Transcripts For SFGTV Health Commission 4417 20170409

Commissioner pating commissioner loyce present. Commissioner president chow and welcome and commissioner sanchez the second item is the actual commissioner president chow you might want to say something. We want to welcome dan our new commissioner he is chief of staff of democratic leader pelosi who as you may know was the first woman to serve and speaker of house of representatives and responsible for the ac a act pga in no idea. Hes dictated his life to Public Service serving in the white house under bill clinton and as the president ial appointee of the u. S. Department of education were pleased hell be joining us commissioner. clapping. would you like to make some comments. Achieve and commissioners thank you very much for welcoming me director garcia very grateful for the leadership in San Francisco for many years ive mainly living with hiv for 20 years since 1990 and the work on this commission for decades i believe is what has allowed me to be hereby San Francisco create a model of care that became a model for the nation and what was the basis of retrofitting and getting to zero initiative to have the emissions to zero at a time with uncertainty on the National Level what will be happening with the healthcare act im here to lend my commerce and whatever i can do thank you very much. clapping. thank you next item, please. Second item on the agenda the approval of minutes march 29, 2017. Right so the minutes are before you a motion is in order. So moved. And a second. Second. Any corrections to the minutes . Seeing none, were prepared for the vote all in favor, say i. I. Opposed . The minutes have been approved our next item, please. The directors report good afternoon, commissioners and welcome on board commissioners were so excited to have you you mean the repeal of the Affordable Health care was stalled but were concerned there are efforts to do that and we know other ways to be impacted our budget i want to note we have been continuing to be advocates in this way your policy director went rookie and met with the leader the San Francisco clinic consortium to 0 support their efforts to have federal funding so the efforts to be continued around the advocacy is incredibly important we want to protect the resources and also the services so for those San Francisco folks that work will continue and the commission for your support to continue to support us in continue to provide the great care for all of San Francisco we want to announce i think an Incredible Program Law Enforcement we received over 5 million this called lead lead is a program that was developed in seattle that we are near here in San Francisco to refers repeat low level drug offenders to communitybased and social serves as an altercate e alternative to jail it is bans a Successful Program by the same name and begins in april in two parts of the city the tenderloin, civic center and bart station and mission 16 bart station were working with all the criminal justice with the Police Department and the bart police and acknowledge angelica that is taking the lead for policy director colleen that has been leading it for us with the Police Department and all of the other providers in the community our other providers will include the adults probation for the institute we hope to get this off the ground weve been awarded two San Francisco came out first and los angeles second i dont get to say that many times so laughter . San francisco quick campaign doubled up to help smokers quit a 2. 00 tobacco tax from the Health Department with sf quit as of yesterday to provide quick multiple tips to help people cut down i wanted to note that the National Public health is april 3rd to throw the 9 as you may know were celebrating our public accreditation a great way to do that and to acknowledge impractical that one the visionary of the year and the San Francisco chronicle visionary award this thing week well be celebrating an employee from Mission Mental Health that will be retiring on may 1st an 63 years work for the city and county of San Francisco he harassed been a korean war veteran and wrautd the purple heart and celebrated his birthday on april 3rd and working for the department in 1953 as an orderly and San Francisco general and laguna and sam has said many memorable moments in his career and our new center hes 86 years old and some clients known for 25 or thirty years we want to celebrate him and will be having both a public here to the Central Office and note other Civic Leaders that want to come and congratulate him that concluded my report. If theres any other questions from commissioners commissioners questions commissioner loyce. Yes. Thank you director garcia im at that point hesitant to congratulate all of you the republican Affordable Health care act failed they couldnt get the votes but concerned about the fact i understand that director price with the Human Services agency has authority to impact to deliver services i hope we continue to watch what comes out of washington there will be another effort by the Republican Party to repeal the Affordable Health care act even though i want to honor president obama that was oriental the Affordable Health care act we need to acknowledge that. Thank you commissioner pating. I like to what may be with my fellow commissioners honor the gentleman, and, secondly, the lead for Law Enforcement the diversion is the dollars deemths dollars to use for the announcement or is this more passive youll a transfer to a line item of implementations wondering. This will be a multiple year program but a lot of will be on the outcome how well, we do there were looking for cities to do this and some have applied hopefully, well be awarded those extra dollars and pilot for us and if it works certainly ill sorrow recommending for budgetary staff one of the important parts of this this will provide to Probation Department to open up theyre Community Service center for twentyfour hours a day 7 days a week that will help dropoffs and providing two organizations