Erik Mikaitis, MD (Host): Hi, everyone. Thanks for joining the second episode of Pulse Check. Pulse Check is our internal podcast for the CCH team to get the latest updates and learn more about our incredible institution. We're going to be doing a lot of that today, kind of a brief history, of the system.

And I have here with me today, Dr. Claudia Fegan, our Chief Medical Officer, and Shannon Andrews, Chief Equity and Inclusion Officer. Today's episode is particularly special, Dr. Fegan is going to be retiring at the end of 2024, which is just a couple days away. So we're recording this episode in gratitude for her leadership and her contributions over the last 24 years.

So before we get into the actual podcast, I do want to just do a few other updates, starting with offering kudos and congratulations again to our Provident Hospital team. They were named Top General Hospital by the Leapfrog group, and this is, uh, of course, a recognition that acknowledges the modern high quality care that's being provided at Provident.

It's a testament to the unwavering dedication, compassion, and expertise of the entire Provident team. So join me again in congratulating the wonderful team. On another note, there's a little more housekeeping, but it's also good news. Pulaski Day was added back into the fold as a Cook County holiday.

 It falls on March 3rd this year, and it's our health centers, clinics, and administrative offices are going to be closed. Again, that's on March 3rd. The holiday recognizes Kazimir Pulaski, who came from Poland, supported the Americans during the Revolutionary War, and is known as the father of the U. S. Cavalry.

Okay. So with that, let's jump into the discussion. When we started the podcast, we asked everybody to submit ideas for issues or topics that we could cover. And this one for today comes straight out of the suggestion box. We're going to talk about the history of Cook County Health and how we came to be the large integrated enterprise that we are today.

 Claudia and Shannon, I'm sure you both have unique perspectives on the history of the system. We'll start with you, Claudia. Why is this such an important topic to cover?

Claudia M. Fegan, MD, CHCQM, FACP: You know it's important for people to understand our origins, where the organization, from whence we came, understand our core mission and values. We have been a leader. We were the first training program for physicians across, what has become across the world, because we started the first internship, people come here to train and then, go out into the world to practice.

So it establishes our worldwide mission, and that we take care of everyone regardless of their ability to pay. But we take great pride in being one of the best institutions in terms of the quality of care we provide. And so I think it's important to help people know more about the organization for which they work and have a sense of pride about being a part of something that is so important historically and continues to be a leader in the health care that we provide and are known nationally and internationally for that. So, I think it's really a good topic for us to discuss.

Host: Definitely, and I think one of the first things you shared with me when I started in the system was that it's hard to work anywhere else and not bump into at least a person or two who have had some type of relationship, whether they worked here or trained here, at Cook County Health.

Claudia M. Fegan, MD, CHCQM, FACP: They have come through our doors at some point.

Host: Yeah.

Excellent. Shannon, any other thoughts?

Shannon Andrews: You know, I think I bring an interesting perspective to it as the inaugural chief equity and inclusion officer here at Cook County Health. Folks are often surprised, based on our rich history, at least external to the organization, that this is the first time we've had this role in, this space, but I think that what those of us who are a part of the family are uniquely aware of is that Cook County has really been doing equity long before it was sexy, if you will, before it became a buzzword.

The reality is that our mission is steeped in making certain that people who are disenfranchised and are typically forgotten about in the community; have a place to get quality health care. And that's really the essence of equity. And so when we talk about history, and the history of the organization, I think that in the current climate, it's really important to stand strong and hold on to the rich history of the important work that we do, around equity. We talk about here, one of the first patients, if not the first patient at Cook County Hospital was a German girl with an abscessed hand. That's where we started our work being on the west side, and in the communities that are often forgotten about.

So, it's exciting to know that our colleagues and the family, want to continue sharing that history and I'm really happy to be here today with both of you to do that.

Host: Absolutely. So Shannon, you shared a little bit of history. Can you kind of go back to the beginning and tell us a little bit about the system?

