(soft music)
-: Welcome and thank you for joining us.
I'm Stacey Barrett, a Research Scientist
in the Joint Commission's Division
of Healthcare Quality Evaluation.
At the Joint Commission,
we believe that reducing healthcare disparities
is not only a quality and patient safety imperative.
It is a moral and ethical duty.
Our enterprise's mission to continuously improve healthcare
commits us to finding actionable solutions
to reduce healthcare inequities.
An important step in this process is for us to connect
with organizations that are engaged in work
to improve healthcare equity.
In doing so, we've heard about the challenges,
mitigation strategies, and the valuable lessons learned.
We are grateful to the organizations
that have opened their doors to our research team
and given us an opportunity to learn about their commitment
and their work to reduce healthcare disparities.
One of those organizations
is Cook County Health in Chicago, Illinois.
Today, I'm here with Israel Rocha,
CEO of Cook County Health.
This is the first of six segments
where I will talk with leaders from Cook County Health
about efforts to close the gap on healthcare disparities.
Hi Israel, it's great to be with you today.
-: Thank you so much for having me.
I'm so excited for today and our interview.
-: We know that Cook County Health
has a long history of striving for equitable healthcare
and that tremendous work has occurred
and continues to occur to achieve this goal.
As the CEO of Cook County Health,
what do you see as the primary role of leadership
in reducing disparities and improving healthcare equity?
-: Well, first I would say the Cook County Health
has been at the forefront of health equity
for nearly 200 years.
We serve 600,000 people a year
through our health system and our health plan.
75% of our patients identify
as either African American or Hispanic.
As one of the largest public health safety net systems
in the country,
it is our mission to provide comprehensive health
to everyone who comes through our doors,
regardless of their immigration status, ability to pay,
or any other barrier that they may be experiencing.
I'm immensely proud to serve
as the Chief Executive Officer of Cook County Health
and fully understand my responsibility
to maintain that nearly 200 year mission of adopting
and making sure that the myriad of changes that happen
in our healthcare industry do not result
in any loss of healthcare access for our patients.
The latest began during the COVID-19 pandemic
and we saw that there was an illumination
of the inequities that happened throughout our country.
And while Cook County Health
has been in the business of health equity,
we also wanna make sure that we continue to do more,
that we have a better impact
that we're helping to serve our communities in a new way
and that the higher morbidity and mortality
that is occurring in vulnerable community comes to an end.
So what I see our role is to be able
to provide new innovations, new access points,
and to ensure that at at every level,
we are examining the processes of our care
so that we ensure that the outcomes for all patients
are the same regardless of any socioeconomic challenges
or other factors that people may have.
That whether you have the greatest amount of resources
or you have the greatest need for resources,
that the outcome of your care will be the same.
That for me is the definition of health equity,
ensuring that everyone has access
and availability to world class medicine
at the same standard, in the same level,
in the same delivery manner, and that we help to mitigate
any challenges that prohibit patients
from experiencing a full recovery
because of factors that they may encounter
at home or in their life.
-: Thank you for that.
Can you share a bit about your vision
and strategic focus to address disparities?
-: Sure.
At Cook County Health, we recently updated our vision
to one that I'm so proud of which is that our vision
is to ensure that health is a human right,
and that means that everyone will be able
to live their best life
and accomplish their highest availability for health
in their terms.
An empowered experience.
Health equity, community health and integration
is one of our strategic pillars.
It's part of our three year strategic plan.
Our entire work is led by our focus
in creating just spaciousness where our patients
and communities comprehensive health needs can be fully met,
guided through our development and in partnership
with our patients for that empowered experience.
Some initiatives are underway,
some initiatives are being created,
and some initiatives are yet to have even been thought of.
But some of those include the work
that we have recently done,
which was to establish an office of equity and inclusion.
We recently administered one million COVID vaccines
across the entirety of our service area and county
to ensure that no one was left behind
in their quest to be able to get vaccinated.
We conducted hyperlocal campaigns
to make sure that individuals who needed assistance
to get to either vaccination centers
or needed care teams to come into their homes
were available to have these vaccines.
And we helped to establish community advisory councils
that then in turn shaped our messages, our outreach,
and our ability to communicate with our patients
in an effective way.