outreach component and then working with the District Attorney the Public Center and the courts as well as with some of the Community Organizations and were meeting this with our prop 47 well see some expanded treatment beds not well touch no north well, not everybody will quality but individual will be general Obligation Bond in my opinion to serve to provide low to her we referrals we have to get the protocols and in lui of service those will be dropped by the da so all the protocol in the planning stage weve been working on this four almost a year in trying to get ready we hope we can shorten that planning period to have a memorandum of understanding between entities and working with all of them. Ive seen the pbs it looks interesting ill be interested to hearing our future report. It is challenging for us in california we have prop 47 and seattle has flown i didnt see we believe when we offer People Services in this department for the director we found 50 percent of our clients were oh, the service verse a versus a citation weve hopefully that people will take us up on this. Any other questions commissioner sanchez. No, i would add to our colleague i think that the i really on the kickoff for Public Health a unique the accreditation of our department of health weve set the benchmark and institutionalized the skills and commitments you name it, it is all there and have the bench line to build i want to congratulate everybody that was involved in the leadership just so extend with the communities internally and externally you name it weve set the benchmark and congratulations to the department of health opens Public Health week. Thank you, everybody for a job well done. Thank you any further questions if not oh, then well move on to our next item, please. Item 4 general Public Comment ive no idea received requests taillight will move on to item 5 the report back from the finance committee. Yes. Today, we took up the draft report on the charity report we received every year to make comments to the editing of the report and the report will be present in may here at the commission. I believe that was our only item of this. Yes. It was a short meeting. Thank you so item 6 the Health Commission officer elections. So the officer election were postponed until today, were prepared for the election first, the president , and, secondly, the Vice President. Ill take niemthsdz for the president at this point. Commissioner pating. My honor to nominate commissioner president chow so for the president youve done an excellent job leading through the changes in the last year and hope youll continue in that role. Thank you commissioner pating is there a second to that. Second. Thank you are there further nominations seeing none, will someone call for closing the nomination. So moved. And is there a second. Second nominations are closes precede with the election. All in favor, say i. I. Opposed . Thank you for this trust again my fellow commissioners and i hope to be able to assist you in our work this coming year thank you. Nomination for Vice President. I commissioner sanchez. Id like to offer the nomination of david i think an exceptional commissioner during his brief time hes been more than able to serve on various committees because of some of the things over the past year and done an exceptional job and hell think an exceptional Vice President for the commission i nominee him. Thank you. Is there a second. Nomination and second further nominations is there a motion for nominations to be closed so moved. Second. Nomination are now closed proceeded to the pole all in favor, say i. I. Commissioner pating as president i. Opposed . Hes been elected Vice President congratulations. Proceeded to the next item, please. Congratulations to both of i look forward to working with you tell me 7 the accreditation a happy today. Good afternoon, commissioners and director garcia im very enthusiastic to be here to give you an update on the Public Health and accreditation ill introduce cesarean with a live presentation i want to say. Few words about karen im not sure how many of you know carney met her in the 1990s when i starting to do work in bayview Hunters Point and at this time she was ancillary activist giving us tours of Hunters Point and something that a lot of people dont know shes held many occupations and used to be a meter maid a muni bus driver a lawyer she worked in kr5b9 and im sure she has many other job toilets shows an, an exceptional source of wisdom and mentorship and honest and out sfoelgz e spoken shields tell me exactly what i dont want to hear he value her the Health Commission is fortunate we were 80 able to convince her to to be the coordinator and again karen please. clapping. thank you tomas let me me get act made commissioners and especially all my colleagues, i wanted to take you on a quick tour of a very long journey the commission made puc accreditation a 5 year goal along with two other priority goals in 2011 immediately the over of policy of planning started developing two of the 3 prerequisite documents for accreditation in 2012 after reorganization of our public Health Department section we became the new Population Health division and we started the Strategic Plan the third document required in 2013 we sent the statement to apply for health and safety accreditation to the board and once the prerequisite plans were adopted we took the formal steps sending our application our formal application to the fab board the fab accreditation board they call themselves that we call them that two thats a picture of 80 mass in front of all the directors and managers pushing the button for the formal application and time forward we focused on implementing the prerequisite plan thats United States Community Health assessment the Improvement Plan and our Strategic Plan and gathering examples of the work that we do to demonstrated how we need fab standards on march 92016 we submitted our documentation that included 3 willed and 24 be examples laughter those binders hold those three hundred and 24 examples you can see