>> in the interest of time and acknowledging it's been five weeks that you have actually put together a wonderful presentation but high expectations with regard to what the office is. so what i prefer to do is present my questions to you and give you time to answer those questions in a written form. >> thank you. >> for all of us, as i'm sure there will be additional questions from folks. this is a very very, very impord of high interest subject matter to the commission and to the constituencies. so here are a few questions. is someone writing them down? [ laughter ] >> some of them are related and not. one has to do with referring

back to dr. chow's question around the two different paths of equity and workforce equity. i know you won't achieve one without the other. >> yes, they're the same. >> i'm wondering how will we find a way to measure the effect or impact an increasingly or achievement on the workforce equity goals and its impact on health equity and vice versa. that's one question. the other is -- so that's an intersectionalty question and cannot be measured and then with our external partnerships. so with this alliance across the government, how do we both benefit that alliance and benefit from that over time so we're not just sort of following standards that are set but,

obviously, this is something that will be growing and experiencing over time and san francisco is a unique environment in which to apply a lot of the things coming out of this. how does that relationship have some neutral benefit and is that something that we are going to be able to hear about and somehow influence? >> the relationship between us and other city departments? >> yes. >> us and other cities. >> to ask the question appropriately, but obviously, we're part of a larger experience in standard-setting and goal setting. >> this is a collective and we are in this collective with the -- i think all nine counties plus whos and there was a cohort

of 20 institutings or municipalities in the northern california co-hort and there were nine state departments in the capital cohort and i think next year will be something like 18 and there are some in the teens in southern california and that's just the state of california and so it is a group where we can look online and answer a question from arizona and look at somebody else's work that they're doing in florida or other places, but also it's linking the city departments through the human right's commission. >> so my question is what is the larger benefit we'll see? so it's a reference point and it is sharing environment, but sort of from we're trying to catalyze big change here. so what does the participation in that tell us? and i know it's an esoteric question. >> it's not, we're not ahead. we're ahead in some areas but

this isn't one and we have lots of models to use. >> the third question is, we're part of a larger effort now within the city. >> yes. >> my question would be similar, how does what we're doing, very particularly in the department of public health inform and relate to efforts that are happening in the other departments of the city? because i'm sure they'll have processes there. they do and how does that all come together and again, not a question you have to answer now but something you would probably need to be able to consult with others. and the last question had to do with, because we are a department that does a lot of our work with outside contractors, nonprofits and we are also in a rich environment in health in the private sector a lot of cross-sectionalty of the providers and care and their systems, how does our -- even with ucsf, for instance, how

does what we're trying to do here. that we don't get siloed and we put our heads down and do the work, which is important work and we forget that there is a larger sphere of influence both external and internal that we could have? >> i'll answer at length, but i will say that that is the point of centralizing. so when primary care is doing hypertension, there's virtually no way for them to really do that with an awareness of what even ph.d. is doing, let alone what hsa is doing or what other

institutions are doing. that's my role. so that's the role of us centrally, to maintain awareness of where the other departments are doing and to bring in resources from other cities and municipalities so that we're not reinventing the wheel. we took our respect policy and modeled it after one of the park and rec and we're using our mta, just came to me to about some f the work we're doing there. that's the role of having a central office so that dph can be represented in those spaces and that's always a struggle for us, because if you send someone from the network, they represent the network and if you send someone from behavioral health, they represent behavioral health. we were not able to do that before. the point of centralizing is to do that and to be ail t able toe the department and alignment with everybody else and move it in alignment with each other and to take that whole department effort and then make sure it actually has some view of the

outside world. >> just in response, i would like to say you representing that central role very well. thank you. >> thank you. >> from my point of view, i want to acknowledge the work that you have done. i thought it way insightful and helpful in terms of our discussion today and there will be more discussion based on the questions that my colleagues have asked you. so i don't want to repeat any of their questions, but i do want you to answer in writing -- because i also am i ware of your time -- to us, the notion of hiring, recruitment, hiring, retention and disciplinary effects on black african-americans and the question of retention is the critical cal. one. if you recruit and hire and put folks in discipline and leave here, that's not doing much for the bottom line in terms of equity. so i want to make sure we have a strategy to address that. so along with all of the other