Because part of healthcare starts
with understanding our patients,
for them to understand what we're trying to accomplish
as a health institution and how we come together
to create that empowered partnership
so that everyone can get the tools that they need
in their journey for health.
-: Thanks.
Could you share a bit more about your current goals
and perhaps at a high level,
can you describe your organization's vision
for meeting those goals?
-: Sure.
Cook County Health has implemented numerous programs
to improve our health equity
and to mitigate social risk factors of health.
And there has never been a louder call to change inequity
than in this moment.
We must act from creating new access
to primary and specialty care,
to improving accesses to diagnostics,
therapeutics and interventions.
The time is now.
To help make this happen, we are establishing
the Change Institute of Cook County Health,
which seeks to develop innovative, comprehensive strategies
to bridge the gaps in treatment and prevention.
Founded in 2002, the Change Institute of Cook County Health
grew out of crucial conversations about health equity
in the wake of the Corona pandemic,
which disproportionately impact the communities
of color and underserved populations.
Part of what we're doing with this institute
is to make sure that everybody has access to care.
If you cannot be able to get care,
we need to find innovative ways
for you to be able to receive it.
One of the things that is so exciting
that has already happened
with the Change Institute at Cook County Health
is that we created the first integrated health atlas
across our county.
Before, to understand what was happening in our community,
individuals had to go to the city or to the county,
and it really depended where you live
on what information was available.
So even just uniting the healthcare,
the healthcare outcomes, the socioeconomic factors
and risk factors that impact our community
was difficult to ascertain depending where you lived,
by zip code, by region.
What we did most recently was to create the health atlas
which is part of this,
and it's tied to the Change Institute of Cook County Health.
And what that means is for the first time,
if you wanna see how people
are having different diseases impact them,
whether it's a heart condition, obesity,
a different factor that you wanna look at,
you can look at how it's trending
across the geography of our service area
from those that have the most resources
to those that need the most resources.
You can see how diseases are impacting them.
-: That's fantastic.
Could you speak a little bit more
about how you define the organization's role
as it relates to the surrounding patient community?
-: So let's say that Cook County Health
has a unique role in our region.
We are hyper-focused on communities in Cook County.
We are continuing to grow our services
across the continuum of neighborhoods
and we are wanting to understand and to better treat
the ongoing involving needs of our patient.
Over the past several years,
Cook County Health has invested more than eight million
to modernize our Provident campus
including upgrading our emergency department,
expanding our medical surgical capacity,
reopening the intensive care unit
and installing a new MRI,
and including also opening up
a new outpatient dialysis center.
In October, we resumed accepting ambulance runs
and we're looking forward to expanding our specialty care
on the campus over the next 18 months.
This is just one of the many ways
that we are trying to help and empower our community.
-: How would you say that your strategic vision
has kind of evolved over time,
and maybe speak a bit to the ways
in which this may have changed in the last couple of years,
in the last two to three years?
-: Sure, even after all these years,
Cook County Health continues to stand
as a symbol of commitment to health equity
for the residents of Cook County
and the mission to care for everyone.
It is a commitment that we continue to this day
as we face new challenges in the healthcare landscape.
The COVID-19 pandemic illuminated inequities for everyone
and new responsibilities even of our healthcare system.
But what I would say more than anything else
is that it is probably clearer now than at any point
that we've had in the past to understand that where we live
and the challenges we face all impact our healthcare
and our healthcare outcomes.
We wanna make sure that we are providing access
to patients on their terms and their way.
We have needed to transition to telehealth services.
That created an opening for how else
could we use telehealth services to engage patients
in their care and expand our models and delivery?
We needed to have engagements
in clinical trials and expand our research.
So wanted to see what else we could do
in addition to just expanding our clinical trials program,
what else could we trial?
How could we provide new access to medication?
Do we need to continue with the way that we treat today?
Or can we target specific interventions
for specific diseases by creating new access to that
like high blood pressure,
other conditions that we know we have solutions for,
we have pills for?
We have disease,
we have vaccination that can treat these diseases.
It is undeniable that racism and other factors
are contributing to a public health crisis
and a variance in health outcomes.
Racism results in generational trauma and poverty,
which is also unquestionably causing higher rates
of illness and death in Black and brown communities.