and ford is holding a list of names of all the people that helped us garter that documents and put it together we were then able to actually, i skipped something and we were able to submit our documentation this is another picture of 80 has now submitting our documentation and by the way, i dont know if you see and read it clearly but what happens electronically you push a button and say submit they send this message are you sure you want to submit laughter so we said, yes we were sure we wanted to submit and from that time on fab was in control of our time finally on november 14th and 15 last year, we had our much anticipated plan and we were sweating a lot about that site visit heres facts about the site visit and part of that included a meeting with our Community Partners but we invited a lot of partners and had 33 Community Partners that agreed to come and be part of interview including representations from the Mayors Office and a number of on the city departments and so we want to show you give it a second i believe the little thing on the left at the bottom. Oh. Used to be a dark so we did an interview with some of the folks who participated in the actual asked them to give us comments in the site visit and okay. Oh, yeah. I wrote out my comments so i wouldnt talk forever let me go back a step at the time the policy and planning was doing developing the community height Improvement Plan and the Community Health assessment they were also helping to lead development of our Health Services master plan all the prophesies of the documents informed each other and so we have not quite that many binders but have quite a number of larger binder that represents that work before we were able so were ready now to leave the comments from some of the people that participated and the speakers are external so doing our best to have sound quality. Well, its my expression the two days went well in the sensed we were able to tell our story to the Public Health Accreditation Committee that is a very important function that we are looking toward forward to being able be to accredited well then help valid the work were doing is within the standards that the country has set for the public Health Department. It went very well everybody gave thoughtful answers and the positive work is highlighting the Community Action that takes my breathe away a part of building. In looking at the information that has been put together for our accreditation visit it is clear that the department is doing tremendous work and that we should be very proud that we have a very fine Public Health division. Its been exciting for me all of us coming together and everybody is so amazing in wrg9 everybody with our e their enthusiasm and irritation er organization. The site visit were friendly were all nervous going in but how we involved the community. Everything went well amazing to see how engaged everyone was and wanted to be part of it, it is nice to get feedback about away to improve the Health Department will strengthen our vision. Im looking forward to receiving a positive report from the Accreditation Committee. And another thing i can say about it, it is amazing how incredible Public Health is and everybody is seeing that as like this this makes that a remarkable thing. Especially with the times it is important to be reminded of the good work. Well be the best getting better. I think well get accredited. And as you may know we did get accredited. clapping. i really want to take a minute to point out how many comments there were about the fact that the whole staff was involved there were not not 100 percent but you know we never expect 100 percent but there were quite a few of the folks involved and while we were sweating up to the minute when we got into the site visit one of the people said all we had to talk about was the work we did everybody calmed done and had a good time so, now what are the next steps as part of the report back from fab we were given 3 of our greatest he will strength and basically, their most impressed with the fact we put a lot of effort into insuring that our clients and patients have a real voice in the programs that we do and in the decision that are made they stressed if a lot and i know that the director sometimes that is difficult because things slow down when we were improving our stakeholders such as we do thats our greatest strength and they were required to give us 3 of the most important opportunities for improvement and if you look at closely at the theyre talking about processes theyre not talking about the work we do or how we serve our clients theyre talking about they want to see some policies in writing we dont do a good job of documenting well be working on that as and we move forward and one of the things that were pointed out they dont see we do formal tracking you the commissioners thats because they have a different understanding of the relationship between the commission and the staff and as we go through the next steps i think over the next 5 years well be able to help them understand we dont track you guys we work closely together so what do we have to do we have to present annual reports for the next 5 years and that includes that were continuing to provide the work that is in enforcement with the measures for that and describe how were improving the measures into the Strategic Plan we have updated our Strategic Plan because that was 5 years old and noted to be updated no weve updating our Strategic Plan we have yu79d our Community Health assessment that was 3 years old and we have adopted a policy to update the Community Health assessment every 3 years to conform with our hypotheticals o hospitals requirement under the tax code to do an assessment every 3 years so we can do this together and share information instead of having two or three policies all with the same data and have updated our Community Health Improvement Plan because it was 5 years old and that was there was no new plan the Strategic Priorities have been updated we will be working on our updating our Strategic Plan for