Challenge
Cook County Health and Hospitals System is the centerpiece of the region’s health care safety net, serving hundreds of thousands of residents annually. For more than a century, the system has been an irreplaceable asset—not just to the physical well-being of families, but to the financial stability of surrounding hospitals.

But over time, like many public institutions of its size and breadth, CCHHS experienced chronic funding and operational challenges, political pressures, and frequent leadership changes. Further complicating matters, tectonic shifts in health care promised to upend the entire hospital operating paradigm. How could a large urban public hospital ever hope to keep up?

By 2011, existential questions about the future role and design of CCHHS needed to be asked and answered.

Action
In 2012, the new CEO of CCHHS, Dr. Ram Raju, and Cook County Board President Toni Preckwinkle set out to prove that public sector transformation can happen on a very large scale. In 2012, Dr. Raju asked for the private sector’s partnership in transforming health care in Cook County. He quickly established himself as the kind of client Civic Consulting Alliance looks for: committed to change, able to make tough decisions, and willing to collaborate. Civic Consulting Alliance recruited and coordinated more than 20 private sector partners who brought their expertise and time to help transform this storied institution.

The journey began with the design of a new executive leadership structure that would equip CCHHS to navigate health care changes. To enable the CEO to pick his team, Bain & Company developed the business rationale to fast-track key changes. Bain also established a management office and metrics to make sure the new CountyCare health plan achieved liftoff. Today, CountyCare has enrolled more than 100,000 vulnerable adults, many accessing health care for the first time, and has built a broad network of hospitals and clinics to serve these members.

CCHHS has also worked to improve operations. Financials were assessed. Billing was evaluated and revamped. Procurement was revised. Attention was paid to the skillsets of frontline employees. Strategic Talent Solutions developed and then implemented leadership training for managers of patient-facing staff. The entire patient experience went under the microscope, down to the front desks and comfort of the furniture. Various pilot projects around the organization managed to reduce unanswered phone calls by half; double the rates of patients accessing primary care; and reduce wait times by 25 percent. While financial challenges remain and year-to-year results will vary, in fiscal year 2014 CCHHS lowered its local tax funding by $76 million with county taxes contributing just 15 percent, compared with 50 percent in 2009.

A Journey Begun
And the work of bringing pro bono private sector expertise to this public institution continues today. Strategy& has supported CCHHS in defining its roadmap to take responsibility (and get funded) for keeping residents healthy. Pro bono volunteers are helping the organization transition a declining inpatient hospital into a thriving outpatient clinic in the south suburbs. KPMG and Deloitte are listening to patients’ preferences to prioritize changes at clinics that will make CCHHS accessible. Sg2 and the Boston Consulting Group have examined how other metropolitan areas have managed their uninsured populations.

CCHHS’s journey of transformation will take years, perhaps decades. There are no easy answers given the magnitude of the change and the uncertainties of the health care environment. But the first steps are to make sure everyone is aligned with the direction forward; to optimize daily operations; and to understand what market adjustments must be made.

While challenges remain, today at CCHHS, wait times are lower, the number of insured is higher, the patient experience is better and the future looks brighter. This is what is possible when Chicago’s business community comes together to support a public institution that is so essential to fabric of our communities.

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