Transcripts For SFGTV Health Commission 3116 20160304 : comp

idea knew her so wanted to ask this commission a way to honor her maybe adjourning in her enemy or something like that thank you. >> next yes. >> i don't know if you wanted to answer that marie you'll a be hearing about the dignity fund i think some of you remember that sandy came to talk about the process of looking to put something on the ballot in november more discussion with the mayor's office of housing and the supervisors the legislation will have an important parole for the commission to play i'd like to work with acting director mucking fanned to brief the commission so you understand the legislation and can have answers to the questions like commissioner ow powdered he posed with the fund will it replace money or on top of so the way it is structured it will provide a baseline of funding and the fund will will on top of that maybe we can figure out the best way to share information with the commission. >> commissioner ow. >> did you - >> no comment. >> i just have one announcement and i think we can talk to over director commissioners about the form 700 that is due april 1st am i right. >> correct. >> and talk to our street to give you more information but it is all online i wanted to remind all my commissions you can be fined for not signing it on time any other public comment? if not can i have a motion to younger >> i'd like to honor jessica's request in yrnd the meeting. >> well, he guess it could be under. it could have been under. if you want to make that under public comment >> we done to before we - we've done it before without having it on agenda. >> why not state. >> i will suggest we adjourn in memory of two fan and her unfortunate passing. >> i can't hear you. >> i suggest that we go ahead and adjourn this meeting on two fan that died two weeks ago. >> thank you. the meeting is adjourned as wanted thank you >>[gavel] >> good afternoon everybody. the health commission will please come to work in the secretarial call the roll. >> commissioner pating, here. singer, here., chow be present chung, present. zouzounis has 3 present 2nd item on the agenda is the approval of the minutes of the health commissions meeting of every 2nd 2016 >> the minutes are before you for approval emotion for acceptance as an order. he did so moved >> 2nd? either corrections? hearing none, we are prepared for the vote all those in favor of the minutes please a aye. opposed?. the minutes of the adopted >> item 3 is the directors report. >> good afternoon commissioners. i want to catch yoon the issue of the public health concern we've had a long division street and reposted notices outlining the public health concerns on february 23. this is after months of the homeless chain working with individuals and we have several several several, almost over 200 people without running water, without access to bathrooms. so, we developed a process in which we ask people to vacate and the homeless outreach team did a fantastic job the entire mental health. that has the job of ensuring communication good the homeless outreach team was to get over 90 people into the new shelter at your 80 and continuing to work with individuals that do not decide to go. and we will continue to work with them as we do every day in reaching their concerns and trying to get them into safe sheltering. stephanie cushing has named our new director of environmental health and i don't see her today but she definitely will be coming soon to the commission meeting. she's been selected and she's been working in our health department since 1987. she's been promoted 7 times before being selected. in 2010 as a principal health inspector good among other duties, stephanie has conducted food inspections, of the adherence, she's work on aspects of the hazardous waste program, and her initiative we source and ethics establish her as a leader and a manager within the population health division and stephanie officially starts on march 7. we've already signed her to the roll so we want to welcome her in her new role. the san francisco health network is wrapping up the disaster preparedness as of tomorrow the area will be conducting a tabletop exercise in chinatown public health center and follow with the drill in march 22. the chinatown association will be observing. the as you know, many of the-has been a leader in the chinatown area and we been involved with them for many years in helping and been participating with them. fema has been encouraging a health to many approach to disaster areas involving community partners, consumers and city government and i think the reflection of this drill is a reflection of fema's requirement. the joint commission asked san francisco general to recent 5 stroke. they did come on campus on separate one night in a march 1 they received-and/or able to recertify stroke and traumatic brain injury program. the 45 days for any corrections. i will leave the rest of the reports as is and if there's any questions on any items i will try to answer your questions. >> commissioners, any questions for the directors report that she submitted to us? dr. sanchez >> i would just highlight out of the directors report, the san francisco general foundation had its major fundraiser this past last month at at&t park, and they're anticipating roughly about 1000 because of we have both a lunch and then we have the evening event. dad over 2500 people attend collectively. and were able to raise the largest ever, 1.6 point dollars. which goes directly to the sf gh family including our patients, our staff, our clinics, our doctors etc. etc. so we just want to thank everybody for participating and working in this great effort. it's also noted she mentions the great awards are given and it was one given we want to mention specifically. that is, one of the key members of the hearts of heroes was pam-of the san francisco giants owners. she is retired from the board of san francisco general hospital but she still serves as an ambassador to general hospital. she and her family have been committed to providing resources for the excellence and training of general hospital for many personal reasons including those of her family but was a great honor to see everybody really give her a very very exceptional thinning ovation for many many hours and work she is contributed to the san francisco general hospital facility. so, the director didn't mention that but i want to highlight because it was part of san francisco history. had it not been for the san francisco general hospital foundation started in the late 90s, i think we would've lost our seawall and sitting at a general with all these budget cuts started with back then. so, is a special special calling to have these families really step a board and take on these heavy seas and still provide and continue to provide for our new hospital and trauma center and for the community in which we serve in san francisco general. so, i just want to mention that for the record. thank you so much dr. sanchez but i think that's important and also to note i did give him there a public health award as well. public health hero award on behalf of the department. dr. b chow and i presented that to her. we want to figure for women and she continued to be ambassador for the hospital. just to note, kerry salk from our staff is one of the hearts of heroes awardees and we want to knowledge him in his incredible work of the rebuild of the hospital. the just emerging is from that is licensing came in last week. we really leave strongly that it gave us great components were going to make our may 21 deadline in the move to the new hospital. minor issues that we still have pharmacy to come and in march, but we do believe there were going to be able to meet that deadline. we would love the conference from the state and all on the status of how well our staff knew the hospital, as well as the state of the hospital itself. i think that really goes to the leadership of the hospital and all the training that is done and also you need to the bricks and mortar done and terry did a great job on that. >> thank you. dr. pating >> i want to thank a department for its work in addressing the health hazards on the division street by-my impression from the news it seemed to be handled very compassionately by the department. i just would like to ask a quick question. i think the problem will continue in other areas and i was wondering, first, can we have criteria by which we judge a certain situation has reached environmental hazardous level? are there other areas you have on watch that you're worried about health hazards involving? >> yes. we develop the criteria is a new process for us. we did do that through occupied when we had a whole group of an embarcadero exit one of the issues we want to look at his multiple times together without sanitary support such as running water and bathrooms. so, we are still working on that but the important thing, commissioner, is that moving people to another part of the town is not our goal. we really want to move people inside, and that is why having pure 80 and having the shelter capacity we felt very comfortable about moving this issue. as we speak, the mayor thought this is working very hard and, with other models like this to ensure that. so, i will be looking at that but part of the exit plan of this is to make sure we have some place for people to go so that were not just pushy people from one side of the street to another. that's an important formula to that conversation >> do we have any of the shoulders underdevelopment rainout? >> the mayor's office is working diligently. this is a conversation that's going on for months about additional medication centers. so, there's lots of work being done. we don't have any timeline good that's not within our department but i know dpw is working on it diligently >> with regards the homeless apartment the coming together of the-what is the timeline for that? in the future, are those similar environmental assessments fall to us or to the department of public's-? >> the department of homelessness will not be a finical department. that belongs to the role of the health department. we are responsible to ensure that we collaborate with other departments and we do this like an age is a we do this in foster. we become the clinical partner to them in those services do we will do the same for the homeless department. in the aspect that the leveraging of our housing stock, that is a real focus for this department, to ensure we house the next 4000 individuals, the