training hours across the organization. the training is currently anticipated to be organized around learning modules an they're online. sort of completion about 300 and 165 in-person training. that gives you a high-level summary of how staff and leaders are being engaged in this planning. so right now the current state is we typically schedule patients and then we do the registration and medication at check-in. we try to do a little about that and the patient financial unit tries to do some insurance verification in advance but doesn't hit everyone who shows up. so what we did during the groundwork phases, epic

typically recommend as a combined process of doing scheduling and then doing the registration verification at the same time. that's the ideal state because it ensures when the patient shows up have you the payer to get paid nor -- for the service and they'll do best practice recommendation and we're trying to figure out where our gaps are and vulnerability and make sure staff are trained to do that. during the direction setting, we wanted to demonstrate what registration work flow looks like so the subject matter experts the 900 or so essentially the relevant people saw that and began to say what are the right adoption decisions we need to make during the adoption phase and how do we begin to prioritize and do due diligence around that? and during the adoption phase the domain groups are

identifying the right champions an subject matter expert to inform the build and identify the gaps. we broke them out into four major areas. either there are gaps in what people do now or gaps in not having the right people. the current project in terms of how different it is from the future. technology integration is critical in registration because there are -- the 85 or so contracts winona referenced, there's a number where our schedulers or staff really have to interact to ensure eligibility whether they go outside or check does this person truly have this insurance. there's technology integration that we are uncovering that needs to be incorporated into the training or work flow. and all that gap are being

identified prioritized and work through to next april when they'll have a hard stop and is a no more gap closure. we need to sift everybody to training. during the next phase we'll make sure the domain groups and subject matter experts validate the training curriculum. the content to be taught so our staff understands what they'll be using, how they'll be using it and how they will be accessing information or communicating information to the next person down the work flow stream. and as well as confirming the super users so it will be the domain groups to identify who are the influential leaders in that particular program who actually would make a good super user and then finally during the training, the domain group is going to make sure all staff complete the required training because nay don't they won't have ac stoes -- access to epic as well as make sure the daily

management system team is ready for go live because they'll play a critical role when we go live in what issues are poupg -- are popping up and how to triage and hopeful hopefully that help you understand how we're forming the overall planning. that's about all in terms of the ocm program. >> thank you. was there any public comment? >> i did not receive request for public comment. >> i think one question i did have overall was and you can demonstrate that later, in comparison to our prior schedules, i'm assuming because your go live date is still the same, august 30shgs 30 -- august 30, it would be nice

to know where we go with what we have. and your program has keyed out certain areas but as a visual, >> i can give you more of the grids but the schedule set in january we have not deviated from. we're on schedule. we intend to make our go-live. so far we are on track. >> when we transition from an extensive schedule with blocks and where we are now, it looks like pretty much what you got -- and these may be your new baselines that we're going to follow. and it will be just something that we can follow.

>> you can kind of see how it compares but it's identical. >> one is how much time -- i'm looking at the numbers for training and i'm trying to figure out how many hours do you anticipate the learning modules versus in-person sessions. do you have any sense for who will need which type and how that's going to allocate and anticipated changes in patient flow as you not only train but go live. it's clear several individuals in the system will be spending time well before august working on this and i'm just wondering what the projections are in your various clinics as well as e.r.s and what your anticipated additional staff will be naurngsd -- nursing and

provider side and account for the hours in these various activities. >> great question. i'll take the first one first with how much learning versus person. we are trying to map epic against our h.r. personnel pool in terms of what type of staff fits into what type of training. we have a complement of team in cha -- what content is relative for the training. a lot of that content is getting captured and incorporate into the training curriculum. we don't have specific yet but

in the next month or so we'll have clarity for who needs how much elearning versus in-person training and how much will be nurses versus docs versus critical staff in the front desk. we're working through that. second question, we have an article published that has a command centerers -- command centers and support to to backfill the training. while we currently don't have exact answers or even the vendors to provide the services, we anticipate to start onboarding by march or april or there about so when we hit training in may with all the resources are available to make

