the new roseland hospital transformation proposal

THE NEW ROSELAND HOSPITAL TRANSFORMATION PROPOSAL

APPLICATION TO THE ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FOR FUNDING UNDER HEALTHCARE TRANSFORMATION COLLABORATIVES

April 9, 2021

Table of Contents

INTRODUCTION ........................................................................................................... 1

PROPOSALS

1. THE RCH BEHAVIORAL HEALTH TRANSFORMATION AND ADOLESCENT SUSTAINABLE HEALING PROGRAM ........................................................................... 2

2. THE RCH OBSTETRIC IMPROVEMENT PLAN ............................................................. 17

3. THE RCH CENTER FOR ARTHRITIS AND JOINT REPLACEMENT .................................. 28

EXHIBITS

EXHIBIT A: APPLICATION FOR TRANSFORMATION FUNDING COVER SHEET

EXHIBIT B: ROSELAND HOSPITAL 2019 COMMUNITY HEALTH NEEDS ASSESSMENT

EXHIBIT C: COMMUNITY LETTERS OF SUPPORT

SEN. EMIL JONES III

REP. KAM BUCKNER

REP. MARCUS C. EVANS JR.

REP. JUSTIN SLAUGHTER

REP. JAWAHARIAL OMAR WILLIAMS

SERVICE EMPLOYEES INTERNATIONAL UNION (“SEIU”)

ADVOCATE AURORA HEALTH

CHICAGO FAMILY HEALTH CENTER

INSTITUTE FOR WOMENS HEALTH

PHALANX FAMILY SERVICES

GATEWAY FOUNDATION

TCA HEALTH, INC

EXHIBIT D: RACIAL EQUITY IMPACT ASSESSMENT

EXHIBIT F: RCH EMPLOYMENT DATA BY ZIP AND ETHNICITY

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APRIL 9, 2021

To the Illinois Department of Healthcare and Family Services,

On behalf of The New Roseland Hospital (“RCH”) and the collaborators described herein, we are excited to present the following proposal for consideration and funding as part of the Illinois Healthcare Transformation Collaboratives Program (“HTCP”).

As a critical access hospital on Chicago’s south side, the RCH knows all too well the obstacles to ensuring equitable healthcare access and delivery. RCH’s service area spans six (6) zip codes1 and twelve (12) community areas2 within the city of Chicago.3 Of the 300,000 individuals that reside in RCH’s service area, 86% identify as non-Hispanic African American/Black, 8% identify as Non-Hispanic white, and 4% identify as Hispanic/Latinx.4 This is somewhat different than the racial distribution in greater South Chicago where 51.6% of the 1,026,829 persons identify as black, 30.9% identify as LatinX and 28.4% identify as white.5 The CDC has assigned South Chicago a social vulnerability index of 87.6, the highest social vulnerability index in the Chicagoland area.6

As soon as Illinois began its commitment to implementing this healthcare transformation, RCH committed to identifying those strategies and initiatives that will provide the most positive impact on its Community, in terms of health, wellness, access and equity. In fact, RCH has implemented its own transformation program7 independent of the HTCP which is a multi-phase, multi-tiered approach to providing more integrated and coordinated patient-driven healthcare services of the highest quality so as to empower patient-choice across the entire spectrum of acute recovery to generalized wellness.

Although there are so many opportunities for transformation, RCH is pleased to introduce and request funding for three (3) of its most exciting transformation programs during this initial offering for distribution under FY 2020/2021:

1. The New RCH Behavioral Health Transformation and Adolescent Sustainable Healing Program;

2. The New RCH Obstetric Improvement Plan; and 3. The New RCH Center for Arthritis and Joint Replacement.

1 60617, 60619, 60620, 60628, 60643 and 60827. 2 Auburn Gresham, Avalon Park, Beverly, Burnside, Chatham, Greater Grand Crossing, Morgan Park, Pullman, Riverdale, Roseland, Washington Heights and West Pullman 3 See Roseland Hospital 2019 Community Health Needs Assessment, at p. 3. (A copy of the Roseland Hospital 2019 Community Health Needs Assessment attached as Exhibit B.) 4 Id., 5 See University of Illinois at Chicago, Transformation Data & Community Needs Report: Chicago- South Side, February 2021, at 14. 6 Id., at 18. 7 https://www.roselandhospitaltalks.org/roseland-hospital-talks-transformat

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THE NEW ROSELAND HOSPITAL (“RCH”) ADULT BEHAVIORAL HEALTH TRANSFORMATION

EXECUTIVE SUMMARY

The RCH Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program will be a robust collaboration to expand and improve the current behavioral health services that The New Roseland Hospital (“RCH”) provides to its patients and in service to the community.

The Adult Behavioral Health Transformation will expand RCH’s current adult behavioral health unit (“BHU”) by adding nineteen (19) beds to its existing twenty-four (24) bed adult BHU, for a total of forty-three (43) adult BHU beds. These additional nineteen (19) adult BHU beds will allow patients in crisis to be placed more quickly and avoid languishing in emergency departments. Transformation funds, if awarded, will be used to add these beds and ensure there is appropriate and adequate staff, equipment and resources to provide high-quality behavioral health care.

The Adolescent Sustainable Healing Program will be a new offering at RCH that will transform two stand-alone residential buildings on RCH’s campus into two gender-specific, 7-bed “healing centers” where adolescents can receive intensive inpatient behavioral, mental and substance abuse treatment. RCH recently discontinued its adolescent acute mental illness program because it did not have the resources and space necessary for a successful adolescent behavioral health program. With help from the Healthcare Transformation Program and in consultation with Maryville Academy, RCH will develop and implement a sustainable residential treatment program that will take adolescents1 from self-destruction to self-empowerment in a program that utilizes a Trauma-informed model of care and offers highly skilled professional services led by Dr. Jody Reed, the New RCH Behavioral Health Medical Director, and RCH’s other board-certified psychiatrists, psychologists, and therapists with advanced degrees and specializations in teen mental health, substance abuse, depression, anxiety, and eating disorders. RCH’s behavioral health team will utilize proven modalities and apply innovative treatment approaches to address the complexities of teen dual diagnosis disorders, including identifying and healing the core issues that underlie self-destructive behaviors.

Both the adult and adolescent programs will benefit from a transformational collaboration with outpatient and community service providers to provide earlier, and more comprehensive, cooperation to identify and address patient’s transition needs in advance of the “warm hand off”. By introducing and connecting the patient, their family and/or their support system(s) to the patient’s outpatient care plan as well as necessary community resources while still an inpatient, RCH can attack the social determinants of health that create obstacles to successful transitions, outpatient engagement and sustainable healing. RCH looks forward to facilitating more robust education and orientation to help patients, their families and their support

1 Adolescents will be defined as persons age 13-17 and adults will be persons age 18 and order.

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systems understand where to find help, how to find covered help and why outpatient follow-up is crucial for sustained healing.

Additionally, this collaboration can also address other post-discharge issues that may relate to safe housing, employment, available food and other barriers that cause patients to forego follow-up care and leave their treatment.2 By working together during the inpatient process and facilitating as many outpatient and community service connections as possible, RCH can help patients find sustainable healing in their community.

Ideally, by ensuring adequate placement and proper treatment for adults and adolescents in crisis, this collaboration can improve the utilization of outpatient treatment programs, reduce readmissions and ultimately reduce the costs borne by the Community for a system that does not currently support sustained healing.

South Chicago is in desperate need for more mental health professional services as the shortages that exist in that area are pervasive.3 Those that have studied this shortage recommend programming that incentivizes clinic-community linkages, promotes collaborative care models and builds capacity.4 RCH believes this proposal, if funded, will achieve the goals of this Illinois Healthcare Transformation Program and requests the Illinois Department of Healthcare and Family Services award this collaboration $5,000,000 to begin to operationalize the plan for its service area, an area with a community desperately in need.

PARTICIPATING ENTITIES

The RCH Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program will involve the following entities:

The New Roseland Hospital;

Maryville Academy;

Gateway Foundation;

Beloved Community Family Wellness Center;

Phalanx Family Services;

TCA Health; and

Chicago Family Health Center.5

Please refer to the Application for Transformation Funding Cover Sheet, attached here to asExhibit A.

2 Id., at 40-43. 3 Id., at 51. 4 Id., at 54. 5 As this collaboration has been formed, there has been a great deal of interest in participation. RCH may request to include additional collaborators if the project is funded and operationalized.

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COMMUNITY INPUT

This collaborative endeavor will benefit a service area in south Chicago, which is part of Cook County that includes:

Zip Codes Community Areas 60617 60619 60620 60628 60643 60827

Auburn Gresham Avalon Park Beverly Burnside Chatham Greater Grand Crossing

Morgan Park Pullman Riverdale Roseland Washington Heights West Pullman

RCH identified and confirmed this service area needs more and improved behavioral health services through a commissioned Community Health Needs Assessment, which is attached as Exhibit B.

RCH and members of the Alliance for Health Equity (“AHE”), a collaborative of more than 30 hospitals, 7 health departments and 100 community partners, worked together between March 2018 through March 2019 to conduct a comprehensive Community Health Needs Assessment (“CHNA”) in Cook County.6 The primary data for the CHNA was collected by:

(i) Community input surveys; (ii) Community resident focus groups and learning map sessions; (iii) Health care and social service provider focus groups; and (iv) Two stakeholder assessments led by partner health departments (Forces for Change

Assessment and Health Equity Capacity Assessment).7

Secondary data was compiled and analyzed in partnership with epidemiologists from the Chicago Department of Public Health and Cook County Department of Health, the Illinois Public Health Institute and member hospitals.

The CHNA confirmed that all of RCH’s service area has mental health/behavioral health professional shortages.8

6 See Roseland Hospital 2019 Community Health Needs Assessment, at 4. A copy of the Roseland Hospital 2019 Community Health Needs Assessment is attached as Exhibit B.). 7 Id., at 4. 8 Id., at 17, 18.

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The CHNA community participants identified access to mental health services as one of the most important factors for a health community.9

This study confirmed that RCH’s service area would benefit from additional and improved mental and behavioral health services to address community concerns related to chronic stress, pervasive trauma and fear related to a multitude of factors including child abuse, domestic

9 Id.

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violence, living in high-crime neighborhoods, ongoing and continuous racial discrimination and homelessness.10

Since then, RCH has also hosted a series of Town Hall Meetings (personally and virtually) for legislators, community members, and employees over the last two years in preparation of submitting this Transformation Plan. Additionally, RCH’s Chief Executive Officer has presented the Strategic Transformation Plan to the State of Illinois Legislative Medicaid Working Group. Legislators, community members, community services organizations, collaborators and employees have provided overwhelming support for these projects. Many have provided Community Letters of Support, which are attached to this Proposal as Exhibit C.

Given the need for adolescent and adult behavioral health services in the areas beyond RCH’s service area, it is all but certain this collaboration will benefit surrounding communities when area hospitals face capacity issues and patients needing placement may not have in-network insurance coverage at a particular area hospital.

DATA

Second only to childbirth, mental health and behavioral disorders are the “most frequent hospitalization blocks for South Chicago.”11 And in South Chicago, “the greatest percentage of readmissions and resource intensive hospitalizations [relate to] mental illness and substance abuse disorder.”12 Mood affective disorders, schizophrenia and psychoactive substance use disorders are among three of the top six disease blocks for hospital admission frequency and hospital readmissions.13 Moreover, these disease blocks are resource-intensive and outpatient treatable.”14 Unfortunately, “outpatient care prior to or subsequent to hospital-level care is proportionally low”.15

It well established there is a need for greater inpatient behavioral health services, especially in hospitals like RCH that accept all patients and cases regardless of payor source. This collaboration, however, will do more than simply add beds for inpatient care. The goal of this collaboration is to use the expanded inpatient service to facilitate and build stronger connections between patients, families, outpatient providers and community resources to incentivize ongoing recovery and improvement in a less acute and less resource-intensive setting.

In the South Chicago area, only 10% of patients who are hospitalized from the ED for mental disorders received outpatient care during the three (3) months before the hospitalization. Furthermore, only 14.5% of patients in South Chicago hospitalized for mental disorders received

10 Id. at 12. 11 See University of Illinois at Chicago, Transformation Data & Community Needs Report: Chicago- South Side, February 2021, at 22. 12 Id., at 25. 13 Id., at 27. 14 Id., at 26. 15 Id., at 28.

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outpatient care after the hospitalization; the lowest outpatient follow-up rate in the Chicagoland area.16 This remarkably low utilization of outpatient care leads RCH to believe that more must be done to connect patients and their families with outpatient resources, and build a foundation for that outpatient journey, during the hospitalization. By simply creating time and space to connect patients with the outpatient services and resources they need to forge a path for sustainable healing, RCH believes it can increase the percentage of discharged patients that continue with outpatient and follow-up care post-discharge. If successful, this program can make significant inroads to interrupt the viscous readmission cycle that plagues South Chicago hospitals and takes a toll on the surrounding communities.

Mental health, behavioral health and substance abuse admissions in the area typically arrive through the Emergency Department. By zip code, RCH’s service area has a significantly high percentage of emergency department visits that relate to mental health and substance abuse.

Emergency Department Rate due to Substance Abuse (age-adjusted rate per 10,000)

Emergency Department visits due to Mental Health among adults (age-adjusted rate pre 10,000)

Furthermore, the current pandemic has only exacerbated the mental health crisis that exists nationwide, and in RCH’s service area. According to a NHIS Early Release Program survey, only 11% of adults surveyed reported symptoms of anxiety disorder and/or depressive disorder between January and June of 2019; however, by January 2021, 41.1% of adults surveyed reported symptoms of anxiety disorder and/or depressive disorder a US Census Bureau Household Pulse survey, 41.1% of adults surveyed reported symptoms of anxiety disorder and/or depressive

16 See University of Illinois at Chicago, Transformation Data & Community Needs Report: Chicago- South Side, February 2021, at 28, 30.

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disorder.17 The US Census Bureau found younger adults were experiencing the most significant mental health impact related to the pandemic:

In addition to younger adults, minorities and persons of color are experiencing pandemic-related mental health symptoms at a disproportionate rate.18

The South Side of Chicago will only benefit from increased access to high-quality, sustainable mental health, behavioral health and substance abuse treatment if this collaboration receives the funding being requested.

17 https://www.kff.org/report-section/the-implications-of-covid-19-for-mental-health-and-substance-use-issue-brief/18 Id.

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HEALTH EQUITY AND OUTCOMES

As described above, the majority of individuals in RCH’s service area identify as African American and RCH’s service area has been described as having a mental health professional shortage.

MENTAL HEALTH PROFESSIONAL SHORTAGE AREA MAP

On the above map, the Health Professional Shortage Areas (“HPSA”) are scored on a scale of 0-25 with the higher score indicating the highest need. All of RCH’s community service area, as well as other adjacent and surrounding areas, have been identified as having a mental health professional shortage.

Funding the RCH Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program will increase capacity for inpatient mental health, behavioral health and substance abuse treatment in the underserved RCH service area, thereby increasing access to these necessary treatments in a community that is predominantly African American.

If funded, the program will also address the specific cultural and community barriers that have been identified in the RCH service area that prevent individuals from seeking outpatient care and services before or after an admission for mental health, behavioral health or substance abuse services. Addressing these community-specific and/or cultural barriers is something RCH believes to be transformational and critical to increasing access to treatment and sustainable healing.

QUALITY METRICS

The RCH Adult Behavioral Health Transformation will support HFS’ Pillars of Improvement focused on adult behavioral health by providing better care through:

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Improved access to care by adding nineteen (19) adult BHU beds to facilitate appropriate placement out of Emergency Departments and other holding areas and timely treatment.

Community-specific strategies to facilitate improved outpatient utilization and reduced re-admissions

Improved quality treatment and coordinated care to decrease inpatient hospitalizations

RCH proposes the following metrics to be used by HFS following a Transformation funding award to monitor and track the projects progress in achieving the goals of the HFS’ Pillar of Improvement for adult and child behavioral health:

1. Percentage of outpatient follow-up after inpatient care (7-day and 30-day follow-up); 2. Number of visits to emergency departments for behavioral health services that result in

hospitalization after inpatient treatment; 3. Mental health symptoms reduction from admission to discharge; 4. Productive engagement following admission (employment, job training, school

enrollment, etc.)

Although the first two metrics can be tracked and monitored through Medicaid claims data, the Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program will commit to gathering the data for the 3rd and 4th metrics through internal records, patient assessments and/or surveys.

CARE INTEGRATION AND COORDINATION

As described in the Executive Summary, above, the RCH Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program will combine inpatient behavioral health treatment with outpatient providers and community resources to bridge the abrupt transition from inpatient to outpatient treatment to encourage and incentivize ongoing recovery. By introducing and connecting the patient, their family and/or their support system to the patient’s outpatient care plan as well as necessary community resources while an inpatient, RCH can break down the social determinants of health that create obstacles to sustainable healing.

As part of the physical transformation, RCH will create space for nineteen (19) adult BHU beds and fourteen (14) adolescent behavioral health beds in two separate gender specific residential healing centers. All behavioral health rooms and spaces will comply with all requirements for successful and safe behavioral health treatment. Additional communal, activity and group therapy space will be created for both the adult unit and the adolescent healing centers to allow RCH to facilitate the evidence-based treatment programs to bring about healing. Furthermore, the adolescent healing centers will be equipped with secure outdoor space where adolescents can participate in recreational activities - a critical component of adolescent treatment.

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RCH will develop a robust education and orientation program to help patients, their families and their support systems continue the journey towards sustained healing by providing the tools and resources to understand:

The disease from which the patient is recovering and what to watch for during the patient’s healing journey;

What outpatient and community services will be most beneficial to the patient and where/how to access those services;

What covered services are available to the patient;

How to seek help in addressing coverage issues that may arise;

What community support systems and resources are available to address the patient’s specific social/cultural/economic needs post-discharge;

How to integrate healing strategies and recommendations in “the real world”; and

Specific strategies the patient, family and support system can employ to help the patient pursue their own healing journey without compromising and sacrificing their other responsibilities and priorities.19

Additionally, by involving outpatient and community resources, this collaboration will also help each patient address the other post-discharge issues that could impede their sustainable healing. The collaborators will work together to address potential issues with the patient’s ability to secure safe housing, employment, available food and other needs, that if not met could that cause patients to forego follow-up care and leave their treatment. By working together during the inpatient process and facilitating as many outpatient and community service connections as possible, RCH can help patients find sustainable healing in their community.

ACCESS TO CARE

By adding nineteen (19) adult BHU beds and fourteen (14) adolescent BHU beds (seven (7) in each gender-specific healing center), there will be more available behavioral healthcare, mental healthcare and substance abuse treatment for vulnerable persons within RCH’s service area and beyond. The additional beds will give RCH the ability and opportunity to admit and treat patients from RCH’s own ED as well as other area EDs and reduce the number of patients who need timely specialized services and would otherwise languish in an ED or elsewhere while awaiting appropriate placement.

Based on the Illinois Healthcare Facilities and Services Review Board Data, there are only 43 adolescent acute mental illness (“AMI”) beds within a 10-mile radius around RCH’s general service area. Given the adolescent population of 392,681 in RCH’s GSA, the bed-to-population ratio is one (1) bed to 9,132 adolescents.

19 See University of Illinois at Chicago, Transformation Data & Community Needs Report: Chicago- South Side, February 2021, at 36, 40.

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RCH’s GSA (10-Miles)

Population Beds Beds to Population

Adolescent AMI Beds 392,681 43 1 : 9,132

Adult AMI Beds 1,057,160 313 1 : 3,378

Compared to the city and state bed-to-population averages, RCH’s GSA has far less beds available to serve the adolescents in the community, who are primarily persons of color.

HSA 6 (Chicago)


Adolescent AMI Beds 633,416 304 1 : 2,084

Adult AMI Beds 2,076,118 1,117 1 : 1,859

Illinois


Adolescent AMI Beds 3,223,468 942 1 : 3,422

Adult AMI Beds 9,547,163 3,279 1 : 2,912

By developing a more comprehensive program involving outpatient services and community resources to provide “warmer” handoffs and more education to patients and their families, RCH will be able to increase access to the outpatient services and other resources that are being grossly underutilized.

SOCIAL DETERMINANTS OF HEALTH

The RCH Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program is designed to specifically address the social determinants of health that are unique to the RCH service area, including racial and cultural factors that contribute to healthy communities. RCH has invested in the research and received substantial community input to identify the obstacles and barriers that confront behavioral health patients and their families/support systems generally, and specifically related to mental health.

Through its research and community needs assessments, RCH has learned that participants frequently link mental and behavioral health with the “traumas” that are inherent in the South Side Chicago community. Fears of violence, unsafe housing, poverty, domestic abuse, job security and lack of family support have been identified as an important contributor to mental and behavioral health issues. To confront these social factors, RCH will work with its collaborators to develop a Trauma Informed care model. Trauma Informed Care is based on the premise that all individuals experience trauma in their lives and clinicians must be cognizant of individual patient traumas to provide critical understanding and support while avoiding triggers that can exacerbate prior trauma. The Trauma Informed Model of Care is particularly important on the South Side where adolescents are often exposed to violence, domestic abuse, poverty and loss at a young age and persistently through childhood. The Adolescent Sustainable Healing

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program will create an atmosphere of trust and support to address prior traumas and guide the adolescent to develop sustainable, positive relationships that will equip them with the tools and confidence to achieve their highest form of well-being.