t h b and moving forward with implementation of a Performance Management system and so pretty soon youll see the dashed with meeting the goals and vision and with that, i want to thank you for the support from the commission and from our faith in me that i could get this done we had 5 years we were about 6 months over the 5 years but we had no control over quite a bit of that so i think we brought is in on time and im very proud of not only the fact we achieved other accreditation but all the work that was done by staff many of them are here but there is as you can see a lot more that couldnt make it today im open for questions. Why not have the staff stand who participated in this. clapping. thank you thank you for all you do. Thank you very much describing such an arrestus journey and all the work to achieve this accreditation may i the commissioners comments. Commissioner loyce. Ms. Pierce thank you for the clear and concise and deep profound statements ive known you since d f s its been moved into the 2000 i guess i really appreciate the work i know the work around how important that was and the towers you were doing and this is to me a culmination of accredited and our relationships with the internal in the department and working with the community to have their voice heard thank you very much and thank you staff. Thank you commissioner pating. My greatest appreciation as well having the opportunity to hear the details of a lot of the work youve done the Community Population i know it is a lot of work and with that said, were at the end of the road i hope youll have the opportunity to celebrate the things im looking for 3 things the collective impacts that word is in my mind you got recognized for that at a National Level is great my question is on the areas of improvement i was wondering what phase they were thinking about the question number one, Quality Improvement that lacking what is Quality Improvement with the Public Health Division Look like we have our Community Assessment not our Community Improvement process what else do we need to do that were already doing ill be tdr are interested in hearing our thoughts. Im going to turn it over to tomas i want you to know wore to do a quality Improvement Plan as part of documentation. Doctor arrest give. It about having Performance Improvement message and documentation to what you see concurring as possible in healthcare they started the journey years ago in Public Health were beginning to catch and the investment that are occurring in the lean Management System is actually were in really good shape next time just right now i can tell you were ahead of many places this is a lien that led that will help us. This is more than our indicators and score card. It having a systematic method of improvements how we differ from the healthcare side were for us we have a lot of really amazing tools for improving our internal processes and do collective impact and for that we use the result accountability which is also a Quality Improvement method designed to engage community so those two methods are really the pilars. When a sounds like you have a plan nun two the consensus code benefit for branding and Navigation Center they mean the department or the Public Health. So their meaning both we use we dont have a marketing plan we use the marketing plan the department has thats what we follow anyway a major concern of fab and the whole Accreditation Process people dont understand what Public Health is they hear Public Health and think clinics and hospitals this whole Accreditation Process to help us move as a country to a different understanding of our needs when it comes to health we need to be looking at then thank you so much this actually is a very important day probably more important than all of us today getting this presentation i think as we look at the future so the stories are not over the game is not ended only the beginning there is a process a National Process to evaluate what the public Health Department is doing both as a city and county level this came out many of us at the commission felt this frns just as important as it was that we have joined accreditation at the hospital and that we have a state license at laguna that we needed to have a way to measure and to show the rest of world what were doing does count and is measurable as being the best doctor argons point well do better where we want to go and in the next several months now we have a structure and you have a plan of action and youll have score cards well be able to integrate this into the process of oversight they couldnt have come about as commissioner sanchez without the vision of our director and the fact that the director not only has a vision but choose to put resources although they have competing needs in this congratulations this is a great beginning we look forward to working with you and a stronger Public Health program. How about one more round of applause for director garcia. clapping. and move on to item 8 ill note no Public Comment and the San Francisco Health Network update. Mr. You were not the meter maid and i didnt have this position but my first job in healthcare was sort of a nursing assistant on the board so i too like karen have come a long way from earlier jobs laughter well, good afternoon commissioners im roland director of the San Francisco Health Network so it is my pleasure to provide you with and just want on the status of network as you may know ive come on a quarterly basis to keep you informed of our progress this slide shows where the network stand within the departments infrastructure you remember when the department was reorganized in 2013, the two organizations the Public Health division you heard from and the San Francisco get Health Network that brought together the direct Patient Care Services any part of system is under the network umbrella. So in todays presentation were going to cover a few things first ill provide you with an update of some recent leadership changes between the department and network and share with you where we are with the