions brings purchasing and contract compliance within the system with HR in process. Building and Trades will now be centralized within the Health and Hospital System, rather than being handled by other County administrative offices. Participation in Graduate Medical Education needs review. Attention was drawn to the many affiliations with other hospitals, some of historic origin, not all explainable. This is an area where guiding principles are needed. Currently, an affiliation with University of Chicago is being explored with a view to a mutually beneficial use of Provident Hospital, now underutilized. A proposal will be brought to the Board in March.

Work continues on the Strategic Plan with a deadline of May; different scenarios will be presented. Areas under scrutiny include the Community Needs Analysis which should clarify where to target services, looking at socio-economic and health profiles. Data is available now on where patients come from. CCHHS through the Ambulatory Care Network and the separate Federally Qualified Health Centers (FQHCs) provides primary care throughout the County, but there are pockets of need for out-patient primary and specialty care. Closure of inpatient services at Oak Forest and Provident Hospitals remain under discussion. The negotiations with U of C regarding Provident will affect any such decision. A Board Retreat to consider all the data is tentatively scheduled for the April 30^th meeting.

Minutes of the various Committees were approved. The Finance Committee reported an increase in Medicaid patients. The Group Purchasing Organization, or GPO, for pharmaceuticals satisfactorily dealt with the required minority member inclusion. A lease of Hinsdale property (the former TB Hospital) was also approved.

--Submitted by Nancy Staunton

Strategic Plan Status Update at CCHHS Board Meeting, January 29, 2010

Jeanene Johnson, Director of the Office of Performance Improvement, gave an overview of activities and progress. The staff of three, specializing in finance, operations, and IT, oversee consultants with a goal of improving all business functions and becoming unnecessary as the management team grows. They will store all records on a restricted access website for future use. Their target is $105 million in reduced expenses. Some focus areas are lab consolidation and pharmacy formularies.

Ten employees will be funded to participate in relief efforts in Haiti for 10 days each.

CEO Foley reported on system leadership goals. The Strategic Plan and 5 year financial plan should be completed by June for approval by the Board. It will include management restructuring to achieve the budget reduction of $105 million (400-500 positions). It will include attention to cultural diversity, patient satisfaction and staff morale. A Board member reminded him that productivity is basic to budget reduction; the director of the Ambulatory & Community Health Network (ACHN) provided data that showed some improvement, e.g., the increase in patients seen per primary care physician session. Concerns continue regarding referrals to specialists. Financial statements will be provided next month. Management is in preliminary discussions with University of Chicago to explore shared use of Provident Hospital.

The Finance Committee Report noted that the Graduate Medical Education study showed inadequate documentation to claim reimbursement due to poor record keeping. Payment systems are still challenging. Systemic issues still need attention.

The Board adjourned to closed session to discuss relevant issues. 
--Submitted by Observer Nancy Staunton

CCHHS STRATEGIC PLAN NEEDS MORE WORK

Cook County Health and Hospitals System Board Meeting November 19, 2009

Public comment included a citizen who accused the Board of undesirable relationships with private providers and failure to recognize the role "Chicago politics" will play in their acceptance. The Board responded by assuring him that any relationships that are developed are examined from the perspective of what benefits they bring to the County System. A Dietician from Oak Forest Hospital reported that employees there are demoralized over layoffs recommended in the Navigant Report [a report generated by consulting firm Navigant Consulting Inc.]. She enumerated 200 in non-clinical positions and also related the difficulties of providing efficient meal service in a physical plant spread out over three locations.

As part of on-going Board of Directors education, the coordinator of the Internal Medicine Residency gave an overview of that program which includes 144 positions. Those accepted were selected from about 5000 who apply yearly. The program has been accredited since 1955 and has high standing among 370 comparable programs in the U.S. These Residents participate in every patient encounter throughout the hospital, including the ICU and ER. About 50% go on to Fellowships.

CFO Foley reported that the Strategic Plan would not be adopted at this meeting. It needs further analysis after public and internal meetings. The emphasis will continue on improving access.