sure staff can go to training and still maintain the lights on for patient access as well as be available at the time of go-life with support. -- go-live with support. the answers on the other two with specificity because we're working through those. >> commissioner brannel. >> first your images of the closests before and after are relatable. on slide 3 you're talking about the i.t. improvements and you've increased customer satisfaction and are these the same mortgage you'll be uses once have you it fully implemented or will have you a new set of measures? >> we can continue to do

m.o.d.l. but we're changing that program as well so it's more operational direct mangers doing that. we're implementing a knew tool to measure things -- a new tool differently and better. some will change. i will prefer to give you what our network uptime is going forward now that we have a tool but this is all i had to go back to 2015. going forward, i think we'll use the more modern, accurate tools for measuring to looking at a system up is your customer service better and managing tickets better. >> and it will be actual staff using the system, correct? >> yeah. >> thank you.

>> we're looking at usage and satisfaction and around the live environment. >> these are great results so we look forward to seeing the next wave. >> it was a very extensive report and we continue to be on track. >> i want to acknowledge winona and albert for their work on this. the e.r. program i worked up close how many balls their keeping up in the air and coordinating resources of a huge not only the big project team but keep them engaged.

i want to acknowledge what they've done and i wanted to thank commissioner green who came came and spent time with the team and lessons learned in the process to watch out for. that was appreciate. thank you, commissioner. >> they brought the highest level of leadership from cnp to the meeting and i was grateful because they added more than what one clinician could add. they brought clinical people as well as hospitalists so it was useful. >> greatly appreciate it. commissioner green, thank you for making the contracts an getting the information. it's clear our project is in good hand at the moment.

we appreciate your work. >> on that there's no public comment and can move to item 12 which is the human resources update. >> thank you. good evening commissioners. director of human resources for public health. i'm going to take just a minute to introduce a couple numbers of my team. we've had a lot of turnover in

the last year so back here we have rhonda simmons. she's now the director of labor relations an diversity. then we have karen hill, she is over merit and operations. she also does the line -- lien project for us and elaine lee does peoplsoft and e-learning. we have two other staff, luis brooks houston for the honda central office area and hailey albert over eeo and ava. i want to take a moment to introduce them and we have representatives from laguna honda and zuckerberg and ambulatory care. those are our customers. i'll give you a quick update and answer any questions you have. i want to talk about ep thangd electronic -- epic electronic

health records and we have a key role and we're getting more spent on epic and ehr. phase one we did a lot of hiring and phase two and we have a lot of h.r. work to do. one is what are called vacation plaqueout dates. so because we need to train up to 10,000 people on 300 online modules an 100 in-person courses, we're asking people to restrict vacation from early may to the end of september. so we need to meet to negotiate in terms of something reasonable. right now we're delaying approvals. so that's getting a lot of attention from our unions an staff. what's holding us up is the training modules an the ability to schedule them in the electronic learning system.

the other thing is as we redesign the work in the clinics and other areas to do the eligibility and registration, we'll have to change some of our classification and have more class fictions. we'll have to work with unions on that as well. so hailey albert works for rhonda simmons. these are just what we had noticed is we didn't have enough staff management cases and disability accommodation so we've staffed up as you can see we went from three staff to 10. and hailey has done a lot of with the staffing to help us respond more quickly to complaints. that allows us to reduce risk. so showing the complaints where it comes from and where the complaints come from and it pretty well mirrors the size of the organization for example, zuckerberg you would expect more because it's a larger piece of

our organization. you recall or probably saw there was a hearing in september on racism and discrimination in the workplace and a lot of the management here listened to the complaints an these are some of the activities we're doing working towards a more fair and equitable workplace and we're taking initiatives at zuckerberg and dr. bennet is doing work on in the same area and will give a presentation at an upcoming mighting. labor relations. that's under rhonda simmons. we have bargain this year it

starts about march and ends in may to be approved by the board of supervisors. this is a breakdown of unions and the largest is over just 4,000 in the miscellaneous group and if you add nurses it's about 6,000 staff. they looked at the work we're doing and this gives the idea of the work. we always look at the lowest form of conduct so counselling and last thing you want to do is terminate or do a suspension but we do use that as a tool as well.