Shannon Andrews: Absolutely. So, some fun facts, the reality is that we've been, I often tell people that we have the unique, we sit in this unique space of being both a healthcare system and a government entity. Our history dates back to perhaps four years after Cook County government was incorporated.

 We had our first health services. I checked this pronunciation with Dr. Fegan earlier. First health services were by the name of the Public Alms House. And it was essentially established to care for impoverished residents in Cook County. There was a makeshift hospital, if you will, that was built on Kensian State Street.

I want to say it was 1847, and something else that I think is interesting is at the core of establishing that, it was to care for patients who had been impacted by scarlet fever and the smallpox epidemic, which is interesting after having just come out of from where we sit, I believe, being a leader in addressing our most recent pandemic. This organization, again, uniquely situated to deal with and to provide leadership in that we were founded on some of our very early work was done trying to address those types of issues. And then, maybe, I think roughly 10 years later was when we had our first permanent hospital.

 As I understand it, it was built by the City of Chicago, again, during yet another epidemic, cholera, was taking place. They built this permanent hospital and then shortly after the Civil War, Chicago gave that hospital to Cook County, and a new hospital opened shortly afterwards in 1866.

So, a rich history here in the county of being able to address the needs of the community, not just through the healthcare lens, but through a governmental responsibility or calling, if you will, to appreciate that we had a role in ensuring that the citizens were healthy and had access to health care.

Claudia M. Fegan, MD, CHCQM, FACP: So right after the Civil War in 1866, we had, as I alluded to before, that we created the first internship. Prior to that, people who wanted to become a physician just apprenticed with a physician that they might know or meet, so that they could learn the practice. But we created a firm formalized internship program here at Cook County, and it has become the model for training physicians around the world. And then in 1881, we had the first woman, intern at Cook County, Dr. Mary Elizabeth Bates. So we have a rich, rich history in terms of medical education and to this day, people still travel from around the world because they want to come and train here.

As I said, you can't go anywhere. You said in this country, I would say in this world without encountering someone from Cook County who's passed through our doors at some point. I've encountered county graduates in China and even ran into someone in Fiji. So, I think that we continue to train excellent physicians and then we cast them out into the world where they provide care, that we can all be proud of.

Host: Absolutely. Yeah, you said first a couple of times as well. We have a lot of things to be proud of in terms of medical firsts, right? Things that we've done. You know, the old County building we got up into almost 1900s. So the old building that's across the parking lot, that was built in 1916, 2,700 beds, which is a huge number.

And, over there, there were a bunch of firsts as well. The first surgical fixture of bone fractures, first blood bank was developed by Dr. Fantis in 1937, first comprehensive trauma unit, that was in the cafeteria space in 1966. I'm sure there's a lot of others too, but again, right, sharing all of this just because there's so much to really be proud of in terms of the legacy of innovation and that we're continuing even today.

Claudia M. Fegan, MD, CHCQM, FACP: Yeah, I remember that old building very well in my beginning of my training and running up and down the stairs and, the huge open wards that we had there. But it was an incredible place to learn the practice of medicine. And it was really, medicine in its purest form, just trying to provide the best care for patients with the whatever we had available. The physicians and nurses and all of the staff were incredibly ingenious in trying to make sure that patients got the best things available. I learned a lot. Cook County has evolved over the years to meet the needs of the community.

 That old hospital had the country was ravaged with tuberculosis. We had an entire ward that was dedicated to the care of TB patients. And Quentin Young, who I practiced with early in my career, used to tell me about rounding on the tuberculosis ward when we really didn't have a lot of treatments that we could offer those patients. But, the Pulmonologists, the lung doctors were really committed to restoring these patients to good health. We had lot of surgical advancements, you know, in the 1950s, but then we went on to establish the Cook County Department of Public Health in 1937 to address the issues of education and disease.