The RCH Adult Behavioral Health Transformation and Adolescent Sustainable Healing Programs are also designed to provide evidence-based clinical treatment, as well as social and community based resources and services to help patients transition out of the inpatient environment. By working together, outpatient providers, community service providers and the clinical team will be able to address the social factors that will contribute to a patient’s healing and the social barriers that must be overcome. During a patient’s journey through inpatient treatment towards discharge, this collaboration will provide patients and their families with a clear action plan to address those social determinants, establish a support and accountability structure and guide the patient on their healing journey. As part of the transition, the program will specifically address post-discharge issues that may relate to safe housing, employment, available food and other barriers that cause patients to forego follow-up care and leave their treatment. In terms of education, training and empowerment, the program will also facilitate more robust education and orientation to help patients, their families and their support systems post-discharge.20

MILESTONES

In the event of a funding award, the Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program is prepared to proceed expeditiously to operationalize the programs as follows:

Adult Behavioral Health Unit Adolescent Sustainable Healing

Month 1-3 A/E/C Documentation / Review A/E/C Documentation / Review

Month 4 Construction begins - Demolition and rough framing.

Construction begins - Demolition and rough framing. Month 5

Month 6 Mechanical, electrical, plumbing, fire protection rough out begins Month 7

Month 8

Month 9

Month 10 Interior finish

Month 11 Construction Complete Mechanical, electrical, plumbing, fire protection rough out begins Month 12 Clinical operations start

Month 13

Month 14

Month 15

Month 16

Month 17

20 See, supra at 3.

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Month 18 Close-out construction

Month 19 Begin recruitment, training and orientation of staff (mental health aides, security, counselors, managers)

Month 20 Clinical operations start

RCH intends to work with its collaborators throughout the construction process to develop programs, policies and protocols to improve care delivery and maximize patient healing, engagement and post-discharge success.

RACIAL EQUITY

The RCH Adult Behavioral Health Transformation and its collaborators are committed to promoting racial equity as part of this program. The entire program is designed to bridge the systemic and structural gaps that exist between healthcare delivery in RCH’s service area and other areas of Chicagoland. Furthermore, RCH and its collaborators are actively working to increase staff and vendors to reflect the diversity of the community that surrounds RCH. RCH is committed to providing healthcare services and facilities that meet or exceed the expectations of its patients and community and are consistent with the services and facilities provided at other area hospitals in and around Chicagoland.

A copy of the completed Racial Equity Impact Assessment Guide by RACE FORWARD, is attached as Exhibit D.

MINORITY PARTICIPATION

The New RCH is committed to involving participants and vendors that are majority owned or managed by minorities or are certified participants in the Illinois Business Enterprise Program. RCH currently maintains a preferred vendor list to identify and facilitate contracting with minority business enterprises (“MBE”). To facilitate further minority participation, RCH is currently implementing a program to increase diversity in its vendor programs and contracting so that RCH’s relationships more closely mirror the diversity of its patients and surrounding community. The collaboration expects to be able to expand the list of minority participation once funded and able to engage additional participants.

JOBS

Currently, RCH’s workforce represents communities from all over Chicago and northern- Indiana. RCH is committed to a diverse workforce and proudly employs 490 hard-working individuals. Within the 490 employees, 80% are African American, 6% are Hispanic or Latino, 5% are white and 4% are Asian. See RCH Employment Data by Zip and Ethnicity attached as Exhibit F. RCH has been and continues to be committed to supporting and facilitating a diverse workforce that

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provides equal opportunities to qualified persons regardless of race, color, national origin, religion, sex, age, or disability.

RCH works closely with local organizations through special programs administered by the City of Chicago to hire candidates that reside within RCH’s community. RCH works in partnership with the Service Employees International Union to provide quality employment opportunities to local members.21 RCH also supports local students through affiliation agreements with area colleges so students can complete internships and rotations at RCH.

The addition of 19 adult BHU beds and 14 adolescent beds in its adolescent treatment centers will necessarily require RCH to hire at least 20 additional clinical and non-clinical staff. RCH will follow its current hiring policies and priorities to fill these positions.

SUSTAINABILITY

Funding the RCH Adult Behavioral Health Transformation is a sustainable investment. Once the beds have been added and the outpatient and community collaboration elements have been operationalized, RCH will be able to continue to provide treatment and services to individuals requiring mental health, behavioral health and substance abuse treatment for the foreseeable future. RCH and its collaborators are requesting funds to develop the space and build a program that can be replicated for years to come based on available payer and reimbursement structures and support area hospitals in need of places to send ED patients in crisis.

BUDGET

A brief summary of the proposed project budgets are as follows:

Adult BHU Adolescent BHU

Project Description: Expand Adult Psych by 23 beds, provide behavioral safety upgrades to 2E wing

Renovation of 2 existing residential buildings into Residential Behavioral Program

Project SF: 8370 7372

Projected Budget/SF: $275 $200

Projected Project Budget: $2,300,000 $1,460,000

General Work $1,265,000 $803,000

Mechanical $345,000 $219,000

21 See SEIU Letter of Support, attached as Exhibit C.

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Electrical $230,000 $219,000

Plumbing $345,000 $146,000

Fire Protection $115,000 $73,000

Operations TBD TBD

Salaries TBD TBD

Equipment TBD TBD

GOVERNANCE STRUCTURE

The RCH Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program will be developed and managed by The New Roseland Hospital Strategic Transformation Committee, a 16-person committee that will be led by Chairman Dr. Rupert Evans and includes the current RCH Board of Directors and representative individuals from the local community as well as each collaborating organization.

New Roseland Hospital Strategic Transformation Committee

Dr. Rupert Evans New Roseland Hospital Board Chair

Jai Dev Arya, M.D. New Roseland Hospital Board Finance Chair

Bruce Liimatainen New Roseland Hospital Board Member

Dr. Jeffrey Waddy New Roseland Hospital Board Vice Chair

Tim Egan New Roseland Hospital Board Member

Joyce Chapman Community Leader

TBD Community Leader

TBD Community Resident


Dr. Angelette Evans Governor's State University

Dr. James Munz Governor's State University

Dr. Victoria Brander Operation Walk

Nina C. Aliprandi Maryville Academy

TBD Chicago Family Health FQHC

TBD Beloved Community Family Wellness Center

TBD TCA Health Inc.

The New Roseland Hospital Strategic Transformation Committee will develop all policies, monitor progress, analyze all performance data and ensure all required reporting. Additionally, Maryville Academy will provide consultation services in the development of the Adolescent Sustainable Healing Program.

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THE NEW ROSELAND HOSPITAL (“RCH”) OBSTETRIC IMPROVEMENT PLAN

EXECUTIVE SUMMARY

RCH has always been and continues to be a committed community partner providing high quality obstetric services to our neighborhood families. “Childbirth is the most frequent driver of hospital utilization in South Chicago.”1 Despite having excellent physicians on staff, patients prefer to travel outside of RCH’s service area to deliver their children in more modernized and updated labor and delivery departments. RCH’s labor and delivery department lacks the amenities that expecting and new mothers seek when choosing a hospital. By not having suite-style post-delivery recovery rooms and other amenities that patients seek, RCH is not able to serve the families in its service area, and therefore, cannot connect its community’s families to available local supports and resources they need to live and thrive after they leave the hospital.

The Healthcare Transformation Program now gives RCH the opportunity elevate its labor and delivery department to the standards its patients want and deserve, consistent with the facilities that are available in north Chicago and the Western suburbs, so that the community will utilize RCH’s new and improved labor and delivery department. The funds requested will be used to:

Upgrade patient rooms so that every patient suite will have a private bathroom and shower and space to visit with family;

Invest in bilingual “navigators” to partner with community resources and connect expecting and new mothers with nearby, available services and supports to assist with prenatal care, groceries, car seats, transportation, housing, lactation assistance, pediatric health providers, insurance coverage and other services critical to supporting healthy, stable new families

Develop programs consistent with other sought-after labor and deliverydepartments including, midwifery programs to increase delivery options, lactation support, transportation assistance to help patients see their providers, celebratory catered meals to help new mothers recover from delivery, and other services that will treat expecting and new mothers in RCH’s service area as well as (or better than) the expecting and new mothers in other areas of Chicago.

To facilitate this transformation, the RCH Obstetric Improvement Program is requesting $3,000,000 to fund this collaboration as described in greater detail below.


The RCH Obstetric Improvement Plan will involve the following entities:

1 University of Illinois at Chicago, Transformation Data & Community Needs Report: Chicago- South Side, February 2021, at 22.

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The New Roseland Hospital (“RCH”);

Chicago Family Health Centers

TCA Health; and

Institute for Womens Health.


COMMUNITY INPUT





RCH identified and confirmed this service area needs more and improved adolescent behavioral health services through a commissioned Community Health Needs Assessment.

RCH and members of the Alliance for Health Equity (“AHE”), a collaborative of more than 30 hospitals, 7 health departments and 100 community partners, worked together between March 2018 through March 2019 to conduct a comprehensive Community Health Needs Assessment (“CHNA”) in Cook County.2 The primary data for the CHNA was collected by:




2 See Roseland Hospital 2019 Community Health Needs Assessment, at 4. A copy of the Roseland Hospital 2019 Community Health Needs Assessment is attached as Exhibit B. 3 Id., at 4.

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Furthermore, RCH has also hosted a series of Town Hall Meetings (personally and virtually) for legislators, community members, and employees over the last two years in preparation of submitting this Transformation Plan. Additionally, RCH’s Chief Executive Officer has presented the Strategic Transformation Plan to the State of Illinois Legislative Medicaid Working Group. Legislators, community members, community services organizations, collaborators and employees have provided overwhelming support for these projects. Many have provided Community Letters of Support, which are attached to this Proposal as Exhibit C.

DATA

As discussed above, the vast majority of RCH’s obstetric patients are African American. According to RCH’s internal data the demographics of its obstetric patients shows a very high percentage of treating young, African American women:

African American

Hispanic White Total

# of patients FY 2018 165 2 3 170

# of patients FY 2019 159 6 3 168

# of patients FY 2020 280 14 9 303

Age: 0-17 18-29 30-44 45-54 55-59 60-54 65+ Total

# of patients FY 2018 2 100 56 6 1 2 3 170

# of patients FY 2019 0 118 44 1 1 1 3 168

African American patients are overwhelmingly more likely to experience pregnancy-related complications and death. In 2018, prior to COVID-19, the Illinois Department of Public Health found that, compared to White women, African American women in Illinois were six times more likely to die from pregnancy-related conditions, which is twice the national average.4 The report also found that the vast majority of complications and deaths were preventable.5

This disparity is particularly concerning on the South Side of Chicago, which has become an obstetric and maternity care desert. In the last year, the number of hospitals offering maternity services on the South Side of Chicago has decreased significantly. Specifically, Jackson Park Hospital, Holy Cross Hospital, and St. Bernard Hospital, who are within RCH’s service area market, have all permanently closed their Labor and Delivery (“L&D”) Units. Metro South Hospital in Blue Island also closed, which resulted in the loss of another L&D Unit in the service area. The map below illustrates the available L&D Units in the South Chicago area.

4 Illinois Department of Public Health, Illinois Maternal Morbidity and Mortality Report, October 2018, p. 5 (available at: http://dph.illinois.gov/sites/default/files/publications/publicationsowhmaternalmorbiditymortalityreport112018.pdf) 5 Id.

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Decreased access to obstetrical care in the South Side of Chicago adds disproportionate health risks to African American pregnant patients, including increased infant and maternal mortality in the African American community.

Accordingly, there is a significant need for L&D Unit improvement and expansion in the RCH service area. The remaining providers that are committed to providing obstetric care on the South Side must be salvaged for the sake of the risk-risk patients that reside in the service area. But currently, outdated facilities and low utilization is has resulted in major infrastructure needs and unsustainable operating losses.

Funding improved facilities that will increase efficiencies, outcomes and local utilization is critical – and the Healthcare Transformation Collaborative funds can address this issue head on.

Furthermore, funding a program that improves new and expecting mothers’ access to community-based birth organizations and family supports will facilitate the engagement and intervention needed to encourage greater utilization of prenatal care and other services. Services and supports that make prenatal care convenient and comfortable, including transportation, nutrition support, baby supplies, infant car seat campaigns and other such programs have been shown to increase and improve patient engagement. With greater patient engagement in their obstetric health, including during pregnancy, complications can be identified early and treated to avoid preventable adverse outcomes.

A: University of Chicago Medicine

B: Jackson Park Hosp. - L&D CLOSED

C: South Shore Hospital

D: Little Company of Mary Hospital

E: Metro South Hospital -- CLOSED

F: Ingalls Memorial Hospital

G: Advocate Trinity Hospital

H: Advocate Christ Hospital

I: Holy Cross Hospital -- L&D CLOSED

J: St. Bernard Hospital -- L&D CLOSED

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HEALTH EQUITY AND OUTCOMES

RCH plans to partner with community organizations and area Federally-Qualified Health Centers (“FQHCs”) in the service area to develop more robust programs to deliver pre-natal care and pregnancy management services. With facility upgrades and improvements, RCH will be positioned to draw the community’s women to the hospital so they can receive the preventative care needed to avoid the pregnancy-related complications and other high risk obstetric issues are more frequent in the African American community of Chicago’s South Side.

To encourage patient engagement, capital improvements are necessary. Patients in RCH’s service area frequently travel significant distances to deliver at other area hospitals that look and feel more updated. The two nearest other hospitals with labor and delivery departments are Advocate Trinity Hospital (with 23 beds 13.99 miles away) and OSF Little Company of Mary Medical Center (with 17 beds 18.53 miles away). These new and expecting mothers, who are typically young, single and unemployed, cannot travel these distances to other hospitals and providers regularly, which results in low utilization of pre-natal care and post-delivery follow-up. Patients often choose not to seek local and convenient maternity care at RCH because it feels old and outdated. For example, many patients are put-off by the shared shower room that currently exists on the L&D Unit. RCH plains to use Transformation Funds to install private showers in patient rooms.

The fact that a new or expecting mother lives on Chicago’s south side should not force her to have to choose between her community hospital that can provide high-quality services in an outdated space or a more well-appointed labor and delivery experience significantly far from her home and her support center. Putting aside the clinical benefits of improving local obstetric care at RCH, an improved and updated L&D unit at RCH will increase health equity by providing the women of color who reside in the South Side of Chicago an equivalent experience to what they receive when they travel to the north side or the suburbs.

Enticing local mothers to deliver close to home and in their community will also improve outcomes. More than just a capital improvement, the RCH Obstetric Improvement Plan implement bilingual “navigators” to connect obstetric patients to community resources and partners for pre-natal care and/or post-partum support. Because the RCH Obstetric Improvement Plan participants know and understand the community-based challenges its patients face, the collaborators will be able to connect more new mothers with the resources they need for their family to thrive. RCH and its community partners will work together to ensure every new mother has resources and information related to local, community based pediatric services, nutritional/grocery support, safe housing assistance, transportation home with a safe infant car seat and similar social and community supports.

With Transformation funds, the collaborative will also take the next step to improve health equity and outcomes by creating additional obstetric care choices that will empower patients, such as a midwifery program and a lactation clinic. The collaborative will also work to diversify

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the obstetrics department staff to ensure there are more bilingual staff to support and provide comfort to a growing number of non-English speaking patients at RCH.

QUALITY METRICS

The RCH Obstetric Improvement Plan will support HFS’ Pillar of Improvement focused on child and maternal health. Improving RCH’s L&D Unit will provide continued obstetric and maternity care that is quickly disappearing from the service area. By improving the L&D Unit, RCH will also be able to encourage new and expecting mothers to stay in the community to receive maternity care and deliver at RCH. By becoming the community’s choice for maternity and delivery care, RCH can work with prenatal care providers, other clinical providers and community resources to improve utilization of prenatal and postpartum care as well and provide access to other resources and assistance to help new families and babies thrive in the face of the social determinants of health that plague the South Side.

RCH proposes the following metrics to be reported to HFS following a Transformation funding award to monitor and track the projects progress in achieving the goals of the HFS’ Pillar of Improvement for child and maternal health:

1. Increase access and utilization of prenatal care visits;2. Increase access and utilization of postpartum visits;3. Increase in well-child visits within 30 days;4. Increase in identified pregnancy-related complications receiving treatment

without ED visit;5. Improved utilization of RCH for labor and delivery; and6. Improved patient satisfaction with services and amenities at RCH.

Although the first four metrics can be tracked and monitored through Medicaid claims data, the Obstetric Improvement Program will commit to gathering the data for the 5th and 6th metrics through internal records, patient assessments and/or surveys.


As described above, the goal of the RCH Obstetric Improvement Plan is to create an all-inclusive local, convenient, community-based hub for the RCH service area’s obstetric needs. Through this collaboration, RCH will be able to participate in efforts to increase awareness among expecting mothers to receive early pre-natal care, follow-up post-partum care and well-child care. By connecting patients to these resources, RCH can intervene early, before emergency services are required, to address any complications or high-risk conditions. Furthermore, as described above, by increasing the community’s use of the RCH L&D unit, RCH and its collaborators will be able to connect its new mothers with the resources they need to heal post-pregnancy, receive pediatric care, and identify the community resources they need to thrive at home as a new family.

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ACCESS TO CARE

This RCH Obstetric Improvement Plan will increase access to a more comfortable, modern and supportive obstetric patient experience that is more readily available in other areas of Chicago and the suburbs. Although RCH currently has an L&D unit, it is under-utilized because patients from the RCH service area want a better experience and amenities. The RCH Obstetric Improvement Plan will not only improve access to certain quality of care, it will increase patient’s access to prenatal care, ongoing monitoring for high-risk and complicated pregnancies as well as post-partum supports and services.


Again, new and expecting mothers in RCH’s service area are typically young, single, sometimes unemployed, and sometimes without substantial education. Often times, RCH’s obstetric patients struggle with the complexities of their insurance benefits and coverage, and avoid prenatal care and post-partum supports because of a concern about costs, time away from work, or balancing childcare with a mother’s health needs.6

As the RCH services area has a growing Hispanic population, some patients forego care because of language barriers. By providing a comfortable, supportive hospital environment where local mothers are provided resources to help them navigate the healthcare system for themselves and their families, the RCH Obstetric Improvement Plan will have the opportunity to provide the outreach their patients need to overcome the specific challenges they will face while pregnant and/or with a new baby post discharge.

The collaborators in this project have the knowledge, experience and resources to guide new mothers that need assistance with housing, employment, groceries, transportation, childcare supplies and pediatric services. When RCH community members leave the service area to deliver their child, they may not have the opportunity to learn about and learn from these resources, but are instead discharged home without any assistance or help. The RCH Obstetric Improvement Plan wants to avoid new mothers being left without support and wants to be a focal point in the community for supporting local women and their obstetric needs.

MILESTONES

In the event of a funding award, the Adult Behavioral Health Transformation and Adolescent Sustainable Healing Program is prepared to proceed expeditiously to operationalize the programs as follows:

6 https://allhealthequity.org/wp-content/uploads/2019/06/FINAL_2019_CHNA-Report_Alliance-for-Health-Equity.pdf

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Month 1 - 3 A/E/C Documentation / Review Begin recruiting, training and orienting staff and support services including lactation consultant, social worker, patient educator and health navigator, midwives. Consideration to hiring maternal fetal medicine physician.

Month 4-8 Phase 1 (Patient Rooms)

Month 9-12 Phase 2 (Nursing Station)

Month 13-16 Phase 3 (Common Areas)

Month 17-20 Phase 4 (Caesarian & Delivery)

Month 21-24 Phase 5 (MEP/FP / Med Gas Upgrades)

Month 25-26 Close out and commission

Month 27 Clinical Operations Start

RACIAL EQUITY

The RCH Obstetric Improvement Plan and its collaborators are committed to promoting racial equity as part of this program. The entire program is designed to bridge the systemic and structural gaps that exist between healthcare delivery in RCH’s service area and other areas of Chicagoland. Furthermore, RCH and its collaborators are actively working to increase staff and vendors to reflect the diversity of the community that services RCH. RCH is committed to providing healthcare services and facilities that meet or exceed the expectations of its patients and community and are consistent with the services and facilities provided at other area hospitals in and around Chicagoland.



The RCH Arthritis and Orthopedic Partnership is committed to involving participants and vendors that are majority owned or managed by minorities or are certified participants in the Illinois Business Enterprise Program. RCH currently maintains a preferred vendor list to identify and

Many of RCH’s preferred MBE vendors are already familiar with

this project and are preparing bids for this project. To facilitate further minority participation, RCH is currently implementing a program to increase diversity in its vendor programs and contracting so that RCH’s relationships more closely mirror the diversity of its patients and surrounding community. The collaboration expects to be able to expand the list of minority participation once funded and able to engage additional participants.

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JOBS

RCH’s workforce represents communities from all over Chicago and northern- Indiana. RCH is committed to a diverse workforce and proudly employs 490 hard-working individuals. Among the 490 employees, 80% are African American, 6% are Hispanic or Latino, 5% are white and 4% are Asian. See RCH Employment Data by Zip and Ethnicity attached as Exhibit F. RCH has been and continues to be committed to supporting and facilitating a diverse workforce that provides equal opportunities to qualified persons regardless of race, color, national origin, religion, sex, age, or disability.


