that don't flush, about the gunshots on a regular basis and their concern, i want them to know that i hear them. i lived it. and i will be your mayor too. when i think about our immigrant families, people who are living all over this city in the mission and chinatown and other places, wondering if the federal government is going to separate their family. i want them to know that i will fight for them and i will be their mayor too. [applause] for the small business owner who is struggling and feels that they're being squeezed out by big development on one side and city government fees on another, i want them to know that i will be their mayor too. [applause]

for folks who feel that the quality of life has changed for them in san francisco. our middle-class families who continue to struggle to survive in san francisco, many who are part of our labor movement and community, i want you to know that i will fight for you and i will be your mayor too. [applause] here in san francisco this is such an amazing city. and i want young people to know that their future will be brighter. their opportunities will be greater. their normal will change. i know that by working together that there is nothing that we can't accomplish. we have proven it time and time again with the craziness of what's happening in washington, d.c. on a regular basis.

every single challenge, every time that it's come down, we in san francisco, leaders from all sides, we have stood our ground and we have stood strong and proud. and i will continue to do just that as mayor. standing strong for all of our residents, bringing everyone together, looking forward to a brighter future. and working together. this will not be easy. this will require a lot of patience. it will require a lot of work. and it will require a lot of prayer. but i am hopeful. i am optimistic. i am excited about the future. about what we will accomplish because on this day we are committed to rolling up our sleeves and working together. i want to thank each and every one of you for being here today. i am excited and i'm fired up.

let's go do this and get to work. thank you, and god bless each and every one of you. [applause] >> it's a new day, san francisco. this is your mayor, london breed! [applause] i will never get tired of saying that. the future is female, san francisco. [applause] don't you forget it. congratulations, madam mayor. your majesty, if i may. i felt it needed something ext extra. all right, everyone, we thank you so much for being here as our ceremony is coming to a close. we want to end this day with a message of hope, faith, unity,

positivity, and the belief in a better tomorrow. and now joining the gay men's chorus to make a joyful noise, the world renowned glide ensemble and the change band. and they will be performing a gospel classic "oh, happy day." please welcome them all, please, glide ensemble change band and the san francisco gay men's chorus. [applause] (♪) (♪) ♪ oh, happy day ♪ oh, happy day

♪ oh, happy day ♪ oh, happy day ♪ when jesus washed ♪ when jesus washed ♪ oh, when he washed ♪ when jesus washed ♪ when jesus washed ♪ he washed my sins away ♪ oh, happy day ♪ oh, happy day ♪ on oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ when jesus washed ♪ when jesus washed ♪ when he washed ♪ when he washed ♪ when jesus washed ♪ washed my sins away ♪ oh, happy day ♪ oh, happy day (♪) >> oh, happy day ♪ ♪ he taught me how ♪ to watch ♪ and fight and pray ♪ watch and pray ♪ every day

♪ every day ♪ and live rejoicing ♪ every day ♪ every day oh, oh, happy day ♪ happy day ♪ oh, yes ♪ happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ when jesus washed ♪ when jesus washed ♪ yeah when he washed ♪ when jesus washed ♪ when jesus washed ♪ when jesus washed ♪ washed my sins away ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ he taught me how ♪ he taught me how ♪ to watch and fight ♪ and pray ♪ fight and pray ♪ watch and pray ♪ and live rejoicing ♪ every day ♪ good god

♪ every day ♪ oh, happy day ♪ oh, yes ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ say it together ♪ oh, happy day ♪ going to be a happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day (♪) ♪ oh, happy day ♪ oh, happy day ♪ oh, happy day

♪ when jesus washed ♪ when jesus washed ♪ when he washed ♪ when jesus washed ♪ when jesus washed ♪ he washed my sins away ♪ oh, happy day ♪ oh, happy day. [applause] >> happy day! oh, happy day! yes, the glide ensemble and the change band. thank you. thank you, everybody, for coming out for this most historic occasion to witness the next chapter in the history of our great city and county of san francisco. i also want to quickly remind you that mayor breed, love saying that, will be hosting a receiving line in her office room 200 for a short period of time as we wrap here. so, thank you, god bless you all, may god bless london.

god bless san francisco. and may god bless the united states of america. good afternoon, san francisco! it's a happy day. [applause].

