>> i would like to call the commission to order. i'll take the roll. [roll call] the second item on -- hello, everybody and welcome. the second item is the approval of the december 17, 2019 minutes. >> you have the minutes before you. i would like a motion to adopt these minutes. >> so moved >> is there a second? >> second. >> comments or questions from the commission? all those in favor say aye. >> aye >> thank you. there is no public comment for that item. item 3 is the director's report.

>> good afternoon, commissioners. grant colfax, director of health. happy new year. of a-of-i have a few things to highlight. very exciting news with regard to medy cal expanding coverage to undocumented immigrants up to age 26. this is an expansion that governor newsom authorized as part of the state's 2019 to 20 budget, including full scope medical to eligible adults ages 19 to 25 regardless of immigration status. statewide this is expected to have a wide impact, covering 90,000 people, and enrollment started the first of the year. we have to make that expansion will apply to about 1,000 to 2,000 individuals in san francisco. and we have been working with the human services agency to notify eligible san franciscans, including transitioning those

who qualify from healthy san francisco to medical. this is also an important opportunity to remind residents about the available of medi-cal, that immigrants are not pen liesed when they apply for a green card, and there are no changes to the public charge rule as the courts issued an injunction and the federal government cannot implement or force the rule indefinitely at this time. obviously, the health department just to remind the public, and the commission that we will continue to provide health care services through our clinics and hospitals in the san francisco network, regardless of immigration status or lack of insurance. everyone is welcome, and we encourage all san franciscos to get the care they need and deserve. last year, december, last month, mayor breed issued budget instructions to department heads to guide the budget process for

fiscal years 2021 and 21/22. the mayor directed the department heads to prioritize identifying funding to help people suffering on the city streets and to target deficiencies in their budgets. the city is projecting a budget shortfall of $420 million over the next upcoming budget years out of an annual budget of approximately $6 million. and i think that important for the commission is that the mayor has indicated that a priority for the coming year is providing shelter, housing and services for people struggling on san francisco streets, and this includes opening new shelter beds and expanding behavioral health coverage and services for people. so we will come back to the commission as we do every year, several, a couple times in

february with budget proposals that of course you will review and help us modify and hopefully approve. so looking forward to that process with our staff and with your guidance and leadership. i also wanted to to highlight the fact that given our vast network of services and all the work we do every day in delivering those services, that we are improving health services at three neighborhood clinics, serving more than 12,000 san franciscans. we are this year, we will be working on improving clinic facilities in three primary care clinics including the health center in the western addition, the castro mission health center and southeast health center in the bayview. and i'm a big believer in how care is delivered and the quality of care is also reflective of the environment in which it is delivered in. that care environment, that physical space reflects our

value as providers and as communities and having worked in several of these clinics, a number of decades ago, they certainly, and the staff and most importantly the patients and the community deserve the renovations that are going to go forward. and i'm hopeful it will also improve our ability to provide a top-quality care. so that's my summary today. i stand available for the commission to answer any questions or additional details of things i have covered or not covered. >> is there any public comment? >> not receiving public comment for this item -- have not received public comment for this item >> i have a question under the topic health department educating the public about mobile vendors and food safety and the need to have the current inspection. does that apply to the food trucks that are wandering the streets? >> in terms of current inspection, whether they require

them? >> do the food trucks have inspections? >> yeah. so i'm getting an affirmative from some of our team that led on this. is doctor -- here? do you want to fill in? i believe they do, right? require the defaults? >> so this has to do with food vendors that have trucks, carts. >> the hand trucks? >> correct. so they are permitted. but what happens is we have people that come from other areas that have not permitted, and there's always tension, there's always tension on how we deal with people who are not permitted, because it's really hard to deal with that situation when it happens. the carts should be permitted. what happens is some come that are not permitted, and how that gets mitigated has been one of our challenges. >> my question is not the

pushcarts. it's the food trucks. >> those are also permitted. >> so all the food trucks that are -- >> every single one. >> that everybody has to be inspected? >> absolutely. >> and have a decal? >> i'm not sure they have a decal but they have documentation inside the truck that they are permitted. those are absolutely permitted. we have times when they have violated a permit we have shut down some of those trucks as well. >> thank you, mr. coal max. >> item 4 is general public comment. we have one request. john edmond abraham. >> yes. i have a timer in my hand, and when the beep goes off, please

know that is your time to stop talking. >> some people would say this is the time to stop talking. good afternoon, commissioners. and my name is john edmond abraham. and it is easier to call me mr. abraham. i'm here to -- for a couple reasons. mainly to let you know of the deplorable condition of the way people in charge, small businesses, the aids foundation -- 50 plus at the aids foundation, others open house that are there to support old, gay men and women fall far short of the goal and also the

what's now called the h.i.v. care council, the h.i.v. community council. everybody is dropping the word -- the acronym aids out of the equation. the effect is out of sight, out of mind. they think this thing is over. and i just lost a friend two months ago to a.i.d.s that i've known and there's this huge hole. every other thought is about that person, and our lives, not together, but we were not lovers or anything like that. we were partners in a lot of ways. we came from new york. and i used to say, believe it or not, that the new york city opera and the metropolitan opera, and here, this man was a former eye surgeon, and when he got sick with aids, he couldn't

do that anymore, and when i aim out here and i got sick sic with aids, i stopped singing. is that -- i should shut up now. >> how about you finish -- >> okay. i just want to give you my telephone number because i know this is going to take some time. and this is not anecdotal. this is strait on from my experience. please take out your pencils, everyone behind me and everyone in front, 415-921-6211. we can do lunch or some other way, but i need to communicate the truth of my experience here. >> finish your statement, please. >> that is it. >> thank you. >> commissioners, item 5 is the finance and planning committee report today. >> good afternoon, commissioners.

the finance and planning committee met earlier today to consider a contract report and also a new contract. the contract report has one item on it and it is for the request to approve the total contract amount of $2,296,793. and this is like due to new grant funding in the amount of $120,511 annually from the california department of public health for overdose sponsoring nizers. this is funding going to the harm reduction coalition.

the new contract is a contract in the amount of $107,250 with a 12% contingency. this is for realtime survey services to patients and physicians of the emergency department of zuckerberg general hospital as well as the primary and specialty care, and the term is from january 1, 2020 through december 31, 2020, and both items have been added to the consent calendar for your consideration. thank you. >> any questions, commissioners? questions? commissioners? item 6 is the consent calendar. it contains two items that commissioner chung just noted from the finance and planning committee meeting.

