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tv   Health Commission 9115  SFGTV  September 5, 2015 1:30pm-4:01pm PDT

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announcer: b dreams and good grades aren't enough to get into college. there are actual steps you need to take. finding someone who can help is the first and most important. for the next steps, go to >> we'll call the meeting to order role commissioner pating i'll note to here commissioner singer commissioner chung commissioner sanchez and sxhashgs the second item on the agenda is the approval of the minutes for august 418, 2015. >> there a motion. >> missouri
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any comments no nope i'll call for a vote. > all in favor, say i. > >> thank you. i'll note no public comment for the item. >> the audience this is the first time i've chaired i'll not get it right so. >> you have a skilled secretary here to help you (laughter) so we move on to item 3 the director's report. >> good afternoon wanted to lead the issue on the waiver because we do have a couple of is to have staff people to address this so i'll leave that alone and move on to the next item and right after my report we'll have a couple of staff
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members to report on that the san francisco health commission has worked with the san francisco police department the dope project for the current overdose just to let you know san francisco has the largest number of over disposes in california we've work hard to curve those overdose deaths on thursday august 27th the police department said a police officer o police officer said saved the life of that person the june incident marked the first time the police department officer used the location to give the medication to save the life of that person i've been a supporter of placing a lock on kits with the san francisco police department and the department of public health has approached me according to
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to chief suhr one life lost addiction is too many so doctor martin is here part of the press release and the press reference in march of 2013 it was announced this is a two year pilot program with the police department to make sure they have the locks on available for the experienced opium overdose and questions this is a pilot program please expect me to bring this for full funding that is important to continue to support the police department in this area as you can see they can save lives the san francisco network clinics has been selected as the winner of the award given by the national
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resource corporation it has patient you surveys united nations for the patient experienced for improvements for ratings for the providers on the experience survey that is an acknowledgment of the patient for the come national care two from the providers and we want to thank the staff for the services and clearly being acknowledged by the great support for continuing this work on the transition to our new hospital since i've last report your hospital has a staff approval from the california statewide planning and development we have a few construction items to complete that approval signals a phase of the new hospital from the construction to the transition so a behalf brand new occupied
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facility the two phases are one the staffing and training and orientation which we have observe 54 hundred staff to train and orient and on choosing the equipment and preparation i'll leave that there if there are other questions i'm available to respond at this point unless questions for this report i'd like to ask colleen to start on the waiver updates and dr. martin will precede with that on the substance abuse you we've received an update about the waiver did health commission harder in the financial presentations about the reunder the influence of alcohol of waiver and the importance of that for our budget the amendments you've got updates on are to the existing
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waiver has nothing to do with 80 with the hospital financing to extend medi-cal to pregnant on wee women blofr the passport level and a substance abuse order for snauns dr. martin will speak to the second the first is the prenatal and postmortem care over a hundred percent of the poverty to the current waiver those two elements are on the tail end of the current 1115 waiver expires on october 31st is expected those programs will continue alongside the public hospital programs that we anticipate to be knitted in the new waiver and dr. martin. >> on that program the how many women will it
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affect. >> i don't know the answer to that the women in san francisco. >> the woman in san francisco. >> i don't know the answer i think the majority of the women are below hundred and 38 percent of poverty it impacts the largest proposition. >> good afternoon. i'm mostly here to answer questions if you like the substance abuse medi-cal is the bridge to reform waiver as of 13 it is a demonstration waiver 1115 waiver called the organized delivery system of medi-cal waiver so the state amended the state plan and made a parole to cms approved this
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august to show it if they increased the services covered by drug medi-cal that they could by organizing the system and having smooth trisz from levels of care and using evidence based practices they could improve the care and overall costs of medicaid would not go up you can opt in or not opt the community likes a demonstration waiver they should we we already do so we're coming in and the bay area was chosen as phase one so there are several tasks for substance abuse services i'm in charge of one to have the implement plan with the timelines for
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everything and another one to set rates we negotiate with the state and make a new contract we want the rates to be realistic because if you compare grants the drug medal there is a huge increase in accountability and recordkeeping required for the providers as you may know substance abuse is contracted out and so the main task we already have in the orchid delivery system almost all the services described it is just we have to document those things in different was including the criteria and so the main task we've been working on since 2013 when they started this job was to get our current providers who are not drug medi-cal certified to apply for certification which is a long orus process so we
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have maybe five or six that have applied and maybe of in the next week or so including all the residential programs that have not burger to bill the drug in the short time - so when they apply there is no retroactive payment no incentive in other words, the state didn't give start up incentives the programs are suffering how can i hire a medical director not had to have one before well so for we don't have the money to help you but in the future a steady stream of income maybe that's your incentives those are the things to provide our providers we've hired a instead of person that
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is wonderful and lead in our substance abuse department to help support people get certified and when they get those letters back every single application for drug medi-cal hundred percent of them get a remediation laundry list of things to check off and get in form and that notarized so we're working on that right now. >> that's great, thank you. >> commissioners, any questions? >> do you mind, if any. i have a few questions for dr. martin i've known dr. martin for a long term wards to the fee waiver that is about expanding substance abuse for the medi-cal program this is been the big effort part of this we didn't have a basic drug medi-cal benefit so i want to thank judy
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for arguing on behalf of the county to get an extended benadryl's do come without obligations and responsibilities so with regards to the demonstration it talked about 10 community coming online this is the first phase of the 10 county; is that correct. >> the 10 community were places they've tested out things now most of the communities are opting in this is the actual implementation starting august 13th phase one is the bay area exultant that refers to bays montgomery and san francisco bay area those are part of bay area counties and as far as i know they're all opting
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in. >> as far as the services we have a full breath of services from residential to outpatient to medical services and it sounds like you're trying to bring enough providers on do we have enough provider to meet the needs of city and when will we be there having enough services for the patients. >> i'm glad you, you raised that commissioner pating david was up on the advisory committee he had a lot to say how it is designed we're missing some a became clinicians although we have care plans that are really busy in primary care physicians we're discussing starting safety net oriented awe definition
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medication residency with the 486 we need licenses providers with health care who are licensed and connection may diagnoses right now a lot of the programs only work with certified xhounldz we need to bring the level of professionalism higher in the field and so, yes we need to have i mean right now such minimal payments are brought in by drug medi-cal a lot of the programs suffer from entry-level people interns and high turn over when i meet with the providers i had a staffing check with them and the theme is also we need more counselors we've lost them they come in and work for a couple of
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months on the one hand we're training new people in sabs when they go on to other places on the other hand, it is a high stress for the programs to be doing that all the time. >> so the last question i guess is financial san francisco has had a very whether we get reinforced from the state we offer the services for every person not treated end up in the longshoreman emergency room in the hospital so i think we've been ahead of the curve wards to the new funding coming in for the medi-cal waiver will this change the financial plan at all will we get more money because we offer so many services there
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won't be new funds following or we'll be responsible for things not funded how will the match of u up for the medi-cal environment. >> yeah. i don't know that a clear picture it hadn't happened net i think this is a pioneer tax we'll pay in terms of not being dramatically able to reduce things like looerments visits we have those paid and the general fund the main difference we'll see is that maybe general fund can be used for something slightly different missing or not used at all maybe and the expansion has brought in a significant amateur of federal match hundred percent matched for the medi-cal's methamphetamine clinic we've
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paid for assuring for the uninsured people now since 2013 a lot of those people are insurance particularly the methadone clinics have worked really hard to enroll their uninsured people into medicare to start billing. >> thank you you have your work cut out for you and it's exciting so maybe this effects the waiver in san francisco. >> thank you very much item 4 is there a public comment i've not received any requests. >> item 5 a report back from the finance committee. >> ms. johnson. >> good afternoon the finance
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committee met 3 o'clock we went through the full contract and also the contract report it is all on the consent calendar and in addition the also have added you can romanced for the request from cat and this is for the medical respites and the reason for the relocation there is actually expanding and a.d. another thirty medical records to their current bed coincidence all on the
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speaker cards and documents to be included should be submitted to the clerk. calendar. >> we asked if anyone should be removed. >> if the commissioners want things for separate items. >> shall we move for approval? move to approve the consent calendar >> thank you a second. >> second. >> all in favor, say i. >> i. >> all right. thank you commissioners thank y thank you sxhaurn item 8 the san francisco general hospital bylaws good to see you before just to note commissioners these revisions have been reviewed and recommend for approval by the general cc. >> maybe give us background why some come here and jc don't need to come here.
