have ted, the deputy director. this is about a year ago and he met us and our nurse manages to streamline the hiring process which we have implemented in december and we're starting the results of that. we're using a continuous open recruitment which means can apply and we can get them quickly on the list so we're seeing the fruit of that work. the other photo is dr. alice chin who is a leader for the first leader for lean and we have four activities and another on the week of the 23rd and leaders including [inaudible] part of the leadership and we had a lot of changes and continue to make the positive improvements. next i will talk about operations. i will turn it over. >> good afternoon

commissioners. i am senior personnel analysts in the operations division at san francisco general and karen hill my boss wasn't able to be here today so i am here in her stead reporting on great things we have been doing at our department. i came on board a year ago so i am brand-new to the city with new eyes and was able to -- we just have been getting together a lot. what you see in the slide is nursing, administration, merit systems, and ron and us there talking about our productivity. we look at our productivity every single day, how many packets we're receiving, how much we're putting out the other door getting done with hiring, and we also are actively problem solving so as barriers arise our

partners are there with us and we immediately take it up and if there's a solution we can implement that day we do it. to just keep packets moving quickly keep getting the highest qualified candidates in the door and that's what we -- that's our primary interest so we have been working very hard and the lean groups that have met, the four that have met and the one upcoming have made a significant difference in how we do our work and we're all about i think the mind set of our department has changed completely to one of how can we do this? how can we get it done and what's it going to take from us to support the new hospital and also the nursing service but all of the other departments that we also work with? so we've gotten all our partners together, and we're continually working together to keep hiring as fast as we can get it.

>> i'm going to our account manager talk for just a minute. >> okay. good afternoon commissioners. i am [inaudible] dph merit division manager. so the photo that you're looking at that our hr managers and many are new including myself, and so we're all working together to increase or to improve our efficiencies in hiring, and the other photo, the photo that is just below is one of the things we are realizing is like bill kim mentioned because of the low employment rate in the bay area we are not getting sufficient pool of applicants so we're realizing that we need to do active recruitment so that photo

is public health participating in a ucsf recruitment fair so we're starting to do more of that active recruitment. and as we're the biggest department, public health, we use numerous job classifications and most of them require civil service exam and for merit division our output or product is the eligibles that we create, and this is the list from which the hiring managers they hire -- i mean they select candidates to fill their vacancies, so last fiscal year we created a total of 96 eligible lists and so far this year we have 72 eligible lists and we still have couple of months to go so i fully i am confident that we're on the right track as far as hiring is concerned.

>> so i want to add in the area of recruitment we're hiring someone and will do a posting this friday and hire a recruiter especially to work on nursing classifications and other difficult areas and working with advertising and the administration for areas to advertise in so bumping up our advertising and our recruitings and draw in more qualified applicants. so we looked at some numbers. i have an analyst that is helping us work with numbers as well as the business an analytics unit and i was trying to get a sense of what is going on with hiring and in the memo in july 2012 the county implemented a new system, people soft and took the city and health department time to adjust to the system. it took away

that we could hire more than one person public comment requisition and. >> >> now it's only one person and with that being said we had a deficit which slowed hiring. we picked it up on 2014 but the focus was on the affordable care act. hiring the leadership for the new network and staffing so i saw in the graphics surge of ambut latory area and decline in other areas although it's different staff so it shouldn't have made a significant difference but it did and we hired 743 staff up to this point in the year i am opteddistic that we can double that by the end of the year and we are implementing some of the tools we have been working on these past months so this hiring chart -- again i was trying to get an

idea what is going on with hiring. i have more detailed charts that tell me what classifications we're hiring and that type of thing. i wanted to see if there was a shift and looked like there was a shift that i described 13-14 and we shifted to hiring in ambulatory care and had impact on san francisco general. just to give you an idea of staffing this is sort of our staffing outbreak. of course san francisco general is our largest organization in terms of staffing followed by laguna honda and then broken out from there. and this shows employees by division. this is helpful but what is really helpful we're looking at vacancy rates and targeting san francisco general and ambulatory care and construction of the network was the priority last year and now the priority is san francisco general. i believe

