home, but the home ends at the navigation center. we know that the navigation center is not a permanent home. what are we proposing as item 6? because ultimately a year goes by and we will now have used up a year in navigation, right? >> so -- well, 6 would be home. so that would be getting to their home and the right, safe place. >> i see. >> we need to have six there. >> it looks like navigation is the -- >> no. >> sorry. >> so that's a visual problem there. the navigation center is probably the path to getting them to the home. so the 1,000 people who got prior -- we saw that we're serving them, we assessed them, we prioritized them, the 1,000 people doesn't necessarily mean that the other folks are not

vulnerable in any way, but what it says is it's a very complicated department of homelessness with h.u.d. methodology for how many beds or homes they project to be open with some sort of like how you book a plane, they assume people will drop off, which is true, some people have dropped off. that's where the 1,000 comes from. >> good. thank you. i'm looking at a client standpoint. we have a nice chain that's put together to integrate and understand the client, often it seems to me the client actually responds better if there is sort of an individual that they feel is their advocate or their person or their doctor or their -- is that how we're going to also be assigning that somebody will sort of be your key contact and someone that in

case you go into crisis, have an issue where you would like to pick up the phone, there would be somebody they could talk to? there could be an individual assigned point person. >> yes, some of them are already engaged with an intensive case manager, some of them with case management through the h.u.d. team. so there is a commitment that we will have a street-to-home plan for 135 of them, go find them and find out what they really want and what their real needs are because we don't have enough information about them. that's where the high-intensity care team is critical to get those folks. the other folks, there is a commitment through the center agency that they will prioritize case management of some sort. so we have the navigation case managers who will help them navigate through it. if they have a higher case manager, this navigator might

not be necessary. if they have an intensive case manager, that might be a different route for them. the idea is who is the person and how do they get from here to there. >> you have a two-pronged approach and some are already in a relationship with their case manager. you're thinking there are 135 that you really need to work with and decide what they need? >> right. >> very good. i guess lastly i'd like to know what we'd think would be a good way to be able to track how this is coming if this is such an important program. what would you all be suggesting in terms of a follow up and at the right time? do you think six months would be good to bring something back as to where we are? does that make some sense? >> we show up anywhere and talk to anyone about -- and we can talk for ever about it. >> okay. i'd leave that to staff to

schedule. >> commissioner green. >> yes, thank you. this is incredible, the work you've done and the effort you've put into this, very optimistic. i was wondering whether you could tell us a little more -- kind of what commissioner chow was asking about when you think you'll be able to gather data. especially on some of your outcomes. for example, you can put people in housing, yet what's your benchmark for how long they stay there? i think that "new england journal" article said there was a pretty impressive percent that stay there one to two years. do you develop your targets in some of the areas you're looking for outcomes, targets for avoiding e.r. targets and quality of life. how long do you think you will get data and assessing the data. and correlating that with the

center not opening for two years and with the staffing you may need to be successful as well as the physical placement for individuals. i gather the tipping point opportunity is great, but i'm not sure how all the timing of all that fits together. can you elaborate a little more on that? because it seems like you could be facing barriers with regard to the staff that could both give inadequate care for the patients as well as the placement. and then what about, given those things and the potential funding issues, where you think you'll be able to really give back information, you know, on your 237. we don't expect you to boil the ocean, but it would be interesting to know what you think. >> i would say that the 237 we will have the dashboard that they were creating in about a month. there's about 29 of the folks who have already been housed in

it. so we are trying to, together, get them from here to there and figure out what is stopping them from getting from here to there. the real difference here is that health is showing up and saying that we are there to figure out how to get them services that -- it's a housing-first model, but is there something that they need before they can get in or after they get in to keep them there successfully. so i can't say -- one, we need to know more about the 135, but all the 237, except for three unfortunate folks who've already passed, all the 237 folks have had -- they say, i want housing. they showed up somewhere and said, i will answer your questions to try to get into housing. they are definitely motivated to

get there, but they're also experiencing psychosis and they're not necessarily always regulated to be able to get from here to there. so we're trying to figure out how to do that and what level of care is needed to help them do that. i don't know if we can say right now that we're going to house all of them. certainly we have three months before we start and get reflective about is this the right approach to it. so i don't know that i can safely say how many of them will be housed. can i go so far to say half? maybe. did i answer all your questions? >> i'm curious to know more about the data you plan to gather, when you feel you might have some results. and again, whether you feel there will be barriers in terms of staffing and actually physical placement that might slow down your progress.