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>> the only thing approved by the jc are the minutes and the financial report and anything for confidential patient reports but policy comes to the full commission. >> dr. mash i have 3 the changes in the rex rules and regulations on the current rule limited to positions of the medical staff for the professionals nurse practitioners to the certified midwives pursuant to the standard dices procedure for the plan we submitted to the dph in response to the recent survey they conducted. >> so we do all those of a banish. >> review them all and vote
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together unless there's an issue if you want to pull it out but i believe you can do it all at once. >> the next two are linked they relate to tightening up the process of temporary privileges are granted and so the first is currently, i grant the privileges for the chief of medical staff after the medical staff office valid day the medical licenses and training and letters of reference and service chief can request them to not go through the several month process for the people by conventional and it fournt we're granting about 92
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percent temporary privileges so that's higher than any other health care organizations we want to tighten this up so that's what those balling changes the first action allows the criminal committee and medevac to hold a vote or business that is route wouldn't necessarily be limited but a necessary piece in order to get in time down the second is changes on the granting of the temporary privileges so temporary privileges can be granted to applicants that have clean packet it is defined as completed credentials are verified and not practice sites or missing in the packet it's
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clean to share with the credible committee and credible committee holds an e-mail approval for a vote and approve at which point if there is privileges needed before the jc c needs the chief of the medical staff can grant the temporary privileges that this tightens up, up not credential committee will approve with the chief of staff i hope to have the two e-mail practices we can get most of the applicants to jc c and approve them and the temporary is used in the jc c has met in another month approval that's the changes in the temporary privileges. >> it would be reasonable to
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characterize those not the changing of credentials required. >> right it doesn't consider that are required. >> the goal to reduce significantly the number of temporary privileges by getting packet through the credentials committee and after the jc c for regular approval and not possible at least the chief of staff is granting the temporary privileges on both packets seeing and approved by the credible committee and currently they're not i see them and sign them. >> so the process is granted a reduction in a person has a
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significant reduction around ten percent. >> any questions. >> i brought those they look standard and many hospitals do this to expedite new hirings and getting people in i think this is fine. >> thank you for that comment on issues like this it is important to a licensed physician to pay attention to this so i really precious that. >> i should have said we look for best practices elsewhere and approval is very standard stanford as zero percent because they coffer that by e-mail tests not possible so - >> many things we can do by e-mail now. >> yeah. i wonder if you like just responded to a couple of
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things pertaining to the operational definition number one the we talked about the approval of straightforward and non-controversial matters is there a working definition that's been you know disseminated and as an example i can think of things were there was concept called waiver for appointments, etc. but waivers are different meanings whether by the fred's or state or university or medical staff a really, really comprehensive understanding i want to make sure that everybody understand what is straightforward means and there's a. >> there's no change in the credentialing requirement their linked to medical they implemented revisecy they're in
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good standing where they train they're not significant metal malpractice grants ensue all the reference letters are complete and verified and none of that has changed i mean, the chair the credible committee does have some discretion under the definition of clean for example, how much of a malpractice settlement will constitute that packet not lean clean and sent to the committee members for a vote but if the chair did send it forward the packet will contain that information and any single committee members votes in the negative it has to go through the formal credible. >> thank you very much the other one pertains to the temporary privileges 5.2.2 i was
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curious why the deletion of concurrence of the chief which i have officer on the staff i mean sometime pass there was the ceo and the associate dean or advice dean can you share with me why that would be this is 42.2. >> that's a good pickup because it shouldn't be that. >> okay. >> can you give us a letter so everyone can follow. >> 522 under the application it says the chief of staff for the ceo can grant temporary privileges i missed that i don't know the ceo and the current chief of the medical staff sign all privileges temporary. >> okay. >> thank you commissioner
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sanchez. >> just wanted - and great catch. >> there are no other questions we'll entertain a question. >> disapprove of the - >> all in favor, say i. >> i. >> >> dr. marks. >> i'll not no public comment for this item move on to item 8 did san francisco heartache networ
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update. >> good afternoon, commissioners i'm roland the director of the san francisco health network i've come to you on at least two occasions previously to give you a formal update of the network you mean the network was launched when i was postponed in november of 2012 it took 3 months for the team to coalesce and condense the work between our integrated planning process and again with the h m a performance that generated over a hundred and 50 metrics and milestones that are identified in order for this network to be successful we need to the set and meet i came to you first to give a
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six months just want and then a one there update we're happy to present our 18 months update a significant update that represents the culmination of our pin way forward mefgs those are the key metrics we've presented and you approved early on that guides the development of the network and so you'll hear in 18 months an update where we are with the metrics and so other key medics with those with the patient experience i want to thank my leadership team deputy city attorney and our chief medical officer that will take you through those metrics we hope you'll get an idea of the work and get a picture of what we
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think we should moved in setting the next set of measures for the network and we're happy to present this i'll ask dr. chin to come to the podium. >> thank you. >> good afternoon commissioners director garcia it is my pleasure to present to you today about the metrics so basically, what i'm going to do it is give a high-level of the stream to the ends of the fiscal year and share thoughts e thoughts about what we're learned and pivot and talk about how we're thinking about selecting future metrics according to the challenges and importantly how our thinking in the true framework to develop a cohort set of metrics going
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forward this slide should look familiar those are the 10 measures their broadly categorized into 3 grownups and so namely being able to provide know asset to care and stewardship for the reality that our patient have a choice we're going to be k350e9 with them and meeting to rain our own staff so those metrics came out that the engagement they've served for 18 months, however, with the next time maturing we realized the framework are not what we need to move forward i'm walk us through and talk about how we'll be moving forward this is again, you this look familiar with a metric a star
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we've met or exceeded our proposed target a combra arrow up and down this is a favorable change with between the last database but there is another arrow where are in the wrong direction we've exceeded our target this is a testament to the work across the network this represents the behavorial health and speciality care a wide range effort i'll give you more details i'll go through to quickly i'm happy to field our questions so measures one and 2 in my mind represent our investment in primary care is the foundation of an integrated system our panel size is a one
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measure we made considerable process that is a lot of work and a lot of factors there and in terms of our second measure the support staff ratio while we technically don't have a green star we've pretty much met our goal and we've stated there no are the last two quarters measure 3 is about constitutional fill there are measures for laguna laguna honda it has pretty much hit it's target every quarter and the last uptick san francisco general hospital is an prauchlt so the three-quarters in particular attributable to the documents and care contributions are a hard nut to crack that is the larger social issues we lost
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2 hundred units of boarding care by these that inhibits our ability to provide levels of care 4 around the fiscal stewardship this is while we do don't have the formula this is a close i have it we'll be getting a gastrostar we'll come back if we don't 5, 6 and 8 in some ways highlight our challenges with data and with what measures we've chosen so 5 is the workforce experience and in april we completed our very first dpw wide satisfaction survey the 19 percent were the percentage of employees when rated us a 9 or 10 with the best places to work
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that's compared to our national benchmark of 28 percent the issue the next collection is slated for another two years in terms of civil service hiring you've seen the lead 7, 8, 9 is the highest in the city hundred and 90 days for sifrl positions they're an annual cumulative methodology is the note amenable to the report hundred and 90 days from 2013-2014 and 2014-2015 is drops to hundred and 68 dazed there was an improvement and 8 was measuring the culture and engagement it is notoriously difficult thing to measure we took a stab at the intersection by having our sf h 50 do a web basis around the web network and answer questions it
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hundred percent you know response everyone got it right if you get a hundred percent the first time it is not something to formulate so going back to number 7 this is as experience in behavorial health we have a bio annual survey and as you can see we started off pretty high 4.5 on a 5 point scale and substance abuse we have an annual homegrown survey starting around 4.5 in a 5 scale laguna honda have homegrown surveys jail health is bilingual and jails is going down because of opium and laguna honda is topped out this measure bans how they measure satisfaction and