The Consultant led the Board through the goals in the Plan and some proposed changes in emphasis. With regard to inpatient facilities several additional data are necessary, particularly an evaluation of the need for services at those facilities and what other resources and alternatives exist. He emphasized that the County mission is fundamentally different from that of the private sector. With regard to out patient services, suitable resources at other Centers must be evaluated. The development of Service Lines such as Trauma, Women and Children, and Surgery also need further analysis. Initiatives will be prioritized with time lines of 3-5 years.

There was considerable discussion regarding how to proceed with the financial future in jeopardy. Enabled by improved revenues, the 2010 CCHHS budget was cut by $75 million. Interjected was the roll back of sales tax and what its impact would be on the 2011 budget. Rumors included another $75 million cut in Health which could translate into losing 1250 FTEs. It was noted that Health spending accounts for about 30% of the budget, but reimbursements for health services (which go into the General Fund) reduce the portion of the tax-generated revenues spent on Health to about 12%. Therefore, any cuts in Health should be proportionate. The challenge is how to maximize income other than tax revenue. Some possibilities are better billing and performance improvement. Other communities have added 501(c)3 status to garner voluntary contributions. Critical to any implementation is a Financial Plan. Its development was assigned to the Finance and Audit Committees.

The Director of Public Health reported on the status of H1N1 immunization and incidence. The program is moving as quickly as possible with distribution of doses. Acceptance has been high except among the African-American population. Efforts are underway to reach Ministers and others who could be influential in communicating the benefits of this immunization.

A report on Phase 1 of the Performance Improvement Assessment was detailed. The consultant gathered data from many sources. It addressed physician alignment, clinics, pharmacy, laboratories, hospitals and showed much "opportunity" for improvement. Implementing change would involve modifying the infrastructure and adding tools, including automation. Services have to be managed frequently and staff training is critical. CFO Foley responded with his intention to implement many of the recommendations using the existing management team.

The Board adjourned to Executive session.

--Submitted by Observer Nancy Staunton

CCHHS Takes Another Look at the Strategic Plan

November 5, 2009 Meeting of Cook County Health and Hospitals System Board

During the public comment period, a nursing representative spoke regarding the issuance of 100+ layoff notices to nurses. She claimed that management had not provided a list and that there was a data problem regarding seniority. The nurses look for a process that is fair and accurate. She also challenged the patient/nurse ratio used in determining staffing.

Chairman Warren Batts, while looking at other systems, reviewed a report on Grady Hospital in Atlanta and the recent improvements achieved there over a two year period. Grady hospital is now part of a 501(c)3 Foundation that permits community investment, diminishing its dependence on County support, and staffed by the medical schools of Emory and Morehouse Universities. The Board received a complete report.

CEO William Foley reported that the Performance Improvement final report from Navigant Consulting will be ready for the next meeting in two weeks. Some consulting expertise will be required to implement it and an RFP will be channeled thru the Finance Committee for review.

The Board and management noted that the Strategic Plan needs refinements. After a huge response at the meetings of the public and employees, it was clear that proposed locations, transitions and partnerships need further examination, in conjunction with financial projections. The 3-year financial plan needs to be extended to 5 years. The goals remain intact but there must be analysis of hub-sites. Advisory groups, including patients, need to be engaged for input. The Board will be asked to approve the concepts and time lines at the next meeting.

A late addition to the agenda brought a proposal from the Director of Facilities Management for the County to consolidate CCHHS employees in trades and engineer positions with the County roster. Layoffs might be better absorbed by moving the affected employees to openings throughout the County as needed. It would mean transferring this line item in the CCHHS budget to the Corporate budget. The facilities management director said it would streamline capital planning and regulatory compliance. Board members questioned attention to diversity. The proposal was referred to the Finance and HR Committees for further discussion.

Committee reports were accepted and the Board adjourned to Executive session to hear issues regarding employees, litigation and collective bargaining.