As part of this collaboration, RCH anticipates hiring limited specialized staff (bilingual navigators, midwives, lactation consultants, etc.) to provide additional amenities to obstetrics patients. Needs for additional nursing, support or non-clinical staff will be closely monitored. If additional hires become necessary, RCH will follow its current hiring policies and priorities to fill these positions.

SUSTAINABILITY

Funding the RCH Obstetric Improvement Plan is a sustainable investment. Once the capital improvements are complete, RCH will be able to increase unit utilization and deliver high-quality obstetric care from its specialists currently on staff. The funds will also be used to establish new programming, including a midwifery program and lactation clinic that will also be sustainable once established. The collaborators are prepared to begin working with patients and supporting new families immediately and as utilization increases.

BUDGET

A brief summary of the proposed

budget is as follows:


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Obstetric Improvement Program

Project Description: Patient Room, Nurse Station, Common Areas, Ceasarian & Delivery, MEPFP/Med Gas Upgrades

Project SF: 9725

Projected Budget/SF: $325

Projected Project Budget: $3,160,000

General Work $1,580,000

Mechanical $632,000

Electrical $553,000

Plumbing $316,000

Fire Protection $79,000

Operations TBD

Salaries TBD

Equipment TBD


The RCH Obstetric Improvement Program will be developed and managed by The New Roseland Hospital Strategic Transformation Committee, a 16-person committee that will be led by Chairman Dr. Rupert Evans and includes the current RCH Board of Directors and representative individuals from the local community as well as each collaborating organization.




Bruce Liimatainnen New Roseland Hospital Board Member













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TBD TCA Health Inc.

The New Roseland Hospital Strategic Transformation Committee will develop all policies, monitor progress, analyze all performance data and ensure all required reporting.

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THE NEW ROSELAND HOSPITAL (“RCH”) CENTER FOR ARTHRITIS AND JOINT REPLACEMENT: WALKING TOGETHER TOWARDS A HEALTHY FUTURE

EXECUTIVE SUMMARY

The New Roseland Hospital (“RCH”) seeks to improve the quality of life of its community through Transformation Grant funding to develop RCH’s Center for Arthritis and Joint Replacement (The “Center”). Through leveraging Chicago’s academic and clinical strength in joint replacement surgery, partnering with industry, and taking guidance from its community, the Center hopes to enhance the health and socioeconomic well-being of the RCH community by improving access to and outcome from hip and knee replacement surgery. Directed by Operation Walk Chicago, an orthopedic healthcare nonprofit with extensive experience developing and running similar partnerships in underserved communities, and guided by its community led Advisory Board, the Center will partner Northwestern University academicians, NorthShore University Health System and Northwestern Medicine clinical specialists, the business community (implant and device manufacturers) and clinician-educators in order to provide quality joint replacement in a low-cost, community setting (RCH).

On Chicago’s far southeast side, The New RCH serves more than 300,000 people across six zip codes and 12 community areas. RCH’s patients are among Chicago’s poorest, sickest and most disenfranchised. Principally African American (85%) and poor, the RCH community has been ravaged by chronic disease: a Roseland resident’s lifespan (72 years) is more than 6 years less than their Beverly neighbors’ (78 years).1

Despite the abundant need for healthcare, access is widely lacking, particularly in specialist care. The RCH community is an example of one of the most egregious healthcare disparities: Chicago is renowned for joint replacement surgery and yet there are almost no joint replacement surgeons caring for the RCH community.

Total hip and knee replacements (“TJR”) are among the most effective and cost-effective surgeries introduced in the last 60 years because they restore patients to active, pain-free lives. Unfortunately, these benefits are not shared equally. Disparities in TJR rates and outcomes represent the most glaring of the racial and ethnic disparities that exist in healthcare. For example, black Americans are one-third less likely to receive total knee replacement, and for those that do, their outcomes (e.g. walking distance, knee flexion) early after surgery are worse than their White peers. And although this disparity was first documented over 30 years ago, it persists today and appears to be worsening.2

1 Roseland Hospital Community Needs Assessment 2019, attached to this Proposal as Exhibit B. 2 Ibrahim Curr Orthop Pract. 2010 MAR–APR; 21(2): 126–131.

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Mobility is critical to health, chronic disease management and longevity. Improving cardiovascular fitness reduces death from heart disease.3 Adding even 15 minutes of physical activity a day improves mortality from all chronic diseases.4 Sedentary older people report that it is their joint pain from arthritis that prevents them from exercising. Overcoming this barrier to exercise is critical to getting older people active.5

Disenfranchised, disabled communities are poor communities. Inactivity not only makes chronic disease worse, it leads to more poverty. Disenfranchised, disabled communities are poor communities. The state of Michigan estimated the financial costs of adult inactivity resulted in $8.7 billion of direct medical costs (10 cents of every primary care dollar spent) and $2.5 million in lost productivity (~20 days of work per worker).6

Hip and knee replacement surgeries are remarkably successful at eliminating joint pain and disability and returning people to active, productive lives. For example, when compared with nonsurgical therapy, hip replacement improves average annual productivity by over $9500 a person, and the direct cost of surgery are more than offset by the net societal lifetime return estimated at over $30, 000 a patient.7 Hip and knee replacements, therefore, not only improve an individual’s health but the socioeconomic health of a community. Lack of access to this surgery is one of the systemic barriers that serve to restrict communities like RCH.

We propose establishing an interdisciplinary Center for Arthritis and Joint replacement focused on caring for the most vulnerable patients (elderly, disabled, frail and those without adequate resources), those patients who increasingly cannot access this life-changing surgery and the pre- and post-operative care necessary for success. Through partnering with industry, academicians, established clinical providers, and community organizations, the Center will offer experienced, high quality specialized care in a low-cost environment, using a variety of strategies to mitigate complications and reduce costly unanticipated care. The Center will report to its Advisory Council, where stakeholders will supervise quality and outcomes, guide program development and insure The Center meets the needs of RCH’s community.

Through this novel approach, customized to the needs and desires of each patient, we believe we have a model in which hyper-specialized orthopedic surgery (hip and knee replacement) provided in a lower-cost, local setting (The New RCH) will be cost effective and successful, bringing our community care that is currently unavailable locally and using a model we believe to be superior for at-risk populations. The Center would be, truly, transformational and could serve as a template for other conditions and communities.

3 Lee D J Psychopharmacol 2010.4 Wien, CP. The Lancet 2011.5 Lees FD, et al. J Aging Phys Acti. 2005. 6 Chenoweth, et al Economic costs of physical inactivity in the state of Michigan. Michigan Fitness Council. http://www.michiganfitness.org/indexpagedownloads/CostofInactivity.pdf7 Ruiz D. 2013 J Bone Joint Surg Am.

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To facilitate this transformation, the RCH Center for Arthritis and Joint Replacement is requesting $2,000,000 to fund this collaboration as described in greater detail below.


The Center for Arthritis and Joint Replacement will involve the following entities:

The New Roseland Hospital;

Operation Walk Chicago, including its physicians, surgeons, physical therapists and educators from multiple health systems, including

the Northwestern University Feinberg School of Medicine Department of Physical Medicine & Rehabilitation and Orthopedic Surgery;

Lal Puri MD, Ravi Bashyal MD, and Scott Cordes MD from NorthShore University Health System and University of Chicago;

William Gilligan MD from Hinsdale Orthopedics;

Kiran Chekka MD, Medical Director of anesthesiology and ORs from Global Health Partners at Northwestern and the New Roseland Hospital;

Physical Therapists and administrators from Athletico and Achieve Orthopedic Physical Therapy;

Skilled Nursing Facilities (TBD);

Industry vendors, including Smith & Nephew, Stryker and others.


COMMUNITY INPUT





RCH and members of the Alliance for Health Equity (“AHE”), a collaborative of more than 30 hospitals, 7 health departments and 100 community partners, worked together between March

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2018 through March 2019 to conduct a comprehensive Community Health Needs Assessment (“CHNA”) in Cook County.8 The primary data for the CHNA was collected by:




The CHNA identified treatment of the diseases of aging, which would include arthritis and joint replacement, as among its top needs.10

Since then, RCH has also hosted a series of Town Hall Meetings (personally and virtually) for legislators, community members, and employees over the last two years in preparation of submitting this Transformation Plan. Additionally, RCH’s Chief Executive Officer has presented the Strategic Transformation Plan to the State of Illinois Legislative Medicaid Working Group. Legislators, community members, community services organizations, collaborators and employees have provided overwhelming support for these projects. Many have provided Community Letters of Support, which are attached to this Proposal as Exhibit C.

DATA

Arthritis of the hip and knee is the leading cause of disability in the US. Rates of disabling arthritis are highest in African Americans, elderly and the poor. However, in Chicago, RCH’s service area has among the lowest rates of orthopedic surgery in the region.

Based on the data published and used by the Illinois Health Facilities and Services Review Board, the 10-mile service area around RCH includes eleven (11) other hospitals and nine (9) surgery centers that provide orthopedic surgery services. Although there is limited data on orthopedics, the available data demonstrates that the area within Chicago area Health Planning Area, HPA A-03, where RCH is located, had - by far - the fewest orthopedic cases.

Orthopedic Cases

RCH 10-mile Service Area 15,013

8 See Roseland Hospital 2019 Community Health Needs Assessment, at 4. A copy of the Roseland Hospital 2019 Community Health Needs Assessment is attached as Exhibit B.). 9 Id., at 4. 10 Exhibit B.

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Chicago 34,265

HPA A-01 (Chicago - North and West of the Loop) 16,176 HPA A-02 (Chicago - West and Near Southside) 12,383 HPA A-03 (Chicago - Southside (including RCH) 5,706 HPA A-04 (Southwestern Suburban Cook County) 14,201 HPA A-05 (DuPage County) 15,083 HPA A-06 (Western Cook County) 7,844 HPA A-07 (Northern Cook County) 13,635 HPA A-08 (North Shore) 10,602 HPA A-09 (Lake County) 8,804

In 2019, there were only 5,706 orthopedic cases in HPA A-03 versus 16,176 cases for HPA A-01, which is the City of Chicago north and west of the Loop. HPA A-01 includes Northwestern Memorial Hospital (reporting 6,876 procedures), Lurie Children’s (1,445 reporting procedures) and Swedish Covenant (1,339 reporting procedures).

HEALTH EQUITY AND OUTCOME

Accordingly, this project will bring a new life changing healthcare service to a Chicago Safety Net Hospital that is readily accessible in other areas of Chicago, but underutilized by the poor, people of color and others disenfranchised, including the RCH community. In collaboration with experienced providers, using state of the art techniques and protocols of care patients in RCH’s service area will benefit from the opportunity to address their chronic pain and mobility issues and improve their quality of life. Through this project, with institutional clinical protocols, standards of care, education of providers, mentorship we will improve many areas of RCH’s care delivery for chronic conditions (specifically preoperative medical screening, surgery, anesthesia, postoperative management, therapy services and case management). In addition, the partnership with university hospitals and specialists will enhance RCH’s care of patients long-term, in a variety of ways.

Patients who have advanced hip or knee arthritis will be enrolled. Patients will undergo “shared decision making” decision-analysis process to help them understand their choices and preferences based on their specific needs and goals. This shared decision making model has been shown to overcome the surgical hesitancy seen in people of color. Using a model for comprehensive pre-operative assessment, patient-specific factors for poor outcome will be identified. Barriers to surgery will be identified and addressed. Interventions and treatments will be initiated long before surgery (which might include including medical treatments or social interventions) to reduce risk for adverse outcome. Examples include:

Education about risks and benefits and strategies to improve outcome, in a group setting with individual counselling as needed.

Nutritional support when needed – weight loss counselling, education on healthy food practices and interventions for those whose parameters indicate deficiency;

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Identifying and treating undiagnosed chronic diseases – for example, better diabetic control for three months before a surgery to reduce risk of postoperative complication

Cardiovascular optimization;

Pre-operative physical therapy to reduce disability and enhance self-efficacy;

Pre-operative nerve blocks to reduce opioid consumption in those at risk for abuse etc.

Caregiver identification and training

Coordination with social service agencies, including getting uninsured patients access to healthcare insurance

Specifically, the Center for Arthritis and Joint Replacement will:

Employ experienced case management and outpatient nursing to coordinate care from the first pre- and postoperative care.

Utilize board-certified joint replacement surgeons and specialists from Northwestern University’s Departments of Orthopedic Surgery and Physical Medicine and Rehabilitation, NorthShore University Health System’s Department of Orthopedic Surgery and Operation Walk Chicago. Clinician -educators will perform patient care while educating the RCH clinical staff, ultimately transitioning to a RCH independent sustainable, high-quality clinical service.

Integrate and employ minimally invasive surgical techniques, anesthesia protocols and rehabilitation measures to facilitate rapid recovery

Involve streamlined anesthesia protocols (e.g. ultrasound guided local blocks, pre – and intraoperative);

Incorporate post-operative rehabilitation services in the context of a pandemic, which will include a novel wearable device (Trackpad) and regular remote education and supervision (Healant) for at home rehabilitation.

Develop and operationalize a new outpatient physical therapy and rehabilitation service at RCH, in collaboration with Athletico and Operation Walk Chicago.

Partner with subacute/ skilled nursing facilities that will provide extended inpatient care post-procedure for patients whose frailty and social needs requires further short-term rehabilitation stays.

QUALITY METRICS

The Center for Arthritis and Joint Replacement will support HFS’ Pillar of Improvement focused on equity and aligns with the Department’s goals to improve population health, improve access to care and implement evidence-based interventions to reduce health disparities. More directly, this Partnership will increase access to primary care, preventive medicine techniques and orthopedic specialty care that benefits patients’ mobility, which has a direct impact on their ability to move, work and live health lives.

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This collaboration proposes the following metrics to be reported to HFS following a Transformation funding award to monitor and track the projects progress in achieving the goals of the HFS’ Pillar of Improvement for equity and chronic condition management:

1. Improved pain and function, as measured by the HOOS (hip disability and osteoarthritis outcome score), KOOS (knee injury and osteoarthritis outcome score) and patient assessed healthcare quality of life;

2. Increased utilization and TJR procedures in service area;3. Surgical complication lower than historical rates for comparable population; 4. Overall cost of care at or below historical rates for comparable population; 5. Return to work or community reentry; and 6. Patient satisfaction scores

Although some metrics can be tracked and monitored through Medicaid claims data, the Center will commit to gathering available the data all four metrics through internal records, patient assessments and/or surveys.

Through collaboration with Northwestern University Department of Orthopedics and Operation Walk, patient specific outcomes, including quality of life measures, cost -efficacy analysis, and public health data regarding community rates of disability will be collected, analyzed and shared.


This project will serve to bring a new service to a Chicago Safety Net Hospital, in collaboration with experienced providers, using state of the art techniques and protocols of care. Through this project, with institution of clinical protocols, standards of care, education of providers, mentorship we will improve many areas of RCH’s care (specifically preoperative medical screening, surgery, anesthesia, postoperative management, therapy services and case management). Care coordination will be directed by trained managers, who will use a novel risk mitigation technique designed for at risk populations, data from wearable devices and other methods to maximize patient outcome. The Center will develop and utilize experienced case managers and outpatient nursing staff to coordinate care along with the clinical team from the patient’s initial evaluation all the way through their postoperative care. By partnering with rehabilitation facilities and physical therapy providers, The Center will be able to ensure, efficient and effective coordinated care to maximize outcomes.

ACCESS TO CARE

Disparities in access to and outcome from hip and knee arthroplasty surgery are well-known and well-documented. (see figure 1, below) For example:

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Black patients are reported to have a 40% lower probability of undergoing knee and hip arthroplasties.11

Black patients have worse outcomes from surgery, with longer lengths of hospital; stay, more complications, more hospital readmissions.12

Black and Hispanic patients wait longer (average 1.6 and 1.7 days, respectively) to have surgery after hip fracture than white patients (average 1.2 days).13

Despite controlling for disease severity, surgeons are less likely to recommend TJR to their black patients.14

Even when controlling for insurance status, black patients are less likely to be referred to an arthroplasty surgeon or high volume hospital.15

In a cohort of 102,767 patients followed by the Women’s Health Initiative, black and Hispanic women were significantly less likely than white women to undergo total knee arthroscopy even after controlling for appropriateness for surgery and socioeconomic status.

Since the onset of the Covid-19 global pandemic, in order to reduce use of acute hospital beds, hospitals considerably restricted elective surgeries – initially cancelling all elective surgeries, and more recently, giving preference to patients with resources and capacity to go home the same day or after a very brief hospital stay.

Anecdotally, patients with disabilities, severe disease, multiple comorbidities, and those without the resources to pay for at home help describe increasing difficulty finding surgeons willing to care for them, inability to secure the postoperative care they need (such as home health care, extended outpatient physical therapy, or skilled nursing care) and discouragement to their pursuing this life changing surgery.

11 Singh, J. Ann Rheum Dis. 2014 Dec; 73(12): 2107–2115.12 Id.13 Dy C J Bone Joint Surg Am. 2016 May 18;98(10):858-6514 Grooenweld Arthritis Rheum. 2008 May 15; 59(5): 730–737.200815 Losina E, Wright EA, Kessler CL, et al. Neighborhoods matter: use of hospitals with worse outcomes following total knee replacement by patients from vulnerable populations. Arch Intern Med 2007;167:182—7

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Figure 1 From: McBean AM, Gornick M. Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financ Rev. 1994;15:77–90.


The RCH Center for Arthritis & Joint Replacement is designed to specifically address the social determinants of health that are unique to the RCH service area, including racial and cultural factors that contribute to healthy communities.

The reasons for TJR disparities are complex, involving patient-, physician-, and system-level factors. A number of potential explanations have been described: black patients express greater fear of TJR risks and are less familiar with benefits, black patients are less likely to be referred to orthopedic surgeons, and orthopedic surgeons (of whom only about 4% are African American) are less likely to recommend this surgery to their patients.

Compounding this problem is the historical, systemic disenfranchisement of communities of color. When Black or poor patients are concentrated in an area the disparity increases, suggesting that both individuals’ race and the racial composition of the neighborhoods in which they live drive differential use. Because Medicare covers the costs of total hip replacement and total knee replacement, the disparity cannot be entirely attributed to a lack of insurance or to a lack of financial access. Generations of barriers to quality healthcare and distrust among Black individuals of the health-care system are not easily erased.

Over the last several years, advancements in joint replacement technology, clinical care and reimbursement models have resulted in patients experiencing remarkably quick physical recoveries and dramatically declining hospital lengths of hospital stay. The shifts in healthcare reimbursement towards greater hospital risk, publication of hospital “scorecards,” and increasingly restricted payments to ancillary providers has disproportionately affected at-risk

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populations; over the last few years, the most disabled patients, those whose surgery is expected to be complicated and require more hospital resources, appear to be increasingly discouraged from seeking surgery.

The global COVID-19 pandemic worsened the disparity in our most vulnerable communities. In order to preserve hospital beds, Medicare & Medicaid Services (CMS) recommended halting all elective orthopedic surgeries on March 18, 2020. Although there was significant variation by state, hip and knee replacement surgeries declined 94% and 92%, respectively. More recently, most healthcare facilities have reopened to joint replacement surgery, but preference is given to those patients who have the resources and capacity to go home the same day or after a very brief hospital stay. Patients with disabilities, severe disease, multiple comorbidities, and those without the resources to pay for at home help have described increasing difficulty finding surgeons willing to care for them, inability to secure the postoperative care they need (such as home health care, extended outpatient physical therapy, or skilled nursing care) and discouragement from their pursuing this life changing surgery.

These trends are particularly unfortunate: studies of hip and knee replacement outcomes consistently show that patients who go into surgery more disabled, or wait longer to have surgery, have worse outcomes. Thus our most vulnerable patients, whose care the COVID-19 pandemic has interrupted, are at risk for worse outcome.

Our goal is to improve the physical functioning and quality of life of people suffering from advanced arthritis of the hip or knee who live in the greater RCH community, one of Chicago’s most vulnerable. We have reimagined the delivery of care from the typical surgeon- directed model (historically less successful in communities of color) to one in which shared decision making is the cornerstone of care. The biopsychosocial risk factors that predict poor outcome will be identified, and, where possible, mitigated in order to improve outcome and quality of life. Care coordination will be directed by trained managers, who will use a novel risk mitigation technique designed for at risk populations, data from wearable devices and other methods to maximize patient outcome.

MILESTONES

Construction Operational

Month 1 - 3 A/E/C Documentation / Review

Month 2

Month 3

Month 4 Construction start and mobilization

Operation Walk to develop policies, protocols and schedules for establishing arthritis clinic and surgical center

Month 5 Demolition and rough framing

38 | P a g e

Month 6 Mechanical, Electrical and Fire Protection Rough Out

Month 7

Month 8 Collaboration to begin marketing arthritis clinic to community

Month 9 Begin recruiting and training staff to operate arthritis clinic

Month 10

Month 11 Interior Finish, All Trades Open arthritis clinic 1 day/week

Month 12

Month 13 Close Out

Month 14 Clinical Operations Start Surgical cases begin under direction of Operation Walk with training provided to RCH clinicians and staff

RACIAL EQUITY

The Center for Arthritis and Joint Replacement and its collaborators are committed to promoting racial equity as part of this program. The entire program is designed to bridge the systemic and structural gaps that exist between healthcare delivery in RCH’s service area and other areas of Chicagoland. Furthermore, RCH and its collaborators are actively working to increase staff and vendors to reflect the diversity of the community that services RCH. RCH is committed to providing healthcare services and facilities that meet or exceed the expectations of its patients and community and are consistent with the services and facilities provided at other area hospitals in and around Chicagoland.



