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  Cook County Hospital fills more outpatient prescriptions every day than are filled at 26 Walgreen's drug store combined.

Inspectors slam Stroger Hospital

Sunday, May 20, 2007
Crain's Chicago Business
by Mike Colias

Stroger Hospital recently tanked a key inspection that found numerous flaws affecting patient care and safety at the county's biggest public hospital, which already is battling budget pressures that have forced widespread layoffs.

The hospital got 22 citations — by far its worst performance in nearly two decades — after a weeklong, surprise inspection in March by the Joint Commission on Accreditation of Healthcare Organizations, the main accrediting agency for U.S. hospitals. More than 16 violations can strip a hospital's accreditation and jeopardize its federal Medicare reimbursement, a vital source of funding for Stroger.

Even if Stroger keeps its accreditation, it almost surely will wind up on probation with the commission, a category that just 3% of U.S. hospitals fell into last year.

The poor results raise questions about quality of care at the county's new flagship hospital, opened in 2002 at a cost of nearly $700 million, and cast doubt on leadership at the Bureau of Health Services. It also is likely to put further pressure on County Board President Todd Stroger to cede direct oversight of the health bureau to an independent board (Crain's, April 9), as has been urged by a growing number of observers.

"That number of citations represents a complete failure of management," says Bruce Anderson, a Chicago-area health care consultant. "It points directly to lapses in patient care."
The report also ratchets up pressure on interim health chief Robert Simon, who was appointed in December and has his hands full trying to boost revenue while cutting jobs and medical services. Mr. Stroger slashed the health bureau's budget this year nearly 10%, to $745 million. Illinois lawmakers in Washington, D.C., have told Mr. Stroger he won't get additional funding until he shows progress in restructuring the health system (Crain's, May 14).

Some violations relate directly to patient care, such as a lapse in safeguards meant to ensure that patients don't take the wrong medications after they leave the hospital. Another cited staffers' failure to assess and document whether a patient is prone to falling down. (Officials from both the health bureau and joint commission declined to provide a complete list of citations.)

Dr. Simon blames many of the problems flagged by inspectors on sagging morale among doctors and nurses, who are rankled by more than 1,000 layoffs across the health system. But he denies a slip in clinical quality, noting that key indicators, such as the number of patient deaths or complications from surgery, haven't gotten worse.

"Some employees are disgruntled," Dr. Simon says, adding that he believes staff complaints triggered the recent inspection. But he says many violations were relatively minor and doesn't believe the hospital will lose accreditation.

Poor inspection results cost the hospital its accreditation in the late 1980s, mostly because of safety issues related to the dilapidated former facility. The county regained accreditation in the early 1990s.


Officials at the hospital are scrambling to show they've fixed the problems before the commission formally decides its fate next month. Joint commission officials agreed to drop the number of citations to 16 after hospital administrators in recent weeks showed that some of the negative marks weren't warranted, says Suzanne Klein, Stroger Hospital's director of quality assurance.

That should help prevent a loss of accreditation, but still would land the hospital on probationary status, called "conditional accreditation." That would leave the hospital open to more-frequent inspections.

Low morale likely will hamper efforts to fix the patient-care problems.

One high-ranking member of the health bureau's medical staff says "the majority of doctors are looking for jobs" elsewhere because they fear another revenue shortfall will lead to more pink slips. "The system is in danger of losing a lot of talented doctors and nurses," says the doctor, who didn't want his name used for fear of losing his job.

Thomas Glaser, the health bureau's chief operating officer, says revenue projections for the next fiscal year (starting Dec. 1) are on target. But those hinge on whether health officials make headway in fixing the bureau's sloppy billing system.

Dr. Simon acknowledges that doctors and nurses fear more cutbacks; he expects to lose up to 20% of his medical staff because of the growing disenchantment over the budget crunch. He says the only real solution is an infusion of new revenue.

"When you go through the cutbacks and uncertainty that we've had," he says, "what else do you expect?"

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