next 5000 individuals. so, that's the real focus of this. part of the job we will have is to ensure that when the hot team as an example because part of the homeless department we will be having a mold used in terms of ensuring the critical component of our services wraparound individuals they identified. so, we will still play the role we play. it's really going to be important that we collaborate with the next apartment in ensuring they get the clinical needs of their clients. so, we are working on appeared the deadline for that is going to be part of the budget process. some of the commissioners and i mentioned that with the hr director today and it looks like delay is july is the target date and there's a process of recruitment going on. >> you'll keep us posted on that that would be a benefit. absolutely. >> any further comments? i was in a comment that i was pleased within and we certainly congratulate the hospital for the stellar performance that occurred during the licensing survey. we expect a very positive report from there. and the director noted that we are on target to open the hospital as we have contemplated in may with just some minor adjustments to be made. so, that really is excellent. also, i want to note that ss general did receive the outpatient care grant. you remember we have looked at the pallet of care program and encouraged the task force was set up to work in continue to work with the on that as a collaboration. and that ss general will now be actually having a program in pallet of care. we are doing our part to be sure that the service are going to be available to our clients also. lastly, i did want to note that the disaster preparedness program is wonderful that we are participating and continuing to have neighborhood response and that city with the out reaching further into the neighborhoods in the regards to fema, i would only note there needs to be a lot more coordination of that. i think it's an issue that has been going on for a number of years and ever since 1989 much right to see that the neighborhoods are bolstered and i think the manner you are talking about here shows that we have an active participation in the mission used to also have a song program and maybe this is an opportunity to be able to work and rebuilt the mission program. >> is another process. from the city's administrative office called the resiliency program looking at targeting neighborhoods as well. i think the chinatown model as well. we will at some point in the future of our agenda will try to bring without looks like from the city perspective, possibly come from their office to show that information with you. >> thank you. if there are no further questions or comments, we will move on to our next item >> item 4 is general public comment and we have one request >> public comment. [calling names] >> friday when making public comment i'm in a timer and there's 3 min. on the timer and when it beeps and your time is up. >> cannot begin? >> yes, please >> dear members of the health commission. a statement from the san francisco forest alliance. i'm a member of the san francisco forest alliance. the san francisco forest alliance is concerned about the use of talk toxic herbicides in public places. there's a growing consensus that herbicides are more toxic than the manufacturers claim. now that, long regarded as a safe pesticide has been declared a probable carcinogen. herbicides don't have a place in our part with a good impact vulnerable people. such as those that have reasons to worry about their toxic load. children, who are more sensitive to toxins, because of their small size and their fast growth. our pets are also more vulnerable because of greater contact with the environment and their small size. we are especially concerned about the san francisco recreation and park dept. natural areas program, which applies to your one and tier 2 herbicides. most hazardous and more hazardous respectively. in parks popularly used by families with children and pets, san francisco parks, some of these pesticides remain in the soil and environment for months, even years after their application. many of the natural areas are on high ground or in watersheds, and poisons applied their can spread unpredictably. repeated applications of pesticides are required and plans can become immune to the chemicals. it is not just a one-time application. we believe this is a public health issue and we would like to bring it to you or attention. sincerely, san francisco forest alliance. thank you. >> speak thank you very much. we have one further public comment here. [calling names] >> i'm sorry if i mispronounce accurate >> thank you very much. i'm speaking on the same topic as the previous speaker. i'm personally very concerned about using those herbicides and have been for years. i live near mount dixon did i was working regularly from 2013 and those applications that are happening regularly are far too often. like the latest [inaudible] we are 2 days in november and one day in december, one date in january, and it was already in february. [inaudible]. the notice is usually says it's a spot treatment, but there are areas out like 3 or 4 of them. as i said before, those things stay for years as you probably know. there is also herbicides otto but there regularly applied on the right on the trail. [inaudible] it was safe ends stable for about 4 years. as he notices--[[inaudible]. they are always reading the label. you don't want to be close to them. as i found out now that they're not use only in the park but the water department in crystal springs which probably is not so good for our water. also, i want to mention in september 2015 the american academy of pediatrics that exposure to herbicides is a slightly higher risk of cancer. each single one of them [inaudible]. which can lead to all kinds of results and the constant assurances that the amounts are low- >> time. >> we appreciate your comments. we will have it reviewed by our department. we have one more public comment. [calling names] >> good afternoon. thank you for hearing the public today on many issues. i would like to present-i would like to talk to you about my feelings as a mission residence since 2009 about this sweeps on division street. the claimant they were handled humanely i think is really inaccurate. putting up a -personnel calling peoples only access to what they call a home, a public health hazard without having high. set as to what constitutes a public health hazard, nothing is really disingenuous. claiming sweeps will start in 22 hours and am eagerly starting dpw sweeps when no signs of not waiting 72 hours, and then the fact that neighborhood groups have been working to address what folks are calling a public health hazard on division street the department of public health doesn't bother to get in touch with the community and neighborhood organizations doing this work and just decided to clear the area without actually having which you may place for folks to go to, pure 80 movie isn't a legitimate alternative. interestingly, in the director's reports unfortunately commissions for multiple tenants are congregated have become unsafe. people have been living without access to running water, bathroom, trash disposal were safe heating and cooking facilities and allow point out when pure 80 was open internet many of those affect. it did not have running water or toilet facilities. i've seen pictures of the inside of pure 80 and there's absolutely no privacy. i'm a bit appalled that you can't raise costs off the floor. there's a bunch of public space out in front. if you're a public people being on division street as them to move their tents into the public area in front of the enclosed area. live as they want to live. the shelter system is broken. we only have one bed for every 5 homeless people so to start clearing people without having viable alternatives is not humane. thank you. >> thank you very much. is there any further public comment? >> was all the less i received for this item >> then, let's call the next item >> item 5 is the report that from the financing committee. commissioner chow since you chip would you give that report? >> yes. the committee heard the contract reports including a series of new contacts. first looked at the monthly contract report which was a renewal contract for the lutheran services, and then this will be on the consent calendar along with the following new contract for 1.1 9 million for disposal of medical and biohazardous waste in all our departments designated facilities. a 2nd series of contracts were contracts that relate to providing hiv informed hepatitis c linkage to care service for a five-year period, 3 contractors were selected through the rfp process. we reviewed the 3 contracts. we would recommend approval of 2 of those contracts at the moment.. that is the contract with glide foundation 4 $1.086 million and the contract for sf aids foundation, for an amount of $750,000. and we are reviewing details of the health right 360 come up which we recommend be deferred. we then reviewed a new contract for public health foundation enterprises that will be providing fiscal intermediary and management services for the private program, which was the prep programs that have been discussed earlier and that will be for a five-year period. the last contract that we reviewed is a contact with gartner inc. for consulting-4 services for consultation on the acquisition and implementation of integrated electronic health record, which we have been discussing here as you know, for several months. so, that will be a contract that is $3.7 million and while it is calling for a three-year contract, the bulk of that is going to be done in preparation for the work of negotiating for our new -our new electronic health record program. the committee then heard a proposal for review of the entire contract process and has approved moving forward to having a series of 5 or 6 discussions regarding the methodology being used for determining contracts and for reviewing these contracts. that ends our reports and all be happy to entertain questions were commissioner singer was present can add to that. >> if not, then we can go on to the next item >> item 6 is a consent calendar and if i can remind you all commissioners, commissioners chow noted the health right 360 contract was recommended by the finance and planning to midi to be taken off of the consent calendar and as the dph will be negotiating that in a combat to you in april. >> so the consent calendar is before you. one item