The Center for Arthritis and Joint Replacement is committed to involving participants and vendors that are majority owned or managed by minorities or are certified participants in the Illinois Business Enterprise Program. RCH currently maintains a preferred vendor list to identify and

To facilitate further minority participation, RCH is currently

implementing a program to further increase diversity in its vendor programs and contracting so that RCH’s relationships more closely mirror the diversity of its patients and surrounding community.

For this specific partnership, Operation Walk Chicago is managed and controlled by Dr. Victoria Brander, a female. Global Health Partners at Northwestern Medicine is owned and operated by

39 | P a g e

a female person of color. The collaboration expects to be able to expand the list of minority participation once funded and able to engage additional participants.

JOBS

RCH’s workforce represents communities from all over Chicago and northern- Indiana. RCH is committed to a diverse workforce and proudly employs 490 hard-working individuals. Within the 490 employees, 80% are African American, 6% are Hispanic or Latino, 5% are white and 4% are Asian. See RCH Employment Data by Zip and Ethnicity attached as Exhibit F. RCH has been and continues to be committed to supporting and facilitating a diverse workforce that provides equal opportunities to qualified persons regardless of race, color, national origin, religion, sex, age, or disability.


If additional hires become necessary, RCH will follow its current hiring policies and priorities to fill these positions.

SUSTAINABILITY

In this collaboration, Operation Walk will bring its expertise and experience to develop and operationalize arthritis treatment and orthopedic surgery at the New RCH. The initial investment in capital improvements, staffing and training will be significant. Once the program has been established and the New RCH is able to recruit and train its own clinical staff, the New RCH will be able to adopt and follow-through on the investment to continue to bring arthritis treatment and orthopedic joint replacement to the South Side.

Given the population and payor mix in RCH’s service area, the collaboration believes the majority of patients that will seek arthritis and joint replacement will have Medicare coverage, which will provide sufficient revenue to sustain the program after the Transformation investment has been completed. To address the gap in revenue that may exist for patients who are Medicaid beneficiaries or without coverage, the collaboration has budgeted for an “implant fund” to ensure there is adequate funding to initiate the program and monitor the financial impact of the program on RCH. Should the collaboration find additional funds will be needed to sustain the Center for Arthritis and Joint Replacement, the collaboration will consider additional grants and fundraising to support treatment for non-covered individuals.


40 | P a g e

Hip and knee replacement surgeries are remarkably successful, returning nearly all patients to more active lives. For example, when compared with nonsurgical therapy, hip replacement improves average annual productivity by over $9500 a person, and the direct cost of surgery are more than offset by the net societal lifetime return estimated at over $30, 000 a patient.17 Hip and knee replacements, therefore, not only improve an individual’s health but the socioeconomic health of a community.

Through this novel approach, customized to the needs and desires of each patient, we believe we have a model in which hyper-specialized orthopedic surgery (hip and knee replacement) provided in a lower-cost, local setting (The New RCH) will be cost effective and successful, bringing our community care that is currently unavailable locally and using a model we believe to be superior for at-risk populations.

BUDGET

A brief summary of the proposed budget

is as follows:

Center for Arthritis and Joint Replacement

Project Description: OR, MEP/FP Upgrades and New Equipment Purchase and Installation

Project SF: 5610

Projected Budget/SF: $400

Projected Project Budget: $2,240,000

General Work $896,000

Mechanical $560,000

Electrical $448,000

Plumbing $224,000

Fire Protection $112,000

Operations

Salaries $2,387,500

Equipment & Related Upgrades

$560,380

Implant Fund $625,000

17 Ruiz D. 2013 J Bone Joint Surg Am.

41 | P a g e


The Center for Arthritis and Joint Replacement, will be developed and managed by Dr. Victoria Brander and supervised by an interdisciplinary advisory board of stakeholders. The Center will report into The New Roseland Hospital Strategic Transformation Committee, a 16-person committee that will be led by Chairman Dr. Rupert Evans and includes the current RCH Board of Directors and representative individuals from the local community as well as each collaborating organization.




Bruce Liimatainen New Roseland Hospital Board Member













TBD TCA Health Inc.

The New Roseland Hospital Strategic Transformation Committee will develop all policies, monitor progress, analyze all performance data and ensure all required reporting.

EXH IBI T A P a g e | 1

Application for Transformation Funding Cover Sheet

THE ROSELAND COMMUNTIY HOSPITAL (“RCH”) ADULT BEHAVIORAL HEALTH TRANSFORMATION AND ADOLESCENT SUSTAINABLE HEALING PROGRAM

Primary Contact for Collaboration

Entity: Roseland Community Hospital Name: Tim Egan

Position: CEO Email: [email protected]

Office Phone: 773-995-3015 Address: 45 W. 111th , Chicago, IL 60628

List of Participating Entities

Entity: Maryville Academy Name: Sister Catherine Ryan

Position: President CEO Email: [email protected]

Office Phone: 847-294-1999 Address: 1150 N. River Road, Des Plaines, IL 60016

Entity: Gateway Foundation Name: Teresa Garate

Position: Vice President, Strategic Partnerships and Engagement Email: [email protected]

Office Phone: 312-663-1130 Address: 55 E. Jackson Blvd. Suite 1500, Chicago, IL 60604

Entity: Beloved Community Family Wellness Center Name: Margie Johnson, MS

Position: Chief Executive Officer Email: [email protected]

Office Phone: (773) 651- 3828

Address: 6821 S. Halsted Street, Chicago, IL

Entity: Phalanx Family Services Name: Robbie “Tina” Sanders


Office Phone: 773-291-1086 Address: 837 W. 119th St, Chicago, IL 60643


Entity: TCA Health Name: Veronica Clarke

Position: President and CEO Email: [email protected]

Office Phone: 773-995-6300 Address: 1029 E. 130th Street, Chicago, IL 60628

Entity: Chicago Family Health Center Name: Barrett Hatches


Office Phone: 312-768-5000 Address: 120 W. 111th Street, Chicago, IL 60628

THE ROSELAND COMMUNITY HOSPITAL (“RCH”) OBSTETRIC IMPROVEMENT PLAN






Entity: Chicago Family Health Center Name: Barrett Hatches


Office Phone: 312-768-5000 Address: 120 W. 111th Street, Chicago, IL 60628

Entity: TCA Health Name: Veronica Clarke

Position: President and CEO Email: [email protected]

Office Phone: 773-995-6300 Address: 1029 E. 130th Street, Chicago, IL 60628


Entity: Institute for Womens Health Name: Guillermo Font, MD

Position: Director Office Phone: 708-366-4370

Address: 814 Park, River Forest, IL 60305

THE ROSELAND COMMUNITY HOSPITAL (“RCH”) ARTHRITIS AND ORTHOPEDIC PARTNERSHIP: INCREASING ACCESS TO ORTHOPEDIC HEALING


Entity: Operation Walk Chicago & Northwestern University’s Department of Physical Medicine & Rehabilitation

Name: Victoria Brander MD Position: Associate Professor, Physical Medicine & Rehabilitation

Northwestern University Feinberg School of Medicine Email:

Office Phone: 312-416-4363 Mobile Phone:

Address: Global Health Partners at Northwestern 161 East Chicago Avenue, Suite 960 Chicago, IL 60611 USA

Additional entity

members:

William Gilligan MD from Hinsdale Orthopedics S. David Stulberg MD from Northwestern University’s Department of Orthopedic Surgery Lal Puri MD, Ravi Bashyal MD and Scott Cordes MD from Northshore University Health System Kiran Chekka MD from Global Health Partners at Northwestern





Entity: Operation Walk Chicago & Athletico Physical Therapy Name: Mark Kaufman

Position: Chairman/Founder, Athletico Physical Therapy Ltd Operating Partner, Shore Capital Partners

Email: [email protected] Office Phone: 1-877-ATHLETICO


Mobile Phone: Address: 625 Enterprise Drive

Oak Brook, IL 60523

Entity: Operation Walk Chicago & Achieve Physical Therapy Name: Robert Johnson PT

Position: Physical Therapist Co-Founder and Co-Owner, Achieve Physical Therapy

Email: [email protected] Office Phone: 1-312-642-3963

Address: Achieve Orthopedic Rehab Institute 900 North Michigan Avenue Chicago, IL 60611

Community Health

Needs Assessment

2019

EXHIBIT BP a g e | 1

Roseland Hospital 2019 Community Health Needs Assessment (CHNA)

2

Table of Contents

I. Intro to Roseland Hospital and Description of Roseland Hospital Service Area……………….........… 3

II. Overview of the Community Health Needs Assessment (CHNA) process……………………………… 4

III. Key Community Health Data and Community Input in Communities Served by RH............................ 6

Community Input Survey.................................................................................................................. 6

Community Focus Groups................................................................................................................8

Community Priorities.............................................................................................................9

Secondary Data...............................................................................................................................12

IV. Summary of Roseland Hospital’s Previous CHNA Implementation Activities, 2013-2016………........ 27



3

I. Intro to Roseland Hospital and Description of Roseland Hospital Service Area Roseland Hospital’s service area spans across six zip codes containing 12 community areas in the City of Chicago (Figure 1). Around 300,000 individuals reside in Roseland Hospital’s service area (2016 5-year estimates, American Community Survey) with 86% identifying as Non-Hispanic African American/black, 8% Non-Hispanic white, and 4% Hispanic/Latinx. Figure 1. Roseland Hospital Service Area Map and List of Communities

Zip codes in Roseland Hospital’s service area:

60617

60619

60620

60628

60643

60827

Community Areas in Roseland’s Hospital’s service area

Auburn Gresham Morgan Park

Avalon Park Pullman

Beverly Riverdale

Burnside Roseland

Chatham Washington Heights

Greater Grand Crossing West Pullman



4

II. Overview of the Community Health Needs Assessment (CHNA) process Roseland Hospital (RH) and members of the Alliance for Health Equity (AHE), a collaborative of over 30 hospitals, 7 health departments, and 100 community partners, worked together between March 2018 through March 2019 to conduct a comprehensive Community Health Needs Assessment (CHNA) in Cook County.

Summary of our collaborative health equity approach to CHNA The AHE's collaborative CHNA combined robust public health data, community input, existing research, existing plans, and existing assessments to document the health status of communities within Chicago and Suburban Cook County and to highlight systemic inequities that are negatively impacting health. The CHNA also provided insight into community-based assets and resources that should be supported and leveraged during the implementation of health improvement strategies. AHE completed this collaborative CHNA between March 2018 and March 2019. Primary and secondary data from a diverse range of sources were utilized for robust data analysis and to identify community health needs in Chicago and Suburban Cook County. The Illinois Public Health Institute (IPHI) worked with the CHNA committee and steering committee to design and facilitate a collaborative, community-engaged assessment. As with the 2015-2016 collaborative CHNA, this 2019 CHNA process is adapted from the Mobilizing for Action through Planning and Partnerships (MAPP) model, a community-engaged strategic planning framework that was developed by the National Association for County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). Both the Chicago and Cook County Departments of Public Health use the MAPP framework for community health assessment and planning. The MAPP framework promotes a system focus, emphasizing the importance of community engagement, partnership development, and three types of data--secondary data, community input, and system analysis. AHE chose this inclusive, community-driven process to leverage and align with health department assessments and to actively engage stakeholders, including community members, in identifying and addressing strategic priorities to advance health equity. Primary data for the CHNA was collected through four methods:

Community input surveys

Community resident focus groups and learning map sessions

Health care and social service provider focus groups

Two stakeholder assessments led by partner health departments-Forces of Change Assessment and Health Equity Capacity Assessment

Secondary data for the CHNA was compiled and analyzed in partnership with epidemiologists from the Chicago Department of Public Health (CDPH) and Cook County Department of Public Health (CCDPH), IPHI, and member hospitals. The partners worked with the AHE steering committee to select a common set of indicators based on an adapted version of the County Health Rankings and Roadmaps Model. Data was organized in the following categories: overview of health inequities; social and structural determinants of health; mental health and substance use disorders; access to quality health care and community resources; and chronic conditions. Secondary data used in the CHNA were compiled from a range of sources, including the American Community Survey from the U.S Census Bureau, the Behavioral Risk Factor Surveillance

The Affordable Care Act (ACA) includes a number of components designed to strengthen the healthcare

system’s focus on prevention in addition to treating people who are ill. Under the ACA, hospitals are now

required to conduct a CHNA every three years that has specific components including:

a description of the CHNA process, methods, collaborations, prioritized community health needs, and a

description of existing facilities and resources in the community;

input from persons representing the broad needs of the community;

the CHNA must be posted and made available to the public; and

the Hospital must adopt and submit an implementation strategy to IRS within 5½ months of posting the

CHNA.



5

System, and the Health Chicago Survey from the Chicago Department of Public Health. Additional information can be found in Figures 6 and 7 of the full Alliance for Health Equity CHNA report. In alignment with the purpose, vision, and values, the Alliance for Health Equity prioritizes engagement of community members and community-based organizations as a critical component of assessing and addressing community health needs. Community partners have been involved in the assessment and ongoing implementation process in several ways both in providing community input and in decision-making processes (Figure 5 of Full CHNA Report). The community-based organizations engaged in the Alliance for Health Equity represent a broad range of sectors such as workforce development, housing services, food security, community safety, planning, community development, immigrant rights, primary and secondary education, faith communities, behavioral health services, advocacy, policy, transportation, older adult services, health care services, higher education, and many more. All community partners work with or represent communities that are disproportionately affected by health inequities such as communities of color, immigrants, youth, older adults and caregivers, LGBTQ+, individuals experiencing homelessness or housing instability, individuals living with mental illness or substance use disorders, individuals with disabilities, veterans, and unemployed youth and adults. AHE has several focus areas that different partners are working together to address including the social and structural determinants of health, mental health and substance use disorders, chronic conditions, access to care and community resources, maternal and child health, and injury prevention. Alliance for Health Equity - Overall Community Health Focus Areas


https://allhealthequity.org/wp-content/uploads/2019/06/FINAL_2019_CHNA-Report_Alliance-for-Health-Equity.pdf


6

III. Key Community Health Data and Community Input in Communities Served by

Roseland Hospital The following section highlights primary and secondary data related specifically to the Roseland Hospital service area. Primary Data Community Input Survey The community input survey was a qualitative tool designed to understand the community health needs and assets from the community residents. The community input surveys, along with focus group data, informed the priority areas and strategies for community health improvement in Chicago and suburban Cook County. There were 324 survey respondents from the Roseland Hospital service area. Table 1. Demographics of Community Input Survey Respondents in Roseland Hospital Service Area. The community survey asked residents about top health issues, top needs for a healthy community, greatest



7

strengths in the community, and what needs to be improved.

The top health issues identified by respondents in the communities served by Roseland Hospital were

diabetes, mental health, age-related illness, substance-use, and cancers. All of these health issues were

selected by 30% or more of survey respondents.

Figure 3. Community Input Survey Data – Top Health Issues (Note: 313 respondents from the Roseland Hospital service area answered this question and multiple responses allowed per respondent)

Survey respondents also identified the top needs for a healthy community. These top needs include access to

healthcare and mental services, safety and low crime, access to community services, access to healthy foods,

and quality job opportunities (Figure 4). These community needs were selected by 25% or more of the survey

respondents.

4%

4%

4%

4%

7%

8%

9%

9%

14%

28%

30%

32%

33%

33%

38%

44%

Other

Child abuse

Mother and Infant health

Motor vehicle crash injuries

Infectious diseases

Dental problems

Lung disease

Sexually Transmitted Infections

Obesity

Heart disease and stroke

Cancers

Substance-use

Violence

Age-related illness

Mental health

Diabetes



8

Figure 4. Community Input Survey Data – Most Important Factors for a Healthy Community (Note: 313 respondents from the Roseland Hospital service area answered this question and multiple responses allowed per respondent)

Figure 5. Community Input Survey Data – Greatest strengths and areas for improvement

Community Focus Groups

Between August 2018 and February 2019, Alliance for Health Equity partners collaborated to conduct a total of

57 focus groups with priority populations such as veterans, individuals living with mental illness, communities

of color, older adults, caregivers, teens and young adults, LGBTQ+ community members, adults and teens

2%

8%

8%

9%

9%

12%

15%

15%

16%

19%

20%

23%

26%

31%

34%

40%

45%

Other

Arts and cultural events

Affordable childcare

Diversity and inclusion

Parks and recreation

Access to transportation

Strong family life

Strong community cohesion and social networks

Religion or spirituality

Affordable housing

Clean environment

Good schools

Quality job opportunities

Access to healthy food

Access to community services

Safety and low crime

Access to health care and mental health services

What are the greatest strengths in the community where you live? (open-ended, n=254)

Responses most commonly related to the following categories:

Community Cohesion

Transportation

Safety and Low Crime

Education

Parks and Recreation

What is one thing that you would like to see improved in your community? (open-ended, n=227)

Responses most commonly related to the following categories:

Safety and Low Crime

Economic Development

Health Care

Food Accessibility

Infrastructure

Community Cohesion

Cleanliness



9

experiencing homelessness, families with children, faith communities, adults with disabilities, and children and

adults living with chronic conditions such as diabetes and asthma.

Thirty-six focus groups were conducted by IPHI and 21 Learning Map Sessions were led by West Side United,

a regional collaboration of hospitals serving the West Side of Chicago and West Suburban Cook County, with

notetaking by IPHI. IPHI developed the focus group questions using resources from existing CHNA toolkits and

peer-reviewed studies, in consultation with the CHNA committee and colleagues at partner health

departments. Each focus group was hosted by a hospital or community organization. The sessions were

approximately 60-90 minutes long with an average of 8-12 participants. A total of 5 learning map

sessions/focus groups were conducted with residents living within RH’s service area (Table 2).

Table 2. Focus group sessions conducted within Roseland Hospital’s service area

Focus Group and Learning Map Sessions

ABJ Community Services

Affinity Community Services

Gary Comer Youth Center

NAMI Chicago Family Members

NAMI Chicago Individuals

Teen Living Program (Currently Ignite)

Theace Goldsberry Community House (x2)

Timothy Community Corporation

Community Priorities

The major themes that emerged from focus groups on the South Side included social determinants of health,

food systems, chronic diseases such as asthma and diabetes, access to care and community resources,

behavioral health, and community safety and violence. Additional community input is highlighted in the

secondary data section.

Social Determinants of Health

Socioeconomic inequities were mentioned by several focus groups. Inequities in community economic

investment and development, employment opportunities, quality affordable housing, education opportunities,

community safety, and food access were highlighted.

Employment

A lack of employment opportunities was one of the most frequently discussed issues among focus group

participants. Participants living in the South regions of the county described having the least number of quality

job opportunities and employment resources. However certain populations such as those living with mental

illness, young adults, homeless individuals, and formerly incarcerated were highlighted as having significant

barriers to employment regardless of their geographic location. In addition, multiple youth of color on the South

Side described instances where they felt that their racial or ethnic background prevented them from obtaining

employment. Within certain communities, jobs are available, but they are described as lacking benefits, part-

time, temporary, and/or low paying.

“Access is one of the main things within our community - black community, people of color

community. There are many stressors when we don’t have benefits, jobs, and access to healthcare.”

- Community resident from Affinity Community Services focus group



10

Education

Education was another widely discussed topic among focus group participants who mentioned the importance

of quality education opportunities. The major education-related concerns expressed by focus group

participants on the South Side of Chicago included school closures and diminishing education opportunities

and poor-quality schools. Youth on the South Side of Chicago mentioned that school closures have led to more

student dropouts. Multiple adult participants across Chicago mentioned serious concerns about the quality of

Chicago schools, particularly schools that are majority students of color. Participants identified education as an

underlying root cause of unemployment. Additionally, they linked education issues to many of the same

problems caused by unemployment such as higher rates of community violence, increases in health issues

such as substance use disorders and mental illness, and generational poverty.

Housing

Homelessness and housing instability are associated with high rates of mortality and morbidity (Kushel, Gupta,

Gee, & Haas, 2006). Housing instability does not have a standard definition and encompasses several issues

including difficulty paying rent, overcrowding, frequent moves, living with relatives, and cost-burdened housing

(Frederick, Chwalek, Hughes, Karabanow, & Kidd, 2014; Kushel et al., 2006).

“I think I have mold in my house. I have a lot of stress in me, I could be managing it better, but it is still there.”

- Community resident from ABJ Community Services focus group

Focus group participants on the South Side of Chicago highlighted that segregation results in poor quality

housing being concentrated in communities of color with high rates of violence and poverty. Some of the

housing quality issues mentioned included dilapidated and crumbling structures, incomplete units, plumbing

problems, and pest infestations. Renters described how these issues can be left unaddressed by landlords and

property owners for extended periods of time or indefinitely. Some homeowners described these issues within

their own homes but stated that they lacked the financial resources to address them. The health problems that

were most often associated with these housing quality problems included exposure to mold, asthma, and

stress. Children were identified as being at a higher risk for health problems associated with poor quality

housing. A further complication is that several residents reported living in buildings where smoking is allowed

within units and explained that this can further exacerbate health issues such as asthma.

