2014 budget but any additional questions if you like to i couldn't i'll be happy to. >> thank you for presentation thank you. >> thank you. >> good afternoon. i'm ron the human resources director for publicity i was here a year ago and gave a presentation similar to this i want to let you know we've followed up on items to better track our hire and supervisors are informed and monitor the process we implemented 5 event one in audubon society august of 2014 and that was at that time, we find the nurses hiring was average hundred and 93 days and we wanted to knock that down our goal to reduce temporary

employees we've developed mayor's office of housing and economic development matrix weekly reports in the tunsz improvement part we've partnered with not only the dui department of home sharing and the lean in august the controller's office was there and union representation we had county representative and continued that model i'm going to turn it over to briefly to the department of human resources and ted will explain about the partnership thank you ron arrest supervisors good afternoon. i'm ted the manager deputy director about a year ago mickey the home sharing director asked me to work with the department of public health and to identify and address the

amount of time to hire a re7b8d nurse at san francisco general the partnership was established between dph and h.r. the work of the aspirin began with a thorough and holistic approach to identify all the steps it takes to hire a registered nurse from the point of vacancy to the nurses first day on the job we identified what steps and who was doing that work and how long that was taking and importantly what that work valuable in hire a registered nurse and placing that individual in a position we discovered that there are so many processes in the system that are merged by stakeholder westbound the dph and the mayor's office of budget we identified on average where an hundred and 90 to 2 hundred days

to hire a hire a nurse that was anecdotal true it takes too long the good thing about the data it serves as a post we could attache case attack what we needed to implement in a efficient process based on the data director callahan helped us to develop a process but maintained our core values of merit based hire some of the successful hiring the krument activity clearly if we developed a quick selection process unless we can target the candidate pool we recognized as a merit system under the civic rules documentation of progress and selection are necessary; however, the current process was

paper intensive and another strategy to do you want a selection and communication to us this meant for the first time we're prioritizing the candidates in the selection process we wanted our new progress to be respect and the efforts to apply as well as mooefb updates to the candidates to they misunderstood would was expected and the timelines they had to deal with us in get thirty to that selection process this transparent opened up the door and we heard about the process and all of a sudden no communication through the partnership and the labor partners we've got a new hire we call it the pc p hiring process we believe that it can serve as a model for other clarifications

citywide that maybe experiencing hiring details one of the key components we accept applications and allow the candidates to an online on demand process we we implemented an e electronic for current nurses working in dph for the same class a repositioning that was manual and paper intensive and eliminated all process steps that caused details and we believe the selection steps were important were met simultaneously to the extent possible expedite the process we better defined the nursing role with the flexibility and discretion they needed under the civic service rules to select

the most qualify for the position we've provided hiring books and on demand videos to make sure our efficiency is sustainable about again, it was designed to increase the effectiveness and to reduce the hiring timelines from hundred 90 today's to 40 days and ron will provide you with hiring timeline data we've received from the duplicate and it indicates we've been successful or made significant improvements in reducing the hiring time more importantly we believe we've delivered a comprehensive hiring program. >> the pcc p was launched in april of last month. >> the way we launched it many components are take place in

order for the hiring manager to have eligible folks interested in the position we launched it now for the first phase with dph was to insure people were provided with information submitting 0 online on the documents we needed at the end of the process causing delays and provided a milestone maker so the process includes the following steps and the timelines to include the steps that led to the companionships of eligibility and the civil service rules to see if they're interested in a position that process is happening as we speak the first real access to eligible candidates in positions will happen later this week to the hiring manages to start.

>> thank you when i visited the hospitals a lot of the nurses talked about how long it takes in the past that many nurses decide to not work for the city but elsewhere i'm wondering if there was a look at others dph systems in the private or the non public sector that helped to put together this plan and how do you see comparing to what is happening to people discussing to stay have we eliminated those barriers. >> supervisors we've attempted to eliminate as many barriers as possible we're within the civil service constraint ware merit based so we attempted to eliminate all of the hurdles that caused the details in the selection process major focus of this program is

really providing the hiring managers with discretion and flexibility to make the hiring decision to identify people that are best qualified for the position under the old system supervisor a tremendous amount of rigidity in how much flexibility a hiring manage would go under the referral if the hiring manager was unable to make a hiring discussion we at human resources had to back out of the positions tied to the referral in order to give the hiring manager flexibility we tried to do all the work up front in h.r. and better dining room the hiring managers have an obligation to identify individuals that are best suited for the job they 14 interview the people in h.r. we want to make sure the data that the hiring manager has access to the

materials at the their fingertips there are significant details in the selection processed we're waiting for documents to get mailed or sent in and sow we were detailing what the hiring managers told us the opportunity to express interest in a key candidate we've heard again and again the manager has a candidate in their greatest i think the process will take oath 3 and a half months we want you to stay with us we eliminated those that opportunities if we do our jobs right in h.r. the 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. >> 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