has been removed. it is a motion on the part of the budget committee already. so, further comments from the commissioners were any further extractions? seeing none, we are prepared for the vote on the consent calendar. all those in favor of the consent calendar as modified please take the i. although opposed? than the consent calendar has been approved. thank you. >> item 7 is the dph nonhospital employee awards. >> the health commission is pleased to be able to present awards in this various divisions for employees who are performed outstanding duties. we know there are many more employees that have been those who have stand for all of us as examples of the work that the 6000 members of the department of public health perform everyday delivering excellent care to our citizens. so, we have been privileged to be able now, in this case, to highlight for different organizations and people will work within them. we would ask that as each of those are named and are commended, that they would come to the commission area and be able to receive these certificates from dr. sanchez gave each of the remaining commissioners will be here to read each other the 4 commendations. >> actually, anyone whose name is called these come up on the side where i am and you walk this way. >> thank you. so, we will begin first with commissioner pating and the geo-information measuring team >> it members of the team, as your name is called, i think as mark mentioned, please stand off to the side here so we can all be recognized. >> is my pleasure to call me ms. jane johnson, fred tuma, [calling names] all of the geo-information management development team. this team has successfully designed enablement at the jailhouse services improved medical record charting system called geo-information management. the new system is web based and as relational view between that apartment lcr system in approves worker. an innovation of the system to revise the provider of a patient's drug interaction and drug allergies. because the system is relational, it gives users the ability to continue to develop and enhance the system without relying on a vendor or customization. this project was executed with no extra cost to the dph by these dedicated staff. i'm going to add i actually had the honor of being there the first day that the system became implemented and with dr. golding it was how we were. it was thumbs up all around it was universally accepted from the first aid kit. thank you very much geo-information management team. >>[applause] >> commissioner singer >> next are the environmental health inspectors. >>[applause] >> i'm glad people are clapping because this is a group we really focus on but there were touches all the most everyday. so, as i call your name please come up. [calling names] the san bernardino terrorist tragedies are minor problems while the vulnerability of our health inspectors to enforce our laws daily about the country and here in san francisco. the environmental health branch program includes-and here is the list is really incredible food safety medical marijuana, healthy housing hazardous material, construction sites, massage parlors, includes other old and policy initiatives. it also ensures compliance with graywater, toward busboys, beverage sales, tobacco product sales, air quality and even climate change. today we go to the impact the work of this devoted group of dbh staff. thank you. >>[applause] >>i'm privileged to have the next group. the data and improvement analyst. [calling names]. if you would these come up and be recognized. >>[applause] >> this team of analysts play a critical role in the san francisco primary-care polity improvement and program leadership throughout the dph 15 clinical sites and associated programs. they have been key leaders in the development of the quality improvement program, access improvement initiative, and data driven improvement strategies. when you say our population health analyst has led the efforts to adopt an off-the-shelf occupation registry to support the quality improvement work. amy peterson, care experience analyst, overseas patient experience and staff engagement improvement programs. under her leadership, primary care has implanted a patient advisory council collaborative that has led to the development of advisory groups in the 12 clinics. she is now working to implement a centralized grievance response program through the clinics. jonathan albright is the primary care analyst for access and operations. his expertise is to develop actionable reports which give clinic leaders the access data needed to drive improvements. he's developed a new pc access dashboard, which is a report of 9 key operational areas which must be optimized for clinics to ensure timely access to clinic appointments. we are grateful for these staff members for their very important work on behalf of the san francisco health network. thank you very much. >>[applause] >> commissioner chung >> it's my turn to injuries the childcare health program. [calling names]. >>[applause] >> d php is a vanguard of public health site against the scorches of childhood obesity could they effectively provide dental audio metric, general health screening, assessment and quality control consultation at hundreds of schools and child sites across the country. this 16 member team contributes to creating a healthy and new generation of san franciscans. for promotion through nutrition and exercise the small program wields influence by intervening early and emphasizing prevention and catching thousands of lives. so, please join me in giving a round of applause to them. >>[applause] >>if you don't mind, commissioner can we give a round of applause for all the other employees that are here? >>[applause] >> great work of our employees. we cannot be the great department we are. thank you. we move on to our next item >> commissioners, item 8 is the dph fiscal year 50-6 in 2nd quarter financial report. mr. wagner. >> good afternoon, commissioners. greg wagner chief financial officer reporting to you on our 2nd quarter financial report for the current fiscal year, fiscal year 15-16. the numbers reflect in this report are for the period of july 1, 2015-december 31, 2015,, so we are a little bit beyond the end of this term, but this is consistent with what was issued in the controller 6 month report, which came out earlier in the month of f so were rejected to end the year with the general fund surplus of $20.5 million. there are some things that i've moved around since the first financial report but this is fairly consistent with what we projected at that time. so, in the big picture, we are on track to end the year. this is projective a positive result. we are in night our 3rd year now, halfway through our 3rd year, of projecting to get through the year without need for a supplemental appropriation in any of our divisions. as you all know, especially those of you who have been on this commission over the past several years before that, you know that's an important ongoing thing that we need to emphasize and it's a change from our pattern of historical financial outcomes. to the good. so i won't talk through this table in detail, but this is our summary of our results in terms of surplus and deficit and expenditures and budgets. san francisco general hospital, the largest division, is projecting a surplus of $8.5 million. there are a lot of moving parts that are not in the hospital's financial statements. the reason for that is, as we have a lot of our revenues are tied to transfers out that we have to make that is into categories. for our waiver forms, we draw a lot of those funds through intergovernmental transfer payments. those are programs that are medicaid account funded, where the federal share is paid by the federal government and the nonfederal share is paid by the counties instead of the state as is typical for standard medi-cal payments. so under these programs were paying the nonfederal share, we make a transfer to the state that gets matched and comes back to us. so there's an expenditure out that is tied to the revenue that comes in. so, you can see this in a number of financial statements for san francisco general, where you see a revenue shortfall and a corresponding expenditure savings in transfers out. it looks like we are short on revenues, but really what it is is we do not require as large of a nonfederal share payment, and therefore, we do down less funding but we put in less funding and the net comes out equal. so, it's a confusing fact of the way that our financial statements in san francisco general works, that's part of the variance. you can see that on this slide in the line on the 2nd from the bottom operating transfers out. that is an expenditure savings of $29.2 million. so, that is offsetting some of the revenue losses in other categories. our net patient revenue is continue to come in strong, so that is a very good thing for us. as you know, we have forecasts several years ago that we would have a significant drop in our fee for service revenues them as the affordable care act went into effect and people moved into capitated medi-cal in particular. we have seen some of that drop and not nearly as large a forecast. that is due to an aggressive push on the presumptive eligibility program, which allows us to do some totally built for people that are pending approval for enrollment into medi-cal and also strengthen our commercial revenues. so, that is significant positive number that is to the good. on our waiver revenues, under the new 1115 waiver, we talked a little bit about this during the budget hearings and there is a shortfall in revenues of this $22 million, only about 7 of that is a now lost to us the reason i described at the beginning. the remainder is offset by savings in our igt transfers. that 7 $9 is due to the fact that under the new prime program, which is the successor to the district program, our total maximum allocation is reduced by about $7 million. so we're seeing that in the current year. we are not seeing a negative in the current year from the global payment program, which is the successor to the dish and safety net care pool funds under the old waiver. but, we do expect-and you saw some of this in the budget we presented to you-we will start seeing a downturn in those revenues as we go forward and that is because under the waiver, the federal dish cut that were legislated in order to pay for the medicaid expansion will start to phase in over the next several years. so, we don't see that in these statements but we