Homelessness

Adults and youth who are experiencing homelessness and housing instability reported several health problems

that were a direct result including hypothermia, frost bite, severe weight fluctuations, gangrene, poor sleeping

habits, and severe stress. Behavioral health conditions such as mental illness and substance use disorders

were identified as both a cause of homelessness and the direct result of homelessness or housing instability.

“Not having the right shelter to go to. There are a lot of bad shelters where people do things you don’t

want to be involved in.”

- Community resident from Teen Living Program focus group

Homeless shelters and housing services were difficult to access for some community members. Homeless

youth reported that shelters are particularly dangerous for teens and young adults and that they often resorted

to staying on the streets or breaking into abandoned houses as an alternative. Multiple homeless teenage

youth under age 18 reported being turned away from shelters in favor of families with children. They explained

that they felt it was often due to them being young men of color. As a result, youth emphasized the need for

more youth-specific services and homeless resources.



11

Food Systems

Participants on the West and South Sides of the city county reported a high proportion of fast food restaurants

and limited access to grocery stores selling healthier options. Community members living with chronic diseases

such as diabetes explained that living in communities with less access to healthy food options and more

access to fast food made it more difficult to manage their conditions.

Both youth and adults from multiple communities reported that having a healthy diet can be difficult for several

other reasons as well including:

• youth often find healthy foods unappealing particularly if they have had limited exposure to them;

• the cost of healthy foods was frequently described as a barrier, but there was often disagreement among groups on this issue;

• food pantries do not always provide healthy options;

• fast foods are more convenient particularly for working parents with children; and

• many lack the knowledge of how to prepare healthy meals.

“I work out a lot but I'm not always good with food. It is expensive to eat healthy food, but it is more

expensive to be sick. It scares me because unhealthy food is there. You eat things just because you

want to eat late at night.”

- Community resident from Timothy Community Corporation focus group

Community Safety and Violence

Community safety and violence was a cross-cutting theme that mentioned by multiple focus groups in a variety

of contexts. The mostly commonly mentioned safety issues included gun violence, gang activity, drug-related

activities, burglaries, and armed robberies. Participants related that the prevalence of violence in their

communities has led to health issues such as chronic stress, decreased mental well-being, trauma among

children and adults, and decreased physical activity due to a reluctance to exercise in unsafe neighborhoods.

Behavioral Health

A major theme that emerged from the focus groups was chronic stress. Focus group participants linked chronic

stress to several different health effects. Community members reported that stress impacted their ability to

cope with chronic illnesses such as diabetes and could disrupt their ability to engage in behaviors such as

healthy eating and exercise. Parents caring for children with asthma reported that the stress of caring for a

family member had negative impacts on their mental and physical well-being. Youth living with asthma

reported that stress was a trigger for their asthma attacks. Participants from one focus group directly linked

chronic stress to the development of substance use disorders.

In addition to chronic stress, focus group participants described multiple situations that have led to trauma

among community members living on the South Side including:

• child abuse,

• domestic violence,

• living in high crime neighborhoods,

• continual discrimination against marginalized racial and ethnic groups, and

• homelessness.

“Everyone in the city is suffering from some level of trauma due to fear”

- Community resident from Affinity Community Services focus group

Chronic Diseases

In addition to behavioral health, chronic diseases such as asthma and diabetes were identified as major health

priorities for South Side community members. The major themes that were mentioned by participants included:



12

• social determinants of health such as poverty, limited access to healthy foods, exposure to

violence, and housing conditions are both underlying root causes of chronic disease and are

barriers to the management of chronic disease;

• education about preventing chronic disease, risk factors, and when to seek medical help is lacking

in communities;

• chronic illness such as asthma can be isolating for youth, parents, and adults;

• taking care of a child with a life-threatening chronic illness can often cause severe chronic stress;

and

• community groups that share information about resources and support each other with adjusting to

healthier lifestyles would be extremely helpful to communities.

Access to care and community resources

Multiple participants on the South Side of Chicago mentioned barriers that impede their ability to access the

healthcare system and community resources including:

• the complexity of obtaining and keeping public benefit coverage;

• the high cost of some private insurance plans;

• an unequal distribution of healthcare services and facilities; and

• poor quality healthcare options particularly for LGBTQ+ individuals and people of color.

Secondary Data

This section highlights key data pertaining to social determinant of health indicators including, socioeconomic

factors, housing, food insecurity, community belonging, and health outcomes. These quantitative data findings

are supported by community members’ input during focus group sessions to showcase the importance of the

findings from the community health needs assessment.

Poverty

There is an extreme disparity in poverty rates among the communities of Roseland Hospital’s service area with

Riverdale having a rate of 66% while Beverly has a poverty rate of 4%. Ten out of the 13 communities within

Roseland Hospital’s service area have more than 20% of their population living in poverty, which is higher than

the citywide rate of 19% (Figure 6). Of particular concern from a health perspective, child poverty is very high

in the Roseland Hospital service area. Riverdale has a child poverty rate of 74%, more than twice as much as

the citywide child poverty rate of 28% (Figure 7).



13

Figure 6. Percentage of persons in poverty (100% Federal Poverty Level-FPL), 2012-2016

Data Source: American Community Survey, 2012-2016

Figure 7. Percentage of children in poverty, (100% Federal Poverty Level-FPL), 2012-2016


Income and Unemployment

Median household incomes within the communities of Roseland Hospital’s service area are extremely

divergent with Beverly having a median household income of $93,037 while Riverdale has a median household

income of $14,415. With the exception of Beverly and Morgan Park, all of the communities in RH’s service

area have a lower median household income that the citywide amount (Figure 8). Unemployment rates are

higher in all communities of RH’s service area than the citywide unemployment rate of 8%, with Riverdale have

the highest unemployment rate at 37%. This is more than five times higher than Beverly’s unemployment rate

of 7%.

4%

18%

19%

19%

21%

25%

29%

29%

29%

30%

30%

33%

37%

66%

Beverly

Morgan Park

Washington Heights

Chicago

Avalon Park

Pullman

Auburn Gresham

Chatham

West Pullman

South Deering

Roseland

Burnside

Greater Grand Crossing

Riverdale

4%

8%

18%

21%

28%

31%

32%

37%

39%

42%

44%

45%

55%

74%

Beverly

Burnside

Avalon Park

Morgan Park

Chicago

Washington Heights

Pullman

Chatham

Roseland

Auburn Gresham

West Pullman

South Deering


Riverdale



14

Figure 8. Median household income in the past 12 months (in inflation-adjusted dollars)


Figure 9. Percentage of unemployed adults 16 years and over in the civilian labor force


Housing

Housing is considered to be cost-burdened when a household’s housing costs exceed 30% of that household’s

total income. In Roseland Hospital’s service area, most communities have higher rates of cost burdened

households than the citywide rate of 36%. Burnside has the highest cost burdened household rate at 50%

while Beverly has the lowest (19%).

$14,415

$23,684

$28,154

$29,285

$31,878

$34,612

$36,777

$37,208

$37,675

$38,562

$46,848

$53,006

$59,027

$93,037

Riverdale

Burnside


Auburn Gresham

South Deering

Chatham

Pullman

Avalon Park

West Pullman

Roseland

Washington Heights

Chicago

Morgan Park

Beverly

7%

8%

11%

18%

19%

19%

20%

24%

24%

24%

25%

25%

26%

37%

Beverly

Chicago

Morgan Park

Burnside

Washington Heights

Chatham

Pullman

Auburn Gresham


Avalon Park

West Pullman

South Deering

Roseland

Riverdale



15

Figure 10. Percentage of cost-burdened households (housing costs exceed 30% of household income)


Education

The rates of individuals with less than a high school diploma or equivalent within the communities of Roseland

Hospital’s service area vary widely. At 3%, Beverly has the lowest percentage of individuals with less than a

high school degree or equivalent while Riverdale has the highest percentage at 24% - eight times higher.

As education is an important social determinant of health, because the rate of poverty is higher among those

without a high school diploma or GED, this is of particular concern.

Figure 11. Percentage of Individuals with Less Than a High School Diploma or Equivalent


“There are a lot of jobs out here, but we are not qualified. We don’t have the education.” - Community resident from Teen Living Program focus group (Youth Participant)

19%

30%

36%

37%

37%

39%

41%

42%

43%

43%

45%

46%

48%

50%

Beverly

Morgan Park

Chicago

Washington Heights

South Deering

Pullman

West Pullman

Riverdale

Roseland

Avalon Park

Auburn Gresham

Chatham


Burnside

3%

9%

10%

12%

12%

13%

15%

15%

16%

16%

17%

19%

20%

24%

Beverly

Morgan Park

Washington Heights

Avalon Park

Chatham

Pullman

Roseland


Chicago

West Pullman

Auburn Gresham

Burnside

South Deering

Riverdale



16

Commuters Using Active Transportation

Active transportation (commuting to work by walking, biking, or public transit) is another important social

determinant of health. There is a wide range in the rates of active transportation between the communities in

Roseland Hospital’s service area. Workers who reside in Riverdale and Greater Grand Crossing report the

highest rates of using active transportation at 43% and 42% respectively. Conversely, workers in Morgan Park

have the lowest rate of workers using active transportation at 16%.

Figure 12. Percentage of workers aged 16 years and older who commute to work by walking, biking, or

public transit


Life Expectancy

Life expectancy is the average number of years an individual is expected to live. Figure 13 displays the life

expectancy for the communities within Roseland Hospital’s service area. There is an eight-year disparity in life

expectancy between Beverly (78 years) and Burnside (70 years). With the exception of Beverly, all community

areas in Roseland Hospital’s service area have lower life expectancies than the citywide life expectancy of 77

years.

16%

21%

22%

23%

23%

25%

33%

35%

35%

35%

36%

38%

42%

43%

Morgan Park

Avalon Park

West Pullman

Beverly

South Deering

Washington Heights

Auburn Gresham

Roseland

Pullman

Burnside

Chatham

Chicago


Riverdale



17

Figure 13. Life expectancy at birth within Roseland Hospital’s service area (in years)

Data Source: CDPH, CCDPH, IDPH Vital Stats, 2016

Maternal and Child Health

Maternal and child health outcomes vary across the communities of Roseland Hospital’s service area,

highlighting the overall inequities present. Figure 14 shows the percent of births with low birthweight ranges

between 8% in Beverly to 16% in Burnside. Again, Beverly has the lowest rate of infant mortality (Figure 15) at

5 deaths of infants less than one year old per 1,000 while Avalon Park has a rate of 21 per 1,000. There is an

extreme disparity in teen birth rates within the communities of RH’s service area: Greater Grand Crossing has

a teen birth rate that is eight times greater than the teen birth rate in Beverly. With the exception of Beverly,

and Morgan Park for teen birth rate, all communities in RH’s service area have higher rates than the citywide

rates for maternal and child health indicators.

Figure 14. Low Birthweight (Percent of births with a birthweight less than 2,500 grams among the total

number of number of births)


70

71

72

72

72

72

72

74

74

75

75

75

77

78

Burnside


Riverdale

Pullman

West Pullman

Roseland

Auburn Gresham

Chatham

Washington Heights

South Deering

Avalon Park

Morgan Park

Chicago

Beverly

8%

10%

11%

11%

13%

13%

13%

14%

14%

14%

14%

15%

15%

16%

Beverly

Chicago

Morgan Park

South Deering

Pullman

Avalon Park

West Pullman

Riverdale

Washington Heights

Roseland

Chatham


Auburn Gresham

Burnside



18

Figure 15. Infant mortality (Number of deaths of infants less than one year old per 1,000 live births)


Figure 16. Teen births (Total births where the mother's age is 15-19 years of age at time of delivery per

1,000 population of females aged 15-19 years)


Medical Professional Shortages

A Health Professional Shortage Areas (HPSAs) are identifications of health care provider shortages in primary care,

mental health, or dental health. Primary care and mental health HPSAs are scored on a scale of 0-25 with higher

scores indicating greater need.1 As shown in Figure 17, the communities of Roseland Hospital’s service area,

particularly Greater Grand Crossing, are in great need of primary care health providers. In regard to mental health,

all communities in Roseland Hospital’s service area have mental health professional shortages as indicated in Figure

18.

1 Health Professional Shortage Areas (HPSAs). (May 2019). Retrieved from: https://bhw.hrsa.gov/shortage-designation/hpsas on

October 31, 2019.

5

7

11

12

12

13

13

13

13

14

14

15

19

21

Beverly

Chicago

South Deering

Roseland

West Pullman

Riverdale

Chatham

Morgan Park

Burnside


Auburn Gresham

Washington Heights

Pullman

Avalon Park

6

16

25

32

32

34

34

39

40

41

42

44

48

53

Beverly

Morgan Park

Chicago

Avalon Park

Pullman

Washington Heights

South Deering

Roseland

Auburn Gresham

Chatham

West Pullman

Riverdale

Burnside



https://bhw.hrsa.gov/shortage-designation/hpsas%20on%20October%2031

https://bhw.hrsa.gov/shortage-designation/hpsas%20on%20October%2031


19

Figure 17. Primary Care Health Professional Shortage Area

Source : https://data.hrsa.gov/maps/map-tool/

Figure 18. Mental Health Professional Shortage Area

Source : https://data.hrsa.gov/maps/map-tool/

Mental Health and Alcohol

Mental Health provider shortages are experienced across the Roseland Hospital service area. The rate of

emergency room usage due to mental health varies between zip codes. The lowest rate is 107 per 10,000 persons in

zip code 60643 and the highest is 167 per 10,000 persons in zip code 60619 (Figure 19). Emergency department

usage due to substance use is almost three times higher at a rate of 178 ED visits per 10,000 persons in zip code

60827 than the next highest rate of 63 ED visits per 10,000 persons in zip code 60628. Zip codes 60617 and 60643

have the lowest rates of emergency department visits at 35 per 10,000 persons each (Figure 20).


https://data.hrsa.gov/maps/map-tool/


20

Figure 19. Emergency Department (ED) visits due to Mental Health among adults, (age-adjusted rate per

10,000)

Data Source: Illinois Hospital Association COMPdata, 2015-2017 (Healthy Communities Institute analysis)

Figure 20. Emergency Department (ED) Rate due to Substance Abuse, (age-adjusted rate per 10,000)


Figure 21 displays the rates of emergency room usage due to alcohol which range from 50 per 10,000 in zip code

60643 to 106 per 10,000 in zip code 60619 (Figure 21).

Figure 21. Emergency Department (ED) Rate due to Alcohol, (age-adjusted rate per 10,000)


Leading Causes of Death and Chronic Disease Risk Factors

Rates of obesity and overweight adults in Chicago are similar to national rates; 39.8% of adults reported being

overweight, and 31% of adults reported obesity in Chicago for the time period between 2015 and 2017. With the

exception of Riverdale and Pullman, all communities served by Roseland Hospital have obesity rates higher than the

citywide rate (data for Burnside not available). In Chicago, the percentage of adults with self-reported diabetes is 9%.

Figure 22 shows the percentage of adults with self-reported diabetes in most of the communities that Roseland

Hospital serves.

107

137

148

151

158

167

60643

60617

60628

60827

60620

60619

35

35

51

61

63

178

60643

60617

60620

60619

60628

60827

50

64

69

77

91

106

60643

60628

60827

60620

60617

60619



21

Figure 22. Percentage of adults (18 years and older) who reported that a doctor, nurse or other health

professional has diagnosed them with diabetes (excludes pre-diabetes or diabetes only during pregnancy) Data for Burnside and Riverdale not available.

Data Source: Healthy Chicago Survey, Chicago Department of Public Health, 2016

“One of my concerns is that I have diabetes and so does my daughter. Sometimes when I get home, I make food and sometimes I just grab chicken. I hear some people meal prep. I leave home at 6am and get home at 6 or 7pm, it is hard for me.”

- Community resident from Timothy Community Corporation focus group

The rate of emergency department visits due to diabetes is extremely high in zip code 60827 at a rate of 165 per

10,000 people (Figure 22).

Figure 23. Emergency Department (ED) Rate due to Diabetes, (age-adjusted rate per 10,000)


Emergency department visits due to asthma among adults ranges from 87 visits per 10,000 persons in zip

code 60643 to 158 visits per 10,000 persons in zip code 60619 (Figure 24). Emergency department visits due

to asthma among children within Roseland Hospital’s service area is of great concern as rates are high. As

Figure 25 shows, all zip codes in RH’s service area have rates of emergency department visits due to asthma

that are higher than 100 visits per 10,000 children, with zip code 60619 having the highest rate at 217 visits per

10,000 children.

Figure 24. Emergency Department (ED) Rate due to Asthma, (age-adjusted rate per 10,000)

7%

7%

9%

10%

10%

12%

14%

14%

15%

19%

22%

28%

Washington Heights


Chicago

Beverly

West Pullman

Morgan Park

Auburn Gresham

Chatham

Avalon Park

South Deering

Roseland

Pullman

51

57

62

63

69

165

60643

60620

60617

60619

60628

60827



22


“I always take my child to the ER. As he gets older, it’s has gotten more severe, and he is agitated. He asks questions about when he can stop taking medications.”

- Community resident from Theace Goldsberry Community House focus group

Figure 25. Emergency Department (ED) Rate due to Pediatric Asthma, (age-adjusted rate per 10,000)


HIV

In 2017, the total amount of new diagnosis of HIV in Chicago was significantly lower than the previous year.

However, HIV still disproportionately effects individuals aged 20-29, men, Non-Hispanic African American/Blacks,

and men who have sex with men (MSM)2. Figure 26 displays the rates of people newly diagnosed with HIV. All of the

communities within RH’s service area (of which there is available data) have a higher rate of individuals newly

diagnosed with HIV compared to the citywide rate of 31 per 100,000 persons. Most communities within Roseland

Hospital’s service have lower rates of individuals living with HIV (prevalence) than the citywide rate of 903 people

living with HIV per 100,000 persons. The communities of Chatham and Greater Grand Crossing have rates of people

living with HIV that are higher than the citywide rate at 1047 per 100,000 persons and 1098 per 100,000 persons

respectively (Figure 27).

2 Chicago Department of Public Health. HIV/STI Surveillance Report 2017. Chicago, IL: City of Chicago, December 2018.

87

115

116

124

143

158

60643

60617

60628

60827

60620

60619

134

158

170

184

202

217

60643

60628

60617

60827

60620

60619



23

Figure 26. Crude rate of people newly diagnosed with HIV per 100,000 people Data for Beverly, Burnside, Morgan Park, Pullman, Riverdale, and South Deering not available.


Figure 27. Crude rate of people living with HIV per 100,000 people


Food Insecurity and Food Access

There is an extreme disparity in the risk of food insecurity among the communities of Roseland Hospital’s

service area. Beverly has the lowest risk of food insecurity at 11% risk while the portion of Riverdale that is

within Chicago city limits has 84% risk of food insecurity. Most communities within RH’s service area have a

higher risk of food insecurity than the citywide risk of 39% (Figure 28).

“Build more stores like Whole Foods, Cermack, and Mariano’s on the low ends instead of places like Popeyes.”

- Community resident from Gary Comer Youth Center focus group

31

34

39

42

45

47

49

52

Chicago

West Pullman

Chatham

Washington Heights

Roseland

Auburn Gresham

Avalon Park


215

324

475

562

569

621

651

683

759

844

892

903

1047

1098

Beverly

Riverdale

Morgan Park

Washington Heights

South Deering

Roseland

West Pullman

Pullman

Auburn Gresham

Avalon Park

Burnside

Chicago

Chatham




24

Figure 28. Risk (Percent) of Food Insecurity Among Communities within Roseland Hospital’s Service Area

Data Source: US Census Bureau, American Community Survey 2013-2017

Health Behaviors Related to Food

In regard to health behaviors related to food consumption, there is a great among the communities of Roseland

Hospital’s service area. Most of the communities that Roseland Hospital serves have a lower percentage of fruit and

vegetable consumption than the citywide percentage of 31% with Roseland and Avalon Park reporting the lowest

percentages, at 14% and 8% respectively (Figure 29). With the exception of Beverly, all of the communities in

Roseland Hospital’s service area have higher percentages of daily sweetened beverage consumption than the

citywide percentage of 26% (Figure 30) with Avalon Park having the highest percentage at 60%.

Figure 29. Percentage of adults who reported eating five or more servings of fruits and vegetables

(combined) daily Data for Burnside and Riverdale not available.

Data Source: Healthy Chicago Survey, Chicago Department of Public Health, 2015-2017

11%

29%

32%

36%

36%

39%

40%

40%

41%

45%

50%

52%

53%

53%

55%

84%

Beverly

Morgan Park

All Cook County

Chatham

Avalon Park

Chicago

Pullman

Washington Heights

Burnside

Roseland

West Pullman

Auburn Gresham

South Deering

Riverdale - Suburb


Riverdale - Chicago

8%

14%

16%

20%

21%

21%

22%

24%

31%

32%

34%

40%

Avalon Park

Roseland

Washington Heights

Auburn Gresham

Pullman

West Pullman

South Deering

Chatham

Chicago


Morgan Park

Beverly



25

Figure 30. Percentage of adults who drank soda or pop or other sweetened drinks like sweetened iced tea,

sports drinks, fruit punch or other fruit-flavored drinks at least once per day in the past month Data for Burnside and Pullman not available.


Community Belonging/Engagement

There is a wide range of percentage of adults who report a sense of community belonging within the communities

that Roseland Hospital serves (Figure 31). The community of Beverly reports a high percent of a sense of community

belonging at 87%. Pullman, Morgan Park, and Washington Heights report a higher percentage than the citywide rate

of 63%.