>> so i think what you're getting at with the whole person care funding ending in 2020 and our target date to open the homeless health resource center, which will be the clinical home or hub of whole person integrated care, that will be in late 2021, so within the next year. i mean, what this really does is it -- i don't want to overuse the word "foundational," but it lays the foundation for us to be working together across clinical services to determine what the need is for people showing up to urgent care repeatedly, but they might have one of the street team members or the hot case manager working with them. what it does is brings people together to develop a care model

so that they're actually coordinating care for these folks. we're starting now. we've already started this work, so we're already starting the case conferencing and then working across these existing clinical services with the whole person care team on the shared priority list. >> thank you. >> director cofax. >> i want to thank both dr. hammer and ms. martinez for their incredible work on this and just to emphasize that the literature shows that people suffering from these conditions with support and not as much support as some of us might think is necessary can be housed. i think one of the wonderful aspects of ms. martinez's leadership is she's brought in a number of researchers and

clinicians from ucsf, several of them leaders in this field to bring in a health-based aspect to this work. this is an effort that's going to be saving lives going forward. i mean, the specific when we open hub and how that happens are important pieces. i want to emphasize we are doing this now and going forward. this is really a continuation of our modernizing our system of behavioural health care in response to data so we make the investments going forward to get those people in the housing and get them the wrap-around services we know they need. thanks. >> i wanted to add an example of that, commissioner green. so just as an example of this sort of working across previously disparate services is we have a psychiatric nurse-practitioner from the

behavioural health access team who now basically has jumped and is embedded working with the street medicine team. that's just an example of bringing our staff together who all touch in different ways this patient population, these patients, these individuals -- they're not all patients, and connecting them to services. so he has in a expertise that he can assess people on the street and is an expert in access and how to access our services. >> so first of all, ms. martinez, dr. hammer, i would like to associate myself with the comments made by fellow commissioners about your excellent presentation. thank you. since you're nimble going back and forth on slides, i had questions on three of them starting with this slide here. i know our focus is on

behavioural health and substance use disorders now, but noticing on the slide that 74% have a serious medical condition, 12% h.i.v./aids, 35% hypertension, 4% renal failure. skipping forward three slides to this slide here and looking at the coordinated entry assessment, i'm wondering at what point do these factors enter into prioritizing people for housing and other things? because as we know, housing stability contributes to better health outcomes, whether it's someone with h.i.v. and adhering to their regimen, blood pressure monitoring, sticking to a diet, those things are very important. does that come into the assessment tool at all? >> yes. >> and also skipping forward a few more slides to the outcomes, is there anything in the outcomes that you're measuring when it comes to health outcomes when it comes to these other conditions people have? >> good point on that last

question. i would say that when i first looked at the coordinated entry assessment tool, i know all of the 6,000-some people who have been assessed and all the 1,000 of those people who were prioritized. so essentially what i did is i looked at what the data said. did they assess a pretty good representation mix of who we know are experiencing homelessness? yes, on every single count, the representation of the people in the jail, also the people who -- so like 25% of the general population have a jail history, about 25% of those assessed had a jail history. i looked at about 14 or 15 of those vulnerabilities, and all of them were very well represented with the exception of psychosis, and that makes sense. then i looked at who got prioritiz