we can meet the requirements but as others have done it and use a contingency workers with permanent staff and we will work with management to do that and make up the gap so just to give an idea it's sort of interesting that these 11 classifications hold 50% of our employees so these would be logically an area to target if you want to hire a lot of people; right? the key is however certain classifications even though they have a small number are still critical and for regulatory requirements and some associated with grant funding. you don't get the grant unless you have the position so we're constantly trying to negotiate the priorities but right now san francisco general is the number one priority. i was curious what is going on with staffing and the rns others and there is a steady increase and we have

attrition but gives a snapshot because i am using the same criteria year to year. we have a temporary rn and we have seen an increase in those. this is an area you can be a regular rn and a temporary as well so to get a better picture i will have to pull those out. we talked a lot bit about separations. you see the trend on my left. in 2008 and 09, 10 i believe the city had financial troubles around that time and had to do with layoffs and then it declined a little bit so we have been more or less steady in people leaving. if you look at the graph below that age 21 to 50 is 57% of the employees but when you look at the statistics people don't just leave because of being eligible to retire. they want to maximize the retirement and the years of

service is more like 23 years and you could be average at 11 but people don't tend to operate as soon as they are eligible. city wide work force. we have -- there's been an increase although it's not as drastic as it appears and 2011-12 went up 1,000, 2,000 and then a big jump because that's in the previous years they didn't put the municipal transportation agency in and now they have added that. for our own staff that continued to rise roughly a couple hundred a year and that last slide -- [inaudible] that last slide would read 7,029 i believe. so essentially i think we can be ready to open the new hospital. we will have a lot of new hires on board because of the new systems we have in place. we're

hiring merit staff. and you can't hire without a list and we're creating the list and use a contingency staff to fill in for the gaps so i will welcome any questions that you may have. >> was there any public comment? >> i have received no public comment requests. >> commissioners discussion or questions with our director? commissioner singer. >> thanks. as you know ron this is a subject near and dheer to my heart and i appreciate the progress you have made getting a handle on this. i know if i were in your shoes i wouldn't be here with a full head of hair after this experience. i think the reality is that we need to confess to ourselves the economic climate in san

francisco which is thankfully different from any other place in the world right now and the reality that this is a city and county hiring system that's grown up not to optimize efficiency in recruiting but for other reasons is probably not perfectly suited for the challenges that we face at this point and time, and i think the reality is that you guys are doing amazing job getting us there. i think the other reality as i look at the data for the san francisco general hospital is that in the fall and all last year we were -- we heard about how the build is going, when the hospital is going to open and only recently i think have we come to understand that we're really not going to open the whole hospital which kind of makes sense

operationally, but you don't want to back into that logic right. you want to lean into it, and i just feel that we owe it to the people we're going to be treated there -- certain the mayor and the supervisors that completely backed department in the investment to build that new hospital and the staff at sf general hospital to see how well we can do and therefore i was pleased and i wanted to sort of unpack your plan on the contingency hires because it seems -- so i would like to understand how many resources you're putting behind it? where you're going to find it, the whole plan? and i feel that's where we are today in meeting the needs of the department realistically and where we should focus and not to

minimize the great progress but we're not going to get to where we need to get so the reality is we're going to need as many of the temporary people so could you expand on that? >> i can. so one of the things we have done the director and the director of the network and i agreed that we should meet weekly so we're meeting with sue and terry and iman and role land and this week we came up with a clarifications and. >> >> and look at a plan for each of the clarifications so developing lists which we can hire off so the rns and start recruiting we can add them to the list and no delays so we will see fruition in that area but we have to look at all of the areas and some of the tools -- civil service and 19 categories of civil service exemption. we used those to

get ready for the ambulatory care expansion and doesn't need to go through all of the hoops and we will do that and bring them on faster. and also the registry. there is competition because of the other hospitals in the area but we're working on getting more contracts to have access to registry and a combination of those and look at the vacancy rates and have a plan in the next weeks. >> when you talk about this plan and in your mind's eye how it unfolds and talk about it with your colleagues at the general hospital who are trying to figure out how to do this as you know you think everyone is in sync and comfortable that we will get the people we need to open or do we not have the plan to open and fully baked and it will come? >> i think it will be fully

baked in the next couple of weeks. i think the tools are there and the managers are on board. you always have a couple people that have the view of the world that we can't do it but that's the minority here. certainly with my staff they believe we can do it and staff and managers. >> do you think you can come back next month when we meet -- >> with a detailed plan? >> yes and the contingency map and what it looks like. >> i can give you estimates and the goal is not to have a vacancy rate but come back with a retailed plan. >> thank you. that's it. >> commissioner sanchez. >> i think it was a really well documented area and you really showed the trends going from 2012 to 2008 and not only our department but the other departments and the increase.

