made from the past downturn. another look at the fte side

this is a sense of where the ftes are going. this is a chart that shows you the total fetus by our kind of 4 groupings of goals we used to guide this budget. and we've also carved out the budget neutral one thing i want to point out is we have a heavy investment of our staffing in the access to care category that's reflective of our discussions the critical path we've got to be able to have sufficient access to remain our member population as we go into managed care we've chosen to prioritize and making investments focus on being able to do that. another thing i want to point out we've had discussions that

at the last meeting about our staffing issues in san francisco general hospital we have about 97 ftes being added to the budget as we transition into opening that new hospital. so there's an initiative also that is proposed in the budget that's a salary savings adjustment of about $5 million that came up as a question at the last hearing. when you look at million dollars salary savings you have to look it in context of the 978 ftes we're adding of course, of the budget there's a small reduction to meet our consensus but offsets our growth as we move into the new environment at the

san francisco general hospital. another chart showing where the investments are again san francisco general hospital is a sixth piece of it and our ambulance try and central network administration is about another third of the pie. so and then lastly just another reminder of a couple of things that are not explicitly within our budget initiative but are important in the budget context we have as adopted last year a reduction to community programs that will be phased in over the two fiscal years and starting at a half year for 2014-2015 at

$8.8 million and annual liz to $17.7 million that remains in the budgeted as adapted by the mayor and board of supervisors in last year's budget process. in addition, we are projecting about between a $3 million reduction between ryan white fruksz the federal government and the ongoing to hiv prevention services that is out there we're expecting final awards in may but that's our estimate it will be a hearing from the board of supervisors on this topic we're still renegotiating those factors they are significant and that's on ongoing process. so what's you coming up we have as i said a hearing tomorrow at

the board of supervisors this is a preview of the budget we proposed and also a discussion on the hiv funding issues. june 2nd is the targeted date for the mayors budget commission and having hearing with the board of supervisors through june with the final budget prafld in july. i'm happy to answer questions. >> commissioners questions . >> i really applaud you for the it investments. i think you're running spur fast in that area that's encouraging. i wanted to cite one note of caution i think i've sited cited

before we are on a treadmill we're running fast but not getting anywhere we're just trying to do our job today, we're not as many in my estimation reviving aggressively enough in the next generation the medical records sgrathdz across and the challenge with that it's numerously expensive and we tend to look at it as a cost issue and shy away from it but given the intensify to remain favorite? an increasing competitive world and not be pencils in terms of front seat programs once we do this in the future we're pitting our revenue at risk unless we embark we're

jeopardizing our revenue and increasing our costs and the unfortunate consequences we've spend more money on poor care for our patients. it's a huge challenge for the city that's a lot of money to do that right we don't have an answer but pits our collective responsibility to keep trooib trying to you said how we can aggressively push forward on this it goes to the heart of our solvency of the health care future. and so i imemphasize with you because you and director gary is are in a situation we have under investing we'll pay for the care we deliver to our population will suffer >> thank you. any further

discussion this is the third hearing we've had on the budget. >> i have a question about the additional ftes. the issue that's been before the commission before to fill up the ftes and the whole process how does it play into that that and asking is there a discussion so that's not another year >> it plays into it many multi ways and as you've heard a you couple of times and continue to hear that's a critical priority for us because not only do we need to fill what we have now but ramp up into the transition period for the new hospital and we're going to have to be bringing on staffing to get up

and running. so it's a heavy focus for the department and our h.r. director has been running sometimes, it feels he's running on a treadmill but running hard to barbara has been derivative in making this a priority so our efforts and energy are focused on how to speed up up the pipeline particularly at the san francisco general hospital and get ourselves up to where we need to be today to not fill as many shifts with needed positions and get this going. it's a challenge but we're very focuses on this as a priority for being able to be in a position where we are xhofb comfortable with our level of

operations >> the other part about the call center that was the presentation about t 5 or 3 year plan this is a transitional position where pits rolled into the it infrastructure that's correct. >> i'm having trouble remembering what the conversation was it looks like barbara does. >> it would be part thought i t system but f this is a call interest to help with the access into our care and we've looked at different model eased the staff has looked at this this is one of the recommendation the consultants say we need to centralize those to control the productivity of our providers but a component of our future. just to note i really appreciate

diminishes singerers comments on it one the changes i think goals we need to set for the department very soon and will be having to relook now we have the budget done in the future budget we have to make a priority for i t as you saw bill kim making emphasis presentation at the last meeting is he's building the infrastructure to be prepared for the electronic medical records but again, there's a process of how many people can i possibly hire in a year that's one of the challenges and when you see part of the monies that we're putting ♪ the infrastructure and that includes h.r. we've had a thinner h.r. we've lost a lot of

people so our h.r. director has to rebuild his area we've got structural pieces to reorganize our future so i appreciate all our support for the budget but i think i would be remiss if i didn't say our goal has to be in it and bill has worked with the leveraging of the system and we're one of the few departments that work closely as the largest department we have to look at the servesers and that's an area we're radioactive to put our future in. >> commissioner sanchez.