prioritized and it was significant higher. one of them was medical. so significant higher of those who did get prioritized showed up. so their tool is identifying through the questions they ask, which does ask about some medical conditions, are identifying and prioritizing them and the way we wish to see it with the exception psychoses, and we will be working with them. >> also, i believe i had seen a previous presentation getting to zero on this assessment tool. do i understand correctly you don't draw the curtain all the way back on what the criteria are because sometimes someone who's working with an individual client, for example, might coach answers to advantage somebody in the -- >> yeah, i think that there was a lot of suspicion around whether or not the tool asked the right question, did the right ranking, whatever. what i have experienced is that is sort of set aside. when i said no, i validated the -- how many people were

assessed, representative, and their vulnerability, and i don't get those questions as much -- at all, actually. >> all right. thank you. >> so in terms of the impact on their medical stability, i think that it's pretty much assumed that we will be able to begin to address their medical conditions, but i think it's a good idea to measure the impact. >> i would like to see that. >> i don't want to bombard you with more questions, but i think it sounded to me like eventually you're going to set some indicators so that you know how to measure the progress of the program and it's hard to -- like, just being here and pull some numbers out of your head and saying this is the goal, so i totally understand that. i'm curious about how you will be integrating harm reduction

philosophy into the program, because, as you mentioned, these are clients with lots of different behavioural health issues. some of them may need to access sobering center. even as they're housed, what type of housing would that be? that is another big barriers that a lot of them had challenges with is to stay sober while they're housed. if they're in facilities that are like only in the abstinence model, how are they going to be able to maintain? and also the other issue is how are they going to pay for the housing? i think that's the other issue that is commonly faced by this

population which in my old days it was the program. if they don't have the money manager that sets the money aside, then it's really difficult for them to exercise their own independence because of some of the co-occurring issues that they're facing. >> so one aspect of the street-to-home plan for everyone will be around benefits. so we are talking to our ssic program that was set up in the mental health department so we can get these folks into s.s.i. advocacy so they can get the income that they need. i think the system response team which met again on friday is getting ideas and issues from the provider team that are working with the 237 and they're developing their street-to-home plan. that's getting in the way of

them getting there could very well be that they need a level of care in housing that we don't yet have. so that's a recommendation. it could be that they need a service where there are not enough slots. that's a recommendation. it could be that we have slots, but being there tuesday at 4:00 p.m. just does not work for this -- so there could be very many things that are coming to that system response team of people who are going to say this is the way we need to proceed. so do we need a different kind of service or a different kind of housing that we don't have? a number of the people have sex offender histories where we can't -- so what are the hurdles and the challenges of getting people from here to there? we may not be able to solve all of them, but we are trying to figure out what we can empower

the provider team to solve on their own, versus where they need someone to unjam that, versus what needs to come to grant in the health commission and think about long term. >> thank you. i think that's helpful. >> commissioner chow. >> yes, as we were looking at the serious medical conditions, i was just wondering how we were going to be connecting for -- these. i'm sure you're going to have substance abuse programs and psychiatric programs. there are clinics that would be managing some of the worst of the worst. what would be the connections that we would be doing or encouraging? would we actually be putting them into those or we're going to have this as sort of a

self-contained medical system that's doing primary care and -- and i'm not sure then where some of the more serious issues requires secondary or tertiary consultation would come in. >> the integrated approach for whole person care is based on the work of the medical director of street medicine. what we've been working on is what he's termed a transitional primary care approach. so we have excellent brick-and-mortar primary care centers all over the cities, as you know. yet, these programs that we're bringing together as whole person integrated care are really built to serve the needs of people who are less likely to engage in that sort of traditional primary care model. so we see them in shelters, we

see them in supportive housing sites, we see them on the streets or in urgent care. the goal is really to -- as we're engaging them and treating their whole person from things we didn't mention, dental, podiatry, as well as their chronic medical conditions, identifying what their needs are. and we have a lot of expertise in our system, figuring out what -- how we get them to the care that they need. so i have a lot of confidence in our ability to be innovative and creative in getting people into the care they need. as we started out by saying the first step is really engagement and a continuity relationship with a caregiver from this robust team. >> thank you. >> commissioners, other