Figure 31. Percentage of adults who reported that they strongly agree or agree that they really feel part of

their neighborhood Data for Burnside not available.


16%

26%

27%

28%

28%

32%

32%

41%

43%

48%

50%

60%

Beverly

Chicago

Chatham


South Deering

Roseland

Morgan Park

Washington Heights

Auburn Gresham

West Pullman

Riverdale

Avalon Park

28%

55%

55%

55%

55%

59%

59%

60%

63%

63%

68%

71%

87%

Riverdale


Avalon Park

West Pullman

Chatham

Roseland

Auburn Gresham

South Deering

Chicago

Washington Heights

Morgan Park

Pullman

Beverly



26

Community Safety and Violence

Similar to Community Belonging, communities within Roseland Hospital’s service area report a wide range of

perceived neighborhood safety (Figure 32). Beverly and Pullman report higher rates of perceived

neighborhood safety than the citywide rate of 78% (92% and 89% respectively). Almost all communities that

Roseland Hospital serves, with the exception of Beverly and Morgan Park, have a higher rate of violent crimes

compared to the citywide rate (Figure 33). Greater Grand Crossing has the highest violent crime rate with

10,680 incidences of violence per 100,000 persons.

Figure 32. Estimated Percent of Adults who Report Feeling Safe in their neighborhood all of the time or most

of the time Data for Burnside not available.


Figure 33. Crude violent crime* rates (per 100,000 population)

*Crime incidents relating to violence including homicide, criminal sexual assault, robbery, aggravated assault, and aggravated battery

Data Source: Chicago Police Department, 2016

32%

54%

57%

58%

62%

63%

66%

66%

68%

76%

78%

89%

92%

Riverdale

Auburn Gresham


Avalon Park

West Pullman

South Deering

Chatham

Roseland

Washington Heights

Morgan Park

Chicago

Pullman

Beverly

1797

4214

4491

5711

6149

6809

6824

6981

7916

8165

8437

9417

10680

Beverly

Morgan Park

Chicago

Washington Heights

South Deering

West Pullman

Burnside

Avalon Park

Roseland

Auburn Gresham

Pullman

Chatham




27

IV. Summary of Roseland Hospital’s Previous CHNA Implementation Activities, 2016-2019

Roseland Hospital’s previous implementation strategies were based on assessed community health needs and

included the following activities:

Access to Care

Mobile health services were established that addressed critical needs for services that were unavailable locally. The hospital’s Dental Services Van treated 1,182 children in 2019.The program continues to grow, and the number of children treated in 2020 is expected to exceed 2,000.

Roseland expanded outpatient services through a new outpatient clinic that provided follow-up services for primary care, obstetrics, cardiology, asthma, and wound care.

The hospital established a wound healing center to treat patients with critical wounds.

An outpatient pharmacy within the hospital was opened to provide patients with the ability to leave the hospital with prescribed medications.

Maternal-Child Health

A Maternal Fetal Medicine clinic was established to address the critical issue of high-risk pregnancies and to increase positive outcomes for both mothers and babies.

Substance Use Disorders

A DHS grant was used to expand warm hand-offs of medically stabilized patients experiencing opioid use disorder diagnoses to continued care within linked treatment centers. As a result of the program, the Medical Stabilization Unit Readmission rate decreased from 75% to 5%.

In 2019, Roseland Hospital was an active member of the Alliance for Health Equity’s Hospital Opioid Treatment and Recovery Learning Collaborative. The collaborative provided technical assistance and opportunities for shared learning through six in-person learning sessions over 9-months on topics such as warm-handoffs, Medication for Opioid Use Disorders (MOUD), Naloxone distribution, program design, staff training, funding structures, legal barriers, and more. During the hospital’s participation in the learning collaborative progress was made in several areas including:

o Increased community outreach through the establishment of recovery coaches. o Increased capacity to provide MAT – a provider attended MAT waiver training. o At least four new partnerships with community MOUD treatment providers. o The development of a draft policy for naloxone distribution in ED and outpatient units at

discharge. o Outpatient pharmacists were trained on the naloxone standing order.



28

This Community Health Needs Assessment (CHNA) was approved by representatives of the Roseland Community Hospital board on February 03, 2020. To comment on this CHNA or to request more information or paper copies of the CHNA, please contact Roseland Community Hospital at [email protected] or (773) 995-3015 Hospital Administration.


mailto:[email protected]

GENERAL ASSEMBLY STATE OF ILLINOIS

April 8, 2021

Director Theresa Eagleson, HFS

Prescott Bloom Building

201 South Second Street

Springfield, IL 62763

Dear Director Eagleson,

As a legislator representing the South Side of Chicago, I stand in strong support of the Roseland Community

Hospital transformation proposal. The events of the past year have laid bare the undeniable, and sadly often

fatal, reality of the effects of decades of disinvestment and structural racism that has led to 20-to-30-year

differences in life expectancies of residents of the City of Chicago. Recent history has also shown that large

health systems, often more concerned with profits than people, are all too-willing to cut ties with hospitals

with “undesirable” payer-mixes, which is shamefully leads to greater disparities in care.

My colleagues and I want to see state investment, via the hospital transformation funds, directed to safety-net

hospitals like Roseland, who have been in the community for years and are dedicated to their mission of

providing care to underserved communities, regardless of ability to pay. When the transformation legislation

was being negotiated and eventually passed in the Lame Duck Session, my colleagues and I were under the

impression that stand-alone safety-net hospitals would receive ultimate priority for funding consideration. It

remains our expectation that this will be upheld.

There is no community that is more deserving of healthcare investment than the South Side of Chicago and no

hospital more in need of state resources than Roseland Community Hospital. Roseland’s transformation plan

seeks to invest in behavioral healthcare expansion, OB services, and orthopedic rehabilitation, each of which

are desperately needed in South Side communities.

I am grateful that this much-needed investment is finally coming to fruition. Now, it is extremely important

that the scarce state resources are directed to hospitals who do not have the funds to “transform” on their

own. I am available for any further discussions on this subject and look forward to true transformation for the

communities on the South Side of Chicago.

Sincerely,

Emil Jones, III State Senator – 14th District

EXHIBIT CP a g e | 1

GENERAL ASSEMBLY

STATE OF ILLINOIS

April 8, 2021






As Chair of the Illinois House Legislative Black Caucus and a legislator representing the South Side of Chicago, I

stand in strong support of the Roseland Community Hospital transformation proposal. The events of the past

year have laid bare the undeniable, and sadly often fatal, reality of the effects of decades of disinvestment and

structural racism that has led to 20-to-30-year differences in life expectancies of residents of the City of

Chicago. Recent history has also shown that large health systems, often more concerned with profits than

people, are all too-willing to cut ties with hospitals with “undesirable” payer-mixes, which is shamefully leads

to greater disparities in care.







There is no community that is more deserving of healthcare investment than the South Side of Chicago and no

hospital more in need of state resources than Roseland Community Hospital. Roseland’s transformation plan

seeks to invest in behavioral healthcare expansion, OB services, and orthopedic rehabilitation, each of which

are desperately needed in South Side communities.




communities on the South Side of Chicago.

Sincerely,



April 8, 2021 Director Theresa Eagleson, HFS Prescott Bloom Building 201 South Second Street Springfield, IL 62763 Dear Director Eagleson, As a legislator representing the South Side of Chicago, I stand in strong support of the Roseland Community Hospital transformation proposal. The events of the past year have laid bare the undeniable, and sadly often fatal, reality of the effects of decades of disinvestment and structural racism that has led to 20-to-30-year differences in life expectancies of residents of the City of Chicago. Recent history has also shown that large health systems, often more concerned with profits than people, are all too-willing to cut ties with hospitals with “undesirable” payer-mixes, which is shamefully leads to greater disparities in care. My colleagues and I want to see state investment, via the hospital transformation funds, directed to safety-net hospitals like Roseland, who have been in the community for years and are dedicated to their mission of providing care to underserved communities, regardless of ability to pay. When the transformation legislation was being negotiated and eventually passed in the Lame Duck Session, my colleagues and I were under the impression that stand-alone safety-net hospitals would receive ultimate priority for funding consideration. It remains our expectation that this will be upheld. There is no community that is more deserving of healthcare investment than the South Side of Chicago and no hospital more in need of state resources than Roseland Community Hospital. Roseland’s transformation plan seeks to invest in behavioral healthcare expansion, OB services, and orthopedic rehabilitation, each of which are desperately needed in South Side communities. I am grateful that this much-needed investment is finally coming to fruition. Now, it is extremely important that the scarce state resources are directed to hospitals who do not have the funds to “transform” on their own. I am available for any further discussions on this subject and look forward to true transformation for the communities on the South Side of Chicago. Sincerely,

Marcus C. Evans, Jr. State Representative, 33rd District Assistant Majority Leader



April 8, 2021 Director Theresa Eagleson, HFS Prescott Bloom Building 201 South Second Street Springfield, IL 62763 Dear Director Eagleson, As a legislator representing the South Side of Chicago, I stand in strong support of the Roseland Community Hospital transformation proposal. The events of the past year have laid bare the undeniable, and sadly often fatal, reality of the effects of decades of disinvestment and structural racism that has led to 20-to-30-year differences in life expectancies of residents of the City of Chicago. Recent history has also shown that large health systems, often more concerned with profits than people, are all too-willing to cut ties with hospitals with “undesirable” payer-mixes, which is shamefully leads to greater disparities in care. My colleagues and I want to see state investment, via the hospital transformation funds, directed to safety-net hospitals like Roseland, who have been in the community for years and are dedicated to their mission of providing care to underserved communities, regardless of ability to pay. When the transformation legislation was being negotiated and eventually passed in the Lame Duck Session, my colleagues and I were under the impression that stand-alone safety-net hospitals would receive ultimate priority for funding consideration. It remains our expectation that this will be upheld. There is no community that is more deserving of healthcare investment than the South Side of Chicago and no hospital more in need of state resources than Roseland Community Hospital. Roseland’s transformation plan seeks to invest in behavioral healthcare expansion, OB services, and orthopedic rehabilitation, each of which are desperately needed in South Side communities. I am grateful that this much-needed investment is finally coming to fruition. Now, it is extremely important that the scarce state resources are directed to hospitals who do not have the funds to “transform” on their own. I am available for any further discussions on this subject and look forward to true transformation for the communities on the South Side of Chicago. Sincerely,

Justin Slaughter State Representative, 27th District EXHIBIT C

P a g e | 4


April 8, 2021






As a legislator representing underserved communities in Chicago, I stand in strong support of the Roseland

Community Hospital transformation proposal. The events of the past year have laid bare the undeniable, and

sadly often fatal, reality of the effects of decades of disinvestment and structural racism that has led to 20-to-

30-year differences in life expectancies of residents of the City of Chicago. Recent history has also shown that

large health systems, often more concerned with profits than people, are all too-willing to cut ties with

hospitals with “undesirable” payer-mixes, which is shamefully leads to greater disparities in care.







There is no community that is more deserving of healthcare investment than the South and West Sides of

Chicago and no hospital more in need of state resources than Roseland Community Hospital. Roseland’s

transformation plan seeks to invest in behavioral healthcare expansion, OB services, and orthopedic

rehabilitation, each of which are desperately needed in our distressed communities.




minority communities in Illinois.

Sincerely,

Jawaharial Omar Williams State Representative, 10th District


2229 South Halsted Chicago, IL 60608 Phone (312) 980-9000 www.seiuhcilin.org Member Resource Center (866) 933-7348

April 8, 2021

RE: Roseland Community Hospital Transformation Plan

To whom it may concern;

SEIU Healthcare IL/IN is writing in support of the Roseland

Community Hospital Transformation Plan. As one of three OB

programs on the southside and the only adolescent treatment center

on the southside, the need to expand and improve these programs will

have exponential in the community.

Our members both live and work in the community and their

families depend on the services that such programs would provide

to the Roseland community.

We look forward to working with the hospital as the plan comes

together as a stakeholder.

Sincerely,

Anne K Igoe

Vice President Health Systems

SEIU Healthcare IL/IN/MO/KS

Greg Kelley President

Erica Bland-Durosinmi

Executive Vice‐President

Maggie Laslo Secretary‐Treasurer

Vice Presidents: Jaquie Algee

Shaba Andrich

Jessica Angus

Felecia Bryant

Faith Arnold

Bernita Drayton

Myra Glassman

Anne Igoe

Lenny Jones

Paige Kelly

Tiara Lloyd

Sylvia Martinez

Beth Menz

James Muhammad

Shawndra Robinson

Jaqueline Rodriguez

Brynn Seibert

Aly Young

Board Chair: Maria del Carmen Macias

Illinois 2229 S. Halsted

Chicago, IL 60608

Phone: 312.980.9000

Fax: 312.939.8256

Indiana 1800 N. Meridian Street

Indianapolis, IN 46202

Phone: 317.927.9691

Missouri 5585 Pershing Avenue

St. Louis, MO 63112

Phone: 314.533.3633


April 8, 2021 Theresa Eagleson, Director Illinois Department of Healthcare and Family Services 401 South Clinton Chicago, Illinois 60607 Dear Director Eagleson, It is with great enthusiasm that I write this letter of support for the proposed project to transform OB services at

the New Roseland Community Hospital under the Illinois Healthcare Transformation Program. As a Federally

Qualified Health Center (FQHC), we are committed to our partnership with the New Roseland Community Hospital

to expand and strengthen services which are responsive to the unique needs of our shared communities and

patients.

For over 43 years, Chicago Family Health Center (CFHC) has provided quality healthcare and support services targeting medically underserved and uninsured people to realize its mission: Chicago Family Health Center will promote health, work to prevent disease and provide treatment through the delivery of quality, accessible primary healthcare that is culturally sensitive, affordable, and responsive to community and individual needs. CFHC provides care for the medically underserved on Chicago's south and southeast sides and has grown to a network of six locations in South Chicago, Pullman, East Side, Roseland, Chicago Lawn, and Avalon Park that provide a complete range of high-quality, integrated services, including: primary care, dental, behavioral health, and wraparound services to more than 27,000 patients in 2020. One of the priorities for CFHC is to address the alarming health disparities that exist in our communities around maternal and infant morbidity and mortality. A 2019 report from the Chicago Department of Public Health found that Black Moms Are 6 Times More Likely to Die From Pregnancy Than White Women In Chicago (https://www.chicago.gov/dam/city/depts/cdph/statistics_and_reports/CDPH-002_MaternalMortality_Databook_r4c_DIGITAL.pdf). CFHC is acutely aware of these disparities, as we provide prenatal care to approximately 1,200 women annually. Many are from the Roseland community and are also seen by the team at the New Roseland Community Hospital. The health outcomes of our patients can be greatly improved with concerted efforts with partners such as the New Roseland Community Hospital and their plans to augment and upgrade its facilities and services. We offer strong support of the application for the New Roseland Community Hospital to transform its OB facilities and enhance its services for benefit of our patients and communities. For any questions, or further information, please contact me at [email protected] or (773) 364-2201. Sincerely,

Barrett Hatches, Ph.D. Chief Executive Officer


https://www.chicago.gov/dam/city/depts/cdph/statistics_and_reports/CDPH-002_MaternalMortality_Databook_r4c_DIGITAL.pdf

https://www.chicago.gov/dam/city/depts/cdph/statistics_and_reports/CDPH-002_MaternalMortality_Databook_r4c_DIGITAL.pdf


April 7, 2021

Illinois Department of Healthcare and Family Services


201 South Grand Avenue, East

Springfield, Illinois 62763

To Whom It May Concern:

We are writing this letter In support of Roseland Community Hospital’s proposal for funding under the Illinois

Healthcare Transformation Program.

The New Roseland Community Hospital (RCH) is an acute service, 134-bed hospital located at 45 W. 111th Street on

Chicago’s South Side. RCH opened in 1924 with a mission to provide care to residents of Roseland and surrounding

communities. RCH has maintained this deliberate focus despite a myriad of social, economic and political changes that

dramatically affected the community.

Over the past several years, the hospital has seen an incremental need for behavioral health services across all age groups.

The complexity of the healthcare needs and existing facilities has made it increasingly challenging to provide behavioral

healthcare services to adult and adolescent patients. To make matters worse, the recent impact of COVID-19 has

exacerbated RCH’s struggles. It is difficult to find appropriate in-patient care for our behavioral health patients. On a

regular basis, we hear about patients being served unnecessarily within emergency rooms for extended periods of time due

to a limited number of available beds at qualified facilities. The delayed transfers precipitates delayed care for this

vulnerable group of patients and further stresses an already stressed system of care - emergency departments.

RCH is accredited by the Healthcare Facilities Accredited Program, and recognized by the Centers for Medicare and

Medical Services as a model hospital. RCH is a recipient of the American Association of Respiratory Care’s Quality

Respiratory Care Recognition Award and accredited by The Joint Commission. The hospital won the National Hospital

Charitable Service Award for programs that have demonstrated excellence in community impact, innovation,

collaboration, leading practices, and transferability. RCH’s patients are 85% African American men and women between

the ages of 35 – 55 and about a third have reported some type of mental illness and/or substance use disorder.

RCH has been a great partner to Gateway Foundation and our mission-driven work in Chicago. We believe their

proposed program will benefit their community and are in full support of their application. Please feel free to reach out

with any questions at [email protected].

Sincerely,

Dr. Teresa Garate

Senior Vice President, Strategic Partnerships & Engagement



EXHIBIT D P a g e | 1

THE ROSELAND COMMUNTIY HOSPITAL (“RCH”) OBSTETRIC IMPROVEMENT PLAN’S RACIAL EQUITY IMPACT ASSESSMENT

1. IDENTIFYING STAKEHOLDERS - Which racial/ethnic groups may be most affected by and concerned with the issues related to this proposal/policy?

Each of RCH’s proposals will benefit the RCH Service area, which is prominently African American, with a rapidly growing Hispanic population. Of the 300,000 individuals that reside in RCH’s service area, 86% identify as non-Hispanic African American/Black, 8% identify as Non-Hispanic White, and 4% identify as Hispanic/Latinx. Any increase in services and quality will have a direct impact on providing additional services to the community’s minorities and persons of color.

2. ENGAGING STAKEHOLDERS - Have stakeholders from different racial/ethnic groups especially those most adversely affected—been informed, meaningfully involved and authentically represented in the development of this proposal? Who’s missing and how can they be engaged?

Yes, before this plan was developed, RCH and members of the Alliance for Health Equity, a collaborative of more than 30 hospitals, 7 health departments and 100 community partners, worked together between March 2018 through March 2019 to conduct a comprehensive Community Health Needs Assessment (“CHNA”) in Cook County. The primary data for the CHNA was collected by: Community input surveys; Community resident focus groups and learning map sessions; health care and social service provider focus groups; and two stakeholder assessments led by partner health departments (Forces for Change Assessment and Health Equity Capacity Assessment). Secondary data was compiled and analyzed in partnership with epidemiologists from the Chicago Department of Public Health and Cook County Department of Health, the Illinois Public Health Institute and member hospitals.

RCH has engaged with several key local organizations serving the African-American population in the area, Hispanics and other racial/ethnic groups. These stakeholders have served the community for decades and have a clear understanding of the service needs.

RCH has also hosted a series of Town Hall Meetings (personally and virtually) for legislators, community members, and employees over the last two years in preparation of submitting this Transformation Plan. Additionally, RCH’s Chief Executive Officer has presented the Strategic Transformation Plan to the State of Illinois Legislative Medicaid Working Group. Legislators, community members, community services organizations, collaborators and employees have provided overwhelming support for these projects.

Once the projects are implemented, gaps can be identified to determine what additional stakeholders need to be engaged or whether certain stakeholders’ involvement needs to be more prominent.


3. IDENTIFYING AND DOCUMENTING RACIAL INEQUITIES -Which racial/ethnic groups are currently most advantaged and most disadvantaged by the issues this proposal seeks to address? How are they affected differently? What quantitative and qualitative evidence of inequality exists? What evidence is missing or needed?

On Chicago’s far southeast side, The New RCH serves more than 300,000 people across six zip codes and 12 community areas. RCH’s patients are among Chicago’s poorest, sickest and most disenfranchised. Principally African American (85%) and poor, the Roseland community has been ravaged by chronic disease: a Roseland resident’s lifespan (72 years) is more than 6 years less than their Beverly neighbors’ (78 years). The African-American community is most disadvantaged in our service area. This community has faced years of healthcare services inequalities, lack of preventive care, lack of primary care physicians and overall social and economic disparities.

The RCH service area has a well-documented shortage of mental health services and mental health professionals. Based on the Illinois Healthcare Facilities and Services Review Board Data, there are only 43 adolescent acute mental illness beds within a 10-mile radius around RCH’s general service area. Given the adolescent population of 392,681 in RCH’s general service area, the bed-to-population ratio is one (1) bed to 9,132 adolescents. Compared to the city and state bed-to-population averages, RCH’s service area has far less beds available to serve the adolescents in the community, who are primarily persons of color. Furthermore, individuals on the South Side of Chicago face social and cultural forces that contribute to mental and behavioral health conditions, including chronic stress, pervasive trauma and fear related to a multitude of factors including child abuse, domestic violence, living in high-crime neighborhoods, ongoing and continuous racial discrimination and homelessness.