we needed a whistleblower complaint to work on lean. that work is now going to be done by karen hill because she had done it at zuckerberg and will do it for the rest of the department. they worked with the office and worked with maggie rakowski. we also have done a lot of work in hiring to create more path ways. we looked at black nurses conference to recruit diversity and make sure once we recruit them we have a program for mentoring and support to have a retention rate. and here's an example of the gross period and then the number of transactions. win payroll it's like other

things in h.r. you don't hear about until you make a mistake. they don't make a lot of mistakes but emain is -- elaine is working for quality assurance to make sure we have metrics in place. merit does a lot of postings an recruit manies. -- recruitments. the job market has tightened so you'll see let applicants. we're screening out those who don't qualify. we're getting better about screening and job posting and the job market is tightening so you'll see less applications overall. this is new hires and processing.

this is what we hire most in which is nursing and other classifications you may find of interest. karen has created a leaves team to manage the complex leaves. it's better for the customer those employee because they have somebody being responsive and better for us because it reduces liability because we make sure you get your protected leave but don't take more than your eligible to receive. performance appraisals is a big push and want to see people complete their appraisals and gotten better at getting mangers to do that. we have a big push right now to ramp up the last period which

was ending the last fiscal year. with have workforce development which say training we now have a training function and we have a service awards program for non hospital employees and career coaching has been popular. any questions. >> no public comment. >> commissioner green. >> how many leave now has that been stable?

>> it's gone up because the state and federal have created more and it's become fairly stable and we want to give you what you are owed and deserve and in the past there was not good control once you went out at leave to come back promptly at then of the period so we're getting better and it's fairly constant. operation managers and executives want us to rein that in and we work with them to do that. other question or thoughts.

>> we looked at how things would work out and is already giving us insight into the areas of responsibility. i want to congratulation you and your staff. you're doing an exceptional job in meeting the continuing challenges pertaining to the workforce. thank you to you and your team. >> thank you for those comments. >> we received a number of updates which show the

comprehensiveness to the other areas same question in a way. we have a 2017 analytics on your slide eight. it would be good to know whether woe have more or less and whether it's meaningful to relate it to just simple numbers or is it to a number per thousands of employees that we have? and where we might go in the future. what benchmarks we have and what objectives we would like to do, in other words, if there's 113 written warnings -- maybe we should have more written warnings and less dismissals.

i don't know. it would be something that would allow to us understand how well we're doing on labor and where we have successes an needs. also, when you get to diversity, where are we with diversity in terms of what goals do we want? and we have spoken about it can't just be simple numbers and so there's a tricky number but at least as we're looking at data, is the employee workforce gaining latinos.

and that's the next iteration of the reports would be helpful. this will be benchmark and the demographics, we did do some early demographics work and we will be able to pull that together. we will be able to do some comparison so the next report we'll able to do labor and demographic. >> it enhances your report. >> other questions or comments? >> any other questions? for the update today this is helpful in understanding where we are this year in the department and we appreciate that. commissioners, item 13 is other business. if you look at your calendars i'd like to point out one thing.

the meeting on november 7 has been canceled so note that for your calendars an the november 6 meeting is the annual meeting and december 16 is the annual laguna honda hospital meeting so noted that in terms of location. >> do you have a question earlier from a commissioner. i thought it may have been on the calendar but it's not. >> when do we plan to get the mayor's instructions for commissioners to have an idea? >> so we will get a schedule anytime now for the mayor's five-year financial forecast.