questions that were asked, i had another question, but i'm not going to ask it. i'll wait for the responses from the one we've given you. but again, thank you for your insightful report. >> i'm really excited to see so much energy and interest and really thoughtful engagement with this issue because the more that you hold us to account about that we're doing about it, the easier it is to move the work along. so it's an inside, outside strategy and we need pressure from both sides. pressure from staff asking for change and pressure from above and outside looking for change and i think we will benefit from both and i will get squished in the middle and i'm comfortable there and we need both. your interest, i hope it continues and challenges us and challenges not just me, because equity is not just me but every other person who comes through with something to say. thank you. >> the last thing, if, in fact,

you run across some articles that would be helpful to understand both ger and health equity means for san francisco, would you forward them to mark and he can send them to us. >> so we're compiling that for the champions that have to do 20 hours of education and we're compiling a list to choose from and i'll include that with my answers. >> thank you. >> you're welcome. >> thank you. >> commissioners, thanks for that great discussion. item 8 is the population health division true north and thank you, doctor, for being patient and mr. wagner for being more patient.

>> good evening. i'm the health officer of san francisco and the director of the health division and today what i'm going to do, just because of the time, i'll i'm gg to move quickly and do a high cover of the true north and how it fits with our performance improvement and i'll go through a couple of examples and we won't have time to go into detail with all of the different metric areas but i'll introduce you, primarily, to the framework. first, i want to point out according to our departmental annual report, the population health division represents about 4% of the health department. so we provide core public health services for the city of san francisco and together with

maternal child and adolescent health, we use that for accreditations. and back in 2011, when i started this position, canya and kramer published an article called collective impact. and that really had a big influence because it really helped us reframe on how to address complex social health problems. and we took that on and we went ahead and embraced results as a primary approach that we're using for collective impact and in 2013, 2014, we started our lean training at san francisco general hospital. by 2016, we had incorporated both lean and rba into the population health division, first in environmental health and you see there in 2016 and in 2017, we received our public health accreditation.

and so the general framework for public health accreditation is based on ten essential services of public health and with a domains of the administration and governance, we have 12 domains that we're upped by. judged by. i'm showing you this slide is something one of the commissioners brought up earlier, is the issue of policy. the population health division says *r does mor does more than. we also work this the area of assessment which includes evaluation, research, epidemiology and also in the area of policy development. so later on, i'll give you a couple of examples so you can see how that fits in. the lense that we're going to use is a lense of performance improvement and that's under where it says there evaluate.

so dr. bennett talked about normalizing and one of the ways to normalize is everybody will show you a lean triangle. this is a lean triangle for the population and health division. starting from the top, we have the vision of the health department making san francisco the healthiest place on earth and our mission at dph is to protect and promote health and well-being for all in san francisco and our logo represents the diversity of community, clients, patients and staff. the next is the true north goals,/metrics. they need to be healthy, thriving and in line with our mission and vision. we have our principles and we have our values. and then humility, compassion

and dignity. i'll be focusing on the true north goals. the other question that we have is, how does results heav-based accountability connect to lean? this is from rba and what you see here is four different quadrants that can be divided by quantity, quality effort and effect and lean has amazing tools for processes and eliminating waste, especially in the area of where it says how much do we do and how well do we do it. rba is relentlessly focusing on outcomes and under that category here, you see where it says effect and the question we ask, is anyone better off? so if you don't remember anything else from this presentation, i want you to remember three questions that i want you to hold this

accountable to every time, which is you want to ask us, how much did we do and how well did we do it and is anyone better off? i'm going to focus on, is anyone better off? i'm going to briefly touch upon those areas, but i'm going to dive into a couple of areas in health impact. you had a presentation on equity so i won't spend any time there. under workforce development, the key metric, percentage of staff recommending ph.d. as a place to work, for service experience, increasing the percentage of our programs that collect service data and use that data to improve services based on what they learn? under the area of financial stewardship, the key one to point out to you is increasing

the use of priority setting and resource allocation methods. this is a tool that we use to help set priorities around budgets and try to focus investing or limited resources in those activities that we think that will have the biggest impact. the other area that i want to point out is in the area of decision quality and increasing the percentage of staff that are decision competent and use decision quality criteria in problem-solving and performance improvement. these are draft indicators and we're still working on them. and the areas to spend more time is in the area of health impact.