oh, i'm sorry. is this better? the consent calendar contains the two items commissioner chung just noted in her report back from the finance and planning committee. >> prepared to take a vote on consent calendar. >> so moved. >> signify by saying aye. >> aye. >> the motion carries >> if there is no public comment, item 7 is a resolution honoring winon a mindolovich. president loyce, commissioners, it is my honor to present a resolution to you this afternoon honoring winona's 21 years of

exceptional leadership with the department of public health. it's a bittersweet moment for me as she is retiring at the end of the week. as you have come to know her over the past years and most recently with her work on our transition formational electronic health program, i have come to see she leads with a great sense of compassion and puts her patients and clients at the center of her work which i think has defined so many of her successes here. she leaves us with a great legacy of diversity, inclusion, and diversity -- i'm sorry, equity, in the work that she does, by having supported and inspiring so many women to join the information technology field, both here and at other areas where she has been involved. i would just like to add that my

initial work with her was not here. i have known her for several years. the first time i remember meeting her is the feeling that i got and the sense that i received was warmth but also just a dogged tenacity to get the work done. and it is that that i'm going to remember most about you in that you just do not let it not get finished. and i'm just moved by that, and i hope that i can carry on as you have after you leave us at the end of the week. the resolution is before you. and if you have any questions, i'm happy to answer them. >> thank you, commissioner loyce. i want to express my gratitude personally and across the

department for your leadership. we weren't able to work together that long, but the time that we had was so incredibly valuable, both from what i learned from you and the integrity that you brought to the work. your perseverance was epic, and i think it's really key to remind ourselves that it got launched during a time when the department was undergoing a lot of transitions, including in leadership and the tremendous progress that was made and the effort that you invested and your attention to detail and the support of the team that actually executed on the august 1, right? august 3, sorry, how could i forget? but really the leadership that you showed, the tenacity and the fact that you have built a leadership team, i think one of the key marks of a great leader is the team that you build, the

team that you mentor, the transition to ongoing leadership is so important, and you have done that. i want to thank you for making a commitment, especially over the last couple years, to staying with the department, seeing this epic transformation be successful and go through, and we will continue the work, and your legacy will lead on. so thank you so much. >> thank you. commissioners. commissioner bernal. >> hi, winona. first of all, i share the observations of the director and him. i would add on top of tenacity, your enthusiasm was infectious this whole time. when you were making presentations, you couldn't help but be on board what you were talking about. my favorite moments were when something moved from red to

yellow or yellow to green. at the top of the like a great victory. you always shared the credit with your team as well, which is admirable because you had a great team. so thank you for seeing us through that whole period of time. we are deeply grateful, so thank you. >> commissioner chow >> i also want to add my thanks. having followed the episode of the birth of dhr from its conception, shall we call it, and the term during its gestation and the real question whether it could be carried off because of the challenges of transition, i couldn't imagine that came off not only on top but as well as it did. and it's got to be from your leadership. so i want to echo that not only i know for the many years that

you have been working here but particularly for that project, which we've been watching so carefully your shepherdship of it, your stupidship of it, and bringing it through -- your stewardship of it and bringing it through is by itself a credit to all you do here. thank you. >> commissioner >> i would like to echo everyone else. they call it epic for a reason. it was an epic task. i remember sitting here being through an implementation, and you would present these objectives and key results, i thought they were beyond stretch goals, i mean how many people you were going to train. i couldn't do the math. yet you did every one of them and got the team on board, and it's not easy working with epic, i mean people out of the corporate offices, and yet you obviously pulled the best from them and the best from our department. and your leadership was just incredible. i was so happy to see.

i couldn't even believe those things were going green as quickly as they were and as on time as you were able to accomplish them. that's fantastic leadership, and we are grateful, and i wish you would stay. [laughter] >> you are in good hands. >> i would like to add my compliments to you as well. i remember a couple of presentations you made for us. i think the compassion, the warmth and care about patients is very important, but i also think bringing a sense of humor and that smile when you were presenting, i always knew you were right on point and that if i listened, i might learn something. so thank you very much for your service. >> the resolution is in the hands of the commission. can i have a motion to adopt the resolution? >> so moved. >> second. >> all those in favor, signify by saying aye. >> aye >> i want to say a couple words to president loyce and commissioners and a few of you i have worked with in finance

committee side of things and director colfax and secretary, it's been with our support that we were able to accomplish this over the last few years and it indeed was an epic journey. there were many contracts and amazing number of contracts bringing to you so with your support and listening to me with my many yellows and greens and our status, and last time presented to you it was before we went live, so i knew we were going to make the date, but it isn't because of me. i had a fantastic team, many of which are in the audience and the leaders in dph, it has been an absolute pleasure to work with this group of people over the last 20 years and just to do the work that we do and serve the population that we serve has been an absolute pleasure for me so thank you very much. [applause] >> thank you.

>> commissioners, after you shake her hand, you can join her for a picture over by dr. colfax and i. [indiscernible]

[applause] thank you, everyone. i'll note there was no public comment for that item. item 8 is the office of compliance and privacy affairs annual report. i would like to note that mr. chatfield has been here three times. this is his third time. twice he had to be canceled due to a meeting having to end so can we thank him by a rand of applause -- a round of applause?

[applause] >> thank you. can someone help me with that? >> sure. no worries. >> okay. good evening, commissioners. thank you for having me tonight. my name is chatfield, i'm the acting director for the office of compliance and privacy affairs. i'm here to give you an update and annual report for the fiscal year 2018/2019. just an overview, it was established to help mitigate the rest of the department, both financial and reputational in four general areas, one being compliance. this context, we are talking about fraud and abuse, financial compliance with the services that we get paid for by medicare and medical. privacy, of course, to protect patient privacy and data

security, making sure when we share our information with our partners and members that it's done legally and appropriately, and then of course to investigate complaints that come to the office either to the program or directly to us. and not just with compliance and privacy, but conflict of interest rules, misuse of city resources and things like that. so we try, as a general overview, we try to educate staff on responsibilities by doing annual training, providing newsletters and advice to departments. making sure our policies -- they understand what is appropriate and required of them, assess risks throughout the department to make sure we are doing the things we are meant to do, and then of course look into wrong doing and come up with corrective actions to correct that if we find something that needs to be corrected. so quickly just organizationally, how we are set up, the director reports to the

director of health. the director currently has been reassigned to home and hospital at the moment. there's currently two compliance officers that are in each hospital as privacy officers and two vacant positions as well for compliance officers. we have an auditor and an investigations officers for whistle blower and then there's three privacy investigation positions, two of them currently are vacant, which we are recruiting for. that's sort of the non-behavioral health side. the behavioral health side, we have more of a beefed-up team. we have an obligation to the mental health side to ensure the providers are doing the right thing. so we have many more auditors in there where we look at what they are doing and making sure they are complying with the rules,

providing them guidance and assess their work. so these laws, i'm not going to go into detail. i just wanted to make sure you are aware of the general universe we operate in, the first being the false claims act. there's a federal verse and state. that does deal with fraud, waste and abuse. our claims, our services, making sure they are appropriate when we go to get reimbursed for them. there are antikickback statutes, not prefers or profiting off that, the reduction act for medical and that with the affordable care act had a lot of compliance requirements in there to make sure that as an organization we have mechanisms in place to mitigate the risk that's inherent in such a large organization like us. and then of course dealing with patient privacy, and then

there's a california equivalent called california medical information act, which is a little stricter than hip pa in - hippa in some regards. a quick overview of some of the things we did accomplish in the last year. we developed a new compliance training module that is on onlie and interactive, a vast improve the over the last powerpoint slide presentation we had. this requires the users to interact with the program, answer questions along the way, click in the modules that they are actively engaged in it. that was the help of our compliance training requirements to show we are providing meaningful training and not just go ahead and read this. we also improved our monitoring efforts at the two hospitals. it went up from 14 projects at the end of the fiscal year prior

to about 25. [please stand by] -

>> are they flowing through properly on the clinical side. quality of care, audio compliance, they go hand-in-hand we want to make sure we are not

delivering substandard care and if something is falling below what is required, that we then look at that because it affects our claims as well. we want to make sure we are sending claims out for quality service we are doing. making sure our documentation is okay, complete and accurate in supporting the services we are sending out. and then most importantly, expanding our exclusion screening. the federal government has stuff to make sure that everyone we do business with, including employees, are not excluded, meaning they can't receive federal money. because we do receive federal money, we have an obligation to check that. we do check some employees, not all. we are working to get that process more streamlined. on the privacy side, for the privacy program, it was set up primarily to make sure our clients, our patients, our

residents that are with d.p.h., their information is protected and we are doing everything we can to prevent any unauthorized exposure or use of that information. we investigate potential breaches, we look and see what happened, to determine whether or not it is a reportable breach it's something that meets the definition of a breach and we need to notify the state and federal government that it has occurred. we provide advice to all of the divisions on their best practices, we encourage people to come talk to us before they do something so we can advise them and guide them the best way that we can. and we also issue a newsletter every other month about the privacy policies. we do focus on information. we have noticed in the last fiscal years an increase in the number of incidents that get reported to us.