Based on labor and delivery data at Roseland over the past three years, RCH has identified that more than 90% of new mothers from the RCH service area are African American. We also know that many expecting mothers often choose to deliver at other area hospitals because the physical space at RCH is outdated. The fact that a new or expecting mother lives on Chicago’s south side should not force her to have to choose between her community hospital that can provide high-quality services in an outdated space or a more well-appointed labor and delivery experience significantly far from her home and her support center. We believe that renovating the space and offering elevated services will afford the minorities that populate RCH’s service area an equal (or better) experience than expecting mothers in other communities who have local hospitals that provide luxurious amenities in the same area where the mother will seek post-delivery services and supports. By improving its facilities for obstetric patients, RCH will be benefitting the minorities and women of color in its community significantly.

Additionally, access to specialty care is also lacking. Although, Chicago is renowned for joint replacement surgery, there are almost no joint replacement surgeons caring for the RCH community. Based on the data published and used by the Illinois Health Facilities and Services Review Board, the 10-mile service area around RCH includes eleven (11) other hospitals and nine


(9) surgery centers that provide orthopedic surgery services. Although there is limited data on orthopedics, the available data demonstrates that the area within Chicago area Health Planning Area, HPA A-03, where RCH is located, had - by far - the fewest orthopedic cases. In 2019, there were only 5,706 orthopedic cases in HPA A-03 versus 16,176 cases for HPA A-01, which is the City of Chicago north and west of the Loop. HPA A-01 includes Northwestern Memorial Hospital (reporting 6,876 procedures), Lurie Children’s (1,445 reporting procedures) and Swedish Covenant (1,339 reporting procedures).

Mobility is critical to health, chronic disease management and longevity. Improving cardiovascular fitness reduces death from heart disease.1 Adding 15 minutes of physical activity a day improves mortality from all chronic diseases.2 Joint pain from hip or knee arthritis is the top barrier to exercise in older people.3

Disenfranchised, disabled communities are poor communities. Inactivity not only makes chronic disease worse, it leads to more poverty. The state of Michigan estimated the financial costs of adult inactivity resulted in $8.7 billion of direct medical costs (10 cents of every primary care dollar spent) and $2.5 million in lost productivity (~20 days of work per worker).4 Thus, this disparity and lack of access is not only detrimental to individuals’ health, it is detrimental to the growth of the community.

4. EXAMINING THE CAUSES -What factors may be producing and perpetuating racial inequities associated with this issue? How did the inequities arise? Are they expanding or narrowing? Does the proposal address root causes? If not, how could it?

For decades the diminishing access to healthcare services has had an impact on the rise of healthcare inequalities. Over many decades, the RCH community has seen community members and patients lose economic opportunities and jobs as large employers relocate out of the area. This divestment in the area, paired with rising crime rates, have led to stagnant growth. By investing in RCH to increase access, services and wellness, the transformational benefits will carry over into the community. Healthier communities have more job opportunities and more capacity for active, involved lives. With a healthier, more successful community, crime should decrease. These incremental steps ultimately have the potential to reverse the impact of the divestment that exists and lift the community.

The transformation proposals RCH has submitted demonstrate there is a significant need in the RCH community for increased behavioral health services, improved local Labor and Delivery services, and arthritis and orthopedic joint repair services. Providing these additional and improved services in the community will allow RCH to partner with local outpatient partners and social resources to support other local clinical providers and also facilitate an ongoing wellness

1 Lee D J Psychopharmacol 2010.2 Wien, CP. The Lancet 2011.3 Lees FD, et al. J Aging Phys Acti. 2005. 4 Chenoweth, et al Economic costs of physical inactivity in the state of Michigan. Michigan Fitness Council. http://www.michiganfitness.org/indexpagedownloads/CostofInactivity.pdf


journey for community members outside the hospital walls. By investing in RCH, RCH can invest in its patients and the patients will be empowered to invest in their own health – which will pay dividends overall.

At a minimum, a transformed RCH will be a source of pride for the community and a cherished asset that serves its community families. South Chicago deserves a hospital of the same caliber of all other hospitals in the region and these transformational projects are a step towards greater equality.

5. CLARIFYING THE PURPOSE -What does the proposal seek to accomplish? Will it reduce disparities or discrimination?

Initially, these transformation proposals will provide increased quality care that is not as available on the south side of Chicago as it is elsewhere in the region. This increased access will reduce the disparity that exists in this predominantly African American community with a fast growing Hispanic population.

In addition to brining much needed behavioral health, substance abuse, obstetric and arthritis/orthopedic healthcare to the RCH community, RCH’s transformation proposals share the common goal of delivering an improved patient experience that will empower the patient to continue their healing journey towards improved wellness and will provide the local connections to outpatient providers and community resources to be successful. For each case that takes the next step to continue outpatient care, or takes the recommendation to seek prenatal care, or finishes a course of therapy, or goes to their support meetings to maintain their sobriety, or reaches out for help to ensure their child receives routine preventative care, there is improvement in health that will reduce readmissions – or at least reduce the acuity of a readmission. As more of these small achievements compound, a community gets healthier, more empowered, more productive and more successful.

6. EXAMINING ALTERNATIVES OR IMPROVEMENTS -Are there better ways to reduce racial disparities and advance racial equity? What provisions could be changed or added to ensure positive impacts on racial equity and inclusion?

Based on the available data, it appears the best way to reduce the racial disparities that exist are to expand available services and provide the investment needed to give patients access to the expanded and improved services.

7. ENSURING VIABILITY AND SUSTAINABILITY -Is the proposal realistic, adequately funded, with mechanisms to ensure successful implementation and enforcement. Are there provisions to ensure ongoing data collection, public reporting, stakeholder participation and public accountability?


RCH has been careful and targeted in its proposals to request investment funds to create programs that will be sustainable after the initial deployment. Each proposal will maximize the use of awarded funds to build space and develop services that can be replicated after the initial investment to serve patients regardless of payer source.

RCH believes and expects that expanded and improved healthcare services, particularly expanded and improved behavior services, will pay dividends in reducing readmissions and increasing patient investment in wellness. With these clinical changes, data and research tells us that reduced crime, increased employment will follow to improve the surrounding community. A healthy workforce becomes an incentive for economic development in the area.

8. IDENTIFYING SUCCESS INDICATORS - What are the success indicators and progress benchmarks? How will impacts be documented and evaluated? How will the level, diversity and quality of ongoing stakeholder engagement be assessed?

Each RCH proposal has identified specific metrics that will be monitored and tracked to evaluate the project’s progress towards its goals. In addition to clinical metrics, each project has identified specific metrics that will be used to monitor how the proposal and project is addressing disparities and racial inequalities. These metrics will be documented and analyzed to determine whether adjustments or revisions are necessary to maximize achievement.

9. CONSIDERING ADVERSE IMPACTS - What adverse impacts or unintended consequences could result from this policy? Which racial/ethnic groups could be negatively affected? How could adverse impacts be prevented or minimized?

For the behavioral health services, RCH’s goal is to ensure patients in crisis have access to treatment, increase outpatient utilization and reduce readmissions from the emergency department for behavioral health conditions. For the obstetric and behavioral health projects, RCH’s goal is to improve utilization, improve outcomes and maximize outpatient success. For the orthopedic proposal, RCH’s goal is to increase access to chronic health services, reduce pain and improve overall health. If these proposals were to fail, there would be continued racial and economic disparities, continued under-utilization of available healthcare services and high rates of admission for high-acuity conditions. By involving collaborators, RCH is confident it can improve wellness with expanded and improved serviced as well as improved connections to outpatient treatment and social supports. These improvements necessarily improve the community as a whole.

10. ADVANCING EQUITABLE IMPACTS -What positive impacts on equity and inclusion, if any, could result from this proposal? Which racial/ethnic groups could benefit? Are there further ways to maximize equitable opportunities and impacts?

There are many key indicators that can demonstrate forward movement and positive results these include:


Improved health outcomes,

Increased engagement in preventative and outpatient healthcare;

Increased employment rates;

Improved employment opportunities and pay rates;

Improved crime statistics, and

Progress towards economic redevelopment.

RCH’s proposals provide momentum to drive the RCH community and service area towards growth and improvement. Years of abandonment will take years of investment to reverse course. However, there are local stakeholders that play a key role in the ongoing collection of data and demographics to assist RCH in monitoring and adjusting its programs to ensure progress continues over the long term.

With progress towards improved services, greater access and improved outcomes, RCH believes it can make substantial progress towards reducing the systemic disparities that exist in their current form

RCH Employment Data by Zip Code

ZipcodeClinical

HeadcountNon-ClinicalHeadcount Asian Black or African American Hispanic or Latino White Unspecified No Self ID

46307 2 0 0 0 0 2 0 046311 1 0 146312 1 0 146320 0 1 246321 0 2 1 146323 0 4 2 1 146324 3 0 3 046327 1 0 146375 0 1 146410 3 2 3 1 160010 1 0 160016 1 0 160026 2 0 1 160091 0 1 160104 1 0 160110 1 0 160142 1 0 160148 0 1 160153 1 0 160162 0 1 160177 1 0 160188 0 1 160302 1 0 160402 1 1 1 160406 6 0 5 160409 16 3 17 1 160411 8 3 10 160412 1 0 160417 1 1 260419 10 3 1 11 160423 1 0 160425 4 3 760426 7 1 860428 3 1 460429 4 2 660430 3 2 560436 1 0 160438 7 2 8 160441 0 1 160443 12 2 1260445 2 1 1 260449 1 0 160451 0 1 160452 4 0 1 1 1 160453 2 3 1 2 1 160455 0 1 160456 1 0 160458 1 0 160459 1 0 160461 2 1 360462 1 0 160465 1 1 2

EXHIBIT FP a g e | 1


ZipcodeClinical


60466 3 1 460467 2 0 260469 1 0 160471 4 0 460472 1 1 260473 8 3 10 160475 1 0 160477 1 0 160478 6 1 760480 1 0 160484 3 0 360487 4 0 2 1 160501 1 0 160513 0 1 160538 1 0 160559 1 0 160561 1 0 160563 0 1 160586 1 0 160605 0 2 1 160607 1 1 1 160608 1 0 160609 2 1 360612 0 1 160613 1 0 160615 2 1 360616 1 1 1 160617 16 5 1 15 2 1 260618 0 1 160619 12 4 1660620 9 4 1360621 5 1 5 160623 1 0 160624 1 0 160628 30 33 1 57 3 1 160629 4 2 1 4 160632 2 1 1 2 160633 1 1 1 160636 2 3 560637 4 6 1060638 0 1 160639 1 0 160643 20 13 32 160644 1 1 1 160649 6 2 6 1 160651 2 1 2 160652 4 1 560653 6 1 760655 0 2 260803 4 1 4 160804 1 1 260805 1 3 3 1