Strategic Plan and the status of our top 5 Strategic Initiatives then owl provide you with our Second Quarter of reports on the status of our true north metrics for the network and finally following my presentation San Francisco Health Network chief medical officer will provide you with an overview to and then the integration network. So this slide shows weve had several leadership changes over the past few months involving about current and newly hired employees many of you know Maria X Martinez that or less left her post as the chief integrity officer to now become the whole person care youll be hearing if maria owe and report as you may know whole person car was the initiative of the medicaid waiver there was gp t and medical another change has been as maria existed as the chief integrity officer maggie you know has been leading the health at home and rehab replaces maria as the officer in the department. And similarly as maggie existed health added home we have assigned those responsibilities to a social administrator and this is hes not added those two additional responsible areas to his portfolio and finally nevertheless of our staff jim has been leading the patient accounting for the network now has assumed the enhanced role of director of patients serves as he and diana hands off the baton to jim and a few new hires when i recorded i believe in december i let you know weve extended the office and he started in january and youll either hearing from him later on this summer well give you an update and want to make you aware a new cfo at zuckerberg San Francisco General Hospital sam that replaced a lady that left for a job in oregon and finally our newest hire thank you alice comes contracosta alameda and be a chief player in the Electronic Health records so as we approach the end of this fiscal year in june well end the first year of our Strategic Plan we plan to have the session in may where we plan to reflect on the successes and challenges in our first year implementing this now Strategic Plan during the past year in addition to implementing the standup 5 chief initiatives we were engaged with the director of health an important and related process of stacey a 3 year dph wide lean program plan and infrastructure to support for spreading past zuckerberg San Francisco General Hospital we know the plan for bringing on the resources will be key to our ability to move forward with our Strategic Initiatives. Is it down there . So open on this slide shows a strategic status of Strategic Initiatives to orient you the green dot denotes the charters that are complete where the initiative is in full implementation mode the yellow dots denote both the charters not finalized and not been fully implemented as weve shared before e h. R. Implementation and that is a Strategic Initiative number one, called the write information every time no where is the number one, priority for both the network and the department over the next one or two years quarterly take advantage of fact were in progress for initiatives 2, 3 and 4 and adjust their scope and their work to make sure theyre better aligned with the Initiative Number one, and they compliment the h h. R. Plan and also as the dph wide Lean Promotion Office comes online this year were anticipate a lien analyst support to help our executive sponsors move forward with their a3 charter so the next 3 slides provide highlights of each of the top 5 initiatives and you see them here again, our number one, initiative is e h. R. We have stood up of the governor in his component of h. R. And meet twice a month in the Steering Committee that alice and myself cochair and establish 14 go forward initiatives that support the Development Implementation of e h. R. And hire two months ago our e h. R. Program director what we see a potential challenge with the e h. R. To make sure we have a smooth process of importing in terms of into the support contract and the overview contract for the e h. R. Vendor this is moving forward on time and schedule our Second Initiative which we call align and care and outcomes for base payment lead by alice chin were now in year 2 of the time Waiver Program and will be coming back back to you with an update on prime to share where we are with you and were actually ahead of schedule in terms of meeting our goals and some other highlights of this particular initiative is doing work in terms of the medicare incentive with the changes of making are and also have made progress in terms of comprehensive joint replacement programs that were issued this year. Initiatives three and four Initiative Number 3, really is the 35ishg9 flow across the system that particular initiative of the a3 itself is on hi i cannot as the leader does a key purpose and plan and some of the challenges as you may know particularly those who serve on the laguna and the sfgh we continue to have challenges really in the flow of patients not being in the right level of pier in the right place much of the team effort to put out those fires in terms of Long Term Solutions but were hopeful to bring in the dph lien of promotions staff will be able to have the support to move this second Initiative Number 2, forward and development the people the office of Economic Workforce Development initiative and had changes in the leadership in sims had been the cochair and marseille and others have replaced the leadership assignment and then our final top 5 initiative stabilize the finances that one has been complete our cfo they have moved into implementation well continue on phase two of our health contracts assessment and negotiations with oliver wine man advising us on the appropriate Health Plan Health Service Contract we have also initiated a Revenue Cycle process that will help us in preparation for the e h. R. And the dph is like the rest of city transitioned to a new Financial Reporting system call f f h p that is on to death and the challenges when it comes to finances is still the unknown for the changes will happen at the federal level and how well solve them and what is the affect on the