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the rest of the surveys are administered by the national folks using the cms in terms of the variation in home surveys it turns out that hard to make heads or tails because you can't say a lot about that i want to pause on this slide for a second this slide represents trumps work of 14 primary care and speciality clinics and packet units as you can see in almost every area we've met or exceeded our benchmarks in fact that the what director garcia was referring to they gave us a national award for the most performed i heard i had to chuckle most approved is a bake
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end compliments but we do deserve credit 9 is around clinic outcomes so this is a rapid overview of the metrics you guys want to pause now and ask questions. >> questions? i'm to make one comment frail i like the way you presented this is it easy to invest than the last presentation i like the context preponderance of evidence i'm looking forward to the fire chief aspect i think the question where do those movkz druf he drive us i looked ahead in our notes but i like what i've seen so for i'll leave
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it at that >> i didn't quite understand can you explain again. >> you mean measure 3? >> so measure 3 is about trying to figure out with we taking care of people alter the least intensive so you want someone in the ic or someone in the hospital that can be in a skilled nursing facility or at home can we get people to the right place in a this fashion the measures are for laguna honda so getting people back to the community with full support for san francisco general hospital we don't want people meeting the community staying i'm sorry you met care
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transitioned. >> okay. so care transitioned is our transition team you'll be hearing from them shortly if this is our wrap around services place to place people with housing and other challenges and may not have a place to go we rely on board and care and stabilization in a non-traditional placement that's what we median by that does that answer your question. >> yes. it does so what do you need to do. >> you'll be hearing from kelly about that. >> commissioners one of the issues the mayor has done in this budget to add 5 hundred units of services and recently met with the mayor we have the stable shin beds we have a plan in terms of trying to look at
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our mental health care and shelters but the first is 5 hundred more unions of housing this year and have 40 some of those replacing the stabilization beds. >> commissioner karshmer that is about the timeframe for hiring are you going to talk about the strategies or the metrics. >> i was going to talk about the hiring or is specific question. >> just the update on the process of trying to reach goals. >> so there are a lot of efforts within our own h.r. division they're a lean stream done circles and a little bit of a disconnect one of the things
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of the metrics the metric we have is one we've teen from the controller's office that a high-level long term measure you does it suggest a different metrics. >> exactly. >> you know through the chair i was just observing again how smooth the flow the data is being presented in reference to our different goals traditionally the years have been different sectors your attacked talked about section one and 2 and 3 and here we're reviewing it in the context and a lot of this is because of philosophy we're all one team and treating patients at different levels of different stages in their lives, etc. we all need to look at the federal
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standards and provide the hard data so see a negative change i want to commend everybody is taken a lot of a lot of work and travel whatever it is present extremely well. >> thank you for that and to pick up on this under the theme of no good deed goes unpunished now we have the data in a comprehensive we're getting interest it illuminating i have that on editorial comment and with an question the editorial examine if you look at extremely high performance organizations they not only focus on the data but the data this is not telling them where they're short i encourage in the future it is much more helpful to us to understand the challenges you guys face to see not just the
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top 57 your meeting but just to see the ones you're not meeting and conceptual we agree on the benchmarks you don't hear about it in the bacteria it leads an organization to a mindset of let's not be congratulation try but focus on the things we're not doing so well, so my question is this it relates to the data about the general hospital the data is not encouraging but fairly encouraging at the jc c last week at the general hospital we saw data that leads i to a different climax we're not doing that well against the public patient experiences and not improving fast enough to get near competitive for the
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experiences elsewhere we know some of the problems we're starting to address but how i sync this presentation of the data and this presentation of the data. >> i'll make anecdot editorial comment you're the comments are good for a cigarette way into the next part of the presentation we're interested in hyphenate the improvements that are part of the you know clean organization to highest the gaps one of the reasons we didn't show you the bottom slide their problematic they're the wrong measures they're actually not driver measures or two hive a level or not measured enough that's what we in terms of the disconnect in terms of what you see here and what you heard at jc c the 8
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count is i don't know 25 questions survey it has the discharge planning and nurse communication and all those domains in order to have a dashboard we're picked one or two questions from each the decisions so with you so f is improvement on the provider ratings and is overall rating of the hospital we have a lot of work to do this is one of the better domains. >> why not pick 23 where we don't do so well. >> i'll august in my next two slides from now we're not doing that well, that's part of the conversation. >> okay. >> sounds like we're in sync. >> just a comment i'd like to
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all the time my contempt to expand my thoughts of what i liked about the presentation you're helping to flush out the narrator narrative that is helping to show was operable this operable aspect we can know where the organization need to do as a whole for me i don't see 10 metrics i like the way you pretty bad it the metrics on primary care capacity for providers and c m a and the metrics for constitutional flow in higher levels to lower levels of care i heard a third set of metrics on revenue but not sure the day reflected that cluster of revenue and stuff like this but the way you described is it
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operational and fundamental units and the last thing an area we need to focus on overall punishment satisfaction you've presented a lot of medics we're not measuring the right thing but rather than thinking of 10 or if we have 4 kind of important units primary care, transition related to and revenues services which the data was not quite full it looks like we're all over the place not collecting the data and various measures of patient satisfaction they drive and keep people informed and show the level the quality of care for patients and so forth had is where i would continue to simplify and tell the story it focuses us and i
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think the patient satisfaction area requires focus on a lot of the areas it sound like something the staff is not returning away from but only trying to fix the problem i hope those are address in the future iterations but a much improved presentation rather than a dashboard. >> i was hoping by another presentation it would be more happy where we are. >> what were the presenters. >> i'm not only halfway through so given the good news is given some of the concerns they sunseted so with 28 months of experience number one some measures are topped out if you
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start with something you're doing well and and meet hundred percent you're probably not having the right length to the component you're trying to measure some measures are not actionable either they're being measured one a year or every two years they need to be breakdown cerebrothe process measures continue the drivers and the metrics is a driver is a measure that is this and actionable a watch medic is high level by and i a regulatory body and their lobbing u lagging and critical to watch by the time they've changed something happened and so you're being reactive so we realize the number are watch metrics rather than drivers and prairie in patient satisfaction in our metric controls we have
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different questions with different frequency and this constitutes a satisfied patient or client and lastly the targets are benchmarks it is the issue how we are doing and too important particularly when we started the internal targets we work in a larger system for example, general health no benchmarks but other areas external benchmarks the next too slides so going back not to sdmish the incredible chuchls 29 to 50 percent a remarkable and 59 to 44 is quite an achievement if you look at the national averages wear 10 percentage below the national average; right? so even though we've set
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the internal benchmarks we ne to look at internal and see where the field is going on the flip do some things we do remarkably well but mammograms not 75 percent we started off higher but it is impartial to the medi-cal's for compatible medicare is the 58 percent we're not proposing to always take the benchmarks we want to be at 75 percent higher but we need to balance that and figure out it is this a topped out benchmark those are not the right measures for this time the question is what are the right measures i don't have a laundry list now
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but share with you our thinking how to develop the measures many of you have seen this the reason i but that up we're attempted to count stuff we need be to be focusing on the over laptop and in our system the offer laptop may installer because the limitation and on top of data that is operational so we're working why the 3 discriminated but we can develop the best measures but the regulatory and financial bodies there will always be scores of external measures to report innovations our original proposal 2 adding
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and 9 proposed metrics the good news it that people are starting to realize this is crazy many say a quote from the vital signs proposes to put together a core set of measures i want to quote from here they recognize thousands of measures are in use today their sure number and lack of focus in the organization measure the overall in approving performance that's where we get caught we have exemptions from the different agencies this is a sign there maybe light at the end of the tunnel we're not there yet given where we are the question is how did he and then the overall network we have any different purposes so the next two slides i'm going to walk you