questions? >> i should also mention, i mean, we didn't talk much about -- there's a lot of work being done in h.i.v. and aids and taking the care to people experiencing homelessness. so i think we have a lot to learn from that team, the team that -- starting at positive health program ward 86, how can we take the care to the people who need it and then slowly engage them in ongoing primary care as well as specialty care. i think zuckerberg san francisco general, their specialty services are experts in providing that sort of care. >> i think actually it would be very interesting how with the director looking to see how it's best to engage so that we get them to accept care first and get them to be able to obtain the expertise that's needed to

really improve some very complicated cases. that would be very interesting. thank you. >> item 8 is the human resources update. do you need any assistance getting the presentation up? >> let me take a shot at it here. >> good afternoon,

commissioners. i'm the dphr director. i'm back with an update from the last presentation, and i believe it was in the spring. i had two people i was going to introduce to you, but they had to leave. one was rachael dan donju and then we have one analyst, his name is nick gonzalez and they helped me put together the data. competing with the priority of this data, we did a3 which we did for the employment engagement survey which i helped to put together. we were finishing up epic and we had to create 5,000 what they call people of interest. it was the people side of the system so they could use epic. then we finished the budget reconciliation. so this -- i'm comfortable with

the data, but i know in the future, as we continue to do this, we can do better. all right. so the first thing we wanted to look at today was the employee engagement survey. what i wanted to point out about that was that in 2015 we did our first employee engagement survey. the response rate was 40%. so the response rate for this time around was 65%, which is a pretty incredible improvement. i'm very happy with that. the question is what do we do with the information now that we've got it? so if you had a chance to look at the a3, i want to talk just briefly about that.

so this is explaining somewhat in create detail what we're going to do with the data. it's this document. i'm not going to get into the details of that, but this is one of the tools we'll be using to make sure we have actionable results regarding the employee engagement survey. the a3 is used in lean process improvement. it states the background, conditions, and has attainable count countermeasures and deliverables. so we've worked, we've published this, shared it with the divisions. then the divisions will come up with their own a3 regarding employee engagement. so our strengths were people like the work they do and people are comfortable referring to patients by whatever pronoun they request, even if it doesn't match their appearance. the top two areas we chose for improvement were different

levels of the organization communicate effectively with each other was low and then adequate staffing was also low. but in the end, the ones we chose for the a3 were communication overall and equity. now, the reason we chose that was that as we looked at the results, we noticed that on the questions of trust and general respect and disrespect, that things were rated differently. on over 96% of the questions, african-americans gave the lowest percent of favorable scores compared to the rest of the organization. when it comes to the lowest scores, the values were, for example, employees from different becomes scored between 77 and 68% on questions that african-americans averaged 49%. on trust and a work unit where

others scored 49%, african-americans scored 41%. these numbers are concerning and we're working on it and taking it seriously. so the next steps for the employee engagement survey are, one, we are taking steps to ensure that the survey data is meaningful and analyzed properly and available. we'll be doing one-on-one meetings with divisions to ensure they can look at the data and creating a dashboard for their use as well. we have the one-on-one consultations. we're doing webinars. currently in the works is a letter to all staff about the survey, focusing on the areas that we talked about. and then developing for the next fiscal year, we're developing an effective communication training, which would be crucial communications and training

along that line. then we go to hiring updates, which is another item we talked about. so we have -- what this shows is data for the d.p.h. workforce. this is 1920 reflect data to date. for fiscal year 2018-19, we see that we are trending in the directions that we had hoped. so we 7,678 employees. one of the things i noticed when i got here when i first did the demographic report, we wanted to increase the number of african-americans, and we did that going out to different conventions. so that's gone from 11.22% to 12.12%. there's been a slight reduction in filipino employees or slight

reduction in white employees. a slight increase in hispanic employees. and a slight rise in asian employees. so document two that i put in our packet which looks like this, so this in the years past we did demographic reports using pie charts -- in the past years we did demographic reports, so it would show by division, zuckerberg would show employees, asian, black, filipino, hispanic, and white. we were trying to see what does it look like. this is a more recent version of that and a little bit more detailed. it shows by unit that same sort

of breakdown. so the idea with these in a division, they can look at these and say, okay, if we want to say match the 11 counties where we pulled our workforce from or match san francisco's demographics, then we need to make some adjustments to how we hire. that's what we would use this tool for and that's what we would ask managers to use the tool for. we can't set specific goals. that's not allowed. i believe it was -- i think it's not an initiative, but initiative 200 -- anyway, there was a lot that says you can't use this sort of information setting goals for hire. we can certainly use it as information. what we continue to do is have our recruiters reach out to areas where we need to improve. the other thing is to continue to get more involved in the hiring panels.