that's the high-level deficit projection. and so as we go through that, we'll report back to you the issues on that. generally the mayor's office will issue that and we'll be able to see what the projected definite numbers are for the coming five years and two-year budget cycle and long with that comes the budget instruction. i would anticipate we'll have meetings in the months of

january and february to the commission to discuss proposals. >> thank you. >> we'll look at december as possible interview dates for the potential cant -- candidates an possibly into january depending on the availability of the candidates in terms of the search process. sometimes it's probably easier to say not this week.

any other announcements? >> through the chair. >> yes. >> i want to state the san francisco general hospital foundation had its annual grantee awards given on the 28th of last month at carl auditorium. and just to give you a baseline, from 2004 to last year the foundation is awarded over $12 million to csfgh for the innovative grants. what this particularly special is we had a unique outstanding speaker who spoke to our staff, awardees, etcetera, why he love san francisco in general and

love this grate city and gave -- great city and gave a great presentation and was had an exception well done presentation and we want to thank him on behalf of the san francisco foundation and board and a member who serves on the awards committee and etcetera. this takes place once a year where it's at candle stick park -- i mean at&t and this year at pier 48. again the monies go to support critical integrative programs and it was just an extremely -- we gave almost $600,000 to i believe 30 projects funded for this year. we want to thank the foundation and all the awardees for a job well done and also our commissioner for doing an outstanding job. >> thank you, for that.

thank you commissioner for -- so any other announcements or items of interest. if not we'll go to the nextite zbl >> item 14 is a report back on the joint conversation committee reports meeting. on september 25, 2018. >> the conference has met and the standards report regarding regulatory affairs in the hospital administrators report and human resources an medical staff report were given and you will see those in your minutes. we also had presentations on optimizing care experienced model in the zsfg way and this is to show the maturity of the lean process for my fellow commissioners.

actually, three of the four were there. in preparation for the november annual meeting, also the committee did review the various policies including provision of care, performance improvement, patient safety, environmental care, annual report and took on the action items of the medical staff which actually helped also confirm several chiefs and acting chiefs which will be in our minutes and in closed session approved a [indiscernible] report. and they again had a very outstanding meeting in their presentation. anything from our other commissioners in regards to that meeting? no? thank you. >> and now consideration for adjournment commissioners. >> there be no other business, a motion for adjournment sin

order.[music] >> san francisco city clinic provides a broad range of sexual health services from stephanie tran medical director at san francisco city clinic. we are here to provide easy access to conference of

low-cost culturally sensitive sexual health services and to everyone who walks through our door. so we providestd checkups, diagnosis and treatment. we also provide hiv screening we provide hiv treatment for people living with hiv and are uninsured and then we hope them health benefits and rage into conference of primary care. we also provide both pre-nd post exposure prophylactics for hiv prevention we also provide a range of women's reproductive health services including contraception, emergency contraception. sometimes known as plan b. pap smears and [inaudible]. we are was entirely [inaudible]people will come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with

her front desk seen that day. >> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> even has had an std clinic since all the way back to 1911. at that time, the clinic was founded to provide std diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquake and the fire a lot of people were homeless and there were more sex work and were homeless sex workers. there were some public health experts who are pretty progressive for their time thought that by providing std diagnosis and treatmentsex workers that we might be able to get a handle on std rates in san francisco. >> when you're at the clinic you're going to wait with

whoever else is able to register at the front desk first. after you register your seat in the waiting room and wait to be seen. after you are called you come to the back and meet with a healthcare provider can we determine what kind of testing to do, what samples to collect what medication somebody might need. plus prophylactics is an hiv prevention method highly effective it involves folks taking a daily pill to prevent hiv. recommended both by the cdc, center for disease control and prevention, as well as fight sf dph, two individuals clients were elevated risk for hiv. >> i actually was in the project here when i first started here it was in trials. i'm currently on prep. i do prep through city clinic. you know i get my tests read here regularly and i highly recommend prep >> a lot of patients inclined to think that there's no way they could afford to pay for prep. we really encourage people to come in and talk to

one of our prep navigators. we find that we can help almost everyone find a way to access prep so it's affordable for them. >> if you times we do have opponents would be on thursday morning. we have two different clinics going on at that time. when is women's health services. people can make an appointment either by calling them a dropping in or emailing us for that. we also have an hiv care clinic that happens on that morning as well also by appointment only. he was city clinic has been like home to me. i been coming here since 2011. my name iskim troy, client of city clinic. when i first learned i was hiv positive i do not know what it was. i felt my life would be just ending there but all the support they gave me and all the information i need to know was very helpful. so i