--Submitted by Observer Nancy Staunton

ANOTHER MARATHON PLANNING MEETING FOR CCHHS

CCHHS Board Meeting October 7, 2009

The Regular Board Meeting had a short agenda to allow time for another Strategic Planning meeting. The only committee report that engendered discussion was that of the Quality and Patient Safety because of confusion over exactly what policy was to be approved regarding employees receiving the H1N1 immunization. Because of the urgency of a decision on the matter it was rescheduled to a meeting the following week.

Several hours were spent reviewing the Strategic Plan. It will be presented again in its revised form at seven "town meetings" in October. The main challenges continue to be geographic access to services, the balance between primary care and specialty care, quality measures, obsolete facilities and low satisfaction among patients and staff.

The focus will be on assuring high quality care and improving the health of the residents of Cook County. Some suggestions include developing "hubs", partnerships, and realigning services and sites. There was a long discussion of closing some services and the impact of any such decision, e.g., the demand for OB deliveries has diminished at Provident and Stroger hospitals and Pediatrics has become a regional specialty. Rehab and long term care services at Oak Forest hospital warrant discussion. The existence of a large network of Federally Qualified Health Centers in the county could meet needs in the ambulatory care network. Other partnerships should also be explored. There is a need for discharge planning and follow up.

The planning process looks toward completion by mid November.

--Submitted by Observer Nancy Staunton

CCHHS STRATEGIC PLANNING PUSHES FORWARD

CCHHS Board Special Meeting September 18, 2009

At a Special Meeting following a regular Board meeting, the Board members of CCHHS spent 3+ hours reviewing the data assembled by their consultant and feedback from the seven Town Hall meetings held in the summer. Their goal is to flesh out a Strategic Plan: what to be, what to do and how to do it. Among the findings were that Chicago has the lowest percentage of uninsured in the country; men, Latinos and 19-24 year olds lack services; infant mortality is highest in the southern part of the County; a large number of Federally Qualified Heath Centers (FQHC) provide services in areas of need; about 4% of Stroger ER services are provided to non-County residents; one-fourth of the budget goes to Provident and Oak Forest hospitals which doesn't coincide with usage. Medicaid usage is low and patients include very few Hispanics.

The reported major concerns raised at the public meetings attended by 400+ individuals were access and services. Regarding access, they noted geographic changes of the past decade have made the locations of facilities inappropriate, wait times are unacceptable and there are both language and physical barriers like parking and ingress. They felt the system is fragmented, has no continuity of care and lacks follow-up.

Observations by the Board regarding the physical plants: Fantus Clinic is deficient and needs to be replaced and its (re)location should be considered. Provident and Oak Forest hospitals are not configured for their current use; long term care and rehab may be more appropriate uses for Oak Forest hospital. Obstetric services are very low at Stroger and Provident hospitals. What should be the long term direction?

With much discussion from all members, some themes surfaced: planning should be patient-need focused, not facilities focused, keeping in mind geographic distribution and vulnerable populations. There is a potential for partnerships with FQHCs, VA services and medical schools. Volume thresholds and more programs of screening and early detection should be explored. Should the County be the provider of care or assure its delivery? Can County Primary Care services be coordinated and/or regionalized? Where should specialty care be located? Other issues: coordination of public health services, more emphasis on prevention/nutrition, role of school clinics, coordination with collar Counties. Is the best use a focus on areas of excellence, i.e., Trauma, Burn, AIDs, and development of others e.g., Diabetes, Asthma, Obesity? Nurse training? Education and research should be continued only as they serve the patient. Any planning must include financial forecasts that compare the current cost structure with a) planned productivity and supply changes and b) any additional changes.

--Submitted by Observer Nancy Staunton

1 Year Anniversary of CCHHS Board

CCHHS Board Meeting - July 16, 2009

This meeting marked the 1 year Anniversary of the CCHHS Board. The board reelected Mr. Batts as Chairman and Mr. Ramirez as Vice Chairman for the next year. Mr. Batts stated that all committee assignments and chairpersons would remain the same.

