Mr. Pickens . Good afternoon, commissioners. Roland pickens, director of the San Francisco health network. Its my pleasure to present to you with the very first update on the network under our newly adopted Strategic Plan. This slide is one we use in all of our presentations to you and to show where the structure fits. In todays presentation, well review four things. First, i will provide you with a brief review of our journey to guide our Strategic Planning and Performance Improvement and daily management activities. Next, ill share with you our current, newly adopted Strategic Plan, which builds upon and refines the work of our previous plan that guided the journey over the last two fiscal years. Third, i will describe how the network is with the greater department of health. And, finally, i will share the status of our quarter one metrics and scorecard. This slide depicts the journey that started in 2012. And quickly spread to primary care in 2013 and then to the network in 2016, culminating in the adoption at the dph level in the Third Quarter of last year, 2017, with a dph Strategic Plan and an accompanying exmatrix. The exmatrix is that onepage document, which you have in your supporting information, that crossreferences the key elements of our Strategic Plan. It shows the outcomes and Performance Measures that well measure over the next few years. Mr. Pickens, if i may, and it has an x on the document, just so you know. Yes. Xmatrix, yes. Thank you, mark. I wanted to show the evolution from our previous to our current Strategic Plan. You will remember when ive come up to present to you, we had nine various strategic, key initiatives. One of the things that we did when developing our new plan and i will talk about this later on, was that we narrowed our scope from nine down to only three strategic initiatives. The ehr readiness, in implementing that, and developing our people. And thats been drafted at the dph level and we adopted them at the network. We prioritize aligning care and finances and outcomes. Really to recognize the shift in Healthcare Reimbursement from fee to service to fee for value. So, again, those are the three things that well focus on over the next two years. And thats also very complimentary with the work were doing with the medicaid waiver and the whole person care. Heres the Multidisciplinary Team that came together this past fall to develop our new network Strategic Plan. So we had representatives across the network from laguna honda, Maternalchild Health and central dph, finance, hr and it. On this slide, we begin to see how weve begun to use the same standard tools like the x matrix, which you have seen before, and the sections throughout all of the visions through dph, with the goal of developing one common language and methodology. And particularly for those of you on laguna honda or jcc, youve begun to notice how weve been using that methodology. So thats across the network and also other parts of the department. And so i put this slide together to show you just another picture of how were beginning, as we matured over the last few years, we really started at the divisional level dph. Now weve done that Strategic Plan. The sfg is about to do their Strategic Plan, and so is laguna. So were beginning our cascading effect. And then for those divisions to take the priorities and figure out how to implement them. Its incorporating a topdown, and bottomup approach to Strategic Planning. So what did we learn over the last two years within the network, as we implemented our first Strategic Plan when it comes to using lean as a roadmap. First, we need to have more focus on a fewer set of priorities and initiatives that are aligned with the more global dph plan, particularly giving our challenges with reliable data. Secondly, we need to have more alignment across the different sections of the network, rather than having them focus on separate things. We felt it was important to end the other divisions and have some common items were working on. For example, staff inquiries, and what theyve chosen. And, finally, we needed to have a real commitment to fidelity of the lean model. It gives you one of the tools for reporting, but if you dont put it in practice, you dont get the power of the process and not able to fully monitor and see your progress. One of the things weve done is weve reported a lean reporting calendar for the network and it shows which divisions will be reporting on their various true north and Strategic Plans. This shied provides a summary of our quarter 1 and our true north metrics. As you can see from the six sections of the network, maternal child health, behavioral, jail health, laguna honda, and dph, we have 47 metrics, which are quality, safety, care experience, work force, financial stewardship and equity. In terms of quarter one Data Available at the time of this report, we show that nine of these 47 metrics are on target. 