Pertaining to the minutes . All in favor, aye . Opposed . Approved. Directors report. Good afternoon, commissioners. Wanted to start my report with the issue of the flu. The flu season is off to an early start nationwide and California Department of Public Health reports widespread flu activity in the state. We encourage san franciscans to get the flu shot and take other steps. We have flu shots being given at the immune clinics, project homeless, and san franciscans can obtain flu shots at their doctors offices, primary care and pharmacies on a walkin basis for a fee. In monitoring the flu activity, weve looked at our Emergency Medical Service call volumes that have fallen to the normal range for this time of year. We reached out to hospitals, and while theyre fairly full, theyre managing to keep up with demand so far. To date, no reported deaths from flu of people under 65. And we have information on our website regarding this. On issues regarding the federal government and health, i just wanted to were closely monitoring three areas. One is the issue of the individual coverage mandate and the impact on those who will not have a mandate to have insurance and as well as the 340b savings cuts in 2019. And the Children Health insurance program. I hope to have some review of the three areas and impact and responses that we have for you in the coming meeting of the health commission. Also just to let you know, we have been working with st. Marys and u. C. To open up 40 Mental Health beds. Its an exciting program. Mid february will be the opening and well send you an invitation for that. Thats the end of my report unless there are questions from the report itself. Thank you. Any questions regarding director garcias report . Theres a lot of things on the radar coming up. Next item, please. Thank you. Item 4 is general public comment. Im noting that only members of the department here. So well move on to item 5. Item 5, lets go. 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 linke