what i'm finding is that it tends to be at the hiring panel level that we start to lose our diversity. even if we get them onto the list, as they go through the panel process, we tend to lose those diverse candidates. there's a couple remedies to that. the most drastic would be for us to say we're going to have an established panel of three h.r. people, a hiring manager, and a subject matter expert. you would have three constant interviewers that would take out a lot of that bias people have whether they know it or not. this line, again getting back to some of the things asked at the last presentation, this shows hiring in the various areas that

we -- where we hire, and it shows it by fiscal year. so you've got central office, laguna, zuckerberg, and all of them overall, you can see the hiring, it's more or less constant. it went up and dropped, but it's fairly constant. you will see where some of the data on slides 9 and 10 don't match. commissioner green had some great questions which i responded to. i'm thinking i may use some of that information but i'll share that with you in the response because it's a lot of informati information. again, this shows that we are trending in the right direction. in terms of actually -- you know, i used to say it's a big ship and it takes a long time to turn it, but it looks like it is starting to turn in terms of we are starting to change the

demographic. >> sorry to interrupt. can you tell me why we are counting filipinos separate from asians? >> because that's how they count it with the census data and that's how h.r. collects the information. >> so it's the h.r., how they collect information? >> right. >> so how do we define "asians" in here? like -- because filipino is a nationality -- >> yes. it's the only one they pull out. that is the only one they treat separately, and i don't know why that's done. >> okay. >> i can get you some more information on that -- >> yes, it's kind of unusual to separate the two groups. >> it is. >> because if you look at it and add them back together, asian and pacific islander, no offense to my own people, you're talking

a really huge percentage of the workforce. >> right. so it's either on the census collection or how the e.e.o., the federal body, makes us collect it. for some reason they make us break it out. i will get you a more refined response, but that's what i recall. this slide, i wanted to show you the impact that epic had on hiring. if you look at that line that starts at 174 and it drops down to 72, that was due to epic. so we had a big drop in hiring. that was planned because we realized we had to stop orientations in july and august because there wasn't anybody to conduct the orientations. the trainers that we needed to train people to do epic were no longer available. we took a hit there, but we'll get it back on track. is a a lot of talk has been made

about hiring times. i'm going to show you some of the work we did here. we did the initial 2014 value street mapping, trying to get hiring times up to where we think it should be. we did reduce hiring times from 330 to 253 over this period for the whole department, but that's still way too high. we did a new value stream mapping in june, and then we're doing these other lean exercises with the k.p.o. office to try to improve hiring. they're keeping us very busy, but we're intent to speed up the process. this question came up at the last presentation, and it's very jarring, as you can see. we are attempting to be very transparent. i have to say that when i got

here three years ago, there wasn't anywhere near this transparency on this sort of information and i don't think i would have been standing up here sharing this because it just wasn't something that was done. now because i think of the government alliance on race and equity, we're seeing a lot more willingness to be transparent. i think it's not only the right thing to do, but important to do. this was a good question asked by the commission. this was our initial take at it. again, commissioner green had some questions and i do have some specific answers and i'll provide a little bit of that here in a minute. we're looking at of course continuing to do recruitment, continuing to help applicants in navigating our complex system and doing other work to try to improve this. some of the questions that were asked about this slide that i will answer is although it was based on working adults with two