>> neighborhood in san francisco are also diverse and fascist as the people that inhabitable them we're in north beach about supervisor peskin will give us a tour and introduce is to what think of i i his favorite district 5 e 3 is in the northwest surrounded by the san francisco bay the district is the boosting chinatown oar embarcadero financial district fisherman's wharf exhibit no. north beach telegraph hill and part of union square.

>> all of san francisco districts are remarkable i'm honored and delighted to represent really whereas with an the most intact district got chinatown, north beach fisherman's wharf russian hill and knob hill and the northwest waterfront some of the most wealthier and inning e impoverished people in san francisco obgyn siding it is ethically exists a bunch of tight-knit neighborhoods people know he each other by name a wonderful placed physically and socially to be all of the neighborhoods north beach and chinatown the i try to be out in the community as much as and i think, being a the cafe eating at the neighborhood lunch place people come up and talk to you, you never have time alone but really it is fun

hi, i'm one the owners and is ceo of cafe trespassing in north beach many people refer to cafe trees as a the living room of north beach most of the clients are local and living up the hill come and meet with each other just the way the united states been since 1956 opposed by the grandfather a big people person people had people coming since the day we opened. >> it is of is first place on the west that that exposito 6 years ago but anyone was doing that starbuck's exists and it created a really welcoming pot. it is truly a legacy business but more importantly it really at the take care of their community my father from it was formally

italy a fisherman and that town very rich in culture and music was a big part of it guitars and sank and combart in the evening that tradition they brought this to the cafe so many characters around here everything has incredible stories by famous folks last week the cafe that paul carr tennessee take care from the jefferson starship hung out the cafe are the famous poet lawrence william getty and jack herb man go hung out. >> they work worked at a play with the god fathers and photos he had his typewriter i wish i were here back there it there's a lot of moving parts the meeting spot rich in culture and artists and musicians

epic people would talk with you and you'd get >> president chow: the commission will come to order and the secretary will call the roll. >> [roll being called] >> second item on the agenda. before you for approval. a motion is in order. >> so moved. >> second. >> president chow: there's a motion and second. are there any corrections to the minutes? seeing none we'll vote on them. all in favor? opposed? the minutes have been approved. next item, please. >> item 3 is the director's

report. >> president chow: great. >> good afternoon, commissioners. i have three important items to share with you and then any other items you would like on my director's report. the first is we wanted to make sure that all of you knew that the department of public health are supporting the rescanning of the retesting of hunters point shipyard land to answer community health and safety concerns. the hunters point shipyard development has been the subject of recent media reports and community concern due to two major issues. the first is the rescanning of parcel a to insure residents of the hill top area are safe and free from exposure. the second is retesting a portion of the shipyard development that was effected by the fraudulent testing oh of -- of a navy subcontractor. the department of public health supporting plans to rescan and retest the land.

it would be conducted by the california department of public health and parcel g by the navy and it's a first step in the retesting of areas. defactions are necessary in the response raised by the community about whether this is a risk to the health and safety of current and future residents and workers. the health department encouraging people who are interested to participate in the comment period for the navy's work land on the parcel g retesting. it's essential to have a critical process that the community can trust. as you know, the hunter's point shipyard is a federal project of a clean up by the navy to prepare the site for an ambitious new development that will add approximately 12,000 housing units in san francisco. the navy is a lead agency for the clean up and the environmental protection agency is providing regulatory oversight. the department has been involved in this project for many years.