you see at the top we have maternal and child adolescent help. we take a framework with the development of children and intergenerational processes, include the social and biological transmission of the effects of trauma and toxic stress and family and community centric approaches and environmental stresses including social and cultural. and continuing in the area of health impact, i'm going to give an example from the middle one, which is preventing infection

and preserving health. and i'm going to give you an example of social, emotional and behavioral health into o to givn idea of the complexity of the problem but to summarize where we as a city in san francisco, we've had a big impact nationally and also around the world. i'll briefly just highlight getting to zero. i won't focus on the data you've heard but really on why getting to zero is so special. and why i think san francisco really stands out. and then i also wanted to spend a few minutes on a public health crisis that we're having right now with a vaping epidemic and sort of paint to you the picture of how much san francisco has actually accomplished when you ask those questions, how much, how well and is anyone better off? so you see this from -- this is

sort of the iconic graft that we have here and where you see the number of new hiv infections are at an historic low for san francisco. the number of people who are surviving is high and also the mortality rate has become more stable here.

focuses othis gets them virals to the viral load and decreasing commission in the community. this requires everybody on board where we have a medical intervention with a public human health impact. the way we measure how well did we do, we have a framework that's called hiv care cascade, where you look at different leveled. so i'vlevels. of people hiv positive, 94% know their status and we've linked 91% of them, in terms of retention, we're at 64% and virally suppressed, we're at 78%. in terms of the standards that

we have globally which is 90-90-90, 90% aware, 90 to care and 90 suppressed, even though we're doing tremendous, we have room to improve. the other area where we have room to improve is in the area of lati n-x, especially with the intersections of mental illness and substance use. those most vulnerable populations are the area we're moving into next and we need to do more. so yes, the wow, we have made tremendous strides and this model of collective impact is unique, we still have areas that we need to make progress in. that's the first example that i wanted to show because it's a special example. the next example i want to show

is with ecigarettes. between 2006 and 2018, san francisco has passed eight laws. smoke-free parks, smoke manufactur-freeentrances, cabs,, outdoor seats, landlord disclosure of smoking status, smoke-free outdoor events, ecigarette use regulate the jusregulated likecigarettes, toe baseball stadiums, prohibiting flavoured products, including menthol. these laws were passed in collaboration with the community and oftentimes with youth groups. so the question is is that how well do we do and is anybody

better off? the answer to that is yes, no, no and yes. yes was in the middle there is national data. you see how the prevalence of smoking has going down dramatically and in california, we were making -- and in sanfrancisco, we were making tremendous progress in reducing the prevalence of smoking, especially in youth. that's the first yes. and we were doing fantastic. but then, a san francisco-based company figured out how to tweak nicotine into a nicotine salt and make it highly addictive, where people would have high levels of nicotine in their brain like this and get youth addicted. we're now in a new public health crisis and that's the national data right there that you see the vaping, ecigarette vaping

epidemic. san francisco right now has the highest rate of ecigarette use of in california for kids in high school. among tenth and 12th grade were at 20%. think about that, 1-5 in san francisco, the highest in san francisco. so while we were making tremendous progress, we fell behind. so what happened? in 2019, right when dr. colfax came on, the city attorney dennis herrera and mr. walton passed prohibiting sales of ecigarettes that were not f.d.a. approved. when that came out, nobody was expecting that. this was an example where the innovative leadership comes out where you least expect it. i heard on monday this would be announced on tuesday and

dr. colfax was talking with the city attorney and we had to mobilize and get behind this. so dr. colfax and myself coauthored an article for the medicine journal and we really went on the offense of really reshaping the narrative on how it's really important to support this ban in terms of f.d.a. approval. we have been so successful -- let me point out one thing, the next thing that happened was the epidemic of vaping lung injury. and so now we had the ordinance that just passed where san francisco was alone. we had an epidemic. lung injury happening in the country and all of a sudden, people are realizing that san francisco has it correct.