will see it moving forward. the next item in this-on this list, miscellaneous revenues, this is another one where it's not a true shortfall because it is offset the low. as you recall, in our budget for the current year we received authority from the mayor and board of supervisors for an appropriation that allowed us to transfer up to $18 million of surplus revenues, revenues beyond what we otherwise anticipated in the budget, for us to receive those and transfer those into the e hr project. so that is a provision that allows us if we have are the news beyond what we truly expected to capture that the project. this report we are not projecting we will see receive those surplus revenues. so it looks like our revenue shortfall under financial statement. what it really means we're going to get $18 million of extra good news that we can apply to the project. so, that is, again, offset in the operating transfers outlined. were going to receive the revenue that means we won't make the transfer into the project. so it's a net neutral. on capitation revenue, we are forecasting a shortfall. that is not to do volume or volume still looks good. we're still having modest growth in our medi-cal managed care enrollment. so that is looking good. this really reflects rate cut. in july, significant there was a cut to cut to medi-cal expansion capitated rates and that's because a lot of plants were having difficulty getting the full amount of money out the door. so the federal and state governments came in and revised that rate downward. so, you all will also see-you do not see that adjusted in the budget we brought before the commission over the last 2 months. hospital is also seen savings in salary and fringe benefits of $5.9 million. that is a more modest figure then we saw last year and that reflects the fact that we are ramping up our howard hiring and spending as were moving into our new hospital. part of that spending is due to the increased work effort to do training, having to backfill staff, having to do preparations for the new facility. laguna honda hospital is projecting a $3.5 million surplus, the bulk of which is impatient revenues. as you will recall we are similar arrangement at laguna at least did at san francisco jacket were 27 $9 of surplus revenues can be transferred into our electronic health records project. we are expected to make that $7 million in addition to what you see in the surplus, so we are receiving that revenue and we are assuming that a transfer will be made into the project. that $7 million that will reduce the need for new appropriation in the budget year ahead of us. health at home, there is a-i have a error in the salary and fringe benefit line here. the net is a deficit of a little under $1 million. that is a one-time payment that was made for privacy breach penalties for some issues that occurred with protected health information that was compromised in the field. in primary care, we have a slight shortfall in our patient revenues. that is more than offset by savings in salary and fringe benefits could this also is coming down from what we saw in last fiscal year's reports, but there still is some room to grow and will start to chip away at that as we shift our hiring resources once we get up to speed at san francisco general. jail health has a modest surplus, and then we have some positive revenue variances projected from our mental health revenues and our state alcohol funds and community programs. so, overall, again, i think we are in pretty good shape. there is a lot of variance that is happening because of these strange factors with the igt and the transfers into the e hr project come up but if you factor those out, you sort of take those out of the equation to see how we are doing kind of fundamentally in our underlying numbers, things look pretty good. we do have are operable operating revenues show us a small modest surplus, and our expenditures are within budget and we are on track to end the year with some amount of salary savings. so, i will leave it at that. i think i've covered the rest of the items on this slide. i'm happy to answer any questions if you have them. >> commissioners, questions? i will just, the first one, if we do not transfer the revenues to the er e hr project, then what does that do to our e hr project projections that we been looking at in terms of transferring? >> yes. so, in terms of the budget we have in the budget you approved at the last cold commission meeting, that included sufficient new appropriation authority for us to web-based manager authority we need without this transfer. so, there still is some work to do on exactly what the funding source looks like and we are working with the mayor's office and the controller's office on the next 3 months to finalize with the appropriations look like in the budget, but this is not feeling bad news compared to the budget you approved at the last hearing. >> commissioner singer >> thanks and congratulations on the performance. maybe you could talk about how--i would ask you to talk to us a little bit about things you are seeing. in the beginning with preamble of the topic i'm interested in learning more about. so, if you look at any of these financial per p periods within 3 months or 6 months or a year some things that go in and out better variances that have to do with the idiosyncrasies of the year or maybe it's set single government government program changing or you decide to manage it. then there are larger forces at work in the financial pressure of the department. we touched on it, but under this seeing that the world is going to pay for performance and the us is in the middle of a coast to unprecedented economic growth and for all of us we are lucky enough to live in the bay area, it's like crazy economic growth. so, how are you thinking about kind of assuming that growth hides everything in terms of forces that are getting more complicated? how are you thinking about getting us ready him and not just for potentially a slowdown in growth, but probably more importantly, the changing fabric and complexion of how healthcare is additions and systems are getting reimbursed? >> that's a big question. so, on the kind of last part of that, first, intrusive the the healthcare world changing, i think the biggest thing for us, so we have a number of factors that are in play when you talk about value based purchasing and pay for performance. the biggest one of those for us is actually our medi-cal managed care program itself because we are taking capitated dollars. a lot of these kind of more defined fee for value or value based purchasing programs have to do with getting an adjustment to your fee for service revenues based on some kind of vague criteria. our big bulk of our medi-cal managed care program is essentially pay for performance dollars by its definition because we are at risk. we are getting a fixed pool of dollars and we are going to get it or not get it based on our performance on her expenditures and the management of our clients. i think that is the biggest pool and the biggest driver and the biggest underlying determinants of our financial future is, number one, are we able to retain our patient population and that goes to patient experience, it goes to quality. and it goes to the image ourselves were presenting to our patients and prospective patients, and then also, on the cost side is our ability to efficiently manage that population. that is revenue source. our capitated revenues in our budget are over $200 million. 5 years ago they were around $70 million. so with our fastest growing. it's the area of our budget where our future is most in our hands in terms of connecting our operations to our finances. so that's a big one. there are also a lot of pieces that are included in the new waiver that i think are indicators of what we should expect beyond the terminal waiver. there are specific government programs in this five-year waiver, they give you a sense of where things are headed under the global payment program in under the prime program, we are going to get paid based on specific metrics, but i think those metrics are a signal of what future payments systems are going to look like for us. so our ability not just to drawdown funds under the waiver but create the infrastructure so that were able to continue to do what were going to get paid for beyond the terminal waiver, that's another really important one for us. so, i think those are kind of the themes and i think we are well aligned in this new waiver is aligned with his all the strategic planning that we been doing as a network. i think everything that we been doing in the direction we been having is getting it reinforced with the new, as we learn, the new way the government is adjusting its payments for medi-cal and medicaid. we are learning that we are on the right trajectory. we didn't start down a path that is different from where the payment policies are headed. then, the last thing i'll just mention, on our sustainability, we do need to continue to focus on our herschel revenues at the hospital and diversified our sources of payments, because that is a big chunk of money and we are going to need to increase focus on that revenue as some of these waiver programs and other sources of public funding become at risk or start to go away. >> thank you. that's helpful. i imagine we'll talk more about these things in the years to come. as these programs continue to grow. the only thing i would add to what you said, and you are super articulate about it, intrusive retaining patients, i think not only has to do with the absolute performance of our network in terms of meeting those patients needs and meeting the metrics that the various payors set out for us, but it is also a relative measure against the hospital system up the street who is also trying to figure out how to serve those patients in the new environment. from the patient's perspective, like, there are some real benefit to having that ability to move because it's sharpens the focus of the providers. but, as a provider, which we are, is going to great old new level of requirements in service. that's the one thing i would add. >> i think that's a good point because were not in a vacuum. everybody's choices is not based on us. it's based on us vs. option b. good point. thank you. >> " >> commissioners can i do think and i want to credit over the past year the city has been willing to actually give us the expenditures necessary to have started doing all that and the ability for us to have even recognized analysts