i would say over two decades. reviewing documents and working with the navy and the epa. we have also -- i met -- talked to the epa with several of our staff members this week and we are going to be having two meetings with them over the phone on a monthly basis to ensure that we are coordinating as well as the regulatory agency. we've had our staff member, amy, who has been our engineer in this area and i've also asked our environmental health director, stephanie kushing who will be supporting amy in the future around all of these needs and issues that we have to work closely with the epa and the navy on this. that is one of the items i wanted to ensure that the department is -- will be supporting the retesting and rescanning of this whole entire area of the shipyard. we also -- many of you have seen in the news an issue that i know

has been very shocking to all of you, which is the separating of immigrant families and we believe this is inhumane and posing health risks. the department of health joins the mayor, the mayor elect, our california senators harris and feinstein, public health and child welfare and many others in condemning the practice of separating children from families along the united states border with mexico as an anti-immigration enforcement policy. more than 2300 children have been separated from their families since early may. from the public health standpoint this practice is inhumane and they have the possibility to lead to short and long term problems for the parents and the children. it demonstrates the broad and detrimental impacts of child separation, abuse and neglect on the health and well being of children into their adulthood.

san francisco is a sanctuary city and we have reaffirmed a commitment to protecting the rights of our immigrant community and the department of health will continue to care for all san francisco residents including immigrants and to support our patients and clients and caregivers during this traumatic event. i know there would be families in san francisco who have immigrants from this immigration issue. we also encourage our san francisco residents to call the members of congress to voice their opinion. we have given the phone number for that. we have a very large way of impacting and advising our a tigs -- practitioners in our communities whenever we find a health concern. we try to be very careful about these because physicians give a lot of health advisories and we don't want to get them insensitive to these but we do want to list the conversation about when we are finding issues

like fentanyl overdoses and one of the things that the drug cartels are doing is that they are very smart in the way they are providing fentanyl. we have recently had a fentanyl overdose from suspected counterfeit oxycodone tablets in san francisco. an individual experienced a near overdose after getting a pill stamped with m30 on june 11th. no pill was available for testing however such tablets are readily available in san francisco. similar events have been reported in arizona. fentanyl has been an increasingly present in street purchased drugs in san francisco including as a white powder and contaminating methamphetamine, cocaine and counterfeit benzos. fentanyl test strips provided by syringe access programs have identified the presence of

fentanyl in many of our street purchased drugs. what we do when we find this, we first and foremost work closely with drug users and we have an organization that does this out reach for us. we wanted to lift the conversation to make sure that physicians and hospitals are well aware of this. many times some hospitals will not test for this kind of a drug and we want to make sure -- we are trying to make sure if we see a theme coming so we are good i think about getting to the drug using community but we also wanted to give to our practi practitioners. some of the actions is to refer patients with opioid use disorder to treatment. san francisco has treatment available on demand which can be accessed at methadone programs or triage center. we just funded $6 million, 3 million per year to expand our access and we have a street medicine chain that we will be work, out of the syringe access

centers and also on the streets of san francisco. those will also be available for practitioners and ensure any patients who purchase any street purchased streets have noloxon, either or direct them to the pharmacies. the pharmacies also carry it or to send to syringe access sites. patients who are using drugs should be encouraged to keep the medication with them at all times. those are the three important messages and then of course we have other items in our director's report and happy to answer any questions. >> president chow: commissioners, questions to the director either in her written report or the added verbal report that she gave us today? >> i have one other item i wanted to ask our cfo to come up and give an announcement regarding the new restructuring in the department concerning our

i.t. >> thank you, commissioners. greg wagner, chief financial officer. we have had a number of changes in our i.t. division and most recent of those is as of last week that departure of our chief information officer, bill kim. so as a result of his departure we will be making some changes in the i.t. division, really important time for i.t. in our department as all of you know as we are continuing to go through the electronic health records project as well as build out our infrastructure department wide. so with bill's departure we named the acting chief information officer for the department. we are at the phase now where on our ehr project wionna has been overseeing the project for a number of years so she's very close to it, very knowledgeable about that so we'll have a lot