But it was basically making sure people had basic things like clean water to drink and safe food to eat. And recognizing that we had to play a bigger role in helping the public and protecting from things that were just around us. And understanding, the role that germs and infections played in our health and what people could do themselves to protect themselves.

The health department helped lead the fight against polio, and Cook County was one of the first public health entities to use the vaccine developed by Jonas Salk for the treatment of polio. So, as you point out, we do have a lot of firsts in our history.

Host: So much to be proud of. So, Shannon, we've kind of covered some of the earlier history, how has the system evolved in, say, like the last 30, 40 years?

Shannon Andrews: Well, it's really interesting because I think one of the things as I talk to people it does not matter who you talk to, they're always amazed at how big our footprint is. I think from its inception, it, it contemplated healthcare in a larger way than just four walls, if you will.

But in 1969, right before 1970, the Cook County Health and Hospitals Governing Commission was established. And at that point, they were charged with managing not just Cook County Hospital, but also the Cook County School of Nursing, which we haven't mentioned, the Oak Forest Hospital and some other community hospitals.

So, when you think about it, it really has been an evolution of this notion that healthcare is more than a one moment effort, if you will, and that there a multitude of elements that are part of that. In addition, to that piece, we also opened, in 1950, the Cermak Jail Hospital, and by 1981, in terms of seeing a growth in their presence, it was named the largest, accredited correctional care facility in the U. S.

So, again, really thinking about how we care for citizens, regardless of where they may enter the conversation of their health care. We also had Cook County's first Community Health Center was opened in 1975, in the South Lawndale community. It's the South Lawndale Health Center, which today is called the Jorge Prieto Health Center.

And I think if my math is right, that will mean that we're coming up on a 50th year anniversary of being situated in that community. So a big piece, I think, of the evolution and a lot of what we're talking about today is that as needs arose and as we identified a way that we could stand in the gap, if you will, that as an organization, as a government entity and a healthcare system, we really tried to meet the need.

Host: Absolutely, another piece of that kind of puzzle that we mentioned earlier at the beginning, was Provident Hospital, and while they joined us only in 1990, I think their history is very much aligned with everything that we've been talking about so far.

 There was, and Claudia, you taught me most of this, so I'm going to hand it over to you in just a sec, but, Emma Reynolds, was aspiring to be a nurse, wasn't allowed into any nursing schools because of her race, and she and her brother, Reverend Reynolds, approached Daniel Hale Williams, Dr. Williams, about opening a hospital. And he convened a group of ministers and doctors and business owners, to try to bring together the resources, to start their own hospital. They took on fundraising efforts and, if I remember, I think it was Armour meat packing company, ended up giving, the down payment for the first building.

 it was on 29th and Dearborn, 12-bed hospital, and on August 17th, 1891, Provident Hospital opened. The first hospital, and nursing school that was owned and operated by African Americans in the United States. Do you want to say some more, Claudia?

Claudia M. Fegan, MD, CHCQM, FACP: Well, Daniel Hale Williams thought that it would be just an easy matter to help Emma Reynolds get into nursing school and then found out really how dug in they were at that time and not allowing a black woman to study nursing. So, the School of Nursing at Provident was really a source of pride for the community.

And then, Provident Hospital being the first African American hospital in the United States, was very important in the Black community and was a, a sort of a beacon, you know, there were physicians who couldn't get privileges other places who were able to work at Provident to apply their craft that they had been properly trained and then couldn't get privileges in the Chicago area.

 So there was a great sense of pride. And then people who were aligned with the civil rights movement, wanted to be practicing at Provident. And then they built, the new Provident hospital. Everyone was excited about it and thought, Oh, this is just really embraced by the community.

And unfortunately, it didn't do well financially. Soon after the new hospital opened, they were forced to close. And so when it was finally purchased for a dollar by the county of Cook, people were very excited to have that new building reopened. It had less than 10 years after having opened.