But this is something that we can change.
We have the power and tools
to be able to make change happen in these areas.
Cook County Health is working to provide high quality
compassionate care in the face of these health disparities
so that poor outcomes are a thing of the past.
We want, as a health organization,
to ensure that we are part of the solution
in creating an organization that engages with local groups
and brings local solutions to bear on local problems.
-: In what ways do you think
that other organizational leaders have helped
to champion healthcare equity efforts at Cook County Health?
-: So I think, you know, as we said,
Cook County Health has established
the Office of Equity and Inclusion
together with our first Chief Equity and Inclusion Officer.
We continue to reexamine our institutional policies
with an equity lens and to make policy solutions
to promote health equity and opportunity.
But what I am most proud of is the ingenuity of our staff.
We every day are doing amazing things to make sure
that we are championing health equity efforts
with the leadership of the Chief Administrative Officer
for Cook County Health's ambulatory services.
Most recently, Cook County Health created
a refugee health center that now serves as a central hub
for providing health to asylum seekers
and refugees in the Chicago area,
a resource that did not previously exist,
but resources now ensuring that everyone has access
to healthcare and that our communities remain safe
-: With so much need,
how does your organization prioritize initiatives
to address all of these health related social needs?
-: We have doing the work of health justice
since our inception and we are so proud
that we continue to find new ways.
And I would really say it's the innovation of our staff,
the relentless commitment to make sure
that they're there for our patients.
We know that there are many social factors
that have an outsized impact on healthcare.
And at Cook County Health,
ensuring that healthcare is a fundamental right
goes beyond just providing access to medical care.
We also wanna make sure that we are doing things
like ensuring safe housing, food,
educational and economic opportunities
and finding new ways to bring care to patients.
That means that we have to change.
We have to be nimble.
We have to listen to our patients.
And so what I would say,
what influences our organization's prioritization
is our patients.
-: Israel, how would you say decisions are made
related to leading some of these initiatives?
There's so many at Cook County Health,
amazing work being done.
How are those decisions made?
-: I would say that our team really leverages
access to healthcare data.
It's important to understand
what you are going to be wanting to make an impact on.
And so if you don't have data to the health conditions
that you're seeing in your community,
if you don't have advisory councils,
patient family councils,
other ways to be able to get that voice from the community
into your patients, into what you're doing at work,
that's the most important and could be a fundamental flaw
if you don't have that voice represented.
So what we help to make sure that is driving our decisions
is to, one, listen to our family advisory councils,
listen to our patient councils,
listen to our community groups,
but then to look at the healthcare data
and to to be able to match that data with what we have done.
Have we opened up new clinics?
Have we launched new service lines?
Have we started new research?
What is the work that's being done
to see we're having any impact
on addressing those challenges?
So in the end, I would say it's listening to your patients,
looking at your care plan your programs,
your innovations, your interventions,
and then looking at impact in the community.
And the pairing of those three gives you a solid roadmap
of how you can make change happen for your future.
-: Thank you.
We know you can't do this alone, and we're really interested
in finding out about some of the internal
and external collaborations that you've formed
in partnerships that help to advance the work
of Cook County Health.
-: Sure.
You know, I always say that success is a team effort
and we are so happy to have amazing partners
here at Cook County Health.
You know, I always say it's so dangerous
when you start naming a few because you might forget one.
So please, for those that I forget, so sorry.
But do wanna give a special recognition
to innovative partners like our Housing Forward
partnership who helped create our respite center
or the Greater Chicago Food Depository
who helped create our food delivery system
for individuals who have food instability.
You know, our Fresh Truck program is the center
of how we're able to deliver this food
and that has been in strong partnership
with the Greater Chicago Food Depository.
And we also want to thank our partners
with the Women Infinity Children's Program
who provide supplemental food nutrition education
in all our facilities.
And then we have even partnership
with other university partners
like the University of Illinois,
who has been be able to provide specialty pediatric care
in partnership with our team,
as well as provide the data that is fueling the health atlas
along with both the Cook County Department of Public Health
and the Chicago Department of Public Health.
And so you have four partners working together
to bring data to the community
so that everyone can make change happen in their own way
at their organizations and their communities.