ZipcodeClinical


60827 14 18 30 1 160914 3 0 2 160954 1 0 161832 1 0 1TOTALS 322 168 20 392 33 25 16 4


RCH Employment Data by Position

Labor Allocation Details Position Description Zip EEO EthinicityAcute Care-Charge Nurse Charge Nurse 60472 Black or African AmericanAcute Care-CNA CNA 46311 Black or African AmericanAcute Care-CNA CNA 60417 Black or African AmericanAcute Care-CNA CNA 60429 Black or African AmericanAcute Care-CNA CNA 60651 Black or African AmericanAcute Care-CNA CNA 60652 Black or African AmericanAcute Care-CNA CNA 60419 Black or African AmericanAcute Care-CNA CNA 60615 Black or African AmericanAcute Care-CNA CNA 60619 Black or African AmericanAcute Care-CNA CNA 60620 Black or African AmericanAcute Care-CNA CNA 60628 Black or African AmericanAcute Care-CNA CNA 60628 Black or African AmericanAcute Care-CNA CNA 60827 Black or African AmericanAcute Care-CNA CNA 60827 Black or African AmericanAcute Care-LPNII LPNII 60461 Black or African AmericanAcute Care-LPNII LPNII 60643 Black or African AmericanAcute Care-RN Registry RN Registry 60827 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60436 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60425 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60425 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60430 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60438 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60443 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60453 UnspecifiedAcute Care-Staff Nurse Staff Nurse 60473 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60473 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60484 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60487 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60487 WhiteAcute Care-Staff Nurse Staff Nurse 60619 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60619 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60621 I do not wish to self-identifyAcute Care-Staff Nurse Staff Nurse 60628 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60643 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60643 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60643 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60643 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60652 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60653 Black or African AmericanAcute Care-Staff Nurse Staff Nurse 60827 I do not wish to self-identifyAcute Care-Staff Nurse Staff Nurse 60914 Black or African AmericanAcute Care-Telemetry TechnicianTelemetry Technician 60478 Black or African AmericanAcute Care-Telemetry TechnicianTelemetry Technician 60617 Black or African AmericanAcute Care-Telemetry TechnicianTelemetry Technician 60619 Black or African AmericanAcute Care-Telemetry TechnicianTelemetry Technician 60628 Black or African AmericanAcute Care-Telemetry TechnicianTelemetry Technician 60651 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityAcute Care-Unit Secretary Unit Secretary 60412 Black or African AmericanAcute Care-Unit Secretary Unit Secretary 60623 Black or African AmericanAcute Care-Unit Secretary Unit Secretary 60409 Black or African AmericanAcute Care-Unit Secretary Unit Secretary 60409 UnspecifiedAcute Care-Unit Secretary Unit Secretary 60636 Black or African AmericanAcute Care-Unit Secretary Unit Secretary 60637 Black or African AmericanAdministration-Chaplain Chaplain 60478 Black or African AmericanAdministration-Communications Specialist and Special Project AssistantMarketing Coordinator 60621 Black or African AmericanAdministration-Communications Specialist and Special Project AssistantSpecial Project Assistant 60651 Hispanic or LatinoAdministration-Director - WICDirector - WIC 60607 Hispanic or LatinoAdministration-Director of Hospital OperationsDirector of Hospital Operations 60453 Black or African AmericanAdministration-Director Support ServiceDirector Support Service 60429 Black or African AmericanAdministration-Executive AssistantExecutive Assistant 60513 Hispanic or LatinoAdministration-Nurse ManagerNurse Manager 60153 Black or African AmericanAdministration-Patient Relations/CMMS CoordinatorPatient Relations/CMMS Coordinator60419 Black or African AmericanAdministration-Physician Physician 60010 UnspecifiedAdministration-Physician Physician 60026 Hispanic or LatinoAdministration-Physician Physician 60142 WhiteAdministration-Risk ManagerRisk Manager 46410 Black or African AmericanAdministration-Security-SupervisorSecurity-Supervisor 60451 Black or African AmericanAdministration-Senior Director - Plant Operations and Safety OfficerSenior Director 60091 Hispanic or LatinoAdministration-Staff Nurse Staff Nurse 60628 Black or African AmericanAdmitting-Admitting ManagerAdmitting Manager 60827 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60473 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60609 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60619 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60628 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60632 Hispanic or LatinoAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60805 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60430 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60628 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60628 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60827 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60827 Black or African AmericanAdmitting-Admitting Service RepresentativeAdmitting Service Representative 60827 Black or African AmericanAdolescent Behavioural Health -Intake CoordinatorIntake Coordinator 60417 Black or African AmericanAdolescent Behavioural Health -Intake CoordinatorIntake Coordinator 60619 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60406 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60406 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60409 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60443 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60616 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60617 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60620 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60643 Black or African AmericanAdolescent Behavioural Health -Mental Health Associate 1Mental Health Associate 1 60649 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityAdolescent Behavioural Health -Nurse ManagerNurse Manager 60473 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60409 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60617 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60617 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60619 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60620 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60628 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60628 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60628 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60628 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60643 Black or African AmericanAdolescent Behavioural Health -SitterSitter 60643 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60487 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60411 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60411 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60426 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60478 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60619 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60620 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60628 UnspecifiedAdolescent Behavioural Health -Staff NurseStaff Nurse 60632 Black or African AmericanAdolescent Behavioural Health -Staff NurseStaff Nurse 60643 Black or African AmericanAmbulatory-Ambulatory CoordinatorAmbulatory Coordinator 60469 Black or African AmericanAmbulatory-CNA CNA 60628 Black or African AmericanAmbulatory-LPNII LPNII 60461 Black or African AmericanAmbulatory-Medical AssistantMedical Assistant 46410 Black or African AmericanCardio-Pulmonary-Cardiopulmonary TechCardiopulmonary Tech 60426 Black or African AmericanCardio-Pulmonary-Cardiopulmonary Tech IICardiopulmonary Tech II 60438 Black or African AmericanCardio-Pulmonary-Cardiopulmonary Tech IICardiopulmonary Tech II 60620 Black or African AmericanCardio-Pulmonary-Cardiopulmonary Tech IICardiopulmonary Tech II 60621 Black or African AmericanCardio-Pulmonary-Cardiopulmonary Tech IICardiopulmonary Tech II 60426 Black or African AmericanCardio-Pulmonary-Cardiopulmonary Tech IICardiopulmonary Tech II 60438 Black or African AmericanCardio-Pulmonary-Clinical Coordinator - CPSClinical Coordinator - CPS 60538 Black or African AmericanCardio-Pulmonary-Echo TechEcho Tech 60628 Black or African AmericanCardio-Pulmonary-Pulmonary Clinical EducatorPulmonary Clinical Educator 60484 Black or African AmericanCardio-Pulmonary-Resource CoordinatorResource Coordinator 46307 WhiteCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60428 Black or African AmericanCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60409 Black or African AmericanCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60411 Black or African AmericanCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60617 Black or African AmericanCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60617 UnspecifiedCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60628 Black or African AmericanCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60649 Black or African AmericanCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60649 UnspecifiedCardio-Pulmonary-Respiratory TherapistRespiratory Therapist 60914 Black or African AmericanCommunication-Switchboard OperatorSwitchboard Operator 60628 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityCommunication-Switchboard OperatorSwitchboard Operator 60643 Black or African AmericanCommunication-Switchboard OperatorSwitchboard Operator 60643 Black or African AmericanCommunication-Switchboard OperatorSwitchboard Operator 60827 Black or African AmericanCOVID-19-Ambulatory CoordinatorAmbulatory Coordinator 60559 WhiteCOVID-19-CNA CNA 60429 Black or African AmericanCOVID-19-Emergency Prepardness CoordinatorEmergency Prepardness Coordinator60649 Black or African AmericanCOVID-19-Medical Assistant Medical Assistant 60406 Black or African AmericanCOVID-19-Medical Assistant Medical Assistant 60827 Black or African AmericanCOVID-19-Nurse Practioner Nurse Practioner 60452 Black or African AmericanCOVID-19-Nurse Practioner Nurse Practioner 60607 Black or African AmericanCOVID-19-Patient Access SpecialistPatient Access Specialist 60914 UnspecifiedCOVID-19-Patient Service RepresentativePatient Service Representative 46324 Black or African AmericanCOVID-19-Patient Service RepresentativePatient Service Representative 60804 Hispanic or LatinoCOVID-19-Patient Service RepresentativePatient Service Representative 46324 Black or African AmericanCOVID-19-UR Case Manager UR Case Manager 60443 Black or African AmericanEmergency Department-Admitting ManagerAdmitting Manager 60643 Black or African AmericanEmergency Department-Charge NurseCharge Nurse 60466 Black or African AmericanEmergency Department-Charge NurseCharge Nurse 60467 AsianEmergency Department-CNACNA 60409 Hispanic or LatinoEmergency Department-CNACNA 60472 Black or African AmericanEmergency Department-CNACNA 60473 Hispanic or LatinoEmergency Department-CNACNA 60609 Black or African AmericanEmergency Department-CNACNA 60620 Black or African AmericanEmergency Department-CNACNA 60628 Black or African AmericanEmergency Department-CNACNA 60637 Black or African AmericanEmergency Department-CNACNA 60827 Black or African AmericanEmergency Department-CNACNA 60827 Black or African AmericanEmergency Department-CoordinatorCoordinator 60419 Black or African AmericanEmergency Department-ED GreeterED Greeter 60458 Black or African AmericanEmergency Department-ED GreeterED Greeter 60419 Black or African AmericanEmergency Department-ED GreeterED Greeter 60425 Black or African AmericanEmergency Department-ED GreeterED Greeter 60426 Black or African AmericanEmergency Department-ER TechnicianER Technician 60653 Black or African AmericanEmergency Department-ER TechnicianER Technician 60827 Black or African AmericanEmergency Department-ER TechnicianER Technician 60827 Black or African AmericanEmergency Department-House AdministratorHouse Administrator 60478 Black or African AmericanEmergency Department-House AdministratorHouse Administrator 60653 Black or African AmericanEmergency Department-LPNIILPNII 60475 Black or African AmericanEmergency Department-LPNIILPNII 60430 Black or African AmericanEmergency Department-LPNIILPNII 60628 Black or African AmericanEmergency Department-LPNIILPNII 60637 Black or African AmericanEmergency Department-Medical AssistantMedical Assistant 60419 Black or African AmericanEmergency Department-Medical AssistantMedical Assistant 60438 UnspecifiedEmergency Department-Medical AssistantMedical Assistant 60443 Black or African AmericanEmergency Department-Medical AssistantMedical Assistant 60628 Hispanic or LatinoEmergency Department-RN RegistryRN Registry 61832 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityEmergency Department-RN RegistryRN Registry 60619 Black or African AmericanEmergency Department-SitterSitter 60459 Black or African AmericanEmergency Department-SitterSitter 60628 Black or African AmericanEmergency Department-SitterSitter 60628 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60586 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60608 AsianEmergency Department-Staff NurseStaff Nurse 46324 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60443 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60452 I do not wish to self-identifyEmergency Department-Staff NurseStaff Nurse 60465 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60466 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60473 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60478 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60487 UnspecifiedEmergency Department-Staff NurseStaff Nurse 60628 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60628 Black or African AmericanEmergency Department-Staff NurseStaff Nurse 60827 Black or African AmericanEmergency Department-Staffing CoordinatorStaffing Coordinator 60628 Black or African AmericanEmergency Department-Triage TechnicianTriage Technician 60633 WhiteEmergency Department-Triage TechnicianTriage Technician 60643 Black or African AmericanEmergency Department-Triage TechnicianTriage Technician 60649 Black or African AmericanEmergency Department-Unit SecretaryUnit Secretary 60617 Black or African AmericanEmergency Department-Unit SecretaryUnit Secretary 60617 UnspecifiedEmergency Department-Unit SecretaryUnit Secretary 60628 Black or African AmericanEmergency Department-Unit SecretaryUnit Secretary 60827 Black or African AmericanEnvironmental Services-Environmental Services AideEnvironmental Services Aide 46321 Hispanic or LatinoEnvironmental Services-Environmental Services AideEnvironmental Services Aide 60827 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60629 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 46323 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60409 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60411 Hispanic or LatinoEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60426 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60428 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60429 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60438 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60615 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60619 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60628 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60628 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60628 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60628 Hispanic or LatinoEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60628 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60628 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60637 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60637 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60643 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60643 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60643 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60643 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60643 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60827 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60827 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60827 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60827 Black or African AmericanEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60827 Hispanic or LatinoEnvironmental Services-Environmental Services WorkerEnvironmental Services Worker 60827 Black or African AmericanEnvironmental Services-EVS SupervisorEVS Supervisor 60411 Black or African AmericanEnvironmental Services-GroundskeeperGroundskeeper 60827 Black or African AmericanEnvironmental Services-Lead Environmental Services WorkerLead Environmental Services Worker60827 Black or African AmericanExecutives-Chief Nursing OfficeChief Nursing Office 60438 Black or African AmericanExecutives-CRO/President CRO/President 60628 WhiteFinance-Accounting CoordinatorAccounting Coordinator 60430 Black or African AmericanFinance-Coordinator Coordinator 60628 Black or African AmericanFinance-Intake Coordinator Intake Coordinator 60628 Black or African AmericanFinance-Medical Director RegistryMedical Director Registry 60453 Black or African AmericanFinance-Payroll Coordinator Payroll Coordinator 60409 Black or African AmericanFinance-Revenue Cycle/Fiscal AnalystRevenue Cycle/Fiscal Analyst 46375 Hispanic or LatinoHuman Resources-Director - Human ResourcesDirector - Human Resources 60425 Black or African AmericanHuman Resources-Employee Health NurseEmployee Health Nurse 60471 Black or African AmericanHuman Resources-Human Resource SpecialistHuman Resource Specialist 60409 Black or African AmericanHuman Resources-Human Resources GeneralistHuman Resources Generalist 60628 Black or African AmericanHuman Resources-Human Resources GeneralistHuman Resources Generalist 60637 Black or African AmericanHuman Resources-Recruiter Recruiter 60619 Black or African AmericanInformation Systems-Clinical InformaticistClinical Informaticist 60619 Black or African AmericanInformation Systems-Computer Systems AnalystComputer Systems Analyst 60616 WhiteInformation Systems-Desktop SupportDesktop Support 46323 Hispanic or LatinoInformation Systems-Director - Information SystemsDirector - Information Systems 46321 WhiteInformation Systems-Infrastructure and Telecommunication EngineerInfrastructure and Telecommunication Engineer60148 AsianInformation Systems-Meditech Fiscal AnalystMeditech Fiscal Analyst 60643 Black or African AmericanInformation Systems-Meditech SpecialistMeditech Specialist 46410 Black or African AmericanInformation Systems-Meditech SpecialistMeditech Specialist 60605 WhiteInformation Systems-Meditech SpecialistMeditech Specialist 60617 Black or African AmericanInformation Systems-Senior Information Technology Business AnalystSenior Information Technology Business Analyst60628 Black or African AmericanInformation Systems-Senior IT Enterprise EngineerSenior IT Enterprise Engineer 60638 Hispanic or LatinoInformation Systems-Senior Systems CoordinatorSenior Systems Coordinator 60455 AsianInformation Systems-Senior Systems Integration AnalystSenior Systems Integration Analyst60188 AsianInformation Systems-Senior Systems Integration AnalystSenior Systems Integration Analyst60441 WhiteInformation Systems-Telecommunication AnalystTelecommunication Analyst 60563 WhiteInformation Systems-Telecommunication AnalystTelecommunication Analyst 46410 UnspecifiedIntensive Care Unit-Charge NurseCharge Nurse 60467 AsianIntensive Care Unit-Clinical Coordinator - CPSClinical Coordinator - CPS 60443 Black or African AmericanIntensive Care Unit-CNA CNA 60637 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityIntensive Care Unit-Staff NurseStaff Nurse 60423 Black or African AmericanIntensive Care Unit-Staff NurseStaff Nurse 60456 WhiteIntensive Care Unit-Staff NurseStaff Nurse 60473 Black or African AmericanIntensive Care Unit-Staff NurseStaff Nurse 60628 AsianIntensive Care Unit-Staff NurseStaff Nurse 60652 Black or African AmericanIntensive Care Unit-Staff NurseStaff Nurse 60803 AsianIntensive Care Unit-Staff NurseStaff Nurse 60803 AsianIntensive Care Unit-Staff NurseStaff Nurse 60803 AsianIntensive Care Unit-Unit SecretaryUnit Secretary 60429 Black or African AmericanIntensive Care Unit-Unit SecretaryUnit Secretary 60617 Black or African AmericanIntensive Care Unit-Unit SecretaryUnit Secretary 60621 Black or African AmericanIntensive Care Unit-Unit SecretaryUnit Secretary 60653 Black or African AmericanLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 46327 WhiteLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 60409 Black or African AmericanLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 60617 Black or African AmericanLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 60409 Black or African AmericanLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 60426 Black or African AmericanLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 60426 Black or African AmericanLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 60443 Black or African AmericanLaboratory-Clerk/PhlebotomistClerk/Phlebotomist 60827 Black or African AmericanLaboratory-Laboratory Billing AssociateLaboratory Billing Associate 60406 Black or African AmericanMaterial Systems-Manager Materials ManagementManager Materials Management 60425 Black or African AmericanMaterial Systems-Material HandlerMaterial Handler 60628 Black or African AmericanMaterial Systems-Storeroom ClerkStoreroom Clerk 60628 Black or African AmericanMedical Affairs-Medical Director RegistryMedical Director Registry 60453 AsianMedical Affairs-Medical Staff Coord/Exec AsstMedical Staff Coord/Exec Asst 60628 Black or African AmericanMedical Records-Medical Records ClerkMedical Records Clerk 60612 Black or African AmericanMedical Records-Medical Records ClerkMedical Records Clerk 60628 Black or African AmericanMedical Records-Medical Records Clerk (CorrespMedical Records Clerk (Corresp 60628 Black or African AmericanMedical Records-Medical Records Clerk (CorrespMedical Records Clerk (Corresp 60628 Black or African AmericanMedical Records-Medical Records TechMedical Records Tech 46323 WhiteMedical Records-Outpatient CoderOutpatient Coder 60652 Black or African AmericanMedical Records-Supervisor Inpatient CodingSupervisor Inpatient Coding 60618 Hispanic or LatinoMedical Stabilization-Accreditation and Quality DataAccreditation and Quality Data 60425 Black or African AmericanMedical Stabilization-Charge NurseCharge Nurse 60443 Black or African AmericanMedical Stabilization-Medical AssistantMedical Assistant 46312 Black or African AmericanMedical Stabilization-Medical AssistantMedical Assistant 60419 Black or African AmericanMedical Stabilization-Medical AssistantMedical Assistant 60619 Black or African AmericanMedical Stabilization-Medical AssistantMedical Assistant 60628 Black or African AmericanMedical Stabilization-Patient Service RepresentativePatient Service Representative 60954 WhiteMedical Stabilization-Peer Recovery SpecialistPeer Recovery Specialist 60624 Black or African AmericanMedical Stabilization-Peer Recovery SpecialistPeer Recovery Specialist 60621 Black or African AmericanMedical Stabilization-Peer Recovery SpecialistPeer Recovery Specialist 60628 Black or African AmericanMedical Stabilization-Peer Recovery SpecialistPeer Recovery Specialist 60629 Hispanic or LatinoMedical Stabilization-Peer Recovery SpecialistPeer Recovery Specialist 60643 Black or African AmericanMedical Stabilization-Project ManagerProject Manager 60628 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityMedical Stabilization-Staff NurseStaff Nurse 60406 Black or African AmericanMedical Stabilization-Staff NurseStaff Nurse 60411 Black or African AmericanMedical Stabilization-Staff NurseStaff Nurse 60430 Black or African AmericanMedical Stabilization-Staff NurseStaff Nurse 60443 Black or African AmericanMedical Stabilization-Staff NurseStaff Nurse 60620 Black or African AmericanMedical Stabilization-Unit SecretaryUnit Secretary 60409 Black or African AmericanNursery-RN Registry RN Registry 60428 Black or African AmericanNursery-Staff Nurse Staff Nurse 60561 Black or African AmericanNursery-Staff Nurse Staff Nurse 60419 AsianNursery-Staff Nurse Staff Nurse 60649 Black or African AmericanNursing Administration-Administrative SecretaryAdministrative Secretary 60443 Black or African AmericanNursing Administration-Claims ExaminerClaims Examiner 60466 Black or African AmericanNursing Administration-Director - RadiologyDirector - Radiology 46410 WhiteNursing Administration-House AdministratorHouse Administrator 60452 AsianNursing Administration-House AdministratorHouse Administrator 60411 Black or African AmericanNursing Administration-Staff NurseStaff Nurse 60827 Black or African AmericanNursing Administration-TransporterTransporter 60633 Black or African AmericanNursing Administration-TransporterTransporter 60628 Black or African AmericanNursing Administration-TransporterTransporter 60637 Black or African AmericanNutritional Services-Clinical DieticianClinical Dietician 60615 Black or African AmericanNutritional Services-Clinical DieticianClinical Dietician 60619 Black or African AmericanNutritional Services-Clinical Dietician RegistryClinical Dietician Registry 60643 UnspecifiedNutritional Services-Cook Cook 60402 Black or African AmericanNutritional Services-Cook Cook 60605 Black or African AmericanNutritional Services-Cook Cook 60628 Black or African AmericanNutritional Services-Cook Cook 60827 Black or African AmericanNutritional Services-Cook Cook 60827 Black or African AmericanNutritional Services-Dietary ClerkDietary Clerk 60653 Black or African AmericanNutritional Services-Dietary ClerkDietary Clerk 60619 Black or African AmericanNutritional Services-Dietary ClerkDietary Clerk 60827 Black or African AmericanNutritional Services-Dietary WorkerDietary Worker 60411 Black or African AmericanNutritional Services-Dietary WorkerDietary Worker 60445 Black or African AmericanNutritional Services-Dietary WorkerDietary Worker 60644 Black or African AmericanNutritional Services-Dietary WorkerDietary Worker 60628 Black or African AmericanNutritional Services-Dietary WorkerDietary Worker 60628 Black or African AmericanNutritional Services-Dietary WorkerDietary Worker 60643 Black or African AmericanNutritional Services-Dietary Worker registryDietary Worker registry 60649 I do not wish to self-identifyNutritional Services-Director - Nutritional ServiceDirector - Nutritional Service 60461 Black or African AmericanNutritional Services-Nutritional SupervisorNutritional Supervisor 60628 Black or African AmericanNutritional Services-Nutritional SupervisorNutritional Supervisor 60827 Black or African AmericanNutritional Services-Storeroom ClerkStoreroom Clerk 60628 Hispanic or LatinoOB/Delivery-LPNII LPNII 60643 Black or African AmericanOB/Delivery-Nurse ManagerNurse Manager 60409 Black or African AmericanOB/Delivery-OB Technician OB Technician 60473 Black or African AmericanOB/Delivery-OB Technician OB Technician 60617 Black or African AmericanOB/Delivery-RN Registry RN Registry 60478 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicityOB/Delivery-RN Registry RN Registry 60643 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60110 AsianOB/Delivery-Staff Nurse Staff Nurse 60302 AsianOB/Delivery-Staff Nurse Staff Nurse 60449 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60613 WhiteOB/Delivery-Staff Nurse Staff Nurse 60411 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60411 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60419 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60428 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60471 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60620 Black or African AmericanOB/Delivery-Staff Nurse Staff Nurse 60621 Black or African AmericanOB/Delivery-Unit Secretary Unit Secretary 60628 Black or African AmericanOB/Delivery-Unit Secretary Unit Secretary 60643 Black or African AmericanPatient Accounts-Biller Biller 60162 Black or African AmericanPatient Accounts-Biller Biller 60419 Black or African AmericanPatient Accounts-Biller Biller 60443 Black or African AmericanPatient Accounts-Biller Biller 60473 Black or African AmericanPatient Accounts-Financial CounselorFinancial Counselor 60649 Black or African AmericanPatient Accounts-Patient Access SpecialistPatient Access Specialist 60617 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60409 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60409 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60419 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60443 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60471 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60617 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60628 Black or African AmericanPharmacy-Pharmacy Tech Pharmacy Tech 60643 Black or African AmericanPharmacy-Staff Pharmacist Staff Pharmacist 60477 Black or African AmericanPharmacy-Staff Pharmacist Staff Pharmacist 60026 AsianPharmacy-Staff Pharmacist Staff Pharmacist 60429 Black or African AmericanPharmacy-Staff Pharmacist Staff Pharmacist 60443 Black or African AmericanPharmacy-Staff Pharmacist Staff Pharmacist 60443 Black or African AmericanPharmacy-Staff Pharmacist Staff Pharmacist 60473 Black or African AmericanPharmacy-Staff Pharmacist Staff Pharmacist 60643 Black or African AmericanPhysical Therapy-Physical TherapistPhysical Therapist 60653 Black or African AmericanPhysical Therapy-Physical Therapy AidePhysical Therapy Aide 60409 Black or African AmericanPlant Operations-Assistant Director of Support ServicesAssistant Director of Support Services60643 Black or African AmericanPlant Operations-Chief EngineerChief Engineer 60655 WhitePlant Operations-Operating EngineerOperating Engineer 60465 Black or African AmericanPlant Operations-Operating EngineerOperating Engineer 46323 Black or African AmericanPlant Operations-Operating EngineerOperating Engineer 60617 WhitePlant Operations-Operating EngineerOperating Engineer 60655 WhitePlant Operations-Operating EngineerOperating Engineer 60805 WhitePlant Operations-Operating Engineer TraineeOperating Engineer Trainee 60803 WhitePlant Operations-Operating Engineer TraineeOperating Engineer Trainee 60453 White



Labor Allocation Details Position Description Zip EEO EthinicityPlant Operations-Operating Engineer TraineeOperating Engineer Trainee 60473 Black or African AmericanQuality Management-Case Management SpecialistCase Management Specialist 60643 Black or African AmericanQuality Management-Clinical Social Worker (MSW)Clinical Social Worker (MSW) 60409 Black or African AmericanQuality Management-UR Case ManagerUR Case Manager 60419 Black or African AmericanQuality Management-UR Case ManagerUR Case Manager 60425 Black or African AmericanQuality Management-UR Case ManagerUR Case Manager 60438 Black or African AmericanQuality Management-UR Case ManagerUR Case Manager 60471 Black or African AmericanQuality Management-UR Case ManagerUR Case Manager 60484 Black or African AmericanQuality Management-UR Case ManagerUR Case Manager 60805 Black or African AmericanRadiology-Radiology Technician RegistryRadiology Technician Registry 60104 Black or African AmericanRadiology-Radiology Technician RegistryRadiology Technician Registry 60177 Hispanic or LatinoRadiology-Radiology Technician RegistryRadiology Technician Registry 60419 UnspecifiedRadiology-Radiology Technician RegistryRadiology Technician Registry 60426 Black or African AmericanRadiology-Radiology Technician RegistryRadiology Technician Registry 60620 Black or African AmericanRadiology-Radiology Technician RegistryRadiology Technician Registry 60827 Black or African AmericanRadiology-Radiology TechnologistRadiology Technologist 60445 Hispanic or LatinoRadiology-Radiology TechnologistRadiology Technologist 60617 Hispanic or LatinoRadiology-Radiology TechnologistRadiology Technologist 60629 Hispanic or LatinoRadiology-Radiology TechnologistRadiology Technologist 60629 Hispanic or LatinoRadiology-Radiology TechnologistRadiology Technologist 60629 UnspecifiedRadiology-Radiology TechnologistRadiology Technologist 60636 Black or African AmericanRadiology-Radiology TechnologistRadiology Technologist 60804 Hispanic or LatinoRadiology-RN Registry - PICC Special Procedure RNRN Registry - PICC Special Procedure RN60466 Black or African AmericanRadiology-Special Procedures TechnicianSpecial Procedures Technician 60462 AsianRadiology-Special Procedures TechnicianSpecial Procedures Technician 60480 UnspecifiedRadiology-Special Procedures TechnicianSpecial Procedures Technician 46307 WhiteRadiology-Special Procedures TechnicianSpecial Procedures Technician 60409 Black or African AmericanRadiology-Special Procedures TechnicianSpecial Procedures Technician 60452 Hispanic or LatinoRadiology-Special Procedures TechnicianSpecial Procedures Technician 60632 AsianRadiology-Special Procedures TechnicianSpecial Procedures Technician 60803 AsianRadiology-Ultrasound TechnologistUltrasound Technologist 60016 WhiteRadiology-Ultrasound TechnologistUltrasound Technologist 60501 Hispanic or LatinoRadiology-Ultrasound TechnologistUltrasound Technologist 60419 Black or African AmericanRadiology-Ultrasound TechnologistUltrasound Technologist 60478 Black or African AmericanRadiology-Ultrasound TechnologistUltrasound Technologist 60644 UnspecifiedSecurity-Public Safety Officer IPublic Safety Officer I 60636 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60438 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60617 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60620 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60620 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60620 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60628 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60628 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60628 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60637 Black or African AmericanSecurity-Public Safety Officer IPublic Safety Officer I 60643 Black or African American



Labor Allocation Details Position Description Zip EEO EthinicitySecurity-Public Safety Officer IIPublic Safety Officer II 60617 Black or African AmericanSecurity-Public Safety Officer IIPublic Safety Officer II 60620 Black or African AmericanSecurity-Public Safety Officer IIPublic Safety Officer II 60628 Black or African AmericanSecurity-Public Safety Officer IIPublic Safety Officer II 60636 Black or African AmericanSecurity-Public Safety Officer IIPublic Safety Officer II 60636 Black or African AmericanSecurity-Security-SupervisorSecurity-Supervisor 60643 Black or African AmericanSecurity-Security-SupervisorSecurity-Supervisor 60643 Black or African AmericanSecurity-Van Driver Van Driver 60629 Hispanic or LatinoSecurity-Van Driver Van Driver 60805 Black or African AmericanSocial Services-Clinical Social WorkerClinical Social Worker 60438 Black or African AmericanSocial Services-Clinical Social Worker (MSW)Clinical Social Worker (MSW) 60628 Black or African AmericanSterile Processing-SPD TechnicianSPD Technician 60411 Black or African AmericanSterile Processing-SPD TechnicianSPD Technician 60609 Black or African AmericanSterile Processing-SPD TechnicianSPD Technician 60617 Black or African AmericanSterile Processing-SPD TechnicianSPD Technician 60643 Black or African AmericanSurgery-Nurse Manager Nurse Manager 60653 Black or African AmericanSurgery-OR Technician Non-CertifiedOR Technician Non-Certified 60402 Hispanic or LatinoSurgery-OR Technician Non-CertifiedOR Technician Non-Certified 60617 AsianSurgery-Staff Nurse Staff Nurse 60406 Hispanic or LatinoSurgery-Staff Nurse Staff Nurse 60409 Black or African AmericanSurgery-Staff Nurse Staff Nurse 60445 Hispanic or LatinoWomen and Infants/Children-Breast Feeding CounselorBreast Feeding Counselor 60628 Black or African AmericanWomen and Infants/Children-Breast Feeding CounselorBreast Feeding Counselor 60628 Black or African AmericanWomen and Infants/Children-CNACNA 60628 Black or African AmericanWomen and Infants/Children-Nutrition Advocate WICNutrition Advocate WIC 60617 Hispanic or LatinoWomen and Infants/Children-Nutrition EducatorNutrition Educator 60637 Black or African AmericanWomen and Infants/Children-Nutritionist WICNutritionist WIC 60639 Black or African AmericanWomen and Infants/Children-Nutritionist WICNutritionist WIC 60619 Black or African AmericanWomen and Infants/Children-Nutritionist WICNutritionist WIC 60652 Black or African AmericanWomen and Infants/Children-Receptionist WICReceptionist WIC 46320 Black or African American


the new roseland hospital transformation proposal

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