of continuity there. she's been with the department for a number of years and so knows the operations. we are moving into a phase with the ehr project where we have gone from planning and building up the team to actually the build phase. so we are now in the build phase in the project management team, the staff is really in place. i was over there a couple of days ago at the offices and it's great for people working on the project. so we've really got the ball rolling. wionna will be reporting to me as we go through the search for a new director. we are going to do a national search for the new cio and we will be reporting to you on that periodically over time as we do our i.t. updates. we've also sat down and developed a plan for other gaps in the organization and some other changes that we need to

make just to respond to the change in leadership. we have appointed a chief operating officer and we are close to hiring a new ethic program director, that's a position that we've had but that has been vacant for a few months. that ethic program director will help a lot with the project development of the epic project to free wionna for more time on operations. we are also recruiting a chief information security officer to back fill a departure recently. i think that we are at a point where we have a lot going on. i think that we are actually in a point of time if we are going to have a change in leadership now is the time that we can take it. we are at a point where the project is really moving along. we are not making any changes to schedule. it will take some adapting but i'm prosecute -- i'm pretty

confident that we are well to do it and we'll get the pieces moving in place. we'll be reporting to you periodically as we do on the ehr proje project and our i.t. operations and let you know how things are going and if there are any issues. just want to let you know that those changes are going on and will start to have some new leadership in the i.t. division. >> also just to let you know, on our calendar july 17th is the next i.t. update. >> president chow: thank you. questions? commissioner guillermo? >> commissioner guillermo: thank you. either for greg or barbara, you mentioned that there were at least three seemingly key positions that are open. do you have a timeline for each of those? i'm just thinking about how difficult in this, you know, area it is to recruit and given that we've got a pretty strict

timeline for our implementation what the -- just knowledge about what the potential disruption might be. first of all i wanted to thank you and barbara for making sure that all of those gaps are filled in the interim. those are three key positions. >> yeah, that's definitely a great question given some of our processes with hiring, which you're eluding to. so for -- aside from the cio position, the other two, the epic program manager and the chief information security officer, those are two that had been vacant previously and so are already in process. i think our cio had reported those hiring plans in place at the last i.t. update. so i wanted to just kind of flag those for you as in process. but the fact that they are already in process means they will be on board relatively soon. i don't know what the exact

timeline is. we are interviewing candidates for the epic program director right now so that should be a pretty quick hire. on the information security position, we are working with the department of technology who has recently gone through recruitment for that position for the city department of technology and they have some resources they are sharing with us to support us in that recruitment. so i believe that that will move on a timeline that is faster than the standard timeline that we would be if we were starting from scratch. so we'll be able to jump a couple of hurdles. so i would hope that we would have those positions within a matter of a couple or a few months. >> commissioner guillermo: and do you have constants given the demand for talent at this high level, particularly the cio, that we are in a position to compete for that talent?

>> i think that we are in a position to compete. i mean, it's absolutely a fair question. it's a tight market. i think one of the things that gives me confidence is number one for people that are healthcare i.t. professionals, we are an exciting place to be because we are doing a lot of things that are not happening elsewhere. but just given the fact that we are in this implementation and the scope and range of things we do within this organization and our focus on community aspects of health, but the second thing is having gone through the last several months of ramping up our organization for the ehr project, that was one of the questions that we kind of flagged as we were going into hiring for the ehr project is given the market out there would we be able to attract and recruit enough in this market to

fill that program. we have been really successful at that. so we found ourselves to be competitive and an attractive place to come work. it will take an active recruitment and we are going to do that. we are not just going to be able to put out the posting on our website but we are going to have to be very proactive and going out and recruiting nationally and then also tapping into networks from the people within the department. we'll work hard at it but i'm optimistic that we are a competitive and attractive place. >> i want to add two things. ehr has a streamlining process to hire i.t. because of the exact things that you just talked about and also epic is a major event for anyone to want to come in and help us with. it is very attractive in that way. the first issue is the fact that ehr has seen the issue of the department of human resources.