children, we're not assuming family size, but we used that just as a way to take some kind of an average. the medium household income in san francisco was $96,265. that was from the u.s. census bureau. so i think what we are trying to do right now is we're trying to do work in h.r. we're starting to look at pay equity. we've always looked at it, but never done it in a systematic way. looking at pay equity. one of the other things we looked at was this premium pay. so just to give you an idea of acting assignment, that's where you get a 5% pay differential if you work in a class higher than yours and it has to be a vacant position. so if i am gone and somebody

steps into my position temporarily, they can get a 5% increase. supervisor differential, that is under most of the labor agreements, that means if i have people working for me that make more than i do, then the contract allows that i would get a little bit above what they make. these what these pay premiums are. there are others that we thought would be good because they have some degree of discretion. the manager gets to decide who they're going to put into those areas. so i would say with all of this information, this would be not the -- this is the beginning of looking at this information, not the end. so we still have a lot of work to do in looking at this. only 23% of the population are

receiving the pay premiums. that's the kind of thing we will be looking at. this slide has to do with probationary releases and separations. a probationary release -- you can only be released from that position if you're -- a probation is for an employee who intends to become civil servant. only those category of employees can serve a probation. so a temporary employee cannot serve a probation. we had 173 black african-american staff that were hired in fiscal year 2018-19 and six of those released from probation. 33% of all the probation released in fiscal year 2018-19 were african-americans and they are only 17% of the staff hired that year. so these are things that the

county is looking at, the mayor is looking at, and we are looking at. this next slide is from -- this is from the county. this is their web page. this is the data they give to the mayor's office. they have specific definitions for how they view each of these categories of separation. so c.a. is corrective action and d. is discipline. so, for example, if there are 884 african-americans and 16 receive discipline, it's 1.8% of the total black population at dpah, whereas the white population is a little over double that 1866 and 16% received discipline which is only a smaller number of the population. because of the size of the population, the impact was greater on the african-americans. so with all of this, it's great

that we have the government alliance on race and equity. we are trying to make all of this visible. again, what are you going to do with it? some of the things we're going to do to address this is offering mentoring, targeted coaching to lower [ indiscernible ] -- classifications, mandatory training for managers, and training on effective communication and working on dashboards. the other thing is that starting about eight months ago, a policy was instituted that i have to review all separations because i wanted to make sure that they are adequately documented. i rejected some. i actually brought one employee back to work because they had gone through and terminated somebody without my knowledge. we've got to put more checks and balances in place. i'm serving right now as a check and a balance, but i really

don't have the capacity to do the amount of that that we should. it shouldn't just be for terminations. it should be for more than that. i'm looking at setting up some kind of a system where we have a review done by a panel or some other review by more than just the manager and a labor relations person. one of the commissioners at the last meeting asked about feedback on the brown bags and the training we're doing. the staff take the feedback from those summaries and they were able to provide feedback. as you can see the trainings are generally very well received, 80%, 90% ratings. staff seem to really appreciate those trainings. they also added new trainings which i've listed here. i would say that just before we

close that both -- that h.r. is working with anna and she is working with equity. it is a partnership. we have a key role because we control what we need to make things fair is in our realm, but she provides a lot of information for us. i think a lot of this is reflective of bias and racism. the only way to do it is be transparent about it and call it out and address it. that is my goal to do that. i get the sense from the commission that you have the same goal. with that, i will take any questions you have. >> i have not received any public comment requests, commissioners. >> commissioners, questions? dr. chow. >> i'm trying to understand the disciplinary data chart, and that's probably because i don't

understand which way the discipline is going. so we just take -- i guess d.p.a.s you have a big arrow, and we come all the way across to female and male. it tells me we have 69% are female employees and 33% are male. what does the next line tell me, that 63% got disciplined? i don't think i'm reading the chart correctly. >> i think -- i don't -- no. again, this is a city slide, but that is the total population of d.p.h., i believe. like, our gender breakdown. >> right. >> so it doesn't have anything to do -- there's no correlation between that and the discipline. >> what is c.a.d.?