i -- it hasn't necessarily correlated with the breaches that we saw before, however, we think we become more culpable and we make ourselves -- the awareness of staff -- they are more likely to tell us it is going on. although we are happy to see these go up a little bit, we would rather look at a lot of issues and determine where there is problems that we can help mitigate any potential breach. the more we looked into things that might be near mrs., we put systems in place to stop this from occurring. we have seen that go up. i don't have the numbers for this specifically. with that, it is one of our areas to watch. with the vast information this has, it has allowed people to have vast information. so there are chances for people to be looking where they shouldn't.

we are setting up programs to make sure they reject that -- they check that. handling people are records, we want to be careful as we transition away from paper that people don't become cavalier or careless. and they continue to treat it with the same level of care that they always have. we don't want people getting the wrong slips or things like that. and then, of course, making sure the people who are looking at records have a reason to look at that record, not just because they are curious. what we do here is make sure that when we are sharing our information, our health information with vendors and partners that we have a legal way to do so and that is secure. the data sharing side, we have a data sharing officer. they look at these agreements to make sure everything is in place and they have their own security protections in place.

it is important that we do share this information with our partners because we want to make sure care is carried out. we want to make sure -- we had a bit of an uptick in the last meeting. in the last fiscal year, a lot of those specifically were focused for care link, which is one of the ways our partners go into it. they all got approved in this fiscal year so they don't show up here, but we do get routine requests for this all the time and review this information. the program is something we do and work in conjunction with the controller's office. there are two ways we can get complaints. one is through the controller's office program or directly to us there is a hotline which is 24 hours a day or in person. we will investigate the

compliance and privacy, but a lot about the whistleblower investigations involve our misuse of resources, nepotism, and improper conduct. we are always looking at these things from an ethics side to make sure that our staff understands they have obligations under that as well. the results of these all go back to the controller's office if they were referred to us from them as well. looking forward to this fiscal year, as we continue to strengthen our programs, one of the things we are doing is developing a d.p.h. level compliance committee. currently there are separate compliance committees that live in the hospitals and the reporting doesn't -- hasn't gotten filtered out to the executive staff. they can understand what the

risks are within the department. they can help allocate resources and also identify risks that they may see. it is important we get that structure. we already did have our first meeting and we will have our next meeting in february. that is already happening. we do plan on hiring our compliance officer for laguna honda. currently that position is vacant. the compliance officer is covering that for the minutes. we're close to getting that filled within the next month or so. we are happy about that because then we can go ahead and get primary care the compliance program that we want to get established there. i mentioned about epic. one of the things that we have started doing is dedicating our staff to monitor for inappropriate use. we have tools now that allow us to do this much easier than in

the past. we are looking at the reports to see who is accessing it. is it appropriate what they are doing in there? we also want to develop a protocol for putting an auditory service on records that might get flagged as confidential high-profile, something like that, so we do this, but would like to have a routine way of deciding when these get flagged so we can look at who is looking at these records. and then to increase our live training, although we do to the annual computer training, what we are looking to do is targeted topics so that there is an area or division that wants us to come talk about something that is specific to them, or there is something we feel people should know about, then we would add that to that. we are continuing our education efforts. that does conclude my presentation to you.

i'm happy to answer any questions you may have about what i discussed. >> there is one public comment. >> it is public comment. >> good afternoon, commissioners i am a whistleblower. the d.p.h. is coping with the biggest compliance and privacy failure in laguna honda's history, yet today's compliance report seems oblivious to that scandal. no explanation for why the compliance program and its whistleblower hotline missed dozens of patient abuses over three years. no suggestion for how the program could improve to detect future privacy and safety violations.

how could it better deal with a culture of silence? we are not told. there are two reasons why decent employees do not report wrongdoing. the first is that they believe that nothing will be done, and the second is that they fear retaliation. neither of these barriers was addressed today. note how today's presentation only shows the number of investigations without disclosing the outcomes. the message is that nothing was done or that nothing was substantiated. that discourages employees from reporting misconduct and it promotes silence. therefore, investigation outcomes and substantiation rates should be reported.

similarly, complaints of retaliation aren't mentioned. the message is that retaliation is being ignored even though employees know that it happens and fear it. a compliance program that ignores whistleblower retaliation, promotes a culture of silence. the program should report retaliation complaints and what it did to address them. >> time. >> unless the compliance and proxy program explains what it could do differently to prevent future abuses, it should not be expanded. lastly, please consider more frequent compliance reports. once a year leaves you in the dark. thank you. >> thank you. >> dr. colfax, did you want to

make a comment? >> i wanted to acknowledge the progress that has been made. this year has been a challenging year. one thing i want to emphasize is that garrett really stepped up in this role. he is acting director and maggie who is our compliance director was recently at laguna honda and has built a lot of the foundation you built today. i want to acknowledge garrett's leadership. you are on the job a very short time in this role. we were very excited to be able to have him not only join the team, but bring in the leadership here. and the fact that we are really focusing on developing a d.p.h. wide compliance program. i thank you saw the evolution in the summary, but i want to emphasize that. having executive level compliance committee really signals in a very meaningful way

that the d.p.h. values compliance and we need to expand that work across the entire department with executive level oversight going forward. i really want to thank garrett and his team and acknowledge maggie's leadership in developing it up to this point. we look forward to 2010 tito 2020 which will be a year of expanding our compliance and oversight of the department. inc. you. >> commissioners? >> i have a question on one of your risk areas to watch, which was quality of care that you have brought up. how do you monitor, measure the quality of care? do you have specs -- specific variables? how is it measured? >> our compliance primarily focuses on the -- the quality

side of things. we work with quality to understand what they are looking at. we attended their meetings to understand what they are doing. what we look at to see is if quality issues are to the point where we shouldn't be claiming for the services that we are providing. i can't give you a measure at this point because quality, we don't do a quality assessment in compliance. we work with them to try to understand what they are doing and what we are trying to do is focus ourselves to pay attention to that so that we are aware of what is happening on the quality side. >> i guess my question and concern is, if, in fact, they have a metric that they are presenting to you for compliance is there such a thing? >> i don't have that for you. i'm sorry.