[inaudible] hiv care with their health >> about a quarter of our patients are women. the rest, 75% are men and about half of the men who come here are gay men or other men who have sex with men. a small percent about 1% of our clients, identify as transgender. >> we ask at the front for $25 fee for services but we don't turn anyone away for funds. we also work with outside it's going out so any amount people can pay we will be happy to accept. >> i get casted for a pap smear and i also informed the contraceptive method. accessibility to the clinic was very easy. you can just walk in and talk to a registration staff. i feel i'm taken care of and i'm been supportive. >> all the information were collecting here is kept confidential. so this means we can't release your information without your explicit

permission get a lot of folks are concerned especially come to a sexual health clinic unless you have signed a document that told us exactly who can receive your information, we can give it to anybody outside of our clinic. >> trance men and women face really significant levels of discrimination and stigma in their daily lives. and in healthcare. hiv and std rates in san francisco are particularly and strikingly high were trans women. so we really try to make city clinic a place that strands-friendly trance competent and trans-welcoming >> everyone from the front desk to behind our amazement there are completely knowledgeable. they are friendly good for me being a sex worker, i've gone through a lot of difficult different different medical practice and sometimes they weren't competent and were not friendly good they kind of made me feel like they slapped me on the hands but living the sex life that i do. i have been coming here for seven years. when i come here i know they my

services are going to be met. to be confidential but i don't have to worry about anyone looking at me or making me feel less >> a visit with a clinician come take anywhere from 10 minutes if you have a straightforward concern, to over an hour if something goes on that needs a little bit more help. we have some testing with you on site. so all of our samples we collect here. including blood draws. we sent to the lab from here so people will need to go elsewhere to get their specimens collect. then we have a few test we do run on site. so those would be pregnancy test, hiv rapid test, and hepatitis b rapid test. people get those results the same day of their visit. >> i think it's important for transgender, gender neutral people to understand this is the most confidence, the most comfortable and the most knowledgeable place that you can come to. >> on-site we have condoms as well as depo-provera which is also known as [inaudible] shot.

we can prescribe other forms of contraception. pills, a patch and rain. we provide pap smears to women who are uninsured in san francisco residents or, to women who are enrolled in a state-funded program called family pack. pap smears are the recommendation-recommended screening test for monitoring for early signs of cervical cancer. we do have a fair amount of our own stuff the day of his we can try to get answers for folks while they are here. whenever we have that as an option we like to do that obviously to get some diagnosed and treated on the same day as we can. >> in terms of how many people were able to see in a day, we say roughly 100 people.if people are very brief and straightforward visits, we can sternly see 100, maybe a little more. we might be understaffed that they would have a little complicated visits we might not see as many folks. so if we reach our target number of 100

patients early in the day we may close our doors early for droppings. to my best advice to be senior is get here early.we do have a website but it's sf city clinic.working there's a wealth of information on the website but our hours and our location. as well as a kind of kind of information about stds, hiv,there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for 15, 40 75500. the phones answered during hours for clients to questions. >> >>

as a society we've basically failed big portion of our population if you think about the basics of food, shelter safety a lot of people don't have any of those i'm mr. cookie can't speak for all the things but i know say, i have ideas how we can address the food issue. >> open the door and walk through that don't just stand looking out. >> as they grew up in in a how

would that had access to good food and our parent cooked this is how you feed yours this is not happening in our country this is a huge pleasure i'm david one of the co-founder so about four year ago we worked with the serviced and got to know the kid one of the things we figured out was that they didn't know how to cook. >> i heard about the cooking school through the larkin academy a. >> their noting no way to feed themselves so they're eating a lot of fast food and i usually eat whatever safeway is near my home a lot of hot food i was excited that i was eating lunch enough instead of what and eat.