>> if you look at those numbers, that is the percentage of discipline. so let's see how they explain that. okay -- >> it does look like, if i may jump in, it does look like underneath if we do female, it looks like 65.64% of women were disciplined, where only 36% of men were disciplined. i think that's how i -- >> i think it's right. >> that's odd. >> it might be better to use the actual numbers next time rather than percentages. for example, i don't have the gender breakdown, but like i said for white there are 1,866 white employees and 16 received discipline, which is 0.85% of the total population. i think that would be more useful than these percentages,

to have the actual numbers. >> yeah -- it sounds high the way it is there. >> it is confusing. in the next iteration we'll do the numbers. i think it tells a much clearer story. >> okay. because otherwise we seem quite high in our discipline from everybody else in almost all of the categories. >> actually just looking at the data, i believe if you add all the way across, it's the proportion of all of the corrective actions or disciplinary actions added together to show that some groups are overrepresented and other groups are under-represented in terms of the corrective or disciplinary action. is that correct? >> that's the intent of the slide. >> you're saying we should read horizontally rather than vertical

vertically. so the chart reads horizontally, but if you're trying to read between the two categories of 28% and 21%, i'm not sure what that means. >> so going forward, we'll do the numbers maybe as well as the percentages to make it clearer. other questions? yes. >> commissioner. >> do you offer mentorship services to other employees other than just those of color? >> we actually started -- we have a small training group. we started a mentorship program in nursing out at zuckerberg. we couldn't sustain it. i'll try to offer a broad mentorship program, but we want to assist those in the

[ indiscernible ] classification based on the data. it's just what we can do with staffing. >> commissioner green. >> yes, thank you. it's wonderful that you have the addressing disparities plan. this is all really excellent. i wonder, given the confusion with the data, can you just give us your qualitative assessment of where our greatest challenges lie, what our greatest vulnerabilities are. an unrelated question, given the number of days it takes to hire, can you elucidate, given all the new programs that are about to come on board since you've been funded, what is our assessment of hiring needs and if indeed to be successful we need to have staffing for our various programs as well as hospitals, how we can address this time frame and speed it up? because it seems like a lot of the things we intend to do can't be successful because we don't have the manpower to address what we need. >> let me address the first

question on speed of hiring. i had been asked a couple of weeks ago about doing a continuous posting for social workers or case managers, which i think is a good idea. we have done that with nursing. typically with a posting, you post it for a period of time, then people apply, then you close it and go through this big process, and then three years again you open it again. the idea is to have a continuous posting so people can apply and refresh the list in bring in new people. that is one way, a continuous posting. if we're going to hire the number of people i saw discussed during the earlier presentation, i would say one of two things. one, you want to look at hiring category 18, which are three-year project staff. you don't have the same burden of the civil service roles as you do with the normal -- the ones that take 253 days. when you do that, that one

you've got to get the approvals, post it, then there's an appeal period, then you have an exam, then there's an appeal period and all of that with the exam. you can speed all of that up. to do that we would have to get approval of the d.h.r. and the union. i think they would understand. i would say the other possibility is what is called a civil service exemption 12, which is an expert. so we did that with i.t. we now hire some of our i.t. staff under the civil service exemption which is a 12. we hired -- the project manager in h.r. hired on average everybody in six weeks using the epic hire using category 12s and category 18s. i would say if you want the speed of hiring for something like this, i would go with civil service exempt positions, work it out with d.h.r. and the union. the lean process improvement, that's going to take a while.

we don't control a lot of what's going to be changed. it's d.h.r. is the civil service roles. but the existing category 12s and 18s, we could do as fast as six weeks. that's what i would recommend for that. what was your other question? >> i was wondering if you could give us your assessment. >> oh, the assessment. i think that we still have -- you know, this is really a sensitive area because to say we appear to be overrepresented with certain populations of staff does not make those staff feel very good or are very happy about it. so -- but i think the numbers sort of speak for themselves. we still have areas. we need to recruit more african-americans, for example, and we need to recruit them into higher-level positions. the disparity is we hire them into the lower classifications and they never work up to the