the policy that we passed was the right way to go. and so effective that even at the national level, the ama, the american medical association recently is recommending the banning of ecigarettes that are not f.d.a. approved and this is an example of this -- this is policy development happening over years and this is now the nine laninth law passed since 2. it's hard to appreciate the impact it's had. so while nationally, there are over 2,290 cases of lung injury from ecigarette vaping and 47 deaths, in california, there are 170 cases and four deaths and san francisco has only had one case. one case. and the reason -- i think part

of the reason why, in a sense, have been spared from this epidemic is because of all of the work done. when that flavour ban passed, just to give you an idea of what the staff did, they had two approaches. they had an education and outreach approach and they got almost 20 volunteers and they went out to over 800 retail establishments and educated them on the law and how it would be implemented. and then, our inspectors went out and inspected 693 tobacco retailers to make sure that they were compliant. when we measure how well did we do, over 92% compliant.

i gave you an overview of the population health division approach and i summarized true north metrics and i dove into health impact and showed you the broad framework that we use that takes a life course into generational family centric and environmental perspective and i gave you a couple of examples that shows you the complexity of the issues that include policy

as a major focus. it's hard to count policy and there's only nine laws, but they have a big impact and you saw some of the metrics as well. so i want to just thank you and turn it over -- oh, i have to remind you that the three questions that you always have to ask us, how much did we do? how well did we do it? and is anyone better off? that's results thinking, results-based accountability and compliments lean which eliminates waste and we have an integrated approach and if you continue to ask us that question, we'll get better at the metrics. >> commissioners? commissioner green. >> thank you for the presentation.

in terms of the questions you just told us to ask, on some of your slides, you had decreased percentage of blank and one with the opiates in particular, you said decreased number of deaths from x to y. and i wonder if in the future or soon, you would share what your xs and ys are because you had goals but in terms of targets, i didn't see them. >> which question was that one? >> that was just one of them. >> we're going to come back and so this was a high-level overview and we'll come back and go into details. some of the areas, you get details with the hiv folks go into excruciating detail with the hiv but that's what we plan to do. >> i mean, if we could get it after the meeting, because i'm sure you have some mapped out, it would help to have context so

wwe can see how you're viewing the numbers associated with the goals. >> commissioner gerardo. >> i would like to follow that from what commissioner green was saying. under the health impact, let les say, decreasing the vaping. decreasing the middle-school students who drink one ssb yesterday, ssb sold in san francisco, how? i just, again, looking at the metrics, i understand those are great goals, but, then, again, with as i had mentioned in a conversation with you, with the high school studente students iu can't go to the bathroom in the high schools because they're so full of smoke. so how, in fact, are you going

to operationallize the -- what the goals are here? if you can get back to us. >> so just to let you know, in terms of that specific topic, we presented an in-depth presentation to the committee just a few weeks ago and so we can make sure that you have the slides, because that slide goes into detail in terms of our tobacco control efforts.

>> the article is in press and hopefully it will come out shortly and we'll make sure you get a copy. >> then i'm wondering, if, in fact, we are such a high rate of vaping in the state, that was of 2018 -- >> right. >> -- do you think or you have been able to measure whether or not any of the information now being put out to this population has reduced the amount of vaping? >> you're asking a really good question. i think -- i mean, there's two major epidemics and one is in

ecigaretting and juuls and there's cannabis and people -- because the national outbreak is primarily from unregulated cannabis products. and so both of these are happening and most people use more than one product. so oftentimes people are using both cannabis and nicotine. and so i think we're just at the beginning of trying to understand how we're going to deal with the nicotine. if when you look at the slides, you can see that we were really low on tobacco and all of a sudden, in other parts of the country it's worse, it's up to 1-4 kids. we do have a work group right now that's meeting to figure out what we'll do next and i don't have a good answer at the moment, other than the first thing -- actually, let me back up. the first thing we'll do is