who are working with the health network and beginning to create those report cards that are so important to answer these questions and be sure that we are going to be competitive in this pay for performance world. we are not there. almost nobody is really there except for perhaps kaiser, who started along that route sometime before. but, i do think it's important that the department be recognized for having really moved forward on this rather than just saying, well, we are the public health government. i think, recognize this and i believe that all of us is going to be very important and that our chief financial officer knows the lay of the land because half of getting to the solution is knowing the problem. so, thank you. >> thank you, commissioners >> commissioners pating >> following up with that first of all i want to commend this report. i find that the table on the overall comment that you gave in terms of the breakout is very useful. again following up with mr. singer's comment might be interested in expanding in the future report some of the data around the cavitation and fee-for-service revenue given that's important driver. i'm looking here at the primary care surplus of $3.3 million and we have a san francisco general surplus revenue of $29 million. looking at that there's these trends. in the primary care, we showed an increase in capitated revenue which is what we would like because we want to keep our capitation and pottery care, and a decrease in fee-for-service. which would be nice if there going and enrolling at other plans but that's very understandable. in zuckerberg were seeing a deed decrease in it revenue which is good. it probably means were not using the capitated services and hospitals because hopefully, there've been better taken care of in primary care and an increase in deeper service revenue at san francisco general, which is privatizing some of our services and having better capture. i like that friend, but i don't know, over reading it. be interested in the future since this such an important area it would if you can expand that part of the report because i don't know if we get the sense of our efficiency from the service data we are reading and this financial data maybe, but that's a global indicator of dollars following patients and the dollars in the right place and doing a good job. am i reading this properly? >> thanks for the comments. in one area in the capitated revenues, at the french general, that is actually due to our rate cut. that is actually a little bit to the fed side instead of pain you directly dollars per month were going to pay you 95%. so it's not actual utilization but your point is well taken that probably what would be useful is the way that i actually monitor that as i look at our enrollment by programs because the rate we get is going to be the rate that we get. it doesn't really tell you how we doing well or not. if we get a rate increase that's out of our control we shouldn't pat ourselves on the back just because something happened to us. so, it may be useful at a future meeting to look at some of the underlying data of our enrollment and our retention that it really is what kind of driving, are we doing well or not,, in terms of keeping and growing our capitated revenues. we can do the same it san francisco general. so, i think i understand what you're getting at is wanting to see the underlying drivers of those revenue numbers. >> thank you. >> commissioner singer has been emphasizing there is a downsize of paved poor for performance. we lose if we don't perform well. or we can gain better if we perform closer to not just the norm but the ideal. so, that might be another area we want to see what that opportunity is in terms of, what if we get to the 90 or 100, what does that take in terms of cost, which could then be an additional argument to put in the resources, perhaps even faster, in order to avoid losses, and to maximize our gain. i think that is another part of trying to then help in understanding where this new dynamic is going and where the opportunities, then, that have to be developed so that perhaps more quickly and later we are able to do that and minimize the losses that we are, for example, even now projecting in terms of the quality scorecard and we just know the status will continue to really ratchet this down and make this goal even higher in order to achieve any of these paid for performance programs. >> that's a good thought. thank you for that. >> commissioner chow, i agree 100% with your ambition here for us. i think we can even push it further. to my way of thinking, that the care in our network ought to be good enough that employees of the city and county of san francisco want to go have care at our place. if you think about the levers that we can exert as a city on both the care for the indigent and the financial health of our entire city, given the size of our draw from the general fund, the concept that in a competitive environment, our standard is that people with free choice would rather choose our system over kaiser. it's going to both make us financially more secure and ensure that everyone in the city gets a level of care that we are proud of. in the long term and stable. this is a-this is not just like 2 steps from where we are now. it's really 47 million different reasons but i think that's the kind of vision that we have to have proud good our healthcare system is. >> yes. commissioner chung >> i agree with commissioner singer on this. i asked the question a while ago, before even, like we saw the full implementation of-we start seeing billboards of different hospitals, really like bolstering their brand. with their specially care czar, why they're so special, and really highlight relations with these different hospitals. because of the affordable care act and because of medi-cal extension, i totally agree 100% that people have choices now that they can go to different healthcare systems to seek care. so, it comes back to us to asking what exactly is our brands. what makes us contemporary? vs. 10 years ago when we still the safety net provider. i think it's really crucial in addressing some of that. i think that the question becomes, how do we stay competitive in this environment and provide the care that we have always been proud of. how do we really change some of the changes that reflect the health care system? i think that may be something we should spend some time in explore further. >> posted as dir. garcia >> i think all of you are very right. one of the issues that commissioner chung brought up which is visual marketing that we do have a whole new process going on in marketing and branding and rachel kagan is leading us in some of the resources that the foundation of san francisco hospital foundation has provided for us. so, you will see that soon because i've asked rachel to come and bring that to you. i think that is going to be an important piece of that. i also think that we need to recognize that we are a leader in complex care. we been a leader in hiv. we are experts in that. in fact i met with some of our researchers yesterday we are world renown,. i think we will serve many of the other systems by taking on some most complex patients that we have in our system. we have the integrated system to do that and i think we can really do that well and i think we already do that and be able to provide for that, i do think that some the other systems come on us for providing that care to that particular population. commissioner singer talk about employee health and i know greg and others in the network are working really hard to come up with a plan of how we can address up to diving all your comments are really good and i think we identified through this conversation some of the highlights that you want us to continue to hear about and will continue to work on it to ensure you get the information and catch you up as quickly moving in the direction in the apartment considering the way were going to be paid differently for value. i appreciate the comments today. >> my personal belief is to become the first choice of citizens and spare van were going to need to focus on her primary care. we were class hospital. world-class specialty care, but when you're looking to become insured, i don't think the expectation is that you're going to be using the hospital but everybody hopefully uses your primary care provider >> i think you're very very on point. just a note we just received the potential to, i bond of $20 million to be able to provide infrastructure for some of the clinics to address that same issue >> i think the physical refresh as well as electronic refresh will be a big part of that. >> yes, because it will become to the commission that there is a bond issue that will move forward that will also then help address the facility issues within our primary care clinics. that will be-the bond will be coming forth to us at our next meeting for our information. thank you. i'm pleased to hear were going to be looking at the center of excellence idea of some of those world-class services that we offer for the remaining part of the commercial world. commissioner sanchez >> i think this is a thoughtful discussion about what the challenges will continue to be. i think there is a multitude of variables we have to look at good i think what are the key things we need to look at is who are our employees and where do they come from. we are day live? where did their families live? i can tell you, a great many don't live in the city and county of san francisco. many other kids and children and elderly are in other counties and utilize other services. us ucsf, stanford the network is growing and growing and growing. i think our major mission is to provide the highest level of quality care to the city and county of san francisco with the resources we have and god forbid if there are accidents and we need a trauma center etc., whether you go to stanford or opens, we can cover the waterfront when the majority of our employees may not live here in the city and i think that's a real challenge. it's interesting because so many of key health initiatives started here in the city and county of san francisco. kaiser started on market street in the 40s. when you're looking at some of the bonuses among longshoremen and other industrial workers, it's all over it in north carolina. in washington dc and all overboard of zane is it didn't just stay in san francisco, but we are the city and county, we are the public healthy apartment. we are not a kaiser or stanford or