eligible list of interested qualified people will be available for managers to hire. >> great, thank you. >> so the goal back in august of 2014 was to start those lean improvement yipz with the idea of providing better service to the hiring managers and to serve the public as our mandate so this meant we wanted to reduce the time to hire as ted said from hundred 90s days we've taken a snapshot for each month in the beginning of 2014 and gone from hundred 90 days to more recently 29 days from a position to someone walks in the door we'll have 2 hundred and thirty clarifications it is

different when we're doing the tests and issue. >> referral the basic trend a way down we've taken the lead time and knocked it down so to give you an idea of hires we've done this shows we've done a lot of permanent hiring since january 1st of last year over 8 hundred position we want to get away from temporary and registry employees so you'll see that as we trespassed we've done that oar this chart shows the blue is permanent and orange temporary we're trending in the right direction we have implemented this process improvements and seeing large numbers of hires we're knocking down the back wall. >> i'm sorry if you could just what are pcs.

>> civil services versus a are temporary employee pcs is good temporary not good we need them but have the number balanced that's our focus for hire and as you've mentioned or mentioned the civil service each department has the private sector didn't have the enar incumbents but they can do things we can't do we've made great strides. >> the doted lines the lair lines are the goals we're trying to get to or just shows the trend and it is trending the average trending. >> okay. i want to mention briefly the registry ask it is common to use registry we've tried to knock those down as

we've done a lot of hiring like in nursing for a brief time as wear transitioning to the hospital we'll rely on some registry as we take our permanent staff we need someone to back up someone that will operate the hospital was we getting ready to enter the new hospital you have to have someone doing that work you wouldn't want to hire permanent staff. >> how long is that period. >> it is 2016 we'll be moved in and reduce the amount of registry prior to the fall of 2016 we're reducing it we've done a lot of hiring in the last 4 months so we're going to see the reduction of registry. >> is there a place a guideline you're following firemen's in

terms of brown where you expect to be in general where you want to be i'll say as recorded to me there's still a large and sometimes excess use of registry and where we want to be when all things are lined up. >> i think the standard to use as little as we can i know that number is going down we've hired a lot of permanent staff in the last few months it will keep on going down. >> thank you. >> so specifically the emergency department i want to give you a snapshot we've hired 50 positions since i've last recorded and rad metrological we work with the union we have an arbitration and a on the use of

temporary employees, of course adding staffing to metrological - radmetrologicalradiology county as a recruiter we have a krurtd in san francisco general she's helped us to do recruiting but helping us with the other areas at laguna honda at the end of march had over 4 hundred potential nurses interested in working for us we hired a lot of experienced nurses and respect to doctors medical center so going out to into the bay area we've continued the collaborative efforts and lean

work we continue to do that in on font to have a permanent staffing to have the services we provide that concludes my presentation. i'll be happy to answer any questions. >> just a couple about the registry trying to understand it becomes guidelines that you want to be at in terms of the balance between registry and permanent what's guiding our decision making and the use of registry. >> so from home sharing prospective all i want 80 is permanent staff i have to get the managers over the tool it is a hospital operations decide not my decision i can help us one of the hospital staff address that if you like. >> i'll have the director for

nursing general hospital come up and address that. >> okay. thank you. >> and when it comes to rad metrological there's a lot of staff. >> there's been and in the arresting transmission we're going to no concoct that down. >> i'll have to get my glasses on. >> 5 ftes does that sound familiar. >> hi. >> can you please restate the question. >> in terms of where you want to find a balance between the permanent and is registry required to be used and are we not over using registry where it

is at. >> that's a couple part we're moving into a new hospital wore to backfill with registry as said before we backfill to train people that is a 6 to 8 week contract all our folks moving into the new hospital will be able to be trained we're basically running two hospital one with a test investment and one is a rebuild. >> that's a temporary situation there's been a high use of registry and trying to figure out what is guiding the registry and how we make sure that in the future we actually get to the balance we want to have what's principles are guiding that balance when the hospital is set up and moving forward with the staff. >> complentd excellent question

the registry use is based on the vacancy rate ems we've had a high rate of vacancies with r.n.s so unfortunately awhile our vacancy rate was up we were using our temporary employees and many didn't want to be on permanent rec so we had to rely an registry to make sure that the patient had care and adequate staffing levels as well i believe with the hiring we're doing i will be using limited registry i can't give you a number but as numbers are needed we'll backfill with the what not and the vacation that will suffice we'll need a small amount of buffer in case your