mark is wondering what ehr is. the first issue is there's a streamlining process for us to hire so they have a special recruitment process and i think that's going to help us tremendously on this. >> commissioner guillermo: great. that's good to know. thank you. >> president chow: did that answer your questions? thank you. further questions at this point? i have several comments. one is that mr. wagner in fact will be as we heard and that gives me the confidence of being basically the acting cio at this point in time, managing the project and as we know much of the management is really related to also all the things that still need to do through. while we watch in the future the rebuilding of building five in all those contracts were handled and are handled by over people,

in this case as you know, the finance committee is handling all -- millions of dollars worth of contracts. i think that we can take confidence that mr. wagner being our contract and finance person will actually be able to make sure that those are being done appropriately. without that then we don't have the tools to even have our -- to be new cio to have the ability to carry out the programs. i think that was one where we already saw that pie last time where less than perhaps a quarter of the contracts have been totally led and we've got a long ways to go. so to have that not only remain under his supervision but he will now be directly involved until he gets the new cio will be helpful for us. i think there has been a lot also done up to this point with

the changes of our i.t. system here for the last, what, maybe five or six years in which we've actually moved it into the 21st century. it was probably somewhere in the 19th century for many years here. even though we still have multiple systems, at least we had systems. they were all getting put together and i think it's with the work that has been done and will continue to be carried out. i think the department has a good blueprint to carry it out and we've all seen that and we expect that on our quarterly reports. i'm understanding from mr. wagner that there is no real delay in the roll out of our programs and the continuation of the infrastructure.

so i think that was very good. it is going to be good for us. the other aspect i will point out, especially to our new commissioners is that the hunter's point issue, the shipyard, and the shipyard clean up has been going on for many, many, many, many, many years and just to even see residents down in hunter's point at this point has been quite an accomplishm t accomplishment. it's probably taken as long as even building out the whole mission bay thing if not even longer to actually get to development at hunter's point. i think the department's position that of course we need to build the confidence of our residents and to be sure that they are safe over there by retesting the land to be able to show that it is safe and if there are areas that need remediation then those are the things that need to be brought

forth so that the residents there and future residents will have confidence in the development, probably the last large development in san francisco for quite some time. so i appreciate that and i'm sure the remaining of the commissioners appreciate the position that the department is in to help support that which will be done by the navy and by the california department of public health. so we would expect to hear back the results as the director said once those reports are completed. so our role is to be sure that the public is protected and that the studies are appropriate and that is what we are going to be carrying out. if there are no further questions then we'll move onto our next item, please. >> there was no public comment requests for that item. item 4 is general public comment. i have not received any requests.

so we can move onto item 5, which is a report back from today's community and public health meeting. >> good afternoon, colleagues and members of the audience. i'm going to give a report in the community public health meeting. we had two presentations today. one from the in for learning an innovation. they have specific activities which i'll articulate at this point. they do internal capacity building, needs assessment training and technical assistance, workforce development and they have a summer hiv/aids research program which recruiting college students from around the country, particularly college students of colors and introduces them to a model of research so they can make decisions about whether or not they want to engage in there. they have a future program, which is a program designed to deal with people of color and

help them develop skills around research and activities as it relates to public health. they have an external program which is cdc funded which is capacity building assistance for high impact hiv and they do that nationally as well as locally. they have an innovations program which is california preterm birth initiative, it's a community-based par tis -- participation resource program. they have digital story telling. they shared with us digital story telling with regard to their research for young minority students who are interested in engaging in public health research and the practices that they engage in. that program is called shark. -- called sharp. i had the opportunity to be a sharp adviser many years ago.