So to have Provident back was a source of pride. People wanted to admit their patients there, take care of their patients there, and it was a tremendous opportunity. Interesting thing about Emma Reynolds, after getting this degree in nursing; she actually went to medical school and became a physician.

But after becoming a physician, she still went on to want to train nurses. So she was very committed to the practice of nursing and spent her career training nurses in the delivery of care in the hospital side. So, a very rich history. And Daniel Hale Williams, how can you not acknowledge the first open heart surgery?

It was a gentleman who was stabbed in the heart and Daniel Hale Williams was able to repair his injured ventricle and he survived, and went home after the surgery. So, it is a real source of pride and we're happy that Provident Hospital continues to do well having received this recent acknowledgement from LeapFrog, and continues to be a source of light in our community.

Host: Absolutely. And I think that open heart just for perspective was done in the 1890s, right?

Claudia M. Fegan, MD, CHCQM, FACP: Thats' correct.

Host: Incredible. All right. So that's, let's see, we haven't really talked much about the ambulatory center. Shannon, you mentioned, Jorge Prieto, or Claudia, if maybe you could talk about CORE center a little bit.

Claudia M. Fegan, MD, CHCQM, FACP: So the AIDS epidemic, and I remember this so well in my training, really came to rise in the 1980s. I actually remember taking care of the first patient with a transfusion related case of HIV was a young woman who had come from Mainland China, because she had rheumatic heart disease and she needed open heart surgery and she got 10 units of blood product, including two from blood bank in Louisville, which was where the index case for HIV in this country.

So, the first AIDS clinic was opened in at Cook County in 1982, and it served 141 patients. It's important to understand, back then and even to this day, one in three patients with HIV is taken care of at the, uh, Ruth Rothstein CORE Center, which was opened in 1999. But I still think back to Ron Sable, who was a leader on the Cook County medical staff, who led the fight to provide patients with AIDS, the care that they need.

Ron Sable and Ron Chansky were instrumental in setting up that service, and it was a welcoming space at a time when there was a tremendous amount of stigma associated with AIDS, and so the Ruth Rothstein CORE Center, really provided a place where people not just with HIV, but any infectious disease, could be taken care of without stigma and treated in an embracing fashion.

And it's really pivotal because it really became the role model for how we should provide care for those patients with wraparound services, recognizing that people who had this disease at a time when we really didn't have treatments for them; needed not just medical care, but needed acknowledgement of the effect that it had on them with regard to employment.

Many of them lost their employment. They were stigmatized. They lost their housing. So it was the beginning of providing comprehensive services. And with that recognition, CORE led the way with STI clinic to treat patients who could just walk in and be treated, without question and without judgment.

And I think that's important today because we still hold up that banner at the CORE center.

Host: Yeah, absolutely. It's incredible work that's happening over there and, while more recent still, very rich history. So that's one piece the ambulatory team, right? We've in 1995 established ACHN, right? The Ambulatory and Community Health Network. And it spans the entire county with outpatient health center school based clinics and from Arlington Heights all the way down to Blue Island.

 Claudia, you want to talk a little bit about the ambulatory centers?

Claudia M. Fegan, MD, CHCQM, FACP: Oh, well, that's my home. I started, I was invited to come work at Cook County to work at ACHN. At that time, Terry Conway was the Chief Operating Officer for that network. And we built a network of clinics. We got up to about 32 of those clinics. And it was really, it's interesting, it was Quentin Young and Ruth Rothstein who were instrumental in creating that network.

And it was on the, built on a premise that we needed to bring the care to the communities. We needed to bring the care to where the patients were and that all the patients shouldn't have to come to the West side to receive their care. That if we could provide them primary care in their neighborhoods, that we could do a lot more preventive services.

it was really a great advancement. We created the school based clinics. We created small clinics in communities that hadn't had access to health care and yet they were affiliated with the county and when they, they needed to have specialized care, or needed to have testing, they could be sent to Provident, or they could be sent to Cook County or Stroger as it became later in the 2000s.