i just want to say that you know there's been enough -- not enough but we had a number of hospitals and/or facilities under way over the past 15, 20 years in this city including the general in the 80's and some other hospitals or acquisitions of hospitals, and it isn't just when the ribbon is cut and the door is open. the critical phase is do we have a diversity of health practitioners from different disciplines who have been trained for this new challenge who could provide the training and supervision as we get under way in the next year? granted it would be great to have 100% complement, but i can't think of any institution over the last years that have had that per se even going back many years ago when the navy

had hospital ships and we couldn't get enough folks board -- anyway i think the challenge is once we're under way and there are going to be shifts and changes and reviews and we're going to be looking at not only some new graduates coming out from different med schools and residency programs and nursing programs and combined with the it challenge with all of the requirements it will require a new health professional to meet the uniqueness of our patients in san francisco so i know that the staff and others have spent a great deal of time and continue to do so to make sure that we have an operational model that is going to provide not only continuum of excellence but to ensure that we have the due diligence and we could take a look at both new practices, best practices and those that are going to be scuttled

because in the situation we have to navigate something else so there will always be the challenge so i don't want us hung up saying we need everybody on board when we go out. it may happen. it may not happen. what i am saying is i think really the training and supervision once we start to get under way the quality of care, the competencies of our team and support network is really the core of the quality of care that the department of public health and sf general continue to provide, and it's a real challenge. i think we're fortunate to have some exceptional leaders in all disciplines whether from nursing, pharmacy, radiation medicine to you name it. they're there and working as a team and i think we're up to the challenge. that's sort of my thoughts. >> that's a good point. we have jim marks and sue kern and others. it's not just enough to get the staff on board we need

the right staff with the right experience and if we train we need time for that so we're in active discussions about and have to factor in. we have to have them trained properly before we open the question. >> can i just do a short question? >> yes. >> one of the lessons that we heard at laguna honda that they have excellent retention rate and 5% turnover at laguna honda and on average 20 year life span of average employee there so while looking at the new hire end which is coming in are we looking at retention strategies to retain and keeping a healthy work place at san francisco general so it's a desirable place to work? is that part of -- >> it is. we have a group looking at retention rates and also of course strategies and there's some pretty significant differences between this type of

work and the work environment the two organizations but all of those things and succession planning and just the activities available to employees we will look at that and see what the differences are and see what we can build in. we have these work force committees that are active and looking at things to increase retention. >> all right. i have taken from the discussion that one of the requests of commissioner singer was to look at what might be a contingency plan but i would like to broaden that and put it into context and yes we're interested in that but i believe we're interested in the goals that i believe we have all spoken to which is we want to open and open it right, and we also want to be sure that we have an opportunity really to take lessons as we open and learn, and that might in fact change our concept that while all of a sudden 210 beds are

available it might say that maybe there should be 100 beds available or that we should open three of the emergency bays and five of these -- anyway, i would like to understand it's within that context rather than just absolute goal that we have to have the ability to staff every bed that we are licensed for and have built out. what is the rational way of looking at this getting the experience also as we're going into a brand-new hospital? and those that have been able to go there and see it you also know it's a new way of trying to deliver care. it's not even square or rectangular. some of it is round and you go around in circles or i think those that went through the emergency room got lost and went through four or five bays.