i'm glad that's still going on around hiv and aids. i'll stop there with that particular report. if there's any questions i'll make my best effort to answer them. >> president chow: thank you. commissioners, questions? since you indicated and i think that's correct, right, the center is actually one that assists different areas to do training and it's not actually out there creating health programs. >> it is not creating health programs. it provides training both in san francisco and nationally in cdc funded programs. >> president chow: okay. thank you. commissioner, did you have a question here? >> commissioner bernal: no, just underscore what commissioner loyce scahared, i think it's important that it's provided services in more than half of the states in the country and it's really showcasing the excellent work that's being done here in san francisco in terms of hiv

prevention and getting to zero. >> president chow: wonderful. >> vice president loyce: i would also add to that that one of the thing that is this group does is it recognizes that we can learn from other communities and it's willing and receptive to hearing from other communities. i know that san francisco has a reputation of being all that and a bag of chips but in fact we can't learn. >> president chow: do you want to proceed with the second presentation? >> vice president loyce: the second presentation today was from the primary care unit of the san francisco health network. we've presented some very specific work that they are engaged in. they talked about their 3-year relationship with lane and in the lane process they developed and implemented a daily management system that allows for managers to work with the staff around lean objectives and

take their staff and give them the information to allow them to respond and develop lean objecti objectives. one of the goals and the out comes they expect from this is it improves staff moral and ability to manage the services they are providing for the population and it also most importantly gives patients the opportunity to feel connected to and involved in the work of our organization, of primary care particularly. one of the things they are focused on in this report is they wanted to have 70% of the clinics in san francisco do a 7-day post hospitalization follow up with those patients. one of the things they talked about in the tenderloin, urban health hit a 68.2% which is very close to the 70% goal that they had for that center and they

gave us a list of all the centers and where they are in relationship to meeting that 7-day goal and some are closer to it than others but everybody has a plan for addressing it. and with that, that concludes that portion of the report unless commissioner burnel has something to add i'm open to questions. >> president chow: so on the report it seems to indicate that several of the clinics have not or in the schedule will not get to a lean process until 2019. >> vice president loyce: that is correct. they are doing them in cohorts so they have done cohort one and cohort two and cohort three and four will begin in august. cohort three will begin in august and cohort four will begin in october of 2018 with a

completion date expected in january of 2019 and cohort 3 finishing in february of 2019. it is a lengthy process and not something that one can do in short order. training is done primarily by our executive staff in both the networks and in primary care. >> president chow: so in the meantime these other cohorts, are they participating in some sort of a score card or base score card program even though they don't have a lean process? >> vice president loyce: what happens is that dr. hammer hosts on a monthly basis all of the senior managers involved and providing services so they get an opportunity to hear from those cohorts that are actively engaged in the lean process and

they also can begin to apply some of the tools that are being utilized even though they may not have the specific training that cohort one and cohort two has. so once a month 90 people get together to walk through this process. >> president chow: any other questions? yes. >> commissioner guillermo: just a comment. i'm very pleased to see the progress or the process that's been put in place, particularly focused on primary care within the network because i think -- i don't know for sure but it appears very unique to me for this to be in place. i'm althoug also really excited the lean process and i'm looking forward to the reports that will be coming forward for us to review and ultimately the

difference is going to be making in the lives of our patients here in the county, particularly those the most vulnerable and i just hope we are at a point where other counties and other cities are going to be able to look at us and see what we are doing and really sort of maybe model or collaborate on the processes that are being put into place. >> thank you, commissioners. we have also just to note are taking the lean process all the way north for the entire department so it is a leadership issue that we are all very supportive of and we find that we have focus on quality and it also focuses on our patients and consumers and residential individu individuals. it will do well as we are putting our ethics together

because we are using that same methodology. we found the alignment within the department is pretty easy and part of it was because we really did begin with some of the major entities and want to just make sure that we know that it was the one that started this journey for us. we've been trying to catch up as a whole department. it's an incredible journey and one that we will continue on in the department. we are investing in this process and improvement. >> president chow: i just had a thought in regards to the lean process and trying to measure its effectiveness since several of the cohorts don't start until like nearly 2019. does it make sense to see whether there's a difference in performance between the various clinics that is using lean and those not using lean? i just ask mr. pickens if --

