Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health Podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Chief Executive Officer, Dr. Eric Mikaitis, about a clear vision for Cook County Health. Thank you so much for being here today.

Erik Mikaitis: Well, Maggie, thank you for having me.

Host: Congratulations on your first 100 days as permanent CEO at Cook County Health. Tell us a little bit about yourself.

Erik Mikaitis: Absolutely. Well, thank you first for the congratulations, and thanks again for having me this episode. So, I guess I'll just start at the beginning. I was born and raised in Chicago on the South Side. My parents both worked-- well, first my mom, I'll start, she worked in the public sector, first as a public school teacher for just a couple of years, went to the police academy, and ended up staying for a whole career as a Chicago police officer. And then, after retiring, went back to the Chicago public school system to retire for a second time. So, multiple careers there with the city. My dad worked at the University of Chicago as a kind of a buildings and grounds physical plant type of a role, but that afforded them to give us the opportunity, me and my sister, to attend the laboratory schools at University of Chicago, which was a wonderful experience, great opportunity.

From there, I went to UIC, got my Bachelor's in Biology, followed by DePaul for my MBA. So, most of my adult education life as well spent in in and around Chicago. And at that point, it was the first time I kind of left the area. I went to Ross University, which first 18 months are down in the Caribbean. I got to live in Dominica for the first year and a half, but then returned right back to the Chicago area. I ended up doing a lot of my clinical rotations at the St. Anthony Hospital, which is just around the corner from Stroger and at West Suburban Medical Center over in Oak Park.

And while I was there managed to secure an Internal Medicine residency slot at West Sub and spent three years there training in Internal Medicine. And then, at that point, I really was kind of looking for my first real kind of job as an attending physician. And it really clicked with a group out in Crown Point, Indiana. So, I joined a hospitalist group , . and was pretty fortunate working in that health system, a lot of opportunities to kind of grow and develop in the leadership sense. So, I started as a hospitalist and, after about a year, was given an opportunity locally to start working to better develop our palliative care program. We had started with really a nurse and a social worker, really got to grow that more into the provider space, engage the medical staff. That then grew into a regional role where I got to bring on additional physicians and nurse practitioners. We opened up ambulatory centers there for that. So, really great experience in terms of kind of that service line mentality, really growth and operations and all of that.

At the same time, I was able to work in a pair kind of interface from the provider perspective, both as a physician advisor as well as in managed care. So, all of that then combined to provide the opportunity for me to work as a medical director in our accountable care organization. So, value-based care, population health. So, I got to move into that space for a few years, and then became a hospital chief medical officer after that. And at that point, I was there for about four and a half years and then came to Cook County Health in September of '22 as the systems chief quality officer.

So as I kind of look back, it's really been kind of a focus of, improvements and what can I and how can I help people. better, right? How do I improve processes? How do I engage teams differently? And at each step, I think along the career, it's really been kind of larger in different spheres of influence and how I got to really do that work. So, that's really looking back, I think what's really kind of driven me in terms of each next step in the career.

Host: You have been busy. What drew you to CCH?

Erik Mikaitis: So, the CFO where I was the chief medical officer left to come to CCH. She is now our CFO and had been prior to my leaving. But she called me about a year after she left and said, "Hey, you know..." At that time, Israel was the CEO, Israel Rocha. And she said, "You know, Israel is looking for someone to help kind of do things in the quality space," a lot of which she knew that I had worked on as the CMO at that hospital. So, she got me in touch with Israel. And he did just such a wonderful job articulating the mission of service, you know, kind of the engaging the underserved and the opportunities that improvement. So again, tying back to that, what really clicks with me is finding those opportunities to make things better, to engage the team so that it's beyond the outcomes and the experience for the people that we're serving. It's also improving the work that we do and the teams that are doing it.

Host: And so as we mentioned, you hit your first 100 days as permanent CEO on February 1st. Can you tell us what you've been up to?

Erik Mikaitis: Absolutely. So, a lot of work around our strategic plan. It's actually kind of an interesting time right now. We're rounding out the last three-year strategic planning cycle. And this year, 2025, we're going to be preparing '26, '27, '28 for the plan looking forward. So, a lot of discussions with senior leadership, with our teams, with the community, with our board and in preparing what that roadmap is going to look like. And also, behind that, really focusing in on how we articulate that better through the various levels in the organization so that from, you know, the board and our senior leadership team out to our front lines, everybody's got a clear vision of where we're heading, what the plan is, what we're all supposed to be working on. So, really trying to bring that clarity in and around our strategic plan.

But some specifics, I'm proud to say we have entered into our first value-based care agreements. We're in three now with the fourth one warming up. That's been in the last year we've been able to do that. And we have three or four more planned, I think, in the next year that we should have completed by 2025. And then, potentially joining an accountable care organization as well. So, a lot of work in that population health value-based care space, kind of getting ready to launch and, in some ways have already, we've hit the ground running. And then, really focusing internally, I think, on accelerating the scale and the pace of our hiring. I think we have a lot of work to do in kind of that workforce development space. It's a bit of the longer game, but I'm sure we'll talk a little bit more about it, but establishing a more concrete pathway program. Engaging our communities, our students in the communities, to pique interest in the healthcare space, right? And then, create pathways and opportunities to engage with our team in the healthcare space to bring those students in so that they can really see what all the varied options are for careers in medicine.

Host: And you kind of answered it, but what's your vision in a nutshell for the future of Cook County Health? How do you see it?

Erik Mikaitis: Yeah. So, I think first and foremost building on the strong foundation that's already been there, that it's established, and I think looking forward really trying to grow strong roots in equity, in high reliability, and in innovation. I think those are really the key pieces, right? And finding new and different ways, I think, to engage with our communities. You know, right now, we're a very unique health system. We're a provider, we're a payer, we're also a steward of public health, it's pretty unique to have all of those pieces under one umbrella. But instead of just being, one or maybe two of those things to various people in our communities, how do we become a true partner in health and well-being for the communities that we serve? So, really focusing in that direction.

Host: Dr. Mikaitis, what are your biggest priorities?

Erik Mikaitis: So, I'd say probably two things. I'm going to take kind of a broad brush in saying innovation, but that cuts a lot of different ways. You know, when you say innovation, a lot of people really think kind of that technical component, right? What kind of technology are we deploying? And that's a big piece of it. And so, leveraging that technology so that our teams can provide safer, more efficient care, and really focus on engaging our patients in different ways. So, you think about things like remote patient monitoring or tele-sitter, virtual nursing, those types of solutions.

But beyond that, innovations around care delivery models. So, we talked a little bit about value-based care. So, moving us more into that population health space, so that we're focusing on upstream interventions, prevention, wellness for our patients instead of focusing kind of in that transactional acute care space. And then, that obviously involves innovative financing models as well. And at the end, fiscal resilience will happen, I think, with all of that. But at the end of the day, it's really about improving the patient outcome experience of care.

Host: I imagine there are a lot of moving parts. So, what are your biggest challenges?

Erik Mikaitis: Yeah. So, workforce is one of them. Hiring, and another area of intense focus right now. It's really focusing in on how we streamline our internal processes. But then, of course, building kind of those external partnerships. I talked a little bit about the pathway program. We're engaging with Chicago Public Schools at this point, as well as City Colleges of Chicago to really create from grade school all the way through completion of either a degree or certificate program that we're involved with, with those various steps, either through clinical rotations, through on-site discussions, and that cuts across all the different professions. From your more traditional, you know, doctors, nurses, therapists, in through our behavioral health workforce as well.

So, in addition, I would add, we have the Providence Scholarship too that has been growing year over year. We just completed the third year in awards, and exploring how we grow that work as well, whether that's in behavioral health, kind of expanding Providence Scholarship Program. So, hiring and workforce, I think, is one of our bigger challenges.

I would also say being stewards of our resources. We've been ending the last few years positive to our budget, right? We've had a positive margin, which has been fantastic. But I think continuing to look for those efficiencies, ensuring that we're sustainable so we can continue carrying our mission forward.

Host: You mentioned innovation. Where do you see that playing a role in Cook County Health's future?

Erik Mikaitis: So, I think it always has played a role, looking back and kind of learning about the organization over the two plus years that I've been here. We've been rooted a lot in innovation. We have a legacy, right? We were the first blood bank, the first comprehensive trauma center, the first medical internship program, medical training used to be more of kind of an apprenticeship structure.

And Cook County Health actually created that first step into what we know as resident training nowadays. So, they kind of had that first internship program in the country. So, we've also had a lot of clinical advancements that have shaped the practice of medicine today.

I think it's essential that we continue in that path that we not just keep up, but that we're out front, that we're leading, right? So, I think driving innovation in that sense is going to lead to us providing the highest quality of care, having optimal outcomes and being able to, in a lot of ways, serve as many people as possible.

Host: And what are your accomplishments that you are most proud of? Not so much daily activities, but just in general.

Erik Mikaitis: Yeah. I think, to do a lot of the things that we're talking about, the innovation, there too has been a lot of work around kind of continuous improvement, process improvement. I think it starts there and driving that culture change to really empower our frontline teams. And I'll give you an example.

When I came in, and I mentioned when I spoke to Israel and he kind of. laid out the vision and, you know, he talked about mission and the need here for improvements, one of the things we talked specifically about was our performance in sepsis. And this is an example of how we're trying to start engaging our teams a little differently. But in talking through the current state, when I was speaking with him before joining the 12-month rolling performance. So, it's the last year's worth of monthly data average. For the sepsis quality measure, we were performing at 17%, which means only 17% of the time were we actually firing on all cylinders when we identified a septic patient.

So, coming in, we took a bit of a different tack in how we engaged the teams. We did what was called a rapid improvement events. We had a performance improvement expert in the room. And we pulled our frontline team members into the conversation. So, it was nurses, our attending physicians, resident physicians, our phlebotomists, pharmacy, clinical informatics, right? Our frontline team that does the work every day.

So, they sat down for three days and they had three kind of crucial steps in that discussion. First they unpacked the problem. What are all the kind of the nuances in terms of what the issue really is. Then, they looked at how we attack that problem in current state, right? Like what are our current processes, and how we try to address that problem. And then, they looked at the gap between what does good look like and where do we need to get and where are we currently. So, they built out their ideal state and then they looked at how we get from where we are now to ideal state.

And we were very intentional in having that conversation without any leaders in the room. And that's been kind of a way that we've tried to move forward, at least from the quality improvement lens. In that, we want people to feel safe and be able to speak freely in terms of the day-to-day challenges that they're facing and not worry about somebody being in the room who may not like to kind of hear some of those challenges, right?

And I just popped in and out to make sure that the conversation was going in the right direction. And there was this really great light bulb moment at one point where it just happened to pop in as they were starting to talk about that ideal state, kind of the future state where they want to get. And I think it was one of the nurses kind of raised her hand and said, "Wait a minute. You mean we get to kind of design what this is going to look like?" And it was this great, like, "Aha." Like, okay, this is now we're engaging kind of in a really meaningful way, I think at least. But I'm happy to say, just to kind of come back to the accomplishments, this is by no means my work, right? This was a big broad team that did this. And that was one of the teams that looked at it. We did a lot of other work around this as well from abstraction processes, data analytics, how the computer system worked, the electronic medical record and flagging patients for our clinical. There's a lot of different moving pieces to this. But I'm happy to share that. just one year later, we had gone from 17% up to 72% compliance on the sepsis bundle, which actually put us a full standard deviation better than the national average by the end of that year. So, just some phenomenal work done by the team. And it was really encouraging, I think, to see how kind of engaging a little bit differently and empowering frontline teams, to be able to kind of own that work and drive that improvement, has the potential to really make a difference.