uca ucsf or whatever. we can't provide these multitude of services in different county systems, but yet we can still affiliate and provide the resources to ensure that our people are indeed have access to some of these top systems and that's why we have the affiliations we have today. i think it's an excellent point. we really done well. as we dream on, the 400th anniversary of cervantes and don quixote so keep on fighting the good fight. >> be think of. >> we can only do this when you come in with a good report because then we can hook into the wind we find that next dollar, right >> yes. >> remembering the bad times and no, we need to go next door and would we get the money for the rest of the of. i think commissioner sanchez as point is well taken as were trying to be the choice in the city that definitely has laid off before even in a former plan that i was affiliated with many years ago, that was a failing of the southern pacific plan that we were unable to really cover the residence-i'm sorry, the rest of the families because of the way the plan was structured, and it became a real impediment in terms of trying to offer services in a broadway. so, as we are offering it to employees have to be able to meet the needs of families also and figure out how that works in terms of not having a full network that is within where all the demographics of the entire families are. it doesn't mean it can't be done. there ways. we just need to be aware of some of the pitfalls. i'm glad commissioner sanchez reminded us we did for all your comments, i think that speaks to we have to be careful how we design approach and do it in the right way so that we don't overstep and end up in a worse situation we do have strategic b >> commissioner chung be thick with that said, i appreciate what commissioner sanchez brought up right fully believe where a department of innovation could we have something others don't have. we are directly related to the city hall family, so if there's any health issues that float to the top as priorities, we actually have direct influence to policies implementation, and even legislation-wise, we have influenced like no others could. i think that makes us unique and the role of public health also makes us unique. i think that those are not things that we should really overlook. so, i think that in terms of whether we are closest to provide services, i think that is also something that we can innovate. that is how we came up with healthy san francisco and the san francisco health plan, and i think that this is really-to encourage us i to go further and i don't think this is like a conversation of exploring our limits. really to define where we can push the envelope. >> thank you. any further comment? we see where your budget report has led us today. >> thank you. >> commissioners were full blood to the next item i want to note is a gentleman with a camera and he's taking pictures to do ads for sfgov tv for the health commission. just to give you a context could director garcia and i were mentioned and i forgot to remind you about that but that is what's happening. so, smile for the camera. item 9 is the >> i have lunch on my shirt so take pictures of everyone else. >> item 9 is the hr dbh hr update. >> yes, please >> good afternoon, pres. chung and novel members of the health commission didn't find the human resources director for public health. today on the provide human resources update could elect to start by mentioning that work in a number of organizations including 12 years in the united states army 5 years as a labor negotiator for unions, 10 years as the human resources director for seattle public health. norm in all my years in working for other organizations i've never come across and organization that so dedicated to improving themselves in the department of health in san francisco. the amount of change and improvement i've seen in 3 years i've been here has been truly remarkable. human resources has endorsed that same spirit of improvement. in my past update i talked about our preparations and implementation in preparation for the formal care act in january of 2014 and then talked about our use of lean to improve human resource. we had done 5 ween workshops. today over to give a snapshot of our employee demographic talk about a new area of focus which is workforce development. the first 5 slides i'm going to show you show some general employee demographic and nation about the department. this first light shows are ethnic diversity of our work force. now, we have found there was a video provided in the powerpoint presentation which we use in our hiring process that talks about the demographics of the health apartment. the demographics of this house of him and are similar to the seattle health department. so, what were finding is to address specific classifications are worksites in terms of improving diversity in all talk about that word in a future slide. our gender breakdown is not unusual for a health department. but it is an area we can work to improve. the next 3 slides addressed to a certain extent our aging workforce and the concept of retirement. i believe many employees eligible for retirement, what we're finding is that people tend to stay because they want to maximize their retirement benefits. so, simply being eligible for retirement doesn't equally to leaving. as an example, we had as an example, we had in 20 1359 people retire with a service eligibility and accomack site is cut off a little bit-but next year we had 200. the next 5 should say 200. so, total eligible retirement is much larger number as you can see but it doesn't equate to people leaving. in the past we talked a little bit about our most used job classifications, and that has not changed. there've these top 11 job classifications were most of our employees tend to work. 50% of our employees work in 11 job classifications. they are represent by our largest.. we have 117 job classes with less than 5 people. that would be like electrician. i think we have 2. we still have to do job postings and that sort of thing for those classifications, we have certain classification such as these which are more an impact when we do those hires. these are unions. our biggest union is sei you and our biggest unit is the nursing units. we currently are going in bargaining with the nursing units this month. i'm now going to talk about our improvements in hiring. slides 9 and 10*recruitment for the fiscal year. we have recruitments are done by our american. that's counted as our manager we hired her left leg roughly a year ago and she's got a to improve our ability to recruit. today i have the thing you're the exam section which is-we step one are people doing exams not that about eights with increased that. we had to do that in order to break this bottleneck which was the exams partially once the exams are done and we switch to selection of people in hiring him as were the 2 managers coming. you have-this is kathy-but she does hiring for everywhere but san francisco general and karen hill desiring for beef in general. their the personal managers for those 2 units. as it turns out that apartment is roughly split equally between san francisco general and the rest of the departments. so that works out. they work great as a team. there's a made you look at strictly as you can see it's been turned trending upward. in 2012 the emblem of the new peoplesoft system. that drug down the number of new-we do some corrective things in 2013-14 were used civil service exams hires in an effort to catch us up to get ready for the affordable care act. 14-15 we were on a roll and 15-16 we continue to be in a good place. so, this gives you generally an idea where we do the hiring. working-15 as you can see san francisco general 50% of the hires and the rest were spread out throughout the rest of the departments. this is a little bit about the citywide workforce. we looked at this in the past. as the cfo is an anathema we continue to add ftes good i think he is trying to stem that tide that we are working with them to do that we can't continue to grow staffing. we just can't. was starting to repurpose our staffing. this is a general trend of our targeted hiring for zuckerberg san francisco general hospital. these positions identified by the previous ceo and others as critical to opening a new hospital. there's a detailed chart that you are provided with what you see on the right-hand column is a scraping of 4 and 5 and 3 and 2 in various areas of classification. that indicates there's not anyone area that is in trouble. in other words, we can fill those with registry staff were temporary staff. this nothing that would keep us from opening a new hospital in regard to staffing. we've also drastically dropped our use of registry at one point were only using one registry staffing which is an indication we are staffed up. i'm now going to turn to a discussion of workforce development. so, workforce development is an area that we are starting to take some of our energy got away from hiring but in addition to wiring start focusing on workforce development. workforce of him in a letter workforce with our current and future demands for service. i direct resident 54 pillars for this which is shown on the following slide. these -visited her site was created by the controller's office. the controller's office has partnered with us. this is called-they are partnering with us to identify the various pieces of workforce the moment so we can put together in a consolidated focused effort. these 4 pillars, [inaudible] are the 4 pillars that are targeting to focus the workforce to moment piece on. there's one area i've been focusing on over the past-which of the african-american health initiative among the workforce the moment committed was brought into that maybe a year and a half ago to start to do something for in conjunction with the black african-american think tank. these are some of the areas that we are working on. i'm a talk elizabeth about those. the first one is the video i mentioned i hope you get a chance to watch it get it's embedded in the link in your powerpoint presentation. the video talks about implicit bias and and since you were asking, requiring, managers were interviewing managers watch the video and they sign a couple pages of memos talk about nepotism, cronyism, pies and all the things we don't want them to do in the interview panel. that's been fairly well received. i've got my left ear is-she's ugly to implement this brought the departments. if you would raise your hand? we