But, really all of us who worked in the ambulatory network were quite proud. We hired people from the communities that we were serving. And, it was really a huge advancement in the delivery of care for people who hadn't had access to such care previously.

Shannon Andrews: Claudia, I'm curious from your perspective, from the clinical space of it, I mean, that sounds like a heavy lift, as it relates to making that happen. Can you speak a bit or from your understanding of it, was there anything specific that happened or was it more of just an organic sort of understanding that when people left the hospital that they still had healthcare needs?

 It

Claudia M. Fegan, MD, CHCQM, FACP: was a variety of things. It was the community also asking for the care, and a matter of fact, one of the tenants as the clinics were being deciding on the sites, because everybody wanted a clinic in their neighborhood, and, working with those communities, and they're, each of the communities was built to have advisory board, and the advisory boards had to be made up, the majority of the people who served on those advisory boards had to be patients or community members.

More than half of every advisory board had to be either patients or community members. You know, there was a lot of jockeying for who was going to have a site, but a variety of things would come together. So for example, for Jorge Prieto, Jorge Prieto was a primary care physician a family physician.

And he was a big leader in that community in terms of trying to get a site there. So when he passed away, the site that was built, carried his name and he was a very, very sweet man. I had the pleasure of knowing him and his son became an orthopedic surgeon and actually worked at Cook County for a number of years.

For example, the site at Woodlawn, one of the, where I was worked as a primary care physician. That was a community effort as well. So various sites, you know, it had to make sense for the county as well. I mean, we didn't have the funds to build all of these sites at one time.

And so it was where there was a commissioner who was really engaged and able to find partners who might help us decide on the various locations of the clinics.

Shannon Andrews: And that's probably a good space to sort of insert, because again, one of the things that we continue to talk about is the uniqueness of in our history of being connected, again, not just as a healthcare system, but also as a government entity. It was, I think, in 2008, to be specific, that the Cook County Board of Commissioners voted to create an independent board of directors to govern all county health services. I would imagine in no small part because of the vastness of it. It was, I mean, when you think about it, at that point, it was combining and giving the ability to govern not just the hospitals, but our health centers, the correctional health, that mentioned earlier at Cermak, our public health department, putting those things all under one umbrella.

I'm certain with an eye towards, making it easier to maneuver as a system in whole and giving us some autonomy. Of course, the Cook County Board, President Tony Preckwinkle and the Cook County Board of Commissioners, still continue to be involved and provide great leadership over our governance by approving our budget and strategic plans and providing input on our strategic direction.

But I think it really is a unique opportunity, again, for the public sector, the government entity and the hospital have come together to make certain that we're taking care of the needs the community and of the constituents and patients.

Claudia M. Fegan, MD, CHCQM, FACP: Yeah, the enabling ordinance was very important because it came right after a year of really severe financial constraints. We had been mandated to cut a lot of services. So, there was little bit of a backlash behind that, so there were a lot of people who were, concerned about the health system and the direction we were going, and wanted to have more input.

So, creating an independent board, was a very important part of carrying the organization forward. After the decision to cut various services, there was a bit of an outcry about what we were doing, who we were serving, and so this was seen as a way and it was also at a time, a change in leadership.

John Strozier was no longer in charge. Todd Strozier had been the president of County Board, and then President Preckwinkle came in, and it was seen as an important mandate to give the public more of a voice in what was occurring. And so there were a multitude of community groups that were allowed to make nominations or recommendations to the president about who would serve on the independent board to provide direction for the health system.

So it was a period of big change, but it was also a period of again, looking to the public and the community we serve about what were the services they needed and giving them some what of a say. And that group still exists that makes the nominations for the independent board. And it's a variety of community organizations that are allowed to make the nominations for who serves on the board. And that's seen as a way to ensure that we stay in touch or stay connected to communities we serve and make sure that we're still addressing their concerns and their needs.