i want to thank staff for a listening and spending a graechlt and years too half years but whether you look at the chart and the history of the ftes and the cuts we having that had the painful kits we lost key personnel that really almost mandated and required to provide the quality of care that we have pledged to uphold. and at this time we can see we've made significant headway but not where we could be and will be in the future. in the sense we're standing with pride and with all the changes but the fact is the leadership

and the quality of inclusion on focusing on dph and sharing with this over time are different units and different programs that we feel both from the commission and those involved in the day to day programs make a difference and it's really a excellent overly site for this commission i want to aggravated assault congratulate our folks and we've had many challenges and we'll continue to collaborate to encourage and work with you to insure we maintain the highest level of excellence in patient care so thank you >> thank you. >> well done. >> other comments

thank you for the breakdown especially our ftes it often comes into criticism it ignoring goods and services goes back to commissioner singer and the remainder really for better public health and access to care and half of that is because we all passed and wanted a san francisco general so that's going to be much more private and allowing people that have better care it takes more people that's the explanations for the increase of ftes everybody also worries about so 37 nicely done. commissioners, i would entertain a motion to accept the budget and move it to the mayor's

office >> so moved. >> second. >> all in favor, say i. opposed? thank you it's been unanimously passed. >> if i could i want to particularly thank jenny luger i didn't this has been a tough season is navigate and she's pit a lot into this. we all thank you. the clarity is one we want to thank you very much for. thank you >> the next item commissioners is other business i'd like to remind you i put down on the pilot paper a memo that relates to the discussion around the beds and i believe it is calendar at prop 2 at the next meeting but i'll talk to the other commissioners.

>> thank you that's for information. my other discussion of any other business. anybody wants to bring up >> the next is the joint committee reports we have two, that were presented on the same day and alleyway guardian was first. the laguna jc c met at the 1 o'clock and we reviewed and depraved the minutes in open session and in closed session he the credentials were recommended therefore we completed our task >> thank you san francisco general met later that afternoon and we had a presentation regarding the care presentation and task force update that was

alluded to today and an update regarding the san francisco psychic we heard in regards to some personnel issues that we are continuing to work with in the emergency department and other parts of hospital and heard an improvement in terms of the human resources to the hiring at this point. and in closed session reviewed the general credentials for the medical staff and various reports if you have any questions, i'll be happy to answer them or any of my members wish to add anything. okay. if not then was there any public comment any public comment on that item? no public comment requested on any comment

>> next agenda is 11 i want to note that august 19th is the date accessed for your calendars you all confirmed that date was available from 2 to 6 we'll hear more about that later. >> right i also ask the members to look at the tentative calendar to make sure everybody is aware of other meetings that should be on your claurndz. okay >> is driver's license missing any other items in regards to agenda if not, we're ready for a motion for adjournment. is there a second >> second. >> without further decision all in favor, say i. offense this meeting is now

adjourned. thank you

(clapping.) ♪ ♪ ♪ ♪ ♪ i think we have more companies anywhere in the united states it's at the amazing statement we're not trying to be flashy or

shocking just trying to create something new and original were >> one of the things about the conduct our you enter and turn your your back and just so the orchestra. the most contrary composer of this time if you accountability his music you would think he's a camera come important he become ill and it was crazy he at the end of his life and pushed the boundary to think we're not acceptable at this point for sure it had a great influence he was a great influence on the harmonic language on the contemporary up to now.

i thought it would be interesting because they have e he was contemporary we use him on this and his life was you kill our wife you get poisons all those things are great stories for on opera. i was leaving behind a little bit which those collaborative dancers i was really trying to focus on opera. a friend of mine said well, what would you really want to do i said opera what is it not opera parallel. why isn't it are that i have the support now we can do that. i realized that was something that wasn't being done in san

francisco no other organization was doing this as opposed to contemporary we are very blessed in san francisco to have organizations well, i thought that was going to be our speciality >> you create a conceptual idea for setting the opera and you spear ahead and work with the other sdierndz to create an overview vision that's the final product felt opera. ♪ ♪ ♪ ♪ >> i was very inspired to work with him because the way he looked at the key is the way i looked at sports looking at the daily. >> so much our mandate is to try to enter disis particular

work there's great dancers and theatre actresses and choirs we've worked with and great video artists is a great place to collect and collaborate. i had a model they have a professionally music yes, ma'am assemble and as a student i benefited from being around this professional on and on soccer ball and as a conductor i'd be able to work with them and it's helped my growth i had a dream of having a professional residential on and on soccer ball to be an imperial >> it operates as a laboratory we germ a national the ideas technically and work with activity artists and designers

and video all over the on any given project to further the way we tell stories to improve our ability to tell stories on stage. that's part of the opera lab >> i was to investigate that aspect of renaissance and new work so that's why this piece it is important it was a renaissance composer. >> there were young people that are not interested in seeing traditional opera and like the quality and it's different it has a story telling quality every little detail is integrated and helps to capture the imagination and that's part

of the opera how we can use those colors into the language of today. >> so one of the great things of the stories of opera and story combined with opera music it allows people to let go and be entertained and enjoy the music instead of putting on headphones. >> that's what is great about art sometimes everyone loves it because you have to, you know, really great you have to have both some people don't like it and some people do we're concerned about that. >> it's about thirty something out there that's risky. you know, disliked by someone torn apart and that's the whole

point of what we're drying to do >> you never take this for granted you make sure it is the best if you can. >> ♪ ♪ ♪ ♪ ♪