20 are off target. And for some that are off target, many of them are not off target by very much, just one or two points. You are either red or green. There is no yellow, so they ended up being red, being offtarget. And you also notice that 18 show data was still pending at the time of the report or data definitions and sources are still being developed. I wanted to talk more about this. While weve made Great Strides in improving our ability to capture and report timely and meaningful data, we still have room to improve in this area. Obviously, we believe that implementing epic will be one way we can improve our data recording capabilities, also bringing on Behavioral Health services into the lean process. Its probably the last big group within the department that we still need to spread lean and do education and training with that work force. As we continue to have more and more of our reimbursements based on Performance Measures and payments, it will provide incentive to develop more robust data reporting capabilities. So thats just a brief orientation to our new Strategic Plan and performance for this first quarter. When i come back to you in the next few months with quarter one data, ideally were on the right track, well have more Data Available. Thats our overview. I am happy to take questions and comments. Thank you very much for an outstanding presentation and look forward to your additional one and especially some of the variables that you mentioned that you need to look across rather than separate. So well done and thank you very much. Thank you. Commissioner . I would like youre deciding as a network to use common language, its making sense. Finally sinking in better. Thank you. If i may, commissioners, going back to the cascading lean slide. The one with the picture. There you go. Just to note that we now have the full department under this model. And that weve opened up an office for dph that is working with the other groups. So now its taken us over five years to catch up and be able to do the work we needed to do as a department. So its an ongoing process and big learning progress and i would like to thank the partnership that have helped us on the dph oversight of all the work. So now as we fund some of this, we look at how much can we do, particularly as we do the Electronic Health record. And then the Public Health side has their own process as well. Everyone in the major divisions are working under the lean model, so i wanted to acknowledge that and thank all the leaders to help us from a departmentwide perspective on this very good. Thank you very much. Any other questions or comments . Thank you very much. Next item, please . Item 6 the sfdph security update. Commissioners, this was supposed to come to you in october and it was bumped, due to that it was a very busy meeting, so this report is a few months late. Thank you. Good evening, commissioners, director garcia excuse me. Will you speak into the mike or move the mike over . Thank you. So i will give an update as far as the development of the Security Program for dph the presentation will highlight the work thats been accomplished at zuckerberg and laguna hospital and the performance metrics as well as program effectiveness. Since this report, weve also developed a Security Management plan to include performance metrics as well as developing a safety and Security Committee for primary care and Behavioral Health clinics. So this slide and the next slide following calls out eight mile stoin accomplishments in the area of security services, training, education and Electronic Security systems. So in the area of atrisk response, theyve exceeded target as far as atrisk patient response. They had a return of 88 . Customer satisfaction surveys are conducted to measure employee, patient and visitors satisfaction with security at both hospitals. 90 and 81 for the year. This year, we began doing surveys for laguna honda residents, just to receive input from them as far as to provide safety in their environments. So where there are Electronic Security systems, which is applicable in both facilities here, we want to ensure that they remain operational. On a quarterly basis, we inspect 100 of the system with a target of 98 functional. The overall functionality of a system was 95 and 85 . Based on this performance, one of the things we did, we were able to replace the systems vendor at zuckerberg, where were getting more timely response in regards to any system malfunctions. Were holding laguna hondas vendor were holding monthly meetings, so we hold them to task for functionality. Weve added dedicated Security System personnel to address functionality. On a monthly basis, 20 elements of the mou between dph and the Sheriffs Department are measured as far as compliance, so that reflects that in both hospitals for the entire year. The Sheriffs Department exceeded the target for compliance with the mou. This chart reflects the crime stats for zuckerberg for three years. And so we have actually a 22 decrease in crime on campus. A lot of that is contributed to the collaboration that we have with the Sheriffs Department in regards to addressing staffing assignments, increasing visibility and implementation of a Security Awareness program that encourages employees to report suspicious persons and activity. Increased at laguna honda in crime to 40 through no fault of their own. What we found out is that the data for grand theft of facility property included patients personal property and that drove the numbers up, which weve addressed that moving forward. The next slides will focus on use of force. 