we'll implement the ecigarette ban just like for flavours and menthol, week implement the ecigarette ban because proposition c lost 4-1 and that allows san francisco to move forward. same with the mental and flavour ban, we'll do it with esignature repeats. that's our major focus in terms of retail and access. >> thank you. >> commissioners, any other questions? >> thank you, commissioners and thank you dr. eragon and your leadership in the division. i think it's important we look at not only the clinical side of the department but the population health side and one thing to emphasize with a focus on behavioral health and you see in the health impact six areas, behavioral health, historically, the department has not focus on the other hand a population approach to behavioral health and i think you heard them talk

about that a couple of weeks ago. and dr. eragon has brought his team forward to take an approach to across the department in approving our clinical system. so in hearing the questions about implementation in how one moves from point x to point y in terms of outcomes, i do wonder, then, this goes back to dr. bennet's presentation, having a little more detail about how that blood pressure goal was achieved and sort of the steps and the discoveries that were made across the organization over that period of time. i think that would potentially be interesting because i think the lessons learned -- that chart took a lot of work. i would like to say what gets measured gets managed and that's a part of it, but it changed the church and there were a lot of unexpected learnings in that process, as well. the commission looks and holds

us accountable for the outcomes and taking the lessons learned and applying them from nicotine addiction to, you know, some of the behavioral health issues that we'll be looking at. just as we often use hiv as being the forefront of teaching us how to do better, i think that the blood pressure success that we've had in the department, across our clinics, could really help inform some of these implementation questions that have come up today. so just a thought and i will certainly talk to the commissioners and mark about potentially putting that on the agenda if that's something of interest. >> thank you, doctor. >> maybe i ask a question. when do you think it would be best to come back to the commission with more specifics on the metrics? i'm wondering a time frame. >> either every six months or

quarterly, whatever the committee likes. some comes into the public health committee, too. thank you. >> thank you. >> item 9 is the fiscal year '18-'19 fourth quarter financial report, mr. wagner. >> good evening, i'll be brief. i'm reporting on the results of our fourth quarter for the prior fiscal year. this one, our year-end report is later than the other quarterly reports but we have to go true the year-in closing process and

the numbers are moving. and in case, w addition, we pust back but this is late and in some sense, no way around it. our year-end bottom line is a $96.5 million favorable general fund balance. there are a number of pieces that are moving around this balance, but there i this is a r overall and consistent with the reports at the second and third quarters. we've had strong revenue, particularly at zuckerburg san francisco general hospital and we have been close to expenditures on budget, so this year-end performance really allowed us to contribute fund balance that went to balancing the budget and went to funding the improvements that we received in the budget for the current year and the upcoming fiscal year. so all of our financial performance on the budget work together to the city's benefit

and the department of public health's benefit. and so we had a $96.5 million year-end balance. that is net of $26 million of expenditure carry forward and we're also depositing $40 million into our management reserve and that is $40 million of revenue that we budgeted in the current year but received earlier than expected. so rather than allowing that to just fall to general fund balance, we put that in reserve so that we can have it to use in this year, which is the year that the revenues were budgeted. and so when you net those all out, that's about an $82.5 million number and we net that out so that you can see an apples to apples comparison in the third quarter and that's what you see on the second slide. so 82.5 is the number to marie tcompareand we're 9.$8 million r

than we were at the third quarter report. so not a big swing, but it is a positive favorable. the third quarter was used to balance the city's budget and had an additional $8 million will be netted with all of the positives and negatives from other general fund departments and that will be folded into the projected deficit released by the mayor's office in mid-december for the upcoming budget cycle. so i won't go through all of these divisions in detail, because i know it's late and a lot are consistent with what we saw in the third quarter. but our biggest net driver of our surplus is zuckerburg san francisco general hospital and that is in particular our net patient revenues and we saw and discussed earlier in the second

and third quarter financial reports that were significantly above budget in the revenues that's due to a couple of factors and the first is that our census has been higher than budget on average over the course of the year and so that means additional expense but also additional revenue from patient billing. and secondly, the pair mix of that revenue has been more favorable than budget and that means a higher than budgeted proportion of commercial medicare and medicale versus uninsured or lower paying sources and that's not a policy decision. it's the way that things just kind of vary overtime depending who comes through the doors, particularly in the emergency department and that is a little bit of good luck and then finally we have for the last year or so have had a little bit of a structural under-budgeting

of revenues where we've seen sur mrs. *surpluses and we've made n adjustment and the mayor and board of supervisors submitted so we should be closer to our actuals in the upcoming year. laguna honda had a $10 million surplus and that's due to hire than budgeted per per dium rate.