staff needs goes down or attrition as well. >> i have a report that there was 5 hundred and 9 vacancies this might not be for you thank you for answering the last question in november of 2014 there was 5 hundred and 9 vacancies that leads to a high use of registry do you know where we are at in terms of public vacancies and the health care. >> we're hiring we've been very successful we're hiring 40 r.n.'s a month the hundred and 40 hiring i can get the the number and for the record it was carried from san francisco general i'll get back to you with that information. >> so i think we can actually hear from the public and might

be questions i'll bring it ta back to the department of public health and the h.r. staff i appreciate the level of work that's gone on in the past year to expedite the hiring process and the system is in place and the flexibility you've given to the hiring managers it shows significant process and i want to hear what the experience is inside from did workers and see where we're at from there so i have a number of cards and if you asking can your name called come forward if you want to line up line up on the walls where the tvs the windows are here are the names (calling names) if i get our name incorrect my apologies

apologies. >> hi. >> good afternoon thank you very much supervisor avalos for having this hearing on this important issue today, i'm happy to hear 234r the department there's a commitment to reduce registry and have full-time positions that's a very important thing for our members and important for the patient care and we look forward to making sure that happens additionally one thing that we're seeing is that we see r.n.'s being hired but want to make sure that our methods classifications we want to make sure our r.n.'s are equipped with collects we mexican e a's

and c n a not stuck with doing the work the more work they do the less patients get seep we want to make sure that dph has the best care our workers are working in staff conditions with adequate staffing. >> thank you if you get a chance to look at the power point on page 9 it has all clarifications so see how that's effecting clarifications. >> thank you. >> thank you. >> thank you. next speaker, please. >> hello, i'm a registered nurse at san francisco general i want to thank you supervisor avalos for calling this hearing there's been many strides made to reduce there is still work to be done

we've heard about the impatient nurses what about on the you think ununclerks the kitchen staff what about the clinics to be able to provide preventive care as and move forward with the hiring process i want to remind you incorporated to have competent care we have to have a difference workforce what's dphs plan to keep minority nurses the proof is in the pudding. >> thank you very much. >> thank you. next speaker, please. >> good afternoon. i'm kathy linda nicer practitioner at san francisco general i want to start with an examples of a patient that is typical but specifically a patient that one

of our nurse practitioners saw recently she's a 59 year-olds bilingual cantonese vitamins female with active diagnoses with a complex hearing chronic kidney disease, high blood pressure arrest disease a mental bone disorder and diabetes and has had two card- excuse me. 4 cardiovascular letter events and hypertension and dementia she as depression a headaches a complicated patient has been hospitalized in san francisco general last week and made i admitted to ucsf this week and feeling weak because her blood

pressure was low poor kidney functions and high levels of aside in her blood and high levels of calcium and now having seizures and started on dialyses. >> i think she's got more time. >> i've never done this before. >> there is a timer in front of of you. >> enough about her but so patient like this requires follows up ♪ patient clinic and needs follow-up case management including of the ophthalmologist and she's has many others like her >> sorry can i go to the last. >> like 10 more seconds to wrap up. >> the burden open the staff

and the risk should be eliminated if we have full staffing to help the nurse practitioners with those patients i'm asking on behalf of the dedicated nurse praugsz practitioners to expedite the hire of nurse practitioners and hire more operations to prevent a miss medication prescription calling back patient and abnormal labs or referrals and so on and so forth. >> okay>> thank you. next speaker, please. >> i'll read more cards (calling names). >> good afternoon. i'm a charge second radiology department with

the current hospital we're under staff for so many years for the last 4 years using recycling people technicians from 6 months as needed the six months registry we use so much moenz money and resources to pay the registry to have technicians we're professionals we have to have licensed can't have people that are not constantly and to keep it as it is and in the process of getting some of the you know temporary workers because they become permanent and still norwalk stuck at one person at this moment i'm trying to relate to you, we have a hard

time keeping people with the current situation that we have as far as the money we pay it is very less i train people they go to the new you know new hospital at all of those we lost 6 techs we trained they left they're making a couple of dollars less and they just graduated we have lots of proximate causes in the staffing and equipment working equipment the patient you know we don't have the resources to give the exact chair that the places are giving we're competing this is not a competition we're going to win. >> thank you>> thank you. next speaker, please. >> good afternoon. i'm terry representative of sciu i'm new to the bay area and starting

representing folks in the last few months i'm impressed with the city. >> what you have going as much as i'm impressed i have to say at the 60 or so clinics i'm decimated what i'm seeing we want to address that although the issues are started throughout the 60 or 70 locations two examples right here in the neighborhood that is at golden gate that was a vacancy of three to four eligibility workers and rather than getting those filled there were two eligibility workers at b 7 ivy rather than filling the vacancies at golden gate they'll take one of those eligibility workers from 50 ivy and move