>> commissioner ciao? >> yes, thank you for the presentation. this is one of the times were normally where we begin with a slide that shows where your office is. it would have been helpful because i am trying to understand where compliance reports to, which i think is very high up, and number two, if i remember the old chart, and when the office organized itself into this manner? is it a recent organization or is -- has it been there for 10 years in the structure you are showing? >> i apologize for that. is my first time with you. next time i will make sure i will have it for you. >> that is why i was wondering. we have not actually -- i don't think recently we have seen this type of overview. so that is why i am wondering, is this also part of the build

out of compliance to make it -- and privacy, trying to make it more robust. >> sure. i will answer in order. the director for the compliance reports directly to the director of health. that is where it sits in the organization as the division under the director. part of the reason for this overview and the executive level was to make it more robust, provide reports to on a more regular basis. we do intend to report to you more then annually so that you are aware of what is going on, along with d.p.h. leadership and make sure that that is happening >> thank you. if i can, i wanted to hear the follow-up question. i did look at your interactive

compliance module, which i thought was extremely comprehensive and wanted to graduate the department on it. i was stressed by the fact that there was so much information, that i was wondering, was there a means for that to actually be more easily obtained by users? that its employees might think, i remember there was something about privacy but i can't remember what it was and what i can do. while i know we don't really know the number -- that is very nice. i guess i am asking, if resources are available beyond that module, that makes it easy because you have done a lot of work and have a lot of resources and secondly, more specifically, i found the code of conduct extremely detailed and it would seem to me that it really should be a valuable thing on our website. is it on our website?

like here are our objectives and here is our code of conduct and the way that we do our business. >> the code of conduct is on the website. we do try to reiterate what we talked about in the training through the privacy policies in the compliance matters that we issue to try to bring more detail to them. part of what we discuss is expanding the education so that we can either buy invite or by concern of an area, we can present topics in a little more detail. we do really want to encourage people to understand that all of these things are to be part of their daily work. it didn't just happen on the idea about patient privacy and making sure we are acting with integrity and reporting issues. we do encourage that.

those are some efforts we are currently doing. >> if i were an employee step -- working in the living room and i wanted to review, because now i remember -- [indiscernible] is there a way they can do that without going through the whole thing? >> sure. as far as the training, that is a good point. i think there isn't a way at this point, once a training is off the platform, it is off the platform, but that is a good point. i think it's something we can look at and see if that is something we can leave off. our policies are available in the website so we can look at the policies that are behind all the trainings. that is a pretty good point.

>> right. i was fascinated by the fact you do have risk areas you are watching, which means this is sort of your work plan for 20 years. you have given us a preliminary data. it does go back to the question of, from the data, then what did we learn and where do we go from it? which i would anticipate in your next reports we would start seeing. >> you will. >> i think particularly in areas -- we obviously have heard of data breaches and we get -- we get those reported as they happen, but it would be nice to see these in a report coming in and looking at the history and then understanding what we are doing in order to -- and here are the things. just like you did very impressively on the issue of decreasing disallowance is on incomplete clients. we knew that was a huge problem in terms of not properly documenting or inappropriately

diagnosing for a large number of reasons, sometimes under diagnosing and so forth. and to move that out in this type of way is a wonderful outcome of this. i think we would like to see some of the others where you are showing that we either have decreases or increases of reporting. and i know that for specific units, sometimes we get to look at that. i think it is at the -- at the department, this would be helpful. and then the lessons learned. we have this program in place. we think it is really meaningful that we then become much more aware of what is happening and we can articulate to our public that is often asking us because it shows up in the papers, what are we doing about this. >> certainly we can provide you with that data as we move forward when we report to you.

>> thank you very much. >> thank you for your presentation. very impressive. you really can't under -- overstate the importance of your office's work to protect our patients and our resources. and as you said to try to prevent issues, that are particularly challenging an environment that is changing and often uncertain. looking at your organizational chart, there are 14 positions and four of them are vacant. one of them is being reassigned and another has been reassigned internally. that is a lot of vacancies or people doing work that is not there core work. how much of a barrier is that to the work you are doing and how is your progress in filling those positions? >> it is a barrier because people are doing work that is not their primary responsibility they have all done it willingly and i commend them all for doing it. the positions are moving through at the pace that they do.

we do almost have the laguna honda position filled. the other positions are moving along slowly behind there, but i am trusting that the h.r. process is doing what it needs to do to have that happen. to be perfectly frank, it's a challenge because there are people doing a lot of work and doing the best they can in a very, like you said, challenging and changing environment. >> kudos to them for their great work. we hope you will get the staffing you need soon. also, just two other quick observations. as commissioner chow had said, i'm wondering what would you attribute in the disallowance is for incorrect claims? it's an 80% reduction over two years. what would you attribute that to >> there was a big payback with the mental health services

earlier and that -- the former compliance officer overall -- over there did develop a very robust program and that really did help. that was a lot of it. we do hope that this continues, although i wouldev guarantee on that because you never know what can happen. we do like to see that happening >> and assume a question when you're looking at the whistleblower program. it looks like there has been a 50 to 60% reduction year-over-year in investigations for improper conduct in fate -- and favouritism. what would you attribute those decreases to? >> it is not really meant to show a reduction, it is really just the number we looked at. during those two years, it was about 83 in the first fiscal year and 63 total and the other one. this really was to show the areas that we look at the most. that's all that was. it wasn't a comprehensive chart

of reduction necessarily. there were 20 less cases. >> the improper conduct one from 36 to about 17 or 18 the next year and also under favouritism, it went from 16 to about six. >> i couldn't tell you what caused that or because that reduction. it could be we just got less complaints around that. >> at some of that be due to not having a full complement of staff as well? >> yeah,. certainly we only have one person doing this so we handle them as quickly and as best as we can. >> thank you. >> commissioner green? >> thank you for this. it's very exciting all of your plans for the coming year. given that they are so extensive , you shared with us four of the goals or metrics that you have been following today. if you're going to expand the program, do you have any sense of what other objectives or metrics you might incorporate,

and also what the actual numerical changes you might be targeting? we have seen that in other areas , for example, at hospitals i'm wondering if you're doing any analogous work in these areas and when we might have access. i think the corlett his gigantic have you gotten a sense of how you might best utilize it and where you might focus? we have this resource, but without knowing exactly what you want to extract from it and what our goals to that information is , it is hard to assess where we are making progress. will you expand some of these and how will epic be a part of it? when will we be able to get report? >> definitely before the year goes by. i don't know when. that is part of having the executive level committees so we have more regular reporting and we can bring that reporting to you. we do plan to look at

disallowance rates in the various areas and using that as a tool for that. you are right. epic is new and we are still learning how to use its reporting functions and that is our learning curve to be able to look at what is going on there and figure out, okay, what is trending as a problem within their? which is why we are going to do that risk assessment early this year to see what might have a chain -- change in that environment. we can provide you with information on what types of breaches are happening, as well as if they are increasing or decreasing. that sort of thing. >> is that it? >> i just wanted mr. pickens to loop back on the question i was asked about the intersection of quality and compliance because i felt like there might be some more information that could be

provided in response to the commissioners' questions. >> good afternoon. i'm director of the health network. i want to add to garrett's presentation, particularly your question about quality. in terms of quality of care. quality of care sits directly within the delivery system. most of our delivery system is within the health network with a small component also within ph.d., mainly our city clinic and tuberculosis clinic. within the network, each of our units, laguna honda, zuckerberg, the various units of ambulatory care all have quality departments and staff that actually report on the quality of patient care. if you sit on those zuckerberg j.c.c., that is where quality is presented. similarly for laguna honda.

recognizing that we are this vast network, we are in the process of actually elevating quality to the network level so rather than looking at it at each individual section, you will see it up a larger network department level. we will be coming to you, the commission, at the department level to really present what we are doing in terms of clinical quality, what are the measures, the metrics, and so you will see them. it will not only be those who sit on those panels, but the entire commission will be able to see the full picture of clinical quality. those will be coming from the network side and we will also incorporate those components of quality that exist. >> when will those be appealed?