budget and well have to come up with appropriate measures on that this slide shows a summary of the 55 measures the true north at the it compares our current performance to quarter one performance for those commissioners who are on either the Laguna Laguna honda youve seen this data but have not seen the combined with even though rest of the network that is, i presented in the packet to you in the next few slides it is important to see how are we as a 3 and a half yearold network functioning as a whole youll see on this slide across the 6 domain of the networks from quarter one to two were increasing the measurements on target from 16 to 20 and during the same time we increased by one the targets that are off target going from 11 to 12 and when i saw that we saw the there what was that one well, it actually was in the jail Health Service area for the first time were able to report on the measures they didnt have before that was the coordination of discharge for hiv patients leaving the jail so thats now a measure were murray and got the baseline for that and see if they move towards their target and were also making process in terms of of third line Data Available ive shared before different parts of this network were more developed than others in terms of data analytic and capturing the reporting process for the two hospitals because of their regulatory requirements they had more resources and the other parts of network are still building the capacity but increased quarter one from 28 to 23 data was not available were making process in putting out it does not elements to report on the quality and so in terms of some of the highlights across the 5 measures in jail health we have seen the data shows weve actually improved the coordination between the hospital ed and the health in terms of handoffs and coordination of those patients that transfer from the General Health weve also seen improved timely assess in primary care youll hear about weve notified i think a citation from in terms of studying the goals or assessing healthcare but we have challenges too despite hurricane efforts from an 83 you know we continue to have problems in terms of reducing major injuries from falls we transition and watch the process if an overall from the metrics we report on from the processes and improvement in the decisions and those divisions continue to use the staff using the lean methodology to really develop our improvement metrics and we anticipate that well the metrics will continue to be able to improve that process as we bring on the dph lean Program Office so that actually was the last slide of my deck even though not progressing i want to pause before asking doctor chin to come up to take any. Yes. You may have and any competent feedback you have to offer. Commissioners commissioner pating thank you very much the wonderful report so as i was listening rather than digging down the data we are building a system i think that is useful to focus on other reports in the presentation style to see what is the best way to present the data so we can get what we need out of that i like what were doing as laguna honda i saw at the last laguna honda meeting a nice dial metrics that works well, for the data so the gentleman spent more details but i think this works really well, for the overall metrics i want to give you kudos on the bar graph a number of metrics although were digging into 53 measures this is where your moving as a system the only thing im wondering about whether some of the other metrics that are not covered on laguna honda where we can pickup and dig into the outpatient metrics that way to look at the making are and so the micro in the two divisions and a in the matter of support so we can see them quickly and not keep on digging in to a level but i think were getting there. That format it bans our feedback from last time. To make sure we are operating. Thats why im the Vice President laughter . Anyway thank you very much and i guess we see i think there is a Third Division that were missing so if i can get you to drill down and other measures that dont fall if. Primary care will be coming to your committee soon. As were a looking at this this is a trial run so. Thank you. You did have sort of a dashed dashboard is that being presented. We have a dashboard. Those go down into the details. That is sort of a nice diagram also i believe that called the true north score card. Weve tried to take the learning from laguna and see if it applies to the network youre seeing the report in the same format to their contestantcy and regularity. I want to ask questions on the dashboard until we kind of get it into a workable format that is red home sharers i think at the large dashboard reports the review and at some level well determine how it is best to look at many of the formats like as you may know we follow a number of measures and the score card going goes fairly quickly be in terms of understanding everything turns red. But were going to i think need to continue to work with this because it is all coming together but new as to we would look at the best way of oversight on this but youre producing the material so we have something to look at i appreciate that. Any other comments at this point well go on to doctor chins presentation and ask for further comments as appropriate. The second goal great. All right. Good afternoon, commissioners and correct and secretary so rolland tlulsdz about true north as a way to kind of support sdwrags ill add to that by talking about a different kind of integration you wonder why we use the word integration you think about the next time you seem to forget if youre a person we would be in preschool but the foundations of the network go back one hundred and fifty years to 1855 when jacuzzis zuckerberg San Francisco general was opened and laguna honda celebrated its one hundred and fifty anniversary and cash mission was opened and one hundred and fifty and were 3. 