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through the beginning the true north for the specific metrics with an eye towards driver and match metrics it is incredible important how to keating keep the punishment in the center of this; right? >> so true north is used to between the north pole that is one definition of a universal set of ideals when taken together talks about the prospective that a business should be striving for another way it is a group of concepts that catches a heavy heart so it is combined this idea of strategic start with our ultimate purpose of values and direction okay some example the
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san mateo to the south and new york to the east those are their true north this is their true north concepts the patient under care and quality and staff engagement and financial stewardship and religious are the true north for the data care which is a sdrathsd delivery center in apple it is widely recognized one of the highest performing systems in the country their patient system looks at different they have a similar and i ray of services primary care, spreadsheet care and long term and trauma care they have behavorial health so this is the very cool thing about true north when you land on the true north those for sake of customer
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satisfaction those don't change this is who you are and your aspirations what changes the measures that fall under the categories those are cares for this year broad manufacture r measures around medication and access you see the list what's really great about this fraction is that while the true north categories do chunk from service to service the individual metrics what about adjusted based on the needs of that decision for example, long term care the nutrition referrals and with the derivatives i want to point out the people in financial stewardship don't chapping from decision to decision but safety and quality and customer satisfaction really do so mail service ratings for long term
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care and acute and complex patient care and the prompter psychologically the imitation controls were you seen when you wanted to be seen you get a true north and the metrics that roll up under the categories that is a picture director garcia lead a bunch of us in july and i have the picture you can see it is posted for each of the areas there are 2014 results and 2015 and the aspiration goals underneath that depending on the measure and unit they've track it on a mostly and daily sometimes by shift basis depends upon how much their focused on a given measure i want to action within our system san francisco general is one the neglects we moderator
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this will be reviviterateed we' thank god going to a network retreat and commissioner pating will be joining us to develop the fraction and from that derive the metrics that align up and down the organization that are relative and actionable for both the decision sections and so our goal 0 would be in 3 months time to come back with the true north and metrics. >> thank you questions. >> i thank you for this and it makes sense i like the fact you've done the work about the differentiating the start and identify what it is make sense to measure in a
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timeframe that makes sense for a system and in fact, what is the right measure for a ccii u acute is different from a long term care when you come back to us when you think this through do you - in addition to how it is measured did it provide you with direction on strategies to impact to make a difference or is your concentration on developing the total for the framework for that how does that translate do now work on quality safety. >> so that's just - >> the beauty of this kind a framework is that it is not a command and control basically as a goal for true north and it
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allows the people the owners of the measure at the intersection level to think through what the driver is versus the watch measure and how it linked to the north and the leadership team will be providing engaging each of the sections in terms of interqualities and is this the right measure and actionable but i know the goal for not for us to control every measure but have the people doing the work and identifying what is the measure that makes the biggest difference. >> i'll look forward it that. >> that's not a months update. >> (laughter). >> any questions. >> question. thank you for this this was very good i labor to understand it when
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you look at the patient satisfaction it is a huge issue and sometimes impossible to on you notice the differences distinct long term care and primary care this is an issue when it comes to patient satisfaction how do you measure patient satisfaction do you look at trends or a pattern how do i go back and look at that okay. is this a pattern or trend we might want to deal with how does that work what do you look at it. >> i'll give an example in permit satisfaction our vendor sarah is pretty good about giving us analysis around what that he think the drivers are of the overall you know would recommend the place we land on how highly do you rate our
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provider and with my recommend our clinic or health organization that is approved in this case or phenomenon access or one day appointments the primary care has looked at that for the improved telephone access to improve the scores in order to get the net providers our 9 and one and 210 east twos it's a watch measure a lot of things go-go into that does that answer your question. >> commissioner pating. >> thanks this really was terrific and this is hard work to get a system that hadn't been thought of itself as a system hadn't been data obsessed to begin the
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process of figuring out what metrics we picked 8 does it make sense it feels great we're on our way to congratulations to you and everyone and i'll keep it up i struggle with a couple of things they all relate to ambition with our tarts it gets back to my question about trying to put sync are in sync what we hear about the performance of the general versus those metrics i admittedly and am a successful about coincidence processing in terms of definition but what
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they should be metricly my first question how ambitious should we be for the metrics like as a leadership team how do you think about how guy want to be when we talk privately you all a super crowd of what we do here but super fruthd we can do so much better how do you guys think about that. >> i'll give you an initial answer this is an ongoing dialogue i think that i like the cares approach that is where we started our start which is something that won't be so ambitious to make all the staff feel looir like they'll not getting get there their goal is hundred percent we might go
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there or for a national benchmark ambassador talking about nationals benchmarks we do need some relative improvements that is achieveable and fresh goals a number of people heard me talk about the management care medicare and their motto is any planned transition is a failure i've repeated that one-story it be amazing if our hospital it filled with elective surgeries and good things in trauma but we're a long ways from interest it is important to have those benchmarks and have some things that are more within people purify and graph. >> i realize within the lead system there's a well thought through philosophy on how to implement that stuff so it
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sticks i would say that there is some benefit to these interim goals that are achievable but there is an enormous compliments to everyone involved if you set stretch goals it tells the organization we can do this we all think we can do this it tells the patient you deserves this for example, in food services our patients clients depending on where you are they deserve much, much better than what what we are doing. >> guys have put in place aggressively a whole new system an example we ought to have our ambitions not only because it means a lot of reimbursement money to us. >> my opinion it similar this
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is a twist i think we can have the best of both worlds one to have staff driven owned improvement targets and whenever possible to try to match them with the industry benchmarks so we get the power of both the homegrown what has staff people that do this work everyday what is the most important part of the thing going to the people that do the work but at the same time having a compass one that is valid and reliable we can still do a stretch goal for example, alice showed the picker of the n r.c. afternoon is san francisco or 80 percent one of the measures maybe our goal to be the the 90th per actually
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we're at least giving us something to shoot for we're not relying on the comfortable sales we have an extraordinarily force to help to guide us. >> on this point my closing request would be like when you develop those true north metrics be ambitious for the network arrest don't settle because you will hit our targets so i might as well set realistic targets. >> i think being ambitious and we're showing the change of the culture of measurements for example, i kind of went through the behavorial health measures for patients saefbs for 4.5 their themselves after a reflective they're saying we
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should change our method dissolution so what is your average score if that person give us a 9 or 10 on a 10 point sail; right? there be a lot more ambitious and little changes around being willingly and eager to highlight the places rights we're actively aiming to create a culture for people that want to highlight the gaps. >> you get points for highlighting gaps not a modest goal but i'd like to make actually a request it is important that the rest of the commission is involved in the jc c and the public understand much better the struggles you have hiring people and we there was no data here
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presented and so i think it would be helpful to - for i don't know who it is in the san francisco government presented to the full commission was the way we hired here is the way we're hiring because they get paid no where near but made a lot of changes i think everyone will is a deeper understanding of the challenges that the network has in just doing their business if they understood the hiring process. >> that's a great idea that is making the h.r. degree of care director noted today, she sent out a new way to hire in technology so they're with us in terms of trying to change that so i think she'll be open it that we'll set that as an agenda item. >> i think commissioner singer
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it is important to note hundred and 68 days explicit representative the targeting improvements with the hire anothers san francisco general with the hundred positions for the rebuild we've seen of of diminished hiring times of a hundred and 50 more like those were added 90 that was only for san francisco general we have the opportunity to take the small changes and improve and spread it beyond to the rest of the department. >> as you guys heard me say the progress within the framework of the city and county of san francisco has been really very, very positive if you step outside and look at the rest of the free world is the nuts; right? it handcuffs you, we have to be better it is not fair to you guys.