>> as i was inviting them over teaching them basic ways to fix good food they were so existed. >> particle learning the skills and the food they were really go it it turned into the is charity foundation i ran into my friend we were talking about this this do you want to run this charity foundations and she said, yes. >> i'm a co-found and executive director for the cooking project our best classes participation for 10 students are monday they're really fun their chief driven classes we have a different guest around the city they're our stand alone cola's we had a series or series still

city of attorney's office style of classes our final are night life diners. >> santa barbara shall comes in and helps us show us things and this is one the owners they help us to socialize and i've been here about a year. >> we want to be sure to serve as many as we can. >> the san francisco cooking school is an amazing amazing partner. >> it is doing that in that space really elevates the space for the kids special for the chief that make it easy for them to come and it really makes the experience pretty special. >> i'm sutro sue set i'm a chief 2, 3, 4 san francisco. >> that's what those classes afford me the opportunity it breakdown the barriers and is

this is not scary this is our choice about you many times this is a feel good what it is that you give them is an opportunity you have to make it seem like it's there for them for the taking show them it is their and they can do that. >> hi, i'm antonio the chief in san francisco. >> the majority of kids at that age in order to get them into food they need to see something simple and the evidence will show and easy to produce i want to make sure that people can do it with a bowl and spoon and burner and one pan. >> i like is the receipts that are simple and not feel like it's a burden to make foods the

cohesives show something eased. >> i go for vera toilet so someone can't do it or its way out of their range we only use 6 ingredients i can afford 6 ingredient what good is showing you them something they can't use but the sovereignties what are you going to do more me you're not successful. >> we made a vegetable stir-fry indicators he'd ginger and onion that is really affordable how to balance it was easy to make the food we present i loved it if i having had access to a kitchen i'd cook more. >> some of us have never had a

kitchen not taught how to cookie wasn't taught how to cook. >> i have a great appreciation for programs that teach kids food and cooking it is one of the healthiest positive things you can communicate to people that are very young. >> the more programs like the cooking project in general that can have a positive impact how our kids eat is really, really important i believe that everybody should venting to utilize the kitchen and meet other kids their age to identify they're not alone and their ways in which to pick yours up and move forward that. >> it is really important to me the opportunity exists and so i

do everything in my power to keep it that. >> we'll have our new headquarters in the heart of the tenderloin at taylor and kushlg at the end of this summer 2014 we're really excited. >> a lot of the of the conditions in san francisco they have in the rest of the country so our goal to 257bd or expand out of the san francisco in los angeles and then after that who know. >> we'd never want to tell people want to do or eat only provide the skills and the tools in case that's something people are 2rrd in doing. >> you can't buy a box of psyche you have to put them in the right vein and direction with the right kids with a right place address time those kids don't have this you have to

instill they can do it they're good enough now to finding out figure out and find the future for in this san francisco office, there are about 1400 employees. and they're working in roughly 400,000 square feet. we were especially pleased that cleanpowersf offers the super green 100% clean energy, not only for commercial entities like ours, but also for residents of the city of san francisco. we were pleased with the package of services they offered and we're now encouraging our employees who have residence in san francisco to sign on as well. we didn't have any interruption of service or any problems with the switch over to cleanpowersf.

this clean power opportunity reflects that. i would encourage any large business in san francisco to seriously consider converting and upgrading to the cleanpowersf service. it's good for the environment, it's good for business and it's good for the community. regular

meeting of the board of education today. it's tuesday, september 25. and it's my last board meeting. so thank you, all, for being here. we're going to get started. i'm calling this meeting to order. i'm doing some adjustments to the agenda this evening. but before we do that, roll call, please. >> clerk: [roll call]