Mr. Foley, System CEO, introduced his new leadership team which includes a new CFO, Chief Clinical Officer, COO, Performance Improvement Specialist, Director of Human Relations and Director of Public Relations from outside of Cook County. He also introduced a Special Asst., General Counsel, and Stroger CFO who come from within Cook County. From his 90 Day Goals that the Board was reviewing Mr. Foley highlighted the data collection aspect which he said should be completed by the end of September, which will then provide the institution with a strong data set for determining goals and outcomes going forward. He also stated that there was a revised Organizational Chart included in their packet. Mr. Foley was commended for pulling together a strong leadership team within a relatively short time frame.

Personnel Rules were approved that will provide the general framework for the development of policies and procedures for Human Resources. They were compiled from 2 existing sets of rules. Yet to be finalized are the Patient Financial Accounting Policies which will address who the system serves and how identification/residency will be verified.

A $30,000,000.00 Master Lease agreement with Bank of America was authorized for execution and now goes to the CC Board of Commissioners for approval. This agreement is intended to be used for necessary equipment that will not be covered by the bonds issued by Cook County.

An update on the Illinois budget revealed that as of July 15 the County had not received $12m in medicaid funds. Since the budget has been approved and the Intergovernmental Transfer Bill has been signed it is expected that those funds will be forthcoming. The Core Center stated that they have received $3.5m from the state capital bill for refurbishing their facility. After some discussion of various programs that were losing or in jeopardy of losing grant funding a request was made that the board get a listing of all grant monies within the system and what funds could possibly be in jeopardy.

Ms. Duffy, Director of Purchasing, gave an update on the progress she has made within her department. They have a goal of Aug. 1 for the system to take over the purchasing and contract compliance function from the county. She thinks the goal will be reached although there are still some issues.

There was discussion several times during the meeting of an ordinance, dealing with county procurement policies, that is being introduced by Comm. Moldanado at the next CC Board meeting. The HHS Board members wanted to know if the ordinance would impact their contract with a Group Purchasing Organization. The State's Attorney representative stated that the way the ordinance is currently written it should have no impact. The HHS Board approved a resolution that expressed their opposition to any action that would impact their ability to contract with a GPO.

The Strategic Planning Committee stated that their Town Hall Meetings will begin soon, and they also will be meeting with the Commissioners as part of their process.

The meeting began and ended with closed sessions to discuss personnel and litigation issues.

Cynthia Schilsky, LWVCC Observer

Board Rejects Unionization of Doctors CCHHS June 26, 2009

After listening to twelve public comments on the subject of Doctors at Stroger unionizing, the Board moved to closed session for one and a half hours to discuss the issue and returned to re-affirm their position in opposition to the action. Among the public speaking in favor of unionizing were physicians, clergy and representatives from unions and other organizations. One speaker stated that 70% of physicians had signed a petition in favor; others questioned the rationale of "supervising" as relevant, and another spoke of the money spent on legal fees in opposition.

When the Board resumed business, CEO Foley reported on several management positions close to closure: HR, PR, General Counsel, Chief of Clinical Nursing, Chief Compliance Officer and Performance Overseer. He is seeking an interim Chief Operating Officer to replace David Small who has resigned. He sees the possibility of a different management structure after the strategic planning has been completed.

The integration of system-wide programs progresses with collaborations among hospitals and out patient services. Provider salaries among hospitals have been equalized; productivity is under review; department chairs will be full time.

Major contracts were approved. One for almost $34 million over 5 years with ACS will implement electronic healthcare management software. Another authorized entering into a contract with Bank of America for a Master Lease Agreement which would save considerable cash flow dollars. Approval by Commissioners is required and will be sought.

Strategic Planning meetings will be held in 6 locations throughout the County starting July 27^th in South Holland. Other "town hall" sessions are scheduled in August at the Chicago Urban League, Malcolm X College, Truman College, Oakton College and at a west suburban location to be determined. The intent is to involve the public and interested organizations in providing input to the planning process.

The Board moved to closed session to hear a report on negotiations with the U.S. Department of Justice regarding the Cook County Department of Corrections and Cermak Health Services. They also enumerated litigation matters and a labor and employment matter as agenda items for the closed session.

--Submitted by Observer Nancy Staunton