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>> all right. >> so i want to congratulate you on your numbers given that breast cancer awareness month is october and if i could our primary care providers are medical home team models really don't promote and sustain that number we have a medical assistance who review patient coming in the data which paternity are due for the mammograms are they overdue we've done a lot of work a mobile van that goes to the clinics and no excuse for not getting it done you can go to southeast or chinatown or they'll take it there. >> good work. >> a really good thing to point
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out thank you. >> i'll not to public comment on this item we move on to thank you - move on to item 9 which is the san francisco highlight network transition. >> thank you, commissioners for having me, i'm kelly the acting director
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i'm here to give us a highlight of the division it is known as tradition. >> so the transitioned division as created in october of 2013 the response to the affordable health care for hospital readmissions previously the sections in transition are recorded individual to community programs and sfgh so many years ago the bed martin luther king focused on mental health clients flow was managed by i a bed committee to discuss the clients and those were unable to leave the hospital to for it the folks was think the slow side they only met one or two times a week the understanding of moving people
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into a replacement please state your name and address team that assess people in the hospital for the treatment program and residential facilities to insure with room was available at the community designates and that continues success stand to the behavorial health as well as context individuals that needs support to leave the hospital for the context it bend the entire system of care with the ac a focused it was a natural fit for the replacement to expand into the larger division so within the transition position - since new clients needed transition at support to
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stay supported it maids to move them under one position for the access care to maximum news the resources for all the people in the system we pooled under the transition position everything from homelessness to housing we've gone from a community plummet to the outreach team for the coordination unit and sews team we brault in the outreach for the people in the building and also the duplicate the urban is now in our section. >> so overall we we do to insure the plans for stable tied settings in the most cost effective manner we individualize the care for everyone so someone that fits may not be the cheapest for that
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person but that we try to do long term care planning for a person's trajectory 18 not just a short time fit we service people that are san franciscans there are times we'll work with people that are residents of san francisco we focus on lower-income residents and people that willing and those who are not month folks are mental health substance abuse medically commodity that make it difficult for p them to manage we focus on the inappropriate users the care system and those who need to leave the hospital are in order to go back home the transition division does services pretty sure anywhere i'll give you a snapshot of businesses we touch folks and
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try to help to move them to the right level of care we serve people on the streets up to people in the state hospital and the team pretty sure everything in distinct with the jails and laguna honda and treatment facilities getting people in and out and acute care hospitals sfgh between the level hospitals so we're going to start with the homelessness the outreach team by our team the staff is in the outreach on 101 grove and the case management is on the ivy known and tom wisconsin dell place and on the mission to serve the community and our primary staff is at the ivy. >> so the san francisco
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homelessness outreach team was founded in nora 4 expanded in 2014 the modeled has already been to work in small teams to help the homeless individuals most of the clients have severe are being inappropriate users of the system not doing that well we serve the population that is a little bit higher function but try to focus 0 on those who have a problem getting care so we're come permitted a medical outreach team and care management we have a group that is at public library and have a transport in san francisco outreach team 24/7 team so also
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attached to the homelessness team is the home team the homelessness heartache and mobile engagement team a federally fund grant for the medical treatment for the care martin luther king for hiv positive clients and we do shelter health for working with folks that are in shelters trying to get them access to a care and the real focus on reducing the number of new new calls the shelters were making the staff has been helping to get people care so the shelters do have rely on 9-1-1 the outreach is an example of the way we are collecting data to try to select the outreach efforts we're able to map out across the city where the energy are at this point it is an
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example of what we do in may we have an estimated 6 hundred plus people and the single persons and all air belongings consist up to thirty residents the statistics in may the enar displacements had many residents we worked with them and so they'll not be in encampments to approve their quality of life the homelessness outreach team to highlight the decrease in mobile stability and the market has taken them offline so thankful lost stabilization plans.
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>> can you give us a variety of those reasons. >> some of them are there's been a focus effort to move folks through a permanent model all of the units were taken offline by the way, a of a stabilization to make them permanent that's what's happening at hotels we've lost a room as a result of a lawsuit of poor conditions in the sros quite a few of the rooms that haven't come back what can on line and also, because of the changing economy in general in san francisco a lot of the rooms that might have gone for stabilization are being rented out to students and people that work in high tech industry if
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you can get a thousand dollars for a room for a tech worker client is more inclined it work with them so that's taking rooms offline by doing masters arrangements with the students for the dormitory. >> the other thing that's new for us this year, the navigation center a partnership with the mayors hope office and agency and so the actual providers in navigation center is for the community services and the research center partnered to provide the case martin luther king's and connections to housing but the navigation center is a rapid rehousing model so right now from bringing someone off the street into permanent housing is 4 two days with a lot of effort from the
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access expedited applications and moving people to photo ids and walk the person through the process but sf hot does we provide the encampment homeless individual information so we identify the population that will be picked up and engage them and prepare them to bring them into the navigation center. >> 4 two days of permanent housing or transition. >> permanent. >> permanent. >> okay. >> and we work closely with dpw because the belongings the issue and types of initials those are the types of thing for the regulation to get through the housing what is nice because the navigation they let you keep our bloonz big craters and let folks
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couples are allowed to sleep together not in separate dorms and it is a relatively democratic process the sense of community for who wants to house together and how and especially how to get along an interesting experiment. >> what's the capacity of the navigation center. >> 74 they want to leave room for homeward bound folks that want to go to home what in the world bound they won't be able to get a bus for the next day a lot of folks were getting lost in the morning so the navigation center allowed them to spend the night while they wait for the bus in the morning it is helpful to get people reunited with
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their families we try to leaf look at of room a place for that person the other thing we've working hard in the last year to partner with business improvement districts their financial presentation by the i d to have a greater impact on the targeted areas right now we partner with cash for care in the market and partner that union square in the district and then we have been in discussion with the bay area with the court to talk about models that might work specifically for their target areas each the business improvement districts what is appropriate to their population when we partner with the improvement district we conduct a survey and try to give you snapshot views felt types of homelessness in the community
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that is particularly for castro this was a use when we did the survey it turns out many were middle-aged men so targeted view the sense a lot of people not doing well, we found was a fairly large group of folks that were nomadic urban cameer types not entrenched it helped us to allow them to use their security for in their district instead of focusing on homelessness outreach and strengthened the relationships to really target the youth in their district having it survey has helped a lot them to really highlight what we need in their district and it's been a successful partnering and
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lastly we've been making a concerted effort we're trying to do the - we've tried with the homeless outreach team for fits and starts this is the first year we've created a format no matter who is touching the client we fwarth the data for all the people how their teaching a person to be more clear about what types of folks we were encountering and the service niece to create a program that serves them. >> i know it is early days have you learned anything from it data as far that teaches against assumptions we've been making about the population. >> you know i think with the trends match up request the homeless accounts and the uptick in the youth on the street and
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what we've seen previously that is definitely an issue around landlord/tenant youth that are out on the street that need for special attention and the more people are on the street the harder to reach but being able to see it and know that is helpful to figure out. >> what is helpful about the energy maps how people are going through the encampment where people are popping up and how to do better targeted outreach we're helping to form our partnerships. >> so the next division it is closely related to san francisco homeless team our new care division right now it is located
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on laguna honda they'll be relocating to 86 potrero the care section was created to provide the navigation to facilitate the industry and service points for the transition it differences if others it focuses on how to use the multiple system you know the high behavorial issues with the medical issues for the single system and they're the more traditional context population around the country that are focusing on transition of care coordination will be working with the network and the medi-cal manage plan we've in close conversation with anthem. >> do you include the many, many special needs population.