have-next is the mentoring did i attend-isms san francisco jim. she's a nurse mentoring started a mentoring program. this was also part of the workforce the relevant group. i ask you to take on a summons and karen was kind enough to take on the idea of waistcoat a mentoring program going. career counseling. one of the things that members of the black african-american initiative group talked about this some sort of career development function. the karen hill has give me one of her positions repurpose in a to-do career departments will have a starting point for people to say can i come in and talk to how i get from point a to point b. that's important that you were starting this month. the next one is pathways. our talk a little bit about that. pathways often use the term pipeline. where do people come from? i use the example of seattle county where we were doing same type of work and we had a paramedic program. what we noticed was that all the paramedics were white males as we use that as our spring were to say why are they all white males? we had maybe white one white female. we look back on the pathway where do these people come from, agenda picking from small world committees around the seattle area. so we go to the small rural berries that are doubly white of the people on the volunteer fired on a productively white males. so for many many years decades, been getting their aromatics from those areas. so working with the director of the paramedic program, we started to recruit out of la, chicago and other areas more diverse to change that pathway. we are doing the same thing here. we started work on what classifications, what areas are not diverse and what are the pathways for bringing people in and how can we change those pathways. matt talked briefly about these ones i mentioned. these are new programs we started. the first one is called basis for the future. that started in children's hospital in oakland. it's been expanding out to befriend john o'connell high school and were going to be part of that. it supports use from underserved communities and gives them opportunities for academic enrichment and career training well-being. his accommodation of workforce learning and academic improvement. so, we have the schedule for spring internship that starts march 9. it will go through may 4. the lien assembly on march 7 to indicate that these youth have created the school portion of it. nethercutt to the workforce and start to learn how to function in the workplace. it will start out in san francisco general in the fall love another component of this and will let 32 more people. the first cohort is not. the next program we started is a year up program. on august 3 give you orientation to the first group of people who during the cohort for the year of interns if the pipeline used to bring in people. a national pipeline matching entry level needs matching adults from urban committees. again the program is geared towards 18-24-year-olds with high school diplomas or ged. this particular program we graduated first group on generally 22nd this year and will be working primarily in the it area the idea being after they do their internship golf league seeking employment. the 3rd area is the it training classification. we work the counties develop that. the idea here is to target it people because were competing with apple and everybody else. so what were doing is an internship program to bring in young people to teach them the basics about it. the three-year program teaching them the basics in the first year, specialized training in the 3rd year of lien the 2nd year-in the 3rd year bringing them on as permanent hires. it's a way we can bring in our own it people. the last one i want to mention isis year. this is dir. garcia suggestion working with the mayor's office is called interrupt project and organize for safer san francisco. this of program for the mayor's office which is for hotspot neighborhoods and it's for at risk youth. it provides employment opportunities and social support. those are for new pathways in addition to the very many internships, programs we have and the other work we are doing. we also begin this year during orientation for all employees we did have a new employee orientation other than the hospitals this year we start requiring employment revision for all stuck it in the past year we also did a all-day training in this room for over 300 supervisors and managers to teach them about how to do hiring, but avoid getting in trouble with the american with disabilities act, equal employment opportunity commission and the other things they need to know to keep the organization out of trouble and to keep themselves out of trouble. to whether things are minor briefly talk about is, one, electronic performance and electronic learning systems. e-learning going to the peoplesoft system. an it system used on the financial side is used for finances. oracle, maybe you are familiar with that on the human resources is peoplesoft. the e-learning and the performance management system to do performance appraisals. right now we do pay per performance appraisal. this system allows them to do electronically. the pilot program we start october 15. the pilot program is with 4 and 16 employees. 19 classifications and 36 managers participating in the pilot. therefore online tablets were using to capture a variety of different nuances throughout the department for specific needs of that department. the supervisors can comment and make [inaudible]. the performance appraisal cycle would put time for goalsetting is beginning, emitted your checking opportunities to add or delete goals, change goals and finally, completion of the online appraisal at the end of the cycle could the system also generates e-mail reminders and provides input to both the supervisor and the employee. once this is done, this pilot is done, will start looking at this movie wider in the apartment. e-learning is also a peoplesoft system. this feature peoplesoft gets rid of some of the paper and you online electronic learning. in march will be notifying 500 employees have to go into the e-learning system and complete a program on the use policy for vehicles which is a new requirement for the city and cut. consider doing paperwork and use the e-learning system to do that. we are working with the department of education and training at zuckerberg hospital. working with laguna honda and the county and eventually bring in 7200 burners which is 5500 city employees and 1700 ucsf employees at zuckerberg san francisco general hospital. blast area what about is the workforce demographics report. we are working to identify those classifications or areas that lack diversity in beginning this month wanda simmons, on the far left ear, she is working with me to identify these areas and go start meeting with representatives from san francisco general and the good honda and primary care population and/or that a person who report so they get an idea of when and where we need to start focusing our attention. in order to improve diversity. that is not shot of where we've been and where you are today and where we are going to questions are happy to answer them. >> thank you. commissioners, comments? mr. singer. thanks for a much for that. we had a lengthy discussion of greg wagner about the new environment were all moving into that is an environment where everyone would agree that people are there to be-we will have to be more flexible. the apartment is changing. that's one thing. the 2nd thing is if you look at how you're measured against many of these benchmarks,the vast majority of our span is on people. so, my question is, how do you feel about the systems you have to see what is going on in this massive department from a human resources thing? what are you missing and what you need to get us ready for the new environment? >> i think 2 things. one, the human resources information management system is what we pull our data out of. so, right now we have her medical records, we need is a system like that, don't see that happening for 2-3 years because the county won't allow. stuart pointed to from 3 systems. we have multiple from one system which gives us all the data we need. now, i see that >> give us an example of something you would like to do today but you cannot do your >> i want to know how may employees aren't specific classifications, temperament and how many are civil service could run out of payroll and payroll. the system does not allow me to limited duplicates. some people are rents and there may be also a 3rd classification. the system will basically they cut the person 3 times and on the way i can go in and get an accurate count after somebody go in and search through that whole list answer to illuminate all the duplicates. that's one example. if i want to give you an accurate count is just extremely difficult to do. so does it tends to be a cut in the budget is fine. it's very fixed. their 7072 employees. that's the most accurate number i ever have is the budget because it's fixed. once i start putting people in the payroll and hiring them, they start taken on additional jobs my start to lose that ability to get that exact count. i like to have an exact count inward to keep working on it. i would say, because of one of the pillars of the workforce development work we are doing that sort of compensates for my inability to run these accurate reports. the way compensates for their doing operationally pertinent reports and report out for specific areas that tie strictly into human resource. i go to the report outs for emergency room were for the other areas, and that's all about the people. as you said it's all about measuring the people. it's about measuring the time to do things which is all about the people. i have a lot of confidence in our ability, even though we don't have a near-perfect human resources information management system, we do have these other tools such as lean and we have a very innovative and intelligent organization because of the people that are behind it. so were able to make up for some of this with things like lean and a3 thinking. i will continue to work with the controller's office to improve emerges because people software is become one source of the future. the problem as it currently does not talk very well with the systems we have. eventually i like to illuminate our site system which is created probably 15 years ago that's difficult to maintain. the problem is it is about 50 things that the new system can do. so once i get caught up of little bit in the controller's