them to golden gate to left leg the load, however, it left one person at ivy and backed up things and in addition it created another problem the person they took away from ivy was the spanish speaking person now these folks disfranchised that needs someone to interpret i think that needs to be address in addition speaking to those clinics we have an issue as far as security and if i can go past my for a minute. >> sorry your. >> if you could wrap up i should have done it but finish our thoughts. >> the shortage is of not having the armed folks guarding the folks is putting stress on

the folks working there as a result thank you. >> thank you. >> good afternoon, supervisors my name is ride share a registered nurse at san francisco general i work in the critical care department for over seven years and i can say that i'm proud to be a nurse another san francisco general i enjoy my job and the people i work with but ever since i've worked there staffing and hiring has been a concern especially in terms of safety patient and staff safety making sure we have applicable people to turn to feed people and give the proper care you know a lot of times we push our staff ratios to the brink when patient numbers if you can

wait and patients are sick we need bodies on the floor to help us to do the job safety i safely and getting give good patient care with outcomes i want to say as a shop std across the table i appreciate the efforts of supervisors and city h.r. to be more transparent in the hiring process and encourage them to upcoming continue to you know expedite hire for nurses and other ancillary staff and miscellaneous numbers in the department we have people that turn patients safely and get them out of bed and help the nurses to help the patient outcomes and physicians on that

in those staff positions unfilled at that time that is problematic and as of a former ucsf back injury i'll encourage them to push those positions forward thank you. >> thank you very much>> thank you. next speaker, please. >> so people that watch i believe the count down clock with red numbers make sure you follow that there will be one thirty seconds i'll hear a tun and thirty seconds left for your time. >> hi i want to address the board of supervisors and the directors and thank you for making this hearing possible and i'm here to talk about what was already said incidentally you can't pronounce my name i'm

a member of the team and i want to address the seriousness of having separate and additional funding for emergency medication this was not taken seriously i want to talk about the seriousness of that that as a trauma center we need more emergency medication that is has to be ready i work night and sometimes we have to call everywhere stanford ucla and medications have to come from somewhere so that was why i indicated we need at least separate funding for medication and then we also need staffing i work with the department and especially the 2450s and 09 to take care of the critical shifts

the iv and narcotics we need your help so thanks very much. >> thank you. >> thank you. next speaker, please good afternoon supervisors my name is kearney stand before you today first to say thank you, thank you for this hearing and thank you to d h.r. to recognize the need of the department of public health and practices trying to hire and what was wrong with the process it was taking so long in a city that leads in striving for excellence and providing for excellence why not in our department of public health have that same excellence i'm glad to know that the problem was identified in how long it takes people to get hired and now move to the next step we fill the

vacancies that have not been filed we have placed with our nurses and ancillary staff that truly need it's a team we work as a result team when we are missing eligibility workers or food service workers and environmental services workers the team is broken we want to make sure the whole team a complete that is step one but we need to move further and thank you to you to help us get to step two thank you team. >> good afternoon, supervisors i'm jason a nurse in the emergency department and san francisco general i want to remind people in 2008 with the law hospital moved into their facility the staff forced the

closure of department and san francisco general we're walking into the same situation i had the privilege of being a part of lean process that ron spoke to with the right staffing model and the permanent staff on hand we met last november to staff the emergency department that will be thirty percent more beds when this enter disciplinary team with the medicine director and the emergency department evaluated we concluded we needed 25 more percent of staff to cover the beds no commitment to any of the hiring in the last of months what do you mean it will mean a rupture to the time of issues in

the current department we were thirty percent vacant and our new state of the art fat will leave us less able to help folks this is not under scoring the medicine assistants or anyone live he will why are the ceo and the mayor unresponsive to this committee and why not meeting the new staffing in the facility when we run into enclosures god for bid the safety issues who is held accountable for that (clapping.) good afternoon my name is pete i'm a nurse n at san francisco general for 5 years i've been impressed at the rate by which we've been hiring in the nursing

department i was here last year at this time and wanted to focus on staff retention we have an issue with retainting the nurses at san francisco general i went apartment at the general and would have gone to another .6 position but i started working at ucsf who professes to have staff retention they offer staff 6 positions i get paid $12 an hour more and work less and on a daily gas at ucsf it will come up every once to two weeks they'll be short staffing their staffing model is filed and makes a tremendous difference to the