5 years old this is what our communication were not what for example, when you think of the way we look at the Kaiser Permanente everything you touch and feel is experienced you know whatever you want to do with kaiser we are a health brand we have institutions and actually have a long history and identities while the Network Identities is in formation and coming to jell has a way to go compared to the victories this is something we really identity as something we can revisit and i think through so our Communications Director will be coming back to you in a couple of months to talk about some of the thinking around branding with the 3. 5 years so in terms of integration youve heard about lean and true north the first time that causes an array of services General Health and Behavioral Health and actually decided as a network we have 5 areas we agree well measure and have data this is quite an accomplishment a Monthly Group in july they come together to share best practices and done data dashboard across the network and youll hear about in some ways our biggest challenge for integration and talk about the position council when i joined rolland at the network january of 2015 we talked about how could we bring the clinician community to create a common culture more alignment and talked about a counselor this is not healthcare is not a doctor only endeavor but from a practical stand point getting all the people in the room trying to keep it minimum end up with a counselor to give you a sense at the current time one and 67 doctors working for the usf doesnt count zuckerberg San Francisco General Hospital two things one is makes sense within the department sfgh is a Delivery System to the lions share tomas has a group of doctors but most of them on the network side you can see theyre not evenly distributed and San Francisco general they credential more than 13 providers but less than half are fulltime a lot of them come in as needed for surgeries are whatever from time to time so it is really under 5 hundred doctors so even though their faculty at the effect the laguna honda has big footprints in terms of position workforce we have 15 folks and all we did was visited the chief medical officers and sections where the directors position with the San Francisco general and jail health and decided we wanted linkages to the larger departments we have health interdivision and Population Health representatives. We started meeting in january of july of 2015 with those goals monthly and it was really fascinate some of the position leaders that has about think working 10 and 80 and thirty and 3 seven years that never visited the sites and understand the full scope of services we provide understanding the whole elephant, if you will, a big piece of our goal developing trust in alignment was another goal as well as identifying areas for integration and clinician and other goal priorities heres some of the places weve computed the Navigation Center and Mission Mental Health and howard and inspirational silver avenue and laguna honda theres been or are intercohorts many people have not been to jail health but people definitely have not been to most of places and had some strategic discussions around General Health and the medicare waiver in our network so just this past january in spirit of continuance improvement in in terms of use of time our Relationship Building were seen as the valuable activities and again being eye open about peoples work there, there are opportunities for cross efforttion in making the relationships can be turned into constitutional coordination and competing priorities you saw how much we have going on so moving forward were focused on really ongoing Relationship Building and site visits and moving every two months and spent a lot of time role focusing on Strategic Initiative and streamlining our membership for example, well be doing the next site visit at the health care a large component and the next site will be south of market Mental Health that has a staff component the ideas again bringing those areas where the internet is coordinating to create systems where no long goal so i hope that was of interest and leave it on to questions. Any questions. I want to recognize doctor chins work our chief medical officer and has worked towards trying to integrating youll see the positions not out of their locations for a long time so it helps us in our discharges as many of our physicians have second thoughts of moving someone from one level of care to another so her work is valuable. Is this a formal council then and this is formal membership or this is just an ad hoc you put together of course of concept so important to integrate the figures in their thinking of entire system but. It depends on what you mean by formal and if the formal email invitation from me to places and, yes formal i identified the structure of t mo or medical directors for those divisions that are not large enough the medical directors directors or emissions for the 2 hospitals chief of staff and physician representatives from Quality Improvement an Intentional Group of people no letterheads no signs no yes, it is a established council for people and schedule. And therefore sits somewhere in the nord chart. Not an nord chart. Ill see it as 40 the c mo thats how we started the network with preliminary meeting to talk about the networks their work will continue theyre in all the nord charters and the xhoo and thats a great idea i wanted to see how it comes together but w0ird people in the red not liking certain things in the profile. Everyone should go to dale. It is important feedback. It is great to take the leadership together and i dont know where youll go with that it is aside from informing and the leadership knowing what is there in all the different institutions or programs and all there needs to be some sort of osmosis theyll make the decisions based on better information. As you may know doctor chow position theyre incredibly important so i know that is one of the areas we focused on i think that you know this is the beginning and well you know asphyxiation groups develop as you may know they have a life of their own and recommendations you have