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>> a little bit less they have a specialized transition program that is specialized but when we touch them we try to help them with the program and it this is a separate. >> this is a separate endeavor i'll talk about that when i get to that it is around possible - >> so we try to partner with the managers but the team itself is come permitted of a core of managers strong of intensive case managers that are trying to work the population that's part of the challenge so our model is really we're trying to have it so care coordination management is the tiny it group to work with so people can side the navigation
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system by themselves and highly fundamental so get to the system might needs a little bit of coordination. >> so with care coordination we are focusing on the multiple system we coordinate with the primary care martin luther king for highly single systems out of the family health clinic we also have been able to provide bridge medical services and dr. is who is working with us she can provide care patient if connected to primary care that is hard for people to get into a clinic 0 we've had success in breaking and entering the care to them and dr. wellborn helps us with the education of car coordination team and how to teach the patients how to be
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served so to begin the high users is actually the top one percent the top percent over an unanimous timeframe that is out of 50 thousand the service area has to cross with the actual medal and mental health and substance abuse and need to be touching at least 2 of the 3 areas so in san francisco what we would consider you get would be ems use are medical emergency departments. inpatient and medical respite and outpatient care and mobile choice and psych and acute doifshgs and centers and medical
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detox and residential detox >> we're tracking with with a databases or paper targets and radars. >> we actually we've working hard to gather this data so the data is pulled from the h.r. and pulled from the fire department sends us ems data that comes slow but we get it from like other systems. >> shelter system. >> thank you shelter system. >> so we put them together. >> not a unique h m r. >> it is the higher users of
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st. francis but the higherer users we don't count how many times you go outside the units we get data sharing agreements we're limited to the data gasht but for f this snapshot view it is striking. >> so overall the total costs remains unchanged and the total number of individuals unserved a unchanged. >> that's good. >> so what you doing the good news the top 10 percent used to count for 25 percent now 18 percent of costs the high-risk top 5 percent were 55 percent and now only 46 percent of costs when you drill down deeply we're
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reranging we're spending and bringing the costs of the patients down a little bit the efforts are paying off the better we understand the population the better outreach and sooner so they don't become high users. >> can you give us more color on the top one percent how we're thinking about the consequences of a lower spending on the care are they getting better care and conversely on the other group are we getting better results. >> sure on what the counting for spending less money on higher costs we're catching to sooner we're making after that effort to communicate how to find them so in the old days the high
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users went to the hospitals by the time they figured they're there they were gone so they're back on the streets so our catch points are places for the emergency room are p p.s. the more their notified we're looking for a person we'll be able it make sure they're connected and getting help that's that it is contributing and the shifting to lower levels it may cost marrow in the front end to keep someone from a high users but we'll spends more money proportionally on a lower level users but the dividend on the back ends it will be as they
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get connected to the primary care the changes of a person sticking a a primary care for a lot of reasons the fact wear integrating you are clinics making the primary care is it hard to get people to go to one apportionment appointment so those kinds of things help. >> that logic is irrefutable if we could track that is of one example for a lot of places to have the courage we have to do the kinds of things you're doing. >> thanks to maria's work we have the ground work to look at those populations we actually are able to get that monthly used to be on yearly many say though the a super useful tool
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that person can move month to month we can see our efforts are paving and allows is to identify the population we should be serve. >> this is like how we deliver services so we've been trying to come up with different you know interventions like to make sure that if their homeless why not help them and so they can go to the nursery those are part of the staengz we've shown- >> what is nice about bringing all the seconds into transitioned it helps to streamline used to now they have to give you the contact get you to do it; right? and that person says how do i get them in
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now we're all one family it is like you're going to stay with our cousin now and now they're like sure come in it's the logic that makes sense so then the next division is plummet it is for realtime i think we've heard about the plummet pregnancy the fact their locked on 13 thirty laguna and howard and this is the nursing for the program they've been there a long, long time and they're terrific basic the replacement team they're for complex patients for the hospital we had an assessment and utilization for the constructive level of care we do that all the utilization for managers managing all levels of care people in the hospitals
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and people with residential treatment and people in boarding care to make sure they're getting as well as they get and when necessary move on when they're ready to congratulate we monitor that this is the bulk of what we do we make sure they provide the facilitates for the family we're trying to we would want a person to get better and do the psychiatry and medi-cal target we're looking at replacements for if you're at stanford hospital their a medi-cal client they'll review the authorization and we'll do the same for the contract with st. francis to catch the overflow with psychiatry and so forth this is a map of the variety of residential care
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facilities you'll see the vast arrays of beds and the residential care for the elderly and the age break r.c. f for the 4 or 59 years and a lot of we're front loaded on the ambulancey for the clients their modified so very few non-blamey and we have homes for the contract the regional center for the stable population that's been helpful for the clients for the very well disabled as well and we have a bunch of homes we have 5 homes that are cable of providing training and they're able to do spanish and we are hoping to grow that number but it is been challenging we have
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many facilities that provide speciality care for enhanced programming and diabetes care and dementia care for port and are helpful for distancing substance abuseers and we have homes as far south as fresno and north as oregon its been instrumental in helping the includes fits the right people if you need you think my most challenging was a client asked for a eastern broadly care we actually were able to find that we will try and get the right fit and that means sometimes, we have to go outside but it's gone a long way to help to keep people stabilized and san
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francisco facilities are closing 3 homes this year we lost 3 homes because the younger generations are not interested in the old days that went from grapples to the they're thinking their kids will do it and they'll work hard this is challenging a lot of kids not wanting to do this we're getting ready to move another home we were notified that the home is going to be closing so they're trying to find a buyer if at the don't we'll be in a pickle and the stabilization room 50 rooms two years ago and now down to 8 and mental health service with the case manager down to 16 rooms so there is a clear impact
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on the way to stabilize transitional stabilization and what is challenging the medi-cal's for the nursing facility beds are hard to find because the reimbursement rates and the facilities are moved to rehab it is a better reimbursement to folks that are more deyou may step down in the old days would have gone there but that's one of the concerns of san francisco general and also in the community that will be a challenge to find homes. >> director garcia this might be an area we want to hear mr. missouri ambassador but we are lumping together homes in this complexity maybe as we particle
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that out the boarding care and the residential team is really different than the sniff. >> and the funding. >> and the funding i don't think i want to delay you today but i think it might be an interest to look at the future capacity i know that is in the future discussions. >> so what are we doing it the mentally challenged patients where do they 0 go. >> out of county there are is bunch of folks going outing outside of county interesting not a shortage of out of county so that's what's been happening in the short time and thank you for the segue commissioner the behavorial health sorrow is the next thing and part of the
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reason why it because of need we were having a shortage of where to put folks that on potrero next to the campus and our new administrator so within that building on the first floor is psychiatric adult facility 1859 people from surviving from meth and we'll talk about this the second floor used to be a place we've converted it into a elderly place because we don't have the beds for the aging population that's why we decided to do it because of the population needs it make sense we'll take care of our our homes and at third floor is the rehabilitation center this is a
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for acute treatment so we opened in december 8th or 2015 and continuing to admit people to the units and ac matt people and this is the picture of a living room one thing about the program it is a hierarchy staffing of people they're paid there a funding the staff are trained on non-continual supports for the recovery program and opened 0 a.10:0 to 6:00 p.m. and the extended hours to 9:00 p.m. and add saturday hours because people need to go on saturday and allows for the overnight staying this is for the piers for programming pretty much interview the clients that are
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guests it is a drop in place and then you're basically screened in a general sense to make sure your properly - the original intent of the program when you see an inpatient they're not ready to do programming but the treatment felt like if they had support and structure they might do better we thought that might be helpful having a conversation with a peer that's gone through the journey might help you to change our mind and try the residential treatment and so that was what we originally intentionally said people are finding that people are in shelter or in hotels that feel unsafe and would come to humming bird because they need a place to sleep question want to say
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awake at night to say alert a lot of things people come to it highlights the foods insecurity i've been doing studies and it made us realize that is a far-reaching issue so a lot of these people come to eat and the third thing people come for one-on-one conversations to go to them to say interesting you have a lot of programming and music and tv watching and movie watching nobody wanted to do it they wanted somebody to license to them and the peers spends two to three hours with a person north korea stop the nice place about the place what happens they'll talk but a peer to sit and talk with you it's been helpful we have a person that