>> in january we hopefully -- hopefully we will be coming to you within the next six months with a quality report from a network department level perspective. >> thank you very much for your report. >> thank you very much. have a good evening. >> commissioners, the next item is a resolution approving the san francisco department of public health 2020 state and federal legislative plans i have both the resolution on the presentation just for you to know to stay on. >> thank you. >> good afternoon, commissioners i am the director of the office

of policy and planning. today we will be providing you with an overview of the department's 2020 state and federal legislative platform, as well as a summary of some of the actions that we are taking in 2019 -- that were taking -- taken in 2019. i'm here with max was a health planner in the office who i will be sharing this presentation with. as was mentioned, you have a copy of the resolution before you that approves our platform your consideration today. as i mentioned, we'll be providing you with some backgrounds on the purpose and the development of the plan, a summary of the actions that happened in 2019, as well as a high-level overview of the state and federal plans.

we prepared two plans. one federal and one state. these platforms are aligned with d.p.h.'s priorities and missions and serve as guides for monitoring bills of budget proposals and identifying any issues that might come up during the course of the year that may need some city action. the plans are informed using input from department leadership , subject matter experts throughout the organization, as well as many professional associations that several d.p.h. staff are members of. the plans are intended to cover a broad range of issues that are important to the department. additionally, they might serve as helpful tools for staff who are representing the department on other associations when it comes to representing what our position is. every year we present the plan to the health commission annually for your approval.

after which the plans are sent to the mayor's office for review and then they incorporate the plans into a larger city wide legislative plan. i also wanted you to know that if the commission has any additional feedback or input, we are happy to incorporate those thoughts in today. this is a little hard to read up here, but how do we advance positions as we already city department? there is a process that we have to go through. this starts with the plans which are the ones i just talked about as issues come up and are introduced at the state level or the federal level, typically d.p.h. staff work with leadership within their division to analyse and review what potential impacts are. then that policy or proposal will come to the office of policy and planning for review.

we may also reach out to other organizations, other city departments if necessary before developing a specific proposal. and then afterwards, this advances onto the mayor's office of legislative affairs. when it comes to state legislation, they can meet a monthly meeting that has seven members, seven voting members that are representatives of the board, the mayor's office, city attorney, and the controller's office who approves official positions by any city department after we receive approval from the office of legislative affairs and that committee, we may engage in advocacy. typically this is in the form of a comment letter that we can share with the legislature. i also wanted to note that the city contracts with state and from dural lobbyists who will work on behalf of the department

-- and federal lobbyists. we could also provide expert testimony if needed in sacramento. or provide technical support under the high priority issues for the department. on the right side, i wanted to note the nature of state and federal process that requires us to be responsive. we are often, you know, coordinating with partners outside of departments such as our associations, the mayor's office and other city departments and the city attorney's office. looking back on 2019, we monitored around 100 bills that were relevant to the health department's mission or function we officially took positions on 22 bills. six of which were signed into law by governor newsom, two which were vetoed and 14 which

are currently held. they come back as two year bills this year. some of the key issues included behavioral health. substance use disorder treatment this year we sponsored a bill that would have expanded medication assisted treatment options were individuals in the jail. unfortunately this was held this year and it may come back in 2020. we continue to support a bill on overdose prevention programs, conservatorship conservatorship was another key issue. we support it along with the mayor's office which was a follow-up bill to 1045, which is the new housing conservatorship law, which grates a pathway for conservatorship for individuals who are high users of systems as well and also have mental health and substance use needs. another bill that we supported this year was a.b. 1544 which

would have permanently authorized our local e.m.s. agency to transport patients to alternative setting such as a recovery centre. we expect this issue to come back again in 2020. and finally we supported a few proposals that are related to the integration of mental health and substance use funding for same-day billing when individuals are seen at a primary care setting and workforce development really had to introduce loan forgiveness for individuals are practising with the county mental health plan. other key issues this year were related to h.i.v. prevention. we supported s.b. 159 which is a bill that passed and allows for emphasis to dispense drugs. it also prevents insurance companies from requiring prior authorization.

maternal childhood and analysing health. we supported the pregnancy in childhood -- and childbirth act which recognizes maternal morbidity and births are highest among african-american mothers across the state. this requires hospitals, primary care clinics and other centres to implement implicit bias trainings. i will talk about the medi-cal eligibility and expansion proposal on the next slide and long-term care. there are efforts of the state to expand these systems, which would allow medi-cal beneficiaries to be placed in care homes in lieu of more costly nursing facilities. this year the governor was able to advance several healthcare proposals. the first was already mentioned in the opening remarks around

expansion of medi-cal to undocumented adults aged 19 to 25. there was additional expansions for coverage california premium support for individuals between 40600% of federal -- between 400 and 600% federal policy -- poverty level. this is going to require all californians to have insurance or they can potentially face a penalty of up to a minimum of $695 per addled. this year, the government also issued an executive order with the goal of controlling prescription drug costs. there are two key proposals in this executive order. one is the transition of pharmacy services for medi-cal managed-care to free service.

would you expect this proposal to reduce savings for public healthcare systems. the executive order also included a goal to expand the state's bulk purchasing program, which would essentially allow us to collectively purchase drugs for the state to lower drug prices. the other key issues that i know you heard a little bit about from our behavioral health division earlier or in the fall of 2019 is california advancing medi-cal which is the state's process to renew its current waivers with the federal government. there will be a lot of attention and focus on that this year. and finally the governor is planning to release his budget this friday, so we will be

monitoring that and we will provide the commission with an update regarding this proposal. i will hand it to max to talk about some of the federal issues on the platform. >> my name is max and i am a healthcare program planner with the policy planning office. for this section of the presentation i will provide a brief overview of the federal issues that we monitored during -- and were engaged in and provide an overview of the department's proposed 2020 state and federal platforms. this past year, the federal administration engaged in various actions to undermine before able care act, immigration protections, women's rights and lgbtq rights. many of these issues have been ongoing from the previous several years and we will continue to monitor these into 2020 as they progress through the court system or through the

rulemaking process and a more complete overview of these issues are available in the table that was provided to you. at the start of 2019, your appeal of the individual mandate became effective. the california new state-level individual mandate and also the affordability initiatives are projected to help protect the state from impacts from this repeal. in addition to the mandates, other efforts were made to weaken aca related a form -- reforms including an ongoing challenge to the constitutional legitimacy of the aca. the federal administration also continue to undermine the health and safety of our san francisco immigrant communities with attempts to change charge rules which govern how the use of public benefits could impact immigrants or individuals with immigration status. in august of 2019, the state attorney, in coordination with

human services agency of the department of public -- public health office in the mayor's office, filed a legal challenge to the newly finalized public charge rule. fortunately in october of 2019 following that challenge, the board indefinitely delayed his limitation of that rule and is continuing to make its way through the courts now. if the rule does go into effect, it could significantly impact immigrants' use of publicly assisted programs like medi-cal. at the department has developed public awareness materials informing residents that they are welcome at all city clinics and hospitals regardless of their immigration or insurance status. this past year the administration also implemented new restrictions on title x family planning grant plan. these restrictions would restrict clinicians and other clinical staff from being able