that's just a thought. maybe we have sort of a built-in, you know, test here. >> a double blind study? >> president chow: it's not quite double blind but one -- you know, several clients are using one process to try to meet your measurements and others are, you know, not using that process. i'm just wondering if there's any possibility of trying to understand the difference that might occur because one is using lean and one is not? >> thank you for that question. i apologize for not being at that presentation earlier. i was in another meeting so i wasn't there to hear about these different cohorts. so all the clinics within primary care are using the same metrics and they have gone through the lean training so i need to find out more about what this is about the different scheduling of the cohorts

because to my knowledge all of them have gone through their lean training so i need to delve into that a little bit more to understand how that got reported to you. >> president chow: okay. maybe i'm misunderstanding. commissioner loyce? >> vice president loyce: i think that part of the process is, yes, everybody has gone through training but you can't do this big box of training so there were primary cares doing this, taking the principals and the objectives and the metrics and applying specifically to primary care clinics and making it useful to those clinics for the work that they do on a daily basis. the seven categories if you look at them, they are in this document here, i want to get them quick all from the same department. care experience, financial development, financial stewardsh stewardship, quality, safety and equity. that's for the whole department. nothing is different there. so take those and everybody in the department understands those

six, seven objectives and now it's the application of the lean process to them. so as i said earlier, all 90 of the folks who are in primary care in terms oh -- of the seniors have had the opportunity to sit down and have discussions for what we are doing for cohorts in one and two and those in three and four they will get the primary care page but they have the information they need from any department wide perspective. >> so it is true that not every employee within primary care has gone through the exact same lean training, it is a roll out, a cohort process. so there's at least a team of leaders through each clinic who have been through it. so now it's who are the remaining staff in the clinics who still need to go through the process? they are still implementing the lean methodology within all the clinics. they just happened to get caught up in making sure everyone went through the training.

we have new people that may have come on since the staff have been trained and those new people need to go through the next training process. >> president chow: commissioner. >> commissioner bernal: two points to note. number one, this was just focusing oun with -- on one of the metrics, which was safety and 7-day post hospitalization follow up. so it's just to illustrate the progress in the clinics. the second is the focus was on front line managers in terms of engaging them and those front line managers had a patient focused approach. >> president chow: okay. thank you. so as i understand what you are saying, is that all of them are actually using lean and some are a more in depth training for the staff versus others or some may have put in a process for every day huddles and things like that and the other people haven't. >> so my understanding is they are all using the -- what is called dms, daily management system. >> [inaudible speaker]

>> come on up here then. >> president chow: it's okay. we don't really quite know. you can come back and let us know how this is working. >> good afternoon. all of primary care -- >> introduce yourself. >> dr. alice chen. all the primary care clinics are using the lean true north metrics. some of them have embedded daily management system in the daily huddles and daily work, others have used some pieces of it like the visibility walls or occasional huddles but that's the roll out, the full on daily management system and that's tied to our epic implementation. >> president chow: so go back to my first question then. does it make any, you know issues -- you know, any sense to say that this first block do or do not perform better than the blocks who haven't gotten all the training yet? >> you are thinking like a scientist. i think the issue is that the

reason certain clinics are chosen is because of staffing and leadership issues. that are are actually qualitative differences. >> president chow: okay. i won't ask further. >> commissioners, we are getting updates on a regular basis around lean as a whole. as you know in our meetings with both jccs we are trying to standardize the way we report out in a lean model so where he will continue to give you updates on all parts of the lean journey for us. >> president chow: thank you. it's going to be an interesting process. >> commissioners, the next meeting is item 6, a vote to hold the august 7th, 2018, health commission meeting at the richmond recognize creation center, located at 251 18th avenue.