124 incidents where sheriffs deputies used some degree of force to affect an arrest or address Risk Behavior, Risk Behavior, that which is displaying a danger to themselves or others. We break it out. 119 were at zuckerberg and 5 at laguna honda. To give some context, the year prior to this, there were 173 incidents, so compared to 119, a decrease of 33 of use of force on campus and yeartodate, its been only 58 of these incidents. So on this chart, the chart on the left, you have the type of force, which was used, and you will see in most cases, 88 is what is called physical force. Physical force being control, personal impact or physical takedowns. On the right side, you have the demographics as far as those individuals by demographics that the force was used upon. And then down at the bottom on the far right as far as locations, you actually have the highest being at zuckerberg with campus buildings and that consists of the outpatient buildings as well as the campus grounds outside of the hospital, followed by pes and Emergency Department. In regards to opportunities and next steps, at both hospitals, theres a huge opportunity to change the culture in regards to calling law enforce kwchment toe no crime was committed. We had 4,000 calls for patient assist or standby or restraint. As a result of that, 40 of the useofforce incidents were against patients. So we started to address this issue by implementing crisis intervention training for direct patient care. We completed the Emergency Department. This will assist staff in regards to building competence when it comes to deescalating Risk Behavior at the early stage. In addition, also providing that same training for the Sheriffs Department to give them additional tools as far as how to react with Risk Behavior in a hostile environment. Other measures that the hospital has taken to address this issue include Emergency Department response plan, address Risk Behavior prior to Law Enforcement and a behavioral Environment Response Team to provide the escalated support to the highrisk departments. This is an update of the Security Program. Are there any questions . Commissioners, if i may, those of you on the jcc know that security updates have been given at those committees as well. The hospitals are hearing their own data as needed. I just want to thank you. Its remarkable how much youve done in the years youve been doing this and to see this kind of responsiveness and this Co Collaborative work with the Sheriffs Department. Thank you. Thank you. Please turn on your microphone. [no audio] sorry. Just want to say that we have really been impressed by your leadership and the ability to integrate the incidents and data to make a comprehensive review of the situation. If questions are asked, do we have people from inside the system or are they mostly latino or asian or from this area . All of these things could never really be answered in a comprehensive way because much of the data wasnt there and youve been able to work with your colleagues on the team and all units, whether it be the general or laguna, to really provide us with comprehensive insight. As far as where the situations take place, the type, classificati classification, time, place, situation, so we want to thank you for really updating a system that was a couple of centuries back. Thank you for a job well done. Thank you. Further comments . Thank you very much. Thank you. Commissioners, this may be the quickest meeting ive ever attended. Item 7, other business. Do we have any other business . No. Item 8, a report from january 9, 2018, jcc meeting. Theres a summary sheet in front of you. Okay. A report that in essence the jcc at laguna honda pertaining to members brought before us. It was an excellent presentation, staff training, etc. , and we had a comprehensive review of director price and security at laguna honda, but more importantly, as was shared today, how, in fact, its linked to our other facilities and institutions, as we take a look at security for patients and staff and our citizens in San Francisco. We also went into closed session pertaining to medical certification and approvals, hires, terminations, etc. That was for december. My colleagues, if you would like to add anything to that. If not, that concludes the joint Conference Committee for this commission meeting. Next item . Item 9, agenda calendar. On february 6 and 20, there will be two budget hearings. Please let me know you will not be attending, for quorum issues and who needs to be updated on the side. Thats all i have for the calendar, but its before you if you have any questions. Otherwise, its adjournment. Just one thing. I want to see if we can add an item to get an update on insured in San Francisco, because theres new articles that just came out and said that last year there were actually an addition of 3 Million People added in the United States. If were ahead of the curve, i would like to know how ahead we are. Well incorporate that into the mandate. Thank you. Yes. Before we adjourn, i would like to recommend that the commission adjourn in memory of dr. Matilda crim, who passed away today. She did tremendous work along with Elizabeth Taylor and others in research and advocacy at the early days of the aids epidemic. She