And I would say
that one of our most successful collaborations
is with our clinical staff, our medical partners,
and our community that is demonstrated
in the operation of our refugee health center
where both the state and our local city
and county municipalities are coming together
to provide these healthcare interventions
in a coordinated fashion.
And so I would say that it's always a team effort.
I'm sorry for those that I did not remember,
but please know how much we value you
and all the work that you're doing
to make our institution stronger
and to make the availability of healthcare
a reality for the patients that we serve.
-: Great.
How do you monitor your progress over time
and how do you evaluate whether you're being successful?
-: And I think that was so important
that we created the health atlas.
It was done in partnership between, as we talked about,
between the Chicago Department of Public Health
the Cook County Department of Public Health,
the University of Illinois and Cook County Health
and our Change Institute.
That provides broad metrics that lets you look
at the prevalence of illness, disease outcomes,
and how those are are coming to bear on the people
that we serve and the communities that we have.
And so I would always say
that it is important to look at your data
to understand how and what you're trying to affect change on
and what were the outcomes that you looked at.
And sometimes that's a change of disease prevalence.
Other times it's an increase in the number of vaccinations
that were given and those that were vaccinated.
And other times it's as simple as trying to see
that more people are even coming to clinical visits
because we have a new office or a new clinic that was opened
and now has provided greater access.
And so it depends on the measure,
but I always say you have to look at the data
and you have to look at the outcomes of your efforts.
-: Would you share some of your successes
and perhaps provide an example of an initiative
or program that you feel has been particularly impactful?
-: You know, as we've talked about before,
our initiative (speaking in foreign language),
which is the healthcare for South and Central American
asylum seekers in Chicago is a project that was born
from the work of government and community-based leaders
and faith-based organizations and local communities
to strengthen support systems for asylum seekers.
They were bused to sanctuary cities in the United States.
And how that came together to remove barriers
and provide assistance
for individuals needing that care at different levels,
whether it was personal care, healthcare,
or other types of interventions.
All these different organizations working together
to make that happen
has been something that we're very proud of.
Our ability to give one million vaccines
at a time when at the very beginning,
people didn't know how we were gonna be able
to give these vaccines.
These vaccinations required very delicate handling
including super cold freezers, different information.
How we could get that out quickly to the community
knowing that any delay in getting this out there
meant that more individuals could get infected.
And so we really wanted to move forward,
bringing the intergovernmental success
of having our our county government, our state government,
our community come together and be able to transition
what were once closed stores like Walmart,
Hobart and Target to become these large vaccination centers
and to bring the delivery
of those vaccines to our community.
Utilizing outreach in new computer technology
was something brand new for us
and reminded us that when we think we're out of options,
there are many more that can be innovated.
-: Well, we know that with all good work comes challenges.
What type of resistance and barriers have you encountered
as you've worked to strategically address social needs
at Cook County Health?
-: Well you know, I always tell my team
challenges are the fun part.
It's the part that helps us grow.
And so I would always say that one of the things
that can sometimes be overwhelming is the volume of need.
When you wanna get started, you are looking at an ocean
and it's sometimes difficult to decide
here's gonna be my starting point.
And what I always tell my team is,
look in front of you and look around you.
Take two steps forward, you've already made progress.
So it's simply getting started.
One of the challenges and the barriers
can be that there's just a lot of help
and we can feel helpless.
We are all powerful in our own way
and we all have solutions that we can bring forward.
The true trick is being able to use our voice
to advance our efforts
and to work diligent to make those things happen.
But challenges, they will always be there.
It's these challenges that sometimes keep our patients
from accessing the care that they need.
As care providers, as change agents, we need to make sure
that we are not gonna accept no as an answer
and we're not gonna accept the inability to provide care
as a reason why someone will not get
what they need to live their healthiest life.
So we're gonna make those changes into our success
and hopefully transition challenges
into success stories, into innovation,
and into tomorrow's adoptive medical practices.
-: Thanks so much, Israel, for taking the time
to talk with me today about the ways
that Cook County health leaders strategically plan,
evaluate, and monitor ongoing efforts
to reduce disparities and advanced healthcare equity.
Thank you.
-: Thank you.
(soft music)