you all need to vote to move a meeting so the public can be notified. >> president chow: so commissioners, the action requested is before you and so now we are required to follow our rules. we can say that we actually now have to have a formal motion in order to hold the meeting at the richmond. so i entertain a motion. >> so moved. >> second. >> president chow: all right. is there further discussion? if not we will then proceed to the vote. all those in favor? all those disapprove? we have passed the motion and we will be holding our august 7th health commission meeting at the richmond recreation center. >> if i may, president chow, during our community meetings we do several standard work issues there. one is that we give a background to that community in terms of data and the status that we have. we also bring and invite community members to give us their perspectives on the health

status of the communities and then we invite our providers from the communities as well to talk to us and tell us about the work that they are doing. so -- and then neighbors and others come to testify or to listen. so just to let you know, we do that out reach before these -- meetings. i've gotten compliments because we go to them. >> president chow: thank you. i forgot that a number of people have not been to our community meetings. we do invite the representatives, the supervisors from those districts to be able to come also to both participate and hear what the local residents are saying. >> and our supervisor in that area is supervisor fira and we have had conversations with her about this coming up meeting and she's very excited. i think we will try to have her and her staff there. >> president chow: very god.

-- very good. we actually look forward to the neighborhood meetings which are very informative for the commission and most importantly also provide the neighborhood as a form -- forum for them to present what they are doing and what their needs are. so thank you. we'll proceed on to the next item. >> item 7 is the 2016 public bond update. >> mark primeau, capital projects director's office. so there's one error on this slide two. it should say accomplishments since the march 6th meeting that we had so i just wanted to make sure that that's was correct.

so it's not going down, mark. so joining me today on the left is joe chen from dpw and then terry from zuckerberg and then on the right associate vice chancellor, michael from ucsf. this is the first bond sale in 2017. we are only tracking the money that came to dph. the june bond was a $350 million bond split between three agencies of which dph received $272 million. this slide just shows you the

break down of the actual authorization coming to dph. then on this slide we are tracking expenditures and -- we are showing 23% expended. in march we had about 19%. we are not spending as fast as we originally projected and primarily that's the result of having -- instead of -- like when we did the rebuild we had a very large project that had large costs attached to it. in this bond we have several hundred small and enabling projects that have small numbers attached to it. a lot of those projects aren't in construction so you're not seeing as high expenditures until the next maybe two quarters you're going to see a jump up in that. now this is a break down just looking at building five, which is the $222 million of the $272

million. so we are about 10.5% expended. then the next slide shows the community centers, which is the balance of the $272. they are spending around 11.4. i'm going to turn this over to terry and he can go over the accomplishments. >> good afternoon. i'm terry salts from zuckerberg capital programs reporting to you about our accomplishments. i'm happy to say that we have some cause for celebration in this timeline of accomplishments in the last quarter. if you look at -- to point out to you the urgent care clinic, it received its certificate of occupancy. we are waiting for licensing to be complete todayd to provide p

care. we got through the huddle so that's cause for celebration. we started celebration of the ntp that was issued. additionally, we got our plan approved for a seismic retrofit. major hurdle. in june ncp was issued so construction is now beginning. so those are all very great milestones to be celebrated. i do want to point out to you the mechanical core phase one, electrical core phase one. we are getting those studies underway. those are important because it's going to look at existing infrastructure and how it can be applied to these new projects. one example of that is the electrical core of phase one. that will be a study of the electrical distribution. it was a hospital building and it happened emergency power. within this day and age with the

i.t. infrastructure emergency power is a big deal. this gives us the opportunity to look at it, study it and redistribute it to the new needs. moving to the next page, that's the ambulatory care accomplishments. we can celebrate that vaccine hall got the 100% design drawings complete and submitted to the building department for review. the projects are winding thundershower way through the review process and civic review and eir process. so those are not great at construction but they are making their way. i do want to point out that we did complete the seismic assessment at tri-town health center that's being digested. you'll have more information about that next time in your

report. additionally, we are beginning to do seismic assessment in the city clinic. with that i'm going to pass the baton to joe chen from dpw. >> thank you, terry. good afternoon, commissioners. joe chen, public works program manager. i would be providing updates on the upcoming milestone, the activities on the zuckerberg building five component as well as the community health center component. so let's focus first on slide number 10, that will be on zuckerberg building five. we are currently tracking two projects in construction. this is well into construction. contract had some -- had a slow start to get all their infection control submittals in pce