office going to work with them to start to bridge that gap and hopefully get rid of my site system and it emerged to do everything we need it to do. you merge is the system of record for the future. we have to focus our energy on improving that. detect thank you. >> thank you. >> commissioner chung >> so one of the things i was like to like friends and colleagues, how inclusive the city is. and the health care that we provide. it's pretty cutting edge. but there's been no way for me to exactly find a number to say how many transgender draft we have within the dept. of pub. health. i know there's one or 2 over here and one or 2 over there, but how do we reach out to my community, who's been historically marginalized and not getting a lot of employment opportunities to make sure, will talk about workforce development we can get-because we don't see that in normal regular numbers? >> that's a good point. one of the things we did in the last year or 2 is bring on a recruiter. recruiter helps us focus on specific areas were having trouble. this might be an area i talk to my recruiter and that's a not let's not forget this community. but do some extra hours. regarding staffing, race and orientation are all protected. so what employee fills out their application they tell me their race, gender and all that and then they thought the application that you are never to meet. nobody's ever supposed to know basically what you said on these forms. i'm able to go in and the way you get the demographic information here is i can do it because i'm point large aggregate numbers and there's no way you're going to know that was you that said whatever it is you are. i can look at that and see aggregate numbers and see whether or not we accurately report that. if we don't have something i can start working on disease there's a way i cannot people identify so i can capture it and give you some idea of how many employees we have. i can work on that. >> other questions? >> mr. sanchez >> this will give us a unique insight in reference to who are our providers, and support services at such a. then you showed not only in reference to us that apartment of public health and the different units, and the city and county. there are significant differences if you take a look at the data in who serving can i was really grabbed to hear your closing comments we are and that you are linking with our young people in a number of these programs knowing much about what my sons who taught it otto when they open up the score the good of all this new acquaintance in the computer people are going to give us-the poor kids are out selling cookies or whatever just to raise funds to try and get waivers and whatever. now, we are opening up a number of these key programs which could really provide some new pathways to the kids and summer programs and internships and access to some of the higher education programs to city college, through ucsf and stanford at such a which they have signed grants they can provide a number of programs. so, all these things are-have been fragmented get i'm glad now part of us and going to play a key role as far as who's going to be servicing and providing and maintaining the programs that are being developed and will be expanded. as we meet the needs of san francisco in the future. so, thank you >> if i may, commissioner, just to note in my time at the health of our mentor the hr area has been always a frustrating process for all of us. i do have to say, with ron's leadership we've moved that needle, not only in an aspect of the process structure, just the merit system. that means that we he's saying is that the 230 classifications up exams because were in exam-based system. but to think about the number of people who are qualified for retirement in the department, and we talk about the fact who we need to run the department, these pathways in our internship programs are medical training center are all the future employees of the department. i get to meet the union of the residence every year and am always amazed etc. look around the table and i try to figure out who's going to be the next leaders in our health of varmints in this group because the residence have become many of the people in our audience today. who are leaders in the apartment. so, the importance of these pathways, i cannot underestimate and also the aspect of continuing to get a workforce for a diverse community that we serve is really important. i do want to thank all the staff in a jar because you've done a great job. you do a great job every day. i think that we have a long way to go in this era. if you think about what we've done in electronic health records just in the issue of our medical side of the house, we have to do the same thing here and really support hr could i know we have a lot of questions from commissioners that are analytical in nature in a really want to make sure you understand the kind of tax paperwork they have to do to get that data. so, i hope that as we move forward, with that apartment that we have to think-this is part of the robin playing is the new health director for the past 5 years-i just updated my 5th year, the fact that we need to look at the central administration. it's pretty much forgotten and overlooked because we were so focused on providing the care. but that is the customer service for our employees. so, for hr, are budget and finance area, those are critical structures that we have to continue to support for us to do the quality care that we provide. so i want to thank all of you because you are the ones bringing in the people to do our work. i want to thank you and want for his leadership on this. thank you, commissioners >> thank you. i think it really reflects today's where we began with employee recognition and this is obviously a very important area to maintain. i like that idea. this is the customer service to our employees, and that is really good bottle i'm a actually, to try to use. thank you for giving us a snapshot and will be looking forward to understanding how you're going to meet some of the needs for the future and be able to meet the changing needs of a which will be even more challenging for our department here. >> thank you. >> moving onto the next item, which is other business. >> other business is our opportunity to bring up other topics. but another of topics are ready for further discussion. is there any more? i think we might want to remind our planning meeting will be on >> it'll 19th >> it'll 19. commissioner chung >> i'm a little disappointed dr.-left already because i wanted to bring up the issue of resistance,. that is something in the news recently of finding one patient who became hiv-positive while he was on prep and because we actually now are providing prep and also the education piece, i am curious how do we incorporate that story into our work and reaching out and trying to provide otto at the same time giving people a more informed process in making decisions >> i think will be great to be able to bring our prep group to give you an update. they are working hard on trying to get that education and information out to committee members to meet that criteria. so i think giving you an update on that would be important. we have researchers right now working with people throughout the country and i know you do that as well come a commissioner chung. we can bring you an update on where we are in our process in the coming-and the next, and commission meetings and make sure the prep-because that is really a neat process that were going to and i like to hear it as well the science going on between around this issue could we can definitely put that on the agenda and make sure to get updated information. >> that would be good. we'll put that as an agenda item. "any further items? if not will go on to the next item >> item 11, commissioners of the joint conference committee report that a clerical error on the agenda. it should say the that a clerical error on the agenda. it should say the february 23, 2016 san francisco general hospital gcc meeting of the. ugly commissioner sanchez chaired the meeting. >> yes, please be yes, the joint conference committee met on the 23rd. bar open session of the committee reviewed the following areas. that some discussions and some about quality management and regulatory reports and also talked about a number of our visitors who were looking at different facets of building 25 and how, in fact, we were the number of units they'll be coming aboard to complete the different surveys and recommend the excellence and/or planning corrections but all these were discussed in depth and some of the staff had to leave to meet with her surveyors on some of the additional pathways. also discussed the scorecard, hr report, administrators report, and the patient care service report. additionally, we have some discussion pertaining to medical staff reports, which was presented and in particular, to the department of neurology was cited as one of the new flagship units aboard at general were there settings and new records pertaining to quality care, their intake, okay, and follow-up and quality of the programs and services with this new unit. in closed session, we approved the credentials and reports and the committee adjourned and also i will note the fact that we had the award ceremonies at the at&t ballpark, including our top staff who cited again this afternoon and other members. there was also discussed in the repertory committee. i'm am open to any other comments corrections or additions? >> spot on. >> good. the t >> item 12 is committee agenda setting it seems like you already addressed that with other business. >> okay any further agenda items? okay the next item is adjournment. >> i will move for a german but i know mark, you had a tough week and have come through and help this out as you always do on her various committees so thank you for that. >> thank you. >> so there's a motion for adjournment. i heard a 2nd? yes, i do. all in favor please a guy. opposed? this meeting is adjourned. >>[gavel] >>[adjournment] >> >> welcome to the the regularly scheduled meeting of san francisco entertainment commission thursday, february 4, 2016, i am commissioner joseph sitting in for commissioner president tan call the roll. >> typically i know i don't. >> any announcements. >> i don't have the housekeeping spiel please silence all electronic devices. i want to thank sfgovtv perfect. >> for broadcasting this and what am i leaving out call the roll common

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