to provide a complete and unbiased reproductive health information and a full range of services to their patients. last year, the department's funding planning coordinator provided an update on the health commission on these changes in the following august. these changes officially went into effect, at which time the department withdrew from the grant program. the department's maternal child and adolescent health section is committed to could tuning to provide financial support to the family planning program, which had administered the grand. before withdrawing from the grant program, the program had worked with the city attorney's office to provide official comment on the rule and provide testimony in a lawsuit filed by the california state attorney general. the board of supervisors also provided a resolution by opposing these regulations. finally, the federaladministrate changes that would allow providers to refused to provide services, but they have a

religious or moral or religious objection to like abortion or gender reassignment surgery. these changes are referred to as conscience rights in healthcare, and under these changes, federal funding would be taken away from the state -- from state to do not comply. d.p.h. formally submitted written comments to the rules citing concerns with the rule's discriminatory effects in the california attorney general and san francisco city attorney's office filed lawsuits against this rule. in november of last year, a judge blocked these changes from taking effect. so next i will provide an overview of the department's state and legislative platforms for 2020. for the developed of this year's plans, we worked with leadership and experts from across the department to review the platforms to identify emerging policy issues and areas covered in the platforms are not too different from last year. modifications have been made based on the issues that the department is likely to engage

in. this includes a new section on expanding policy goals for long-term care, as well as furthering behavioral health integration. for the 2020 platform, we organized legislative issues based on their intersections to the two additions to the san francisco health network and the population addition. issues are categorized under one division based on who is likely the lead on the issue and to we would first reach out to better understand impacts of the policy those issues both impact both divisions and we will work with experts from across the department to understand the implications of the policy and weigh in on those issues. rather than reviewing the entire platform, we will highlight several state policies that the department expects to focus on in the upcoming year. medi-cal and healthcare reform will be significant issues as the state engages in the cal aim initiative. this will impact many different parts of the department's healthcare delivery system.

we will want to monitor proposals to ensure that adequate funding continues to be provided for public hospitals in the health system and that there is continuity in the whole person care system under the condition of long-term care that continues to be a pressing issue in san francisco and across the stage. we continue to experience issues of residential care facility closures and these facilities offer supportive residential living for individuals who no longer live independently. in order to stabilize and prevent the further loss of these facilities, we will support proposals to increase funding to prevent the further loss of these facilities. i like to discuss the department 's 2020 legislative platform. commissioner ciao, thank you for your feedback. i want to note it has been incorporated into this year's plans. we added language to support

proposals to comprehensively fund hepatitis b services such as education, treatment, screening, and vaccination. if also added a new subsection within the public health care section stating that the department will support proposals to ensure that emergency programs and planning are inclusive of the needs of vulnerable populations including those with access to functional needs, those with disabilities, those unable to be self-sufficient for 72 hours following an emergency, as well as other groups that may be disproportionately impacted during an emergency. given the broader categorization of federal issues, they are not organized by department division on this platform. as i mentioned earlier, the department is expected to monitor many of the same issues from the previous years. these include ongoing issues around a.c.a. health-related reforms, immigration issues like public charge, and proposed

changes propose changes to patient privacy. because of our distance from the federal level, will continue to work closely with professional organizations like california association of public hospitals and coordinate our efforts with the mayor's office and city attorney's office for engaging on any pressing federal issues that arise. this concludes our overview of this year's plans. before you for your consideration again is a resolution approving of the 2020 state and federal legislative platforms. we welcome your input on the platforms. >> is there public comment? >> there is no public comment. >> any comments you would like to make? >> just to reinforce the breadth and depth of the issues that we were looking at here. it is broad and has brought in several mandates.

there are things that are very specific. really want to acknowledge the policy team in the work they do across the department as well as the mayor's office and other departments were a lot of these policies intersect. we know they have a further impact on the people in the communities we serve. i just want to appreciate the work. it will be a challenging year. certainly the department is up to the task with your support. thank you. >> we will have a motion for the resolution. before we do that, i would like to hear from any -- from you any questions or comments you would like to make. >> i just want to thank the department for the work that they have been doing. each it gets even more robust and our issues become even more and the fact that you also have

accepted -- and to explain to my fellow commissioners, that while we were talking about hepatitis c company and civilly, we have omitted, especially in our town, the fact that hepatitis b also had treatment that was available i thank you have -- it's certainly beyond what i would even think about. and likewise, the whole issue of working with the whole vulnerable population. i think it comes up, as even as the director pointed out, in terms of not just the federal level, but within our own programs. i have been waiting for you to tie it all together at the federal and the state level and in our local areas. we do seem to forget that the vulnerable populations are not being treated and cared for or

networked into the care because we have this policy of you were on your own for 72 hours in many of these incidents. i know that reports given back to us recently have shown that, especially with our heat days and all, that we have begun to do more in terms of working with the different organizations or areas to try to reach these people. i think too often our local organizations and especially in the emergency preparedness, looking at the very large pictures and the need to mobilize for large populations forget the individuals. i think therefore, our role is to remind ourselves that they are out there and they are vulnerable, whether it be heat, earthquake, whether it be fire, and that we should be preparing

for that. these are people who cannot survive 72 hours on their own. i really appreciate that you will put that in at the federal level. i'm hoping that at the state and local level we would begin to really emphasize those areas of preparedness. >> thank you. i should also note we included similar language into the state platform as well in our public health emergency preparedness section. >> thank you very much. >> commissioner green? >> thank you for the work. it is remarkable to be able to read this and see it in the -- very easy to understand pages. it seems like the state's priorities and our own priorities have conflict. are there any areas that you feel or high priority for us that might not have been adequately emphasized at the state level and are there any areas of unique vulnerability or concerns that perhaps haven't been prioritized in the same

manner as you might? >> nothing that is jumping to my mind right now. i would say a lot of what you saw on the stateside, a lot of our focus was on behavioral health. i think that is also because of the synergy with a lot of the efforts that are happening here locally. i think we expect that to continue into 2020. right of the top of my head i can't think of anything that is potentially missing from the work that we are doing. >> that is great news. thinks. >> let me just ask the question to follow-up commissioner green 's question. it was just recently put forward on isis and the adverse child experience and i assume you supported it and then it was

also just past that medi-cal -- the medi-cal reimbursement as well. so i know you did mention it, but was that part of it? >> that was part of the governor 's budget proposal in 2019 which we did not take a formal supportive position, but we are supportive of. i checked when with our ambulatory care director about that. it sounds like we are still figuring out implementation of that and we are piloting it within a few places in the network. such as the children's health centre. it will be a process to get that up and running. unfortunately i think the screening was not part of our wave one tool, so i think it is an ongoing target and goal that we have to meet. >> thank you. >> i would just like to say that i really appreciate two things

here. one, the language that is in the narrative that describes exactly what our department's position is on this piece of the legislation both federally and statewide, and the narrative is very explicit and helpful to understand what these pieces of legislation will do and why the department is taking opposition on them or not taking opposition thank you very much for that work. it must be intends to accomplish this in the time frames that you have. thank you for your service today >> thank you, commissioner. >> thank you. >> the resolution vote. >> that is right. >> will someone make a motion to adopt this resolution? >> so moved. >> second. >> all those in favor say aye. >> aye. >> thank you. >> thank you. >> item 10 is the d.p.h. strategic priorities.