higher classifications. i want to work on pay equity. again i was saying if we want to break up these pathways causing us to be lopsided in our diversity, we take away the manager's right to determine where the person comes in at their pay level. i think the only way to break up that is h.r. has to decide and we have to decide that based on pay equity. i'm going to have to staff up to do that. what i would like to do is -- that payroll would do an analysis before we make the offer what we're going to hire you at, i want to make sure we see what we hired everyone else at and bring you in at the appropriate level. right now it's done by the manager and they say step one. unless someone knows better, he says i want to bring him in at step four and they'll justify it. lots of people don't know to do

that. that's how we end up with the pay disparities. >> can you give us more details about the types of positions that we have the greatest challenges. it's one thing to see the diversity charts and another thing to better understand. we have certain issues hiring nurses versus other employees in the d.p.h. if you break nursing out, which has a whole set of different concerns and brought to us information about the other subcategories of employees and how you're going to approach hiring and diversity in those jobs. >> we can do that. i know we've looked at it in the past and going to look specifically at each classification. yeah, we can do that. >> thank you. >> looking at the new hires chart, page number 11, you mentioned there was a dip in new highers in august and september

of this year because trainers were needed to really engage in the epic go live and training there. i know we had reviewed a number of contracts for surge staffing and other things related to epic and when to -- when these needs came up. was this not anticipated or contemplated in the staffing when you were looking at when you might need folks to come in with surge staffing? >> so i think it was -- i didn't of course do those contracts, but i think they did look into what they tried to do is make sure we used our money wisely. what they had done is brought in a surge of trainers and said, look, by mid-july, we're going to be at the point where everybody is pretty well trained except for new people. we're going to cut loose 100 trainers. we're going to keep the core trainers, but we're going to need them to get this launched on august 3. once that's done they can return

to training the new staff. we asked them to get people into the orientations in august and july because there wouldn't be one in september. whether they anticipated this way back i'm not sure. it wouldn't have made sense to bring on those extra trainers. it was a dip in our hiring, but we will make that up. >> thank you. >> looking at that disciplinary table again, it makes me wonder what is the gender parity of our workfor workforce, especially when there is no real way to know from these tables the size of our transgender workforce, you know, in d.p.h., transgender men and women. it's kind of like a -- yeah, i'm

just like -- my head is filled with questions, like where -- how they placed in those city tables. >> so we just started tracking based on -- there was a directive six months ago or so or maybe earlier, they want to give us the option of tracking gender and transgender in all forms. we're starting to track that. we may be able to have that going forward. we're about 75% female and 25% male. something like that. it's been a while since i looked at those numbers. that's not unusual for a health department. we can refine that. that's a good point. i will talk to d.h.r. this is their information, but i think it would be a good point to track that. >> i was disappointed to see that we don't have those data,

especially given the department's work on sogi. we're asking it of the people that we serve, but we're not doing the work we need to inwardly as a reflection. certainly it's a priority to work to get this data that you're asking for. >> commissioners, other questions? thank you very much. >> all right. thank you. >> all right, everyone, we move on to item 9, which is the epic post go live update. >> commissioners and directors.

i am the chief information officer for d.p.h. i'd like to start by sharing a number with you. 8,800. more than 8,800 people have gained credentials and used epic since our go live on august 23, 2019. that includes over 1,500 of our clients. my take-home message for you this evening is we had a great go-live experience, everything from the support of your commission all the way down to all # 7,500 people who participated in classroom training and took proficiency exam to be able to effectively use the new tools. it was across the board an outstanding effort. we had support from across the city. we had support from a number of vendors in addition to epic. and of course we had the support of all of our organization, as we know that it takes attacks on

any company, any agency, to make a transformative change such as we have. all of our consumers as users of epic are getting accustomed to the system and day by day are getting proficient with its use. it takes a little bit of time and we're not even three months in yet. i do want to assure you that we have a systematic process in place, a good-governance program, so we can monitor and improve based on the information we glean from epic. what i mean by that is epic is not just a system we put things in, we're seeing a return on information and not just in the form of reports, but information about how we're using epic, some of this in near-real time, so we can understand how we're making best use of this very large investment. so a handful of