i'm happy to answer any questions but i'll skill through the slides because of time and i'm just note a couple of things. again, all of this has been assumed in the budget or will be assumed in the five-year financial plan presented by the mayor's office later this month. we, despite having a significantly positive revenue bottom line, our expenditures are close to budget, for the size of the variance and expenditures we're cutting it close and we're watching that closely. we have a legally adopted expenditure limit in the budget passed by the mayor and board of supervisors and we have to live within that budget. so we are, i think, putting the right controls in place to make sure that we don't exceed budget

and that we're able to move funds between divisions as needed to balance across where our priorities are. and then lastly, as i said, we deposited $40 million into our management reserve under the admin provisions of the budget ordinance. we started with a balance of 80.$9 million and with this additional 40, we'll be at 120.9. so that is, i think, over the past several years, a very positive financial development for us, both for the ability to weather revenues that are patchy over the years and also sets us up much better than we have been in plier years i prior years ine have a significant recession or large-scale event affecting or finances. so that's a positive to manage our budget and be prepared. so i will leave it at that.

again, happy to go into more details o on any sections from e report. >> commissioners? commissioner chow. >> thank you for another good year in reporting and improvingg clarity. what i wanted to ask was on the management reserve, is any of that part of and is to pay for epic or is that a separate fund that we have been accumulating? >> so that's a separate fund. so for epic, and i think what you're referring to is we did two things that were kind of policy decisions and preparation for our ability to fund epic and also guard against financial risk. the first was this management reserve and what this does is reserves against risk of future

revenue loss or uncertainty and it's not quantifiable to meet a reserve to go through and audit and it's a judgment call, a management call about the risk. so we've established that. the second is the fund that we sed uset up for the epic budgetd we were to take a portion of that good news and move it into the epic project to help fund that and the two are related in that they both draw on favorable year-end news to fund future risk or the ehr as a priority, but they are separate funds. >> so under this, just to have one followup, then, nothing is going to epic from this surplus and it's all going into the management reserve? >> within the $40 million, it's

going to the management reserve and that will be in the management reserve. within the budget that we have adopted and within the financials that you see in front of you, there is a transfer, a budgeted transfer into the ehr and we had budget and equal actuals. so we made a budgeted transfer into the ehr project but that was done through the regular budget. it wasn't doing this, take the year-end surplus and allocate it to the epic project. >> so that was already within our current year, the fiscal year budget. >> correct. >> so there is additional funding. there is funding for epic that will sustain at this point. >> that's correct. >> within budget, of course. >> that's right, yes. >> thank you. >> commissioner green. >> thank you very much for the presentation. i just have one question for clarification. you know, we've talked a lot

about staffing and especially as we expend the behavioral health services and there was a line in this report that said the department is taking additional measures to monitor and control spending, including additional approval for proposed new hires. i wonder if you could maybe explain that in the context to of our our underlying concern that we can have great programs but we can't fill the positions. >> absolutely. department wide, we had a salary budget of a revised budget of $746 million and we had actual year-end salary expenditures of $746.9 million, so we're essentially at our salary budget. and so what that means is not that we are restricting our

reducing positions. it just means that we have to prioritize which positions we choose to hire so that we make sure we're getting the highest priority positions build versus the ones that may be a lower priority. so we do have to abide by when the board passes a budget, we have to abide by the limits of the expenditure authority that we're granted and we have a couple of tools tha tool tools. we manage across divisions where there's a surplus in one division that that allows flexibility to meet priority areas of hiring. the second is, a lot of the areas in particular with hiring that we're talking about, the net impact is really not an issue on our financials and in particular, what i'm referring to with that, is that the