were open to those but that is the beginning of those conversations we have a Major Initiative and our physicians are not aligned with us around the h. R. That will be difficult thats one the Major Concerns for me to insure we have that data. And who was chosen having the leadership within the positions and so the idea for them to be aware of other parts of network and make sure theyre making decisions giving their input informed by a large picture not their own. Commissioner loyce. First of all, thank you director garcia for your leadership around that issue and doctor chin two of our goals that are striking all 4 are important i want to recognize but two prairie create a trust and this is critical in the sense to make sure that the network is actually doing when you say in the next goal to collaborative the coordination of all services ill appreciate and looking forward how their practical applied to the network and the impact on the population thank you for your thinking and leadership regarding this divisions council. Thank you, commissioners i want to respond to that i will admit in putting this together im used to coupling coming with more data and metrics and this to me felt soft culture change and alignment but ill say your experience over the last year and a half people value the people feel ive never met my counterpart and could a pick up the phone and email them and say lets Work Together that actually has emerges as something that is vanilla valuable. So were integrated model led by many physicians and many of the areas so we also have misrepresent clinicians with the Mental Health system as well as the multiple clinical process but the positions are incredibly important. Commissioner sanchez. I wanted to i think that is an exceptional new pathway it really is an out go too of again, the fact we have a baseline were all one moving towards integrated services a number of us in the j. C. Cc general and laguna honda and along with the director sits there selfdefense outstanding we talk with them at laguna honda or talked with the network and working on this how do we this and that we never used to hear that before and as you said i mean a lot of it reminds me of years ago at the university you see members of academic place had to be the and then all of a sudden as the funding decreased and all of a sudden clinical members are voting in and have full Voting Rights same in a sense because all are part of this overall effort to maintain the quality care given the diminishing resources now were part of the same team and not a silo it is a great concept i look forward to more unique outcomes there are unique things that can happen given this type of interaction well done thank you. Yeah. I think your i guess what you call it all the photos the mug shots laughter ties e it would be nice this is an sf h n you put a title for people in the ph. D side so it will show our integrating this. inaudible . So you, you have 3 things you can see how close it resembles. It will be an invite process this will help to the system. Thanks so much. Shall we go on to the next topic. Item 9 is other business. Commissioners do we have any new business you wish to present at this time right the report from the march 28. Ill going go back on number 9 and report this as well in terms of finance and planning a draft document concerning the charity report a good number of pages if you have any comments individually please provide them to colleen or her division in the next several weeks can be reviewed and incorporated to the final documents presentation as skeleton for the first meeting in may here so i forgot to make that announcement in time we would like all commissioners to have input as i see in the charity report draft documents. Okay next item, please. Again. The report back under the march 28, 2017 commissioner president chow. It is my turn again well during open session the Committee Heard a report on the jacuzzis a3 optimizing a care model so you may be well, much more kw5i7b9d. Committee also reviewed the following standards report the Regulatory Affairs with the Patient Care Services our hiring and report on h. R. Actually on target and moving loan with the Regulatory Affairs and the surveys we were undergoing in the several months as you may know weve done very well and kudos to the staff and undergoing all the reviews under the medical staff report the Committee Approved the alcohol clinical regulations and in closed session we approved did credentials report and the picking up minutes and the Quality Council is sgrathd into the competent so that end our report from the zuckerberg and youll receive the written minutes after approval at the next meeting. Are there any questions in regards to those report. Committee agenda setting. Commissioners ill be sending out a request to amend our schedules in the next 4 months to plan for quorum issues that happens in the summer not on the calendar but a place holder for july 18th that may move coauthored to your schedules. Perhaps you can particularly note that is whether that is available with submitting the schedule. Of course and. Well be looking for Committee Assignment and ask if you have a particular Committee Assignment our interested in please let the secretary know and we will take that under consideration and try to pairs out the assignments. I may add that includes the external committee we have several internal. Right so if we have a large number of people mandated well have to go through the process of vetting and seeing. Okay our next item please is. Consideration for adjournment. So a motion for adjournment is in order. All in favor, say i. I. Opposed . The meeting is adjourned okay. Good afternoon. This is the meeting to come to order now. Regular meeting of Vision Zero Committee for wednesday april 4, 2017. Im commissioner norman yee and joined by aaron peskin and believe commissioners safai will join shortly. The Committee Clerk is steve stamose and the committee would also like to acknowledge the staff at sfgtv who record our meetings and make the sc