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was homeless went through the navigation center and very, very disorganized and mentally oil she slept with her dog in the backyard to have her pet she stayed housed but it was helpful to have a facility to work with her this was helpful. >> don't take that the wrong way i want to make sure we have nephew time for you to talk about the challenges. >> okay. >> so the housing unit is our last this is our how's the pro staff are locked on near the
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clinic direct access to a housing right now we have one thousand plus units cross this and alternative models and support services that are part of the section and we have a transitional housing program we do third party rent pamphlets for the chronically ill and the laguna honda has the program that got created out of minute tries introduce the housing program and we have manage our emergency utilization we're having a replacement and homeless outreach team that manage that service and there's a quick snapshot view or where our housing units are located and what's new for them a new
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project for the mentally for the homelessness they'll install an elevator there are clear binds people we're focusing on being the replacement for se of the lost hospitalized room and in partnership with the affordable housing so folks can continue to move and we will continue to have the housing options for the people so our challenges are huge we have in process we don't have any infrastructure wear basically those 5 sections are pushed together to try to figure out how to work well together and the hot issues is the stabilization we have pneumonia things on the horizon and we
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have a couple of millions and have to ramp up quickly we've livered 70 staff in 3 months and training those people to perform well and so thanks to barry and others leadership to make that happen the coordination theme the lack of cheer assessable rooms and taking people to the hospital for a mental place for them and also the fact we don't have enough care in the prior hospital if we don't say have the day we may miss a person because of that. >> and then communities replacement issues increasing aging population in a limited non-ambulancey place and we have a referral place so through our
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registered sex offends they're not allowed to live and participate in the program that's a challenge and missing folks that stands trial they've been identified and a lack of facilities and for the substance abuse i have to say that the seismic population is hard to serve that is hard to constitute and yeah, it is a very challenging population but the behavorial health center serves the population and it is difference than the mental population their designed to serve and the staff is designed to serve we have to look at that and for affordable housing rather than lower-income housing but to focus on van veterans housing for the homeless there
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is not a lot of that so that's through transition and thank you very much. >> it was comprehensive and very informative commissioners, any questions and if we - commissioners i want to acknowledge the folks that work for kelly a small and powerful team that works with the most at risk consumers and clients if you could give them a round of applause they've saved anyway. >> commissioners. >> so this is a lot of stuff you're doing a lot of things you know and it's to comprehensive it is and this is a difficult population it still boggles the mind we have such a problem because it is like we're
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doing one of everybody or 5 of everything and when we've seen lots of articles recently about homeless issues and what's happening in san francisco and you have a betters sense of what's happening so what is our way forward. >> i think this is a multiple prong approach as you've pointed out it is not a single thing but having to craft multiple issues and it is just an opportunities to get creativity to try to figure out how we stretch the limited dollars to the needs. >> even with a lot more dollars. >> with the transition of support housing that hard to stabilize shown when you do know how to find them this is our
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biggest strunl block and that's a tough question to answer inform architecture it is what it is. >> were you talking about some additional thing. >> the mayor is concerned with this as well and given us direction to think creating how we're going to address this one issue we're looking at mental health and have clinicians in the street directed in direction by the outreach team that is something we're working with and have capacity in the upgrade care centers can we do look that talk about the expansion of humming birds with 14 additional by these and we're looking at you might have heard me talk
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about the redwood center we're looking at not to rebuild the old history building but ways to build mod letters to provide opportunities for people to ge out of the city gets treatments and get stabilization so all of us just last week we are worked with h s a works with beds at shelters at night can we get into those beds the mayor put on 5 hundred by these of housing that is housing housing how are you is important that's a big priority in his budgets direction so we keep at the intersection and i have to tell you this is the motive creative staff and they is let's go and ready to move in terms of how we move our programs for example, humming birds for the staff for
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donated kelly knows we can open up 14 beds those are the kinds of creative think outside the box thinking for the population needs it is a multiple prone approach we work at the intersection everyday in trying to improve the health conditions of the people in the streets and with the groups their literally going into the encampments and we have many people going into health with the housing units we lost hundred and 50 by these not make it into permanent housing i council hundred and 50 people to think about the impact that has happened we're trying to get those beds half came back we're ward's with all the departments
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to look at this so the mayor has his folks on this and it is the biggest important we're all under i think a real important direction to really work together closely with all the departments to insure we're trying to do our best in all ideas to try to find people stabilization. >> i also- your new focus on collecting standardized data is crucial you'll look at one the ideas what has the best pay off i know that is the champ of this population but i'm saying yeah, that is an important thing to focus on. >> yeah. thank you. >> i want it is i've been a fan of the team because how it is second related i think we hear a lot about data
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i know how to set targets and benchmarks and costs cutting not enough time to really hear the odds r other side of the stories serving the population i remember one time i was working inform dpw and working to compensate a lot of them didn't survive the first month move on and well marco like - so but there were you know quite a high numbers of you know homeless clients that went in i think because they could relax and they passed away it took a long time for a lot of
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that to realize that maybe that's what they need they want to decembercy to pass on peacefully that is part of how to help them none has to die on the streets i saw a story you know a young woman outside on any streets pshs heartbreaking and remembers us why we have those programs. >> some of the things we've leader is better wrap around health. >> yeah. it used to be called homelessness - >> i want to say this is an excellent report of what really the city han has been navigating over the city sometimes comprehensive and now we have
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the integration a long of communication and comments about how do we handle the deed in the future, in fact, we're losing a number of facilities for the elderly and many of the veterans and i just want to commend you and your staff and the whole city and the mayor for really let's take into account how in fact, we can create new options to me it was interesting in the 80s the johnson foundation wanted to have studies for the homeless they were a concern wherever you had veterans camping out you name it whatever and now look at where we are now so and you mentioned you know hopefully, the va housing in
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particular those with our young veterans coming back with families including those which are grandfathers and great grandfathers to look at sites lake the va hospital nice parks and the presidio's is all military i mean, he many of the veterans served out this and now it is a challenge so what i'm saying we need to look at creative models given the fact wear linlt in reference to space and facilities we know that the city is growing higher and higher yet the cohort of people that all services are working to provide at least some dignity and respect whether young families or children or homeless it is a city problem in san francisco thank god it is from
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old stoilgz and all the other avenues and let's make a defensive it is a sclentd report thank you very much and all of our colleagues involved. >> thank you commissioner sanchez. >> thank you very much as a long time proponent of integration i see the possibilities of providing great care for the folks in need and saving costs to the health system wvpd i'll look to our help and director garcia help and my fellow commissioners we look at the issue of homelessness and in addition to looking at the network and look at it homelessness it is one of the most serious health issues in our city it is not safe more
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healthy to be living on the street is costs citizens and others costs to have proper skewer it goes to the importance of issues i hope we can make it a commission focus in future members of the committee it sounds like the mayor is asking for the same you know, i think there is alignments with that said, my question to director garcia as a commission to focus on issues that might help with the adjourned for example, 93 it seems to me the sro the the board and care issue keeps coming up which perhaps the nonprofits in our city are buying buildings and taking rooms off the market is there a role for the commission to weigh in and set policies that might keep those beds you know in circulation so that's my thought
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another question i might have with the interest of homeless do we have the right staffing this unit is really managing so such function on the hot team the number of staff versus the clients out there and i know people are circulating again do we have a feed on the ground we need and what can that commission do it help you with the funding or whatever resources for are that and lastly with regards to the actual services and policies we have you know think outside the box and give us permission we know that methamphetamine we with the stop program paid consumers $10 a we we pay the same $10 for people it make
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their doctors appointment but it's not a lot for us it makes a big difference and think outside the box you know to model care and that you could lake to us as a commission to do the experiments all the sense in the world if it produces the results i'll look to our help director garcia and commissions for raising this issue of how we're going to treat homelessness a health care system i think we're doing a great job but could do betters with the rights resources and structure or keeping the recent resources maybe two aspects of that.