>> commissioners, if i make break in here before this could presentation is started, i want to provide some background on this document. something that stood out for me when i started here 10 months ago was all the great work going on in the department and the size and the scope of the department and the multiple levels of expertise, and for -- quite frankly, the challenges and barriers that we run into we challenge ourselves to do better there was no one overarching the document that summarized our priorities. i think that this is really an effort. i asked dr. golden, along with her team, to collate the key priorities that were brought forward to the commission in the last year or so to really develop through the lean process

and to remind the commissioners, there are extensive details in those documents with regard to these priorities, including very specific outcomes and timelines for achieving those outcomes. i would also say that for people just starting in the department, and somebody who has been interested in what we are focusing on, perhaps new commissioners and others, those main documents are somewhat challenging to move through, and certainly dr. golden and her team did a great job of hoping orient us. this is really a document that i expect over time in over the years will evolve, but it is our efforts, for the first time in many years, to summarize our broad brush strategic priorities going forward. i will let dr. golden take it from here, but also note that the subject matter experts in these areas are available to

answer more detailed questions, or certain as we go forward we can go into the outcomes and the timelines for achieving the specific granular objectives that you listed in the 83. i will turn it over to dr. golden to provide this. i want to think her for compiling this document with a relatively short notice and the work that her team did. thank you. >> good evening. i'm very pleased to be here and honoured to present the departmental strategies, particularly at the beginning of this new year and this new decade, as we embark on this. dr. colfax said this is the first time that we have actually put together something, a draft like this. it's actually very exciting. it represents the work and thinking of many people across the department and division. many of whom are actually in the room today.

i want to acknowledge that as well. the process for articulating our priorities really began with the affirming and reaffirming of our mission and vision. you maybe familiar with this, our mission, and it was an opportunity to expand on that statement so that it included all in san francisco, which reflects our deep-seated belief in the importance of actually serving all those who walk through our doors and also in serving the community itself. our mission is new. are you familiar with our mission? making san francisco the healthiest place on earth. does that sound familiar in any way? okay. it might sound familiar because it is very similar to something that disneyland does. [laughter]

anyway, it is an aspirational goal, obviously worthy of the challenge. true north triangle is really a visual representation of our mission, our vision, and true north. and it really builds on the work of many of the sections and divisions before ass. so at the bottom you have protecting our mission, protecting and promoting health and well-being for all of san francisco. what we do, who we serve, and at the top, we have our vision, which is what we hope to achieve and what we are striving for. in the middle is our true north, which is a set of universal ideals which, taken together, are a compass for us that describes our ideal state that we are continually striving towards. we may never get there, but we are obviously, hopefully always

moving in that direction. so our true north never changes, but our tactics and strategies may change. we have six dimensions can you rattled him -- can you rattle them off? i'm not sure if everybody in the department can rattle them off yet, with that could be a goal that we would strive for. so equity, which is looking at eliminating health disparities, safety and security, which is about how do we provide the safest environments for our clients and staff, health and impacts, which is really about improving the health of the people we serve, by providing the highest quality care. through service experience, which is about the best experience that we can provide for patients and clients, and then workforce, which is a very, very important piece of this, which is really about how do we

value, invest, and respect in our staff, and lastly, financial stewardship, which is about transparent accountability for the resources that we have. all right. so we went through a process. it is a japanese term meaning needle or compass and method or management and we put it together and we have strategic direction setting. it is a process of identifying and deploying strategic priorities. it is not just a single event, but it is a year-long process for deploying improvement work. there is a series of steps involved in this that includes not just setting the objectives and measuring them so we can focus ourselves, but also to look at how do we measure on a systems level to see how we are performing as an organization,

and then having visual management to allow greater transparency around the operational environment so that in the end, we can improve the work and develop our future thinking. once we set our strategies, we then catch ball them. we share them out with other leaders and managers in the division and other levels of the organization through a technique called catch ball. that is where we get feedback to refine our thinking and to refine our plan so that ultimately this becomes a two way communication and there is feedback between not just the owner of the issue he was responsible for delivering on it , but from subject matter experts at the same time. that strategic plan, which is very broad at the department

level, then gets taken by successive divisions and factions and as they do their own strategic planning, they think about, what is my role, what is my way of supporting the overall departmental goals? and they incorporate that such that the strategic plan is no longer just at the top, as a horizontal thing, but is vertically aligned up and down. this allows people not only to understand what the plan is, but also see what is my role in being a part of the most important objective for the organization? as we cascade down our strategic plan, it may become increasingly narrow, more concrete, more specific, and this allows everyone to participate in what is hopefully a dynamic and

creative environment. all right. the department identified five strategic priorities and this represents a double pronged approach which looks at, first and foremost, the development of the infrastructure for doing this work, whether it's with this topic or any topic in the future, and focusing in on three key areas. we are looking at process improvements, daily management system deployments, as well as looking at how do we continuously improve. we're also looking at how do we engage our staff and our people in doing the improvement work. and lastly, how do we provide them with the tools to doing this improvement work, the data tools, and epic is a comprehensive electronic health record system that will enable

us to provide care across the continuum. the application of those areas focuses on advancing equity, behavioral health and homework -- homelessness health. they're five strategic priorities. the first priority is looking at advancing equity which is really about how do we achieve our vision of being the healthiest place on earth through an elimination of health disparities. there is work already underway through hypertension control and in a black african americans through chlamydia screening in youth, through sexual discriminatory health, and on the flip side, we need to look at how do we create an equitable and respectful workplace for everyone such that they feel like they have the opportunities to succeed. at the same time, we look at how do we train staff to recognize

racism and inequity through the development of equity skills curriculum training, as well as the equity champions, and then establish the department's infrastructure for doing this work overall through the development of an equity council , and the office of health equity. probably we would like to actually align this work with work that is being done throughout the city with other agencies as well, and with, in particular, the office of racial equity at the human rights commission. our second strategy is about workforce development and we acknowledge that an engaged workforce is best able to provide the highest quality care for our staff. based on a recent staff engagement survey, both communication and advancing equity were identified as top

priorities. so we are looking at how do we provide a culture of open and respectful communication by training our leaders and our managers tween communication, crucial conversation, critical problem solving, to look at how they can better manage with greater understanding and clarity. we are also aligning this work with the advancing racial equity work by developing curriculum that is aligned. for our third strategy, we are looking at the power lying -- deploying a performance improvement system and a management system, really as a philosophy around how we do the work. we will try to create greater focus that are really important to the organizational -- organization. we're looking at how do we

communicate that out so it is a vertically and horizontally understood and that everybody has a chance to provide input, particularly our subject matter experts in these areas. one of the main pillars of this is also looking at developing our people, which is about how do we develop 8,000 daily problem solvers, a fundamental building block of doing this improvement work? and then how do we sustain that improvement by employing a daily management system that involves everybody every day and doing improvement work? our fourth strategy looks at how do we use data effectively on the service of our mission to care for all in san francisco? that really is our goal in terms of deploying an electronic health record system. we started that process, we talked about it earlier. we're happy with how things have