did so much to address stigma in communities of color and she was a hero. Second . All in favor, aye. Were adjourned in her memory. Any further discussion or comments . Welcome back, everybody. Happy new year. Is there a motion for adjournment . So moved. Second. All in favor, aye. Opposed . Commission is hereby adjourned. Hi my name is jason jones a xaefrp and communication capture at the San FranciscoWater Department i hnlt a high volume of calls and Radio Communications i enjoy coming to work i still find it challenging i still learn everyday and im going to have the level of activity if zero to 60 in a matter of minutes i take bride pride in handling the emergencies. Have are you available the work order is 2817827 thats one of the great things of sfpuc they offer work shops to help you get ahead you have to care about the job and go above and beyond to find out as much as you can the three puc i so no Glass Ceiling the opportunities are end we think over 50 thousand permanent residents in San Francisco eligible for citizenship by lack information and resources so really the project is not about citizenship but really academy our immigrant community. Making sure theyre a part of what we do in San Francisco the San Francisco pathway to Citizenship Initiative a unique part of just between the city and then our 5 local foundations and Community Safe organizations and it really is an effort to get as many of the legal permanent residents in the San Francisco since 2013 we started reaching the San Francisco bay area residents and 10 thousand people into through 22 working groups and actually completed 5 thousand applications for citizenship our cause the real low income to moderate income resident in San Francisco and the bayview sometimes the workshops are said attend by poem if san mateo and from sacking. We think over restraining order thousand legal permanent residents in San Francisco that are eligible for citizenship but totally lack information and they dont have trained professionals culturally appropriate with an audience youre working with one time of providing services with pro bono lawyers and trained professionals to find out whether your eligible the first station and go through a purview list of questions to see if they have met the 56 year residents arrangement or theyre a u. S. Citizenship they once they get through the screening they go to legal communication to see lawyers to check am i eligible to be a citizen we send them to station 3 thats when they sit down with experienced advertising to fill out the 4 hundred naturalization form and then to final review and at the end he helps them with the check out station and send them a packet to fill and wait a month to 6 weeks to be invited in for an oral examine and if they pass two or three a months maximum get sworn in and become a citizen every single working groups we have a learning how to vote i mean there are tons of Community Resources we go for citizenship prep classes and have agencies it stays on site and this is filing out forms for people that are eligible so not just about your 22 page form but other Community Services and benefits theres an economic and safety Public Benefit if we nationalize all people to be a citizen with the network no objection over 3 million in income for those but more importantly the city saves money 86 million by reducing the benefit costs. Thank you. Ive been here a loventh i already feel like an american citizen not felt it motorbike that needs to happen for good. One day i pledge allegiance to the flag of the United States of america and to the republic for which it stands, for liberty and justice for all. Youre welcome. singing . clapping. introduce the San Francisco field officer director ribbon that will mirror the oath raise your hand and repeat the oath i hereby declare on oath repeating. Citizens cry when they become citizenship to study this difficult examine and after two trials they come back im an american now were proud of that purpose of evasion so help me god please help me welcome seven hundred and 50 americans. speaking foreign language. she wants to be part of the country and vote so much puppy. You know excited and as i said it is a long process i think that needs to be finally recognized to be integrated that is basically, the type of that i see myself being part of. Out of everybody on tv and the news he felt that is necessary to be part of community in that way i can do so many things but my voice wouldnt count as it counts now. Its everybody i hoped for a bunch of opportunities demographics and as you can see yourself theres a good life for everyone. Thats why. You have people from all the walks that life and theyre standing in water 8 hours to be an american citizen and contribute to the city and thats really what makes this worthwhile. Good morning. Today is wednesday, january 17, 2018. Regular meeting of the building inspection commission. I would like to remind everyone to turn off all electronic devices. First item is roll call. President mccarthy. [roll call taken] we have a quorum, and the next item is president s announcements. Good morning. And welcome, everybody, to the first meeting for 2018. And look forward to another busy year here at the city and county of san