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

Raju's Risk

Thursday, February 21, 2013
Chicago Tribune

 Dr. Ram Raju, the chief executive of the Cook County health system, announced an ambitious restructuring of the system's operations and top managers on Wednesday.

He says the changes will cut bureacracy and improve health care. He has earned a fair amount of good will because he has made terrific strides in streamlining the county's sclerotic health system and boosting patient care since he came on the job a little more than a year ago. The system has reduced its operating deficits and the subsidy it requires from taxpayers.

 The county health system was once renowned for providing a cushy home for patronage hacks and for being a stunningly wasteful administrative nightmare. It has made great strides since direct control was wrested from the Cook County Board. It has made great strides under Raju.

 So the hire he announced on Wednesday can, most charitably, be chalked up as ... curious. Raju's choice to lead a new office of clinical integration is Dr. John Jay Shannon. Shannon thrived in the old Cook County health system. He was chief of the divisions of pulmonary and critical care medicine when he left in 2007 to become senior vice president and chief medical officer at Parkland Memorial Hospital in Dallas.

 Last year, Shannon was forced out of his job at Parkland, which is the public hospital equivalent of Stroger Hospital.

 In 2011, the U.S. Centers for Medicare & Medicaid Services found that Parkland's patients were in "immediate jeopardy" of injury or death because of unsafe hospital conditions. Federal regulators forced Parkland to accept independent safety monitors to improve conditions.

Those monitors issued a scathing indictment of Parkland in a February 2012 report. They faulted management for a lackadaisical response to evidence that the hospital was a dangerous place for patients. "We were struck by the number of hospital employees, managers and physicians who did not seem to share that sense of urgency," the regulators said. "Large parts of the organization still operate in a business-as-usual mode."

Parkland officials refused to release that report to the Dallas Morning News. The newspaper finally secured it independently and released the shocking assessment.

Shannon said he had no quarrel with the decision to hide the report. "One of the concerns I had was, is it going to frighten the patients," he told us Wednesday.

 For his part, Raju realized that hiding evidence of dangerous conditions was a crazy notion of how to serve the interest of patients. He told us he would resign if Cook County ever withheld that kind of information from the public.

 In his defense, Shannon said he improved the hospital's operations in five years at Parkland. "Clearly we had some spectacular clinical failures, no one is proud of that, no one is happy with that," he said. He was the last top manager at Parkland to be forced out in the wake of the federal intervention.

As we said, curious. Raju scoured the country to fill a $400,000-a-year job and decided on a hospital administrator who managed in the midst of a catastrophic failure of quality and patient safety. Shannon will now oversee quality and patient safety in Cook County.

 Raju said he didn't know Shannon before he started the search. Raju says no one in county government pressured him to hire the former Cook County hospital honcho. From what we've learned, Shannon did make some positive changes in a difficult environment at Parkland. And we'll say this: He has an impressive resume. But he has a lot to prove.

The Cook County health system desperately needs change agents, not political survivors. "If Cook County has a problem, hold me accountable," Raju said Wednesday. "I am responsible."

 Yes, he is.

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