extremely impressive but how to make best use of getting into that building and of course we also have the licensing challenge. we have to understand that, and is it that there is a better way of gradually opening sections or not? i have no answers. in fact i have no bias. i am saying those are the ways i believe we can take advantage of where we are and see how we can get our best effort and best bang for the dollar, and also to make sure that the quality of people that we have there that we're putting into the staffs are up to what we expect. if they're not there, not available then we shouldn't necessarily open those areas because that's not a service to our people, but i ask director garcia what her thoughts are on this? and she obviously with the ceo sue kern

are working on i imagine these same questions. >> i think you all captured many of the challenges that we have. we have to look how fast we can hire and the time is clicking and what does it mean to have safe staff beds and we need to back into i believe we can hire up and if not use registry for a while. we are budgeted for 210 beds. we will get there, whether it's the first dave the opening that's the. >> >> challenge and i think we need the contingency plan and measure how fast we can hire and have a plan from hr in terms -- because we're so interdependent because we're dependent on how fast san francisco general staff can train the nurses to begin on the floor so i think there is a combination of the irpt dependency between us but we're budgeted for all of the beds. it's a matter of can we hire up

between permanent and registry to ensure we can open safely at that time. >> that's what i meant to broadening the question. it's not simply what is the plan on contingency but the broader range where it appears we're going. commissioner sanchez. >> yeah and i think that makes sense. i think two things i want to repeat. one is i don't think we should back in to the plan you're suggesting because of the hiring. i think we should decide affirmatively what is the best way to open the hospital and i would like to see -- i think it would be great to see we're not going to get the full time bodies. not for a lack of trying. the math doesn't work out and we need

them to train them so i am requesting a specific plan on that in the context of what you said. >> i think it's important to emphasize what commissioner singer was saying this is not because we want to staff all 210 beds. this is an opportunity to really look at what is the best way to open our hospital? and take that opportunity and in conjunction also with understanding financing and happening getting the quality that we want and so the plan needs to come first in essence in terms of what would be the best way of doing this? >> you're asking a question what is the best way to present this? >> yes. in other words study or come to a conclusion at this point -- >> so i think one there is a transition process that the san francisco general hospital staff are going through. we should get an update on that and then we should match that with ron's

work in trying to get the hr process together and i think those two staffs can come together and determine how many beds we will open and the beds and can we do any back fill by registry for example and i agree with commissioner singer. we should try to get a target it should be the 210. that should be the target then we have to figure out what do you have to do to get that done, but again we may not be able to do that and we have to have contingency and transition and flow in terms of expanding beds as we move into the new year of 2016. >> does that meet our condition? >> i understand what you want. >> look forward to it. >> thank you. >> okay. so we will calendar that for approximately a month from now. >> director chow you're asking what i would like to hear again

what is the plan to move into the hospital and how we're staging that and the hr issues are one portion of this larger quality of care concern and financial map -- road map as we move through the implementation of the new building. >> i think that's fair. so thank you. if that is doable then we will calendar it. >> all right. >> i think it shows the importance of the issue and also our flexibility that we want to try to understand what is the best route that we can take. okay>> >> >> commissioners does that go to the full commission? >> to the full commission. i think it should be heard here. >> yeah, unfortunately there isn't the calendar time to go through what you're suggesting which is probably the way that

in normal times that we should do something like this. i feel that we need to understand this because the clock is ticking. >> sure. i was just clarifying. thank you. the next item on the agenda is item 10 other business. >> so commissioners we're at item 10. do any of our commissioners have other business that they would like to bring to our attention at this point? seeing none then we will proceed to the next item. >> item 11 is the joint conference committee and commissioner chow has a report from the san francisco general hospital jcc. >> yes the jcc met and in fact the members -- oh we will get commissioner pating back because the three of us who were at the meeting. in fact commissioner pating did hear and discuss in open session the quality management and regulatory affairs reports the quality

affairs reports and the vacancy report along with the hospital administrator's report and the patient care services report all of which he can read now and we're providing directly on paper the minutes from each of our meetings. in addition the committee gave feedback on a draft resolution that will come before the commission in regards to parking and the sfgh parking garage and improved revisions of the medical forms and to rules and resolutions for various departments and we approved the credential reports and reports on quality care. i don't know if any of my fellow commissioners would like to add to our meeting? otherwise i am open to other questions. >> i have one question. >> yes, go ahead. >> in regard to the in patient