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>> thank you for that i think that that's good empower inform the staff and prepares address with more emergency. >> to commissioner chung. >> having seen the population and seeing none, the challenges and successes where people graduate if the program and go on and get jobs you know it's not a big number but you know like definitely exist you know like how - i think the question how to bring this to those the next level so you know like this is not a closed safety net but you know a way for them to find or you know like someway
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to exit that and gradually don't even betters i think that who else we need to bring in you know to this model and how the housing and health care you know like case management and like job in services so what would that take for them to find that i don't know what it's calls self-confidence what is in front of them i don't think that is something. >> - it is the process app at humming birds to focus because they are living example of what you can do and the same thing with the homeless outreach team the staff travel that journey to employment so those are really go entry points for the
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population to be up front about what you, do if you want to succeeds and transition is going to partnership with them going forward every components of the division works well, that the peer partnering so we'll manager that structure. >> we're excited to here that in addition which one of the services that has the pier led will he program and all the elements that contribute. >> we've hired their graduates and we fund that program so we can hire them. >> i want to echo everyone's congratulations on the presentation today and some of the material that you and your team prepared for us that was background material very helpful it give us an appreciation of how complex a problem of that
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and to tackle but as commissioner pating says it continue to educate us is going to be important to be productive and helpful did the - i wanted to make one point and one question so my optimistic point is mr. petty you're right it is of some concern of losing the by these and people are - in our prop i approval today, we saw an example of community organizations st. anthony's that you are renting more space take a long view of the communities and rather than selling a building in a hot neighborhood south of market actually
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enabling us to increase our capacity there so i think we have to celebrate those optimistic momentums mire closing element is not a closing question but important that relates to african-americans some of the day that you presented way back in one the backs shows the percentage of encounters with the african-american went up 12 percent in the last periods over may and next to white clients they are by far the largest percentage group i did not do the market but a multiple of the population in san francisco i'm wondering what are we doing to be call roll self-evident to address that population in
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context and commissioner i don't think so what you median by counter. >> it's how they begin. >> it was in the homeless day they were researching. >> yeah. >> it was i think that african-americans with disprorlt r prospecting represents between roles o homeless and the other population a population that is overly represented a larger cultural we try to be attentive to make sure our staff has approaching the issue to be kaenld to bring them into care and that is assessable. >> that's true for all the populations part of that is the face of climatic change
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culturally approach for all the populations we serve we have the african-american health initiative that was big for the last few years i think has breath awareness for all the departments and it is very helpful for serving the population. >> thanks for that. >> i wanted to remind the commissions we have the opportunity for clients coming in front of us you're our own metrics so to speak you search warrant the hospital care with a charitable system allowing encouraging the hospitals whether they're a variance thing to focus on with the those with the fact that you you know puts together this billion, billion plus industry helps us in
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initiatives just to keep us that commissioner pating asked us to have our priorities so we anytime we see the opportunities come in front of us to have this affordable time. >> thank you all not inform public comment on this item move on to item 10 is other business. >> any other business? no >> i think we're ready for - okay move on to 11 a brief summary from the august 25th sfgov meeting commissioner singer. >> commissioner chow is not here today i'll do that this is the reports back from the august 25th meeting in open session we've heard a reports on lean and the san francisco general hospital rebuild update
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in addition to the view of the regular port or reports inform the of these administers report and the medical staff report and council report and in closed session the committee reviewed the credentials in the report no other business. >> all right. move on to committee agenda setting this is the time to suggest topics commissioner pating did his. >> yes. >> we're at adjournment. >> a motion for adjournment. >> before you do i want to say you did an excellent time for the record. >> thank you motion to adjourn. >> okay. >> all in favor, say i. >> i. >> this is the best part.
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>> >> hi. welcome to san francisco. stay safe and exploring how you can stay in your home safely after an earthquake. let's look at common earthquake myths. >> we are here at the urban center on mission street in san francisco. we have 3 guest today. we have david
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constructional engineer and bill harvey. i want to talk about urban myths. what do you think about earthquakes, can you tell if they are coming in advance? >> he's sleeping during those earthquakes? >> have you noticed him take any special? >> no. he sleeps right through them. there is no truth that i'm aware of with harvey that dogs are aware of an impending earthquake. >> you hear the myth all the time. suppose the dog helps you get up, is it going to help you do something >> i hear they are aware of small vibrations. but yes, i read extensively that dogs cannot realize earthquakes. >> today is a spectacular day in san francisco and sometimes
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people would say this is earthquake weather. is this earthquake weather? >> no. not that i have heard of. no such thing. >> there is no such thing. >> we are talking about the weather in a daily or weekly cycle. there is no relationship. i have heard it's hot or cold weather or rain. i'm not sure which is the myth. >> how about time of day? >> yes. it happens when it's least convenient. when it happens people say we were lucky and when they don't. it's terrible timing. it's never a good time for an earthquake. >> but we are going to have one. >> how about the ground swallowing people into the
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ground? >> like the earth that collapsed? it's not like the tv shows. >> the earth does move and it bumps up and you get a ground fracture but it's not something that opens up and sucks you up into haddes. >> it's not going anywhere. we are going to have a lot of damage, but this myth that california is going to the ocean is not real. >> southern california is moving north. it's coming up from the south to the north. >> you would have to invest the
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million year cycle, not weeks or years. maybe millions of years from now, part of los angeles will be in the bay area. >> for better or worse. >> yes. >> this is a tough question. >> those other ones weren't tough. >> this is a really easy challenge. are the smaller ones less stress? >> yes. the amount released in small earthquakes is that they are so small in you need many of those. >> i think would you probably have to have maybe hundreds of magnitude earthquakes of 4.7. >> so small earthquakes are not making our lives better in the future? >> not anyway that you can
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count on. >> i have heard that buildings in san francisco are on rollers and isolated? >> it's not true. it's a conventional foundation like almost all the circumstances buildings in san francisco. >> the trans-america was built way before. it's a pretty conventional foundation design. >> i have heard about this thing called the triangle of life and up you are supposed to go to the edge of your bed to save yourself. is there anything of value to that ? >> yes, if you are in your room. you should drop, cover and hold onto something. if you are in school, same thing, kitchen same thing. if you happen to be in your bed, and you rollover your bed, it's not
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a bad place to be. >> the reality is when we have a major earthquake the ground shaking so pronounced that you are not going to be able to get up and go anywhere. you are pretty much staying where you are when that earthquake hits. you are not going to be able to stand up and run with gravity. >> you want to get under the door frame but you are not moving to great distances. >> where can i buy a richter scale? >> mr. richter is selling it. we are going to put a plug in for cold hardware. they are not available. it's a rather complex. >> in fact we don't even use the richter scale anymore. we use a moment magnitude. the richter scale was early technology. >> probably a myth that i hear
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most often is my building is just fine in the loma prieta earthquake so everything is fine. is that true ? >> loma prieta was different. the ground acceleration here was quite moderate and the duration was moderate. so anyone that believes they survived a big earthquake and their building has been tested is sadly mistaken. >> we are planning for the bigger earthquake closer to san francisco and a fault totally independent. >> much stronger than the loma prieta earthquake. >> so people who were here in '89 they should say 3 times as strong and twice as long and that will give them more of an
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occasion of the earthquake we would have. 10 percent isn't really the threshold of damage. when you triple it you cross that line. it's much more damage in earthquake. >> i want to thank you, harvey, thanks pat for we have our quorum again, ladies and gentlemen lets rise and put our right hand over our heart fl pledge of allegiance. >> i pledge allegiance to the flag of the united states of america and to the republic, for which it stands, one nation, under god, indivisible, with liberty and justice for all. thank you very much. mr. clerk good afternoon, could you please call the roll. commissioner cohen, here. commissioner bridges has indicated she is on


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