hospitals, we have a lot of vacant positions but we have staffing ratio requirements and so we need to fill those shifts and we need to do it with permanent positions or with per diems or registry because we need to meet the state-required ratio. in those cases, when we're hiring into a vacant position, that's not costing us. there's a difference between a permanent position and the registry or per diems but they're similar and we're aggressivery trying to hire into those positions because we want those positions filled and we want to have the stability and we want the opportunity to fill as many shifts as possible with permanent staff who are familiar with the hospital who are working regular shifts, et cetera. so even though we're at budget, there are a lot of areas that we're very aggressively trying to hire permanent positions

within the budget that we have. >> thank you. >> dr. kolfax? >> i just wanted to acknowledge greg and his team, leadership in this work. they make it so clear that they risk making it seem easy and it's not. [ laughter ] >> and i just think that, you know, with regard to the financial stewardship of the department, greg and his team have demonstrated excellence in this area and i want to acknowledge that. thank you. >> thank you, mr. wagner. >> commissioners, other business is the next item? and just a reminder that the next meeting is at the laguna hospital and you're now at a vote for ajourning the meeting. >> moved. >> second. >> second. >> all those in favour? >> meeting is adjourned.

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them find capital, provide assistance loans, help to provide small business owners with education. we have had some great experience doing what you might call pop ups or temporary selling events, and maybe the most recent example was one that we did as part of sf made week in partnership with the city seas partnership with small business, creating a 100 company selling day right here at city hall, in partnership with mayor lee and the board of supervisors, and it was just a wonderful opportunity for many of our smaller manufacturers who may be one or two-person shop, and who don't have the wherewithal to have their own dedicated retail store to show their products and it comes back to how do we help companies set more money into arthur businesses and develop more customers and their

relationships, so that they can continue to grow and continue to stay here in san francisco. i'm amy kascel, and i'm the owner of amy kaschel san francisco. we started our line with wedding gowns, and about a year ago, we launched a ready to wear collection. san francisco's a great place to do business in terms of clientele. we have wonderful brides from all walks of life and doing really interesting things: architects, doctors, lawyers, teachers, artists, other like minded entrepreneurs, so really fantastic women to work with. i think it's important for them to know where their clothes are made and how they're made. >> my name is jefferson mccarly, and i'm the general manager of the mission bicycle company. we sell bikes made here for

people that ride here. essentially, we sell city bikes made for riding in urban environments. our core business really is to build bikes specifically for each individual. we care a lot about craftsmanship, we care a lot about quality, we care about good design, and people like that. when people come in, we spend a lot of time going to the design wall, and we can talk about handle bars, we can see the riding position, and we take notes all over the wall. it's a pretty fun shopping experience. paragraph. >> for me as a designer, i love the control. i can see what's going on, talk to my cutter, my pattern maker, looking at the designs. going through the suing room,

i'm looking at it, everyone on the team is kind of getting involved, is this what that drape look? is this what she's expecting, maybe if we've made a customization to a dress, which we can do because we're making everything here locally. over the last few years, we've been more technical. it's a great place to be, but you know, you have to concentrate and focus on where things are going and what the right decisions are as a small business owner. >> sometimes it's appropriate to bring in an expert to offer suggestions and guidance in coaching and counseling, and other times, we just need to talk to each other. we need to talk to other manufacturers that are facing similar problems, other people that are in the trenches, just like us, so that i can share with them a solution that we came up with

to manage our inventory, and they can share with me an idea that they had about how to overcome another problem. >> moving forward, where we see ourselves down the road, maybe five and ten years, is really looking at a business from a little bit more of a ready to wear perspective and making things that are really thoughtful and mindful, mindful of the end user, how they're going to use it, whether it's the end piece or a he hwedding gown, are they going to use it again, and incorporating that into the end collection, and so that's the direction i hear at this point. >> the reason we are so enamored with the work we do is we really do see it as a platform for changing and making the city something that it has always been and making sure that we're sharing the

opportunities that we've been blessed with economically and socially as possible, broadening that