gone. we know we have to continue to deploy to other sites and other areas, and also recognized that there are other groups, community-based partners who we need to connect with in order to create those systems to build better care for our patients. we need to look at how we increase success ability -- accessibility, align organizational priorities such that we can actually meet the operational demands for data and data sets. and lastly, how do we train our staff to use data more effectively in supporting problem-solving, analysis, decision-making, and continuous improvement? our last strategy, certainly not our least is homelessness and behavioral health, which is looking at how do we create a unifying vision for the delivery of behavioral health services to

adults experiencing homelessness and while we know that care is provided individually one-on-one , we also need to step back and look at a systems approach to doing this work. so a population-based approach to behavioral healthcare. looking at streamlining housing and looking at increased access to healthcare. focusing on the 237 highest risk station and building that model and applying it of the population. we are also in silicon valley looking at innovative opportunities for doing this work and aligning it with the advancing equity strategy to eliminate health disparities and using data and evidence-based practices to inform and guide the decision. so we have learned a lot about doing this and we're continuing we are continuing to learn. we know that strategic planning

is not just planning, it is about deployments. it is a year-long process. it is not about a one-day event. it is also about horizontal or vertical alignment in the work that we do. so everyone sees their role in the importance of how they can move things forward. we talked about yellows and greens and reds are things that people are usually really afraid of. we need to teach people that read is an opportunity and that the work is not about individuals, but it is about the system and how do we actually worked through that system. and we need to focus. we need to prioritize and think about where we can do you prioritize in order to have the bandwidth to do all this work.

so this has been a high-level summary of our strategic plan. i want to thank everyone back here for all of their work in putting this together. thank you. >> thank you. i would like to move to public comment. i like to remind you that will be voting on the strategies and priorities. >> commissioners? >> i do have a question. >> thank you. it's not really a question. i was looking at the switch -- the switch. it is a marvellous attempt to pull together everything.

we are trying to understand which year we are talking about as this represen in that case, because you have some bars and also this is trying to get some context on it. you have some examples, but as the director has said, there's a lot of things backing this. what do we then take this as? is this a 2020 version and that is what we are working on? or is it the fiscal year that goes from 2019 to 2020? and where then -- if we are going to use this as the framework, where do we see the arrows which we want to now soon to be -- seem to be hitting the bull's-eye by going to get there , or as you say, if not, what are the opportunities to

move forward. it's like the scorecard that we get in the other measures. will we be seeing there are measures under here that then we could measure your progress and where we are going to go, and that does -- does that then inform a new program? i'm really fascinated by your idea of if we are going to prioritize, we have to do you prioritize. and what does that really mean to a lot of people, and then how does this really affect the poor clinician sitting in the emergency room trying to handle that emergency that just came in and meanwhile, we have these wonderful ideas of what you should be doing? sorry. >> i will try to answer all five of those. these are obviously very broad strategies that are not going to be accomplished in one year. it is a multiyear process.

behind each of the strategies there are measures outcome measures that are going to be looked at, as well as process measures that are also going to be developed based on what we see are the key drivers for this work. and over the course of the year, we want to present each of these strategies so you can see this in more depth. this is really just an initial overview. >> okay. so if i could follow that up, i understand that by doing that, you are seeming to say that this is more than a one year program. so therefore, there was a timeline that stretches this. how do these strategies fit in with all the other ones that we have? i know you have tried, but we

have different objectives through quality measures or, you know, targets and waiting times and the work that the network is doing to give us a comprehensive report. and it's kind of like one day we are going to hitch that report card. that is where all these are. where would we want to go after that? i am just trying to get -- >> i hear what you are saying. i think that is the challenge of the department because we have a set of regulatory measures and compliance measures that we have to work on, and at the same time we need to focus in on our true north and where we hope to get over time. there is always this tension and balance between that.

so we don't stop everything. we still have to do the regulatory and compliance and filled those measures to the extent as we do strategic planning that we can align that. i think that that is obviously the perfect goal. it's not always the case. >> and perhaps because they know the president has asked us to try to weigh in on what we will do with the planning session -- i know this might now become something that could be useful. at one point we were talking about maybe getting educated. but by now we are probably well along our way to understanding the product. now you have just explained more japanese terms. that is great. thank you. perhaps this would be something we could take as -- within the

planning retreat and try to understand how this fits in with our partner as a compilation of where they are going and what we might then be expecting, and what the public might expect out of this strategic plan and how we then continue it as a living document. it is beyond our knowledge today it is a nice exposition of where we are and obviously a great deal of work in order to do it. it might be something where they need a planning session. they've not actually done something like this. it might be a way to learn how much more they are expecting. >> if i could just add to that. one of the challenges is we

could also link it to the specific parts of the people -- how does this apply to getting 20 with h.i.v. infections? these are overarching things. before the broader detailed pieces, we can attach and link the specificity from this document. i think the goal is to summarize something that people would actually look at when they start having an interest in the department that is readable in 20 pages. then we have the much more detailed pages and hold ourselves accountable to these. i think the question of the years is really an important one because these are long-term issues that we need to address

to hit the bull's-eye for most of these. it will take a long time. we thought it would be good to entitled this so as to go through the cycle of the year, we can have that conversation about how from hitting that bull's-eye and are there other things that come in over these five that will display some of these because of an emerging issue or a shifting priority. for right now we were thinking that this would be our anchor and our true north. i'm not trying to contradict that. we are anchoring around what true north is going forward. >> thank you. >> i do have a question. i was in a comment -- i was at a meeting yesterday. one of the issues that is coming up over and over again is not only are we talking about single men out there and large -- a large population of black african-american single men out

there, but we also have to think about families and transitional age youth and transgender communities. this came up yesterday where the folks at the local homes and the advocates the community were saying loudly and clearly, you can't always mend, but you don't count our families are out there and you do not count our youth. i recognize this is supposed to be a global and high-level look, but i think they will have some mention of families and transitional age youth and transgender folks in this discussion. it may be in the details somewhere, but it isn't in this. >> thank you. i appreciate the feedback on that. we can look at how we incorporate that. >> thank you. >> dr. green? >> thank you so much. would it be possible to get this before we have to help with the next meeting? it would create such clarity. i keep thinking about the instruction book and i don't

understand those documents. you can actually tell where they keep their market is. that is easier when you are building systems and all the other roles we have here. >> we can do that. >> that would be very, very helpful. and then we can celebrate and we know we have to rethink. it's really helpful. it would be something we could aspire to. >> yes, absolutely. >> i hope we don't get into some of these problems, a few years ago, we did a structure of the department goals, and then for a while, we were asking that any initiatives or any surfaces coming up get tagged to it.

we are almost doing that with some of these icons. i think we have to be careful having experienced that, that that actually doesn't quite work it gets very rigid and then people get very mechanical to it i don't know if the commissioner remembers around that time, but we were trying to do it, but there was that idea that anything we were doing needed to fit. that is what was created. and so people were writing down and saying this was one a, and this is it. i think that while we were working through it, it looks like a good idea to be sure that everything was matching what we were saying, but i think it did not achieve the purpose that i would think we are hoping for and i know it was a lot of work. there then quoting it and i

don't think we did the department a service in trying to do it that way. i just now suddenly realized that i don't want us to get back into that mechanical area. the idea that they had with trying to link these, but i don't know how accurate it is, but you can come down and see where we are standing with some of the prospects an understanding, how as they rise, they become part of this. it's probably the right way of trying to do it without it becoming over burdened. >> okay. that is good feedback. >> thank you for indulging me. >> thank you so