Host: It's fantastic. It's another step in the evolution, right, of, what we've become and what we're becoming. You know, we think about the health system, and I think one of the things that really makes us as a system unique are all the different components that make up CCH. So, we've talked about public health that remains under the umbrella of CCH, right?

We've talked a lot about, kind of the clinical services that we provide, the hospitals and the ambulatory centers. We haven't really talked about the health plan, though, and one of my goals looking forward is to really figure out how we're going to pull in all of those different teams, right?

So that we are being effective and that we're best able to serve those communities, but the health plan is something that we haven't really talked about, yet. And I think, if I remember, it's a little over 10 years now that it's been in existence. It came around because of the Affordable Care Act. Claudia, you want to tell us a little bit about that history?

Claudia M. Fegan, MD, CHCQM, FACP: Oh yeah, that's an important change. I will tell you that before the Affordable Care Act, 80 percent of the patients we saw as outpatients were unfunded, 56 percent of the inpatients that we took care of were also unfunded. And trust me, if there was any way to get funding for those patients who were on the inpatient side, we got it.

We applied for everything we could for those patients. But, in 2010, when the Affordable Care Act was passed and was going to allow for the expansion of Medicaid, Cook County was leading the pack in terms of we, President Preckwinkle, applied for a 1115 waiver, which would allow us to start enrolling patients in Medicaid before the act took place.

Because with any piece of federal legislation, it takes a long time for it to really, come to fruition. So, there were 170,000 Cook County residents who would have been eligible for the Medicaid expansion. We were taking care of those people already, and the opportunity, if we were able to demonstrate that this was going to work, and that's sort of what the 1115 waiver was about, was demonstrating the benefits of expanding Medicaid.

So, we were among the first in the nation to start that process. And, we enrolled people wherever we met them. If they came to our outpatient clinics, if they were admitted on an inpatient basis, where anyone who walked in our door, we said, give us a chance, let's see if we can't get you on Medicaid.

And we provided patients, who never thought about having regular access to care, patients who were coming to the emergency department and said, Hey, you're eligible for Medicaid. You can have a regular PCP. We cranked up in terms of getting people enrolled. And, the County Care was a big part of that, and helping people understand that, this was a plan that was going to allow them to continue to be seen at Cook County, continue to have the good things that they associated with the county that they had now, bonafide insurance for folks who never thought they would be eligible.

So, in 2013, County Care enrolled 82,000 people. That's no small number. And that was a year before Medicaid expansion took place across the country. So, we had a lot of pride about that because as we told the federal government, these are the people we're taking care of every day.

Shannon Andrews: And it's probably worth noting, I'm super proud of this little factoid, that we now have more than 419,000 members and is the largest Medicaid health plan serving Cook County. So, that's no small feat and I think it, again, it probably speaks, and I'm curious if you both agree with this, I think it speaks to the level of trust that the communities that we serve and the patients that we serve have in us as a part of the community.

And I really think that that speaks to, if you want to talk about equity, that that's really an important point to drive home because there are probably a lot of factors that might have discouraged people from enrolling in this thing that they had never heard of before, but that's pretty significant, I would imagine, in terms of being able to have that level of relationship and trust with the people that we serve.

Host: Yeah, I would add, you know, I think it's, not just that it's there as a product and something for our communities, but they're also extremely innovative in the services that they offer, right? In terms of the benefits, that they've been able to include in coverage. And not only that coming back around to quality again; they just received a four star rating. They're tied for first in the state and in the top 20 percent in the country for health plans. So again, you know, not just delivering a service, but doing it well, which is one more thing to be incredibly proud of right?

Shannon Andrews: Absolutely.

Claudia M. Fegan, MD, CHCQM, FACP: Yeah, I was going to say, it's really because we are so empathic with the people that we take care of and listen to what their needs are. Giving patients who often don't have a voice, and they're actively seeking their input has helped to shape County Care into a plan that's very different from traditional Medicaid plans because those plans have been sponsored by traditional insurance companies and who don't necessarily have an understanding.