Host: That was so smart not to have managers in the room. It obviously works, right? The goal was met. What do you think are the biggest challenges the healthcare industry will face in the next five years? And how is Cook County Health preparing for those challenges?

Erik Mikaitis: Absolutely. So, I think there's really two things. One's a bit of an unknown right now, but it's really that payer space. And specifically, right now, you know, we worry a little bit about Medicaid and what that might look like going into the next few years. Again, that's, still a bit of an unknown. We don't know what's to come, but it's something that we're talking about and kind of preliminarily planning for.

I think the thing that's more immediate right now, and we've talked about it a little bit already, but it's workforce shortages and how they're impacting us. They're impacting a lot of other health systems across the country. We have an office of behavioral health that did a workforce, essentially a symposium and an analysis, and found that in current state, we're in need of 16,000 more healthcare staff just to meet the current need for healthcare demand or for behavioral healthcare demand, I should say. And they were projecting in the next five years, that number is going to be more on the order of 30,000 people, behavioral health workers, and that's for Cook County.

So, it's an incredible need and there's a precipice coming, right? It's between retirements and people leaving the healthcare space. You know, COVID kind of accelerated that a lot. People moved away to remote positions and different options and moved away from the bedside, unfortunately. But that's left a bit of a hole in the workforce. So, we talked a little bit about what we're trying to do already. But, you know, we're partnering with a lot of community organizations, really looking at how we can bolster the workforce. How do we invest in a pipeline or a pathway program across all these areas and then, partnerships with schools, which we've talked about as well, you know, engaging it at the grade school level, kind of piquing interest. I heard it put very eloquently, you can't be what you don't see, right? So really, try and engage with our communities and pique interest in the healthcare space.

And then, you know, I mentioned Providence Scholarship, it's been $3 million now across the last three years to 182 students that depending on which education track they're in is either $10,000 or $20,000 each yea, that's awarded to the students. And we had some very wonderful stories that we heard the last time around of how that changed students' lives. You know, one student told us about how she had to hitch rides with her friends just to get across campus to get to classes and this afforded her the ability to get a car. So, I mean, she was able to go to clinical rotations and get herself to class and all this. I mean, in some ways, really life changing, right?

So, exciting to see that, but we're also exploring parallel programs. During that workforce symposium, we heard another story around, I believe it was a social worker who unfortunately went through a divorce, had custody of the kids and had to drop out during an unpaid internship just to finish their degree program. So, there's a social worker that we otherwise would have had taking care of patients now unfortunately had to leave and find different means of employment because of life situation. So, how do we create maybe a parallel scholarship track that would help people stay when they're in those types of situations and complete their degree program. So, exploring a lot of different options.

Host: Great. Well, it sounds like you've got all the bases covered. Why should the community consider Cook County Health as their medical provider?

Erik Mikaitis: Well, Maggie, we've been around for almost 200 years at this point. And we've been, I think, a leader in advancing healthcare and we have an incredible legacy. Still to this day, we have an incredible medical staff, expert physicians, expert nurses, really at the top of their field. And I think our mission and our vision. We care for everyone regardless of ability to pay or immigration status, right? So, I think that elevates who we are and how we engage with our communities. And it's our aim to create a health system that is going to be a provider of choice for everybody, that will ensure access to high quality care and that we're going to elevate the health of all Cook County residents. We may have evolved over the years, but our mission hasn't changed. And that's ensuring that everyone can live their healthiest life.

Host: Sounds like a good plan. How can listeners learn more about Cook County Health?

Erik Mikaitis: Yeah. So, you can find us at www.cookcountyhealth.org. And we're on every social media platform. So, look us up, Cook County Health and give us a follow.

Host: Thank you so much for making the time and giving us an update today. That was really interesting.

Erik Mikaitis: Thank you, Maggie. Thanks again for having me.

Host: Absolutely. Again, that's Dr. Eric Mikaitis. To find out more, please visit cookcountyhealth.org. And as we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast. Share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.