Recognizing that if you're going to take care of people, it's not just about giving them medication. It's not just about guaranteeing them access to see a provider or physician. It's about recognizing what their needs are and what helps to make them healthy. And I think it's because we've had this broader definition of health and recognizing that everything is health, that having good food to eat, because Cook County, partnered with the Greater Chicago Food Depository, recognizing that people having safe housing is important and why we try to address the needs of housing for our patients.

It's recognizing that broader definition of health and health care, that has helped to make County Care so successful. And it's why we continue to be more successful in meeting the needs of the patients that we serve, and not just providing access to see someone who's going to write you a prescription.

Host: It's another step in that evolution right as we look forward and how we pull all of the different diverse pieces within our health system, to align and really focus on the health of our populations, right? So that we really can start affecting those upstream issues that drive those downstream outcomes.

So very well said, Claudia. Thank you. So I think we're at the end here. I'll, I'll just pause for any final thoughts, Claudia.

Claudia M. Fegan, MD, CHCQM, FACP: Anyone who has worked at Cook County, who has provided care for patients at Cook County, has somehow been part of the team, becomes a part of the Cook County family. I have such pride in being able to say that I'm a part of the county family, that we have changed the the face of medicine, that we understand that everyone deserves good health care. And we provide good health care regardless of the ability to pay, but we provide good health care that makes people who have funding, who have insurance, who want to come here as well, because they recognize we have the ability to provide care and hear the voices of our patients to meet the needs of our patients.

It's something that we've done well for a very long time. We have so many people who come here and then never want to leave because they recognize they have found a home here. And our docs who come here and you know, even after they retire to continue to come back and donate their services, it's because there's something special about Cook County.

And I'm just honored to have had the opportunity to be a part of something so wonderful for such a long period of time. It's really a fantastic place to work. And I'm happy that so many people take pride in the care we deliver because it is something special that we do for our patients every day.

Shannon Andrews: That's so amazing. And I think it's amazing that our colleagues at the started this podcast development, that one of the things that our colleagues wanted to hear about was the history of the organization. And I think that that's some acknowledgement that we stand on the shoulders of some really big work that's been done and some huge accomplishments. And, I feel really lucky. I'm struck by Dr. Fegan, who is officially leaving, but as she has already mentioned, is never really gone. We hope and we know that we'll hear her voice and see her around, but it's a real treat and honor to actually be able to sit on this with Dr. Claudia Fegan, who is retiring, and also with Dr. Erik Mikaitis, who is new to the role of CEO. And so I feel like I'm uniquely situated in between those two spaces, and again, I think it is a testament to the hard work of the people who continue to come through the doors, not only the patients, but also the people who serve those patients.

And so, just excited and honored to continue to be a part of that type of legacy. And I, again, want to go on record that this won't be the last that you hear Dr. Fegan, so.

Host: No, absolutely. I also want to recognize, just the unwavering support that we've had, you know, Shannon, you've said it, we're an arm of the government, but also in the healthcare space, you know, President Preckwinkle, our board of commissioners, our board of directors, they've just been incredibly supportive, and helpful in terms of moving us in this direction and through these evolutions that we've been talking about.

So, Claudia, you said it very nicely, but to the listeners, if you've been here for 30 days or 30 years, you're a part of the story, I just want to again say how grateful I am to you, Claudia, for your tenure here. You've made significant contributions to the health system and to our patients and you will be missed.

Thank you for your time, your talents, and for serving our mission to uplift the health of the residents of Cook County.

Claudia M. Fegan, MD, CHCQM, FACP: Wow. Thank you.

Host: Of course, of course, yeah, so I think that's going to bring us to the end of this episode. Thanks again to our listeners, for tuning in and be sure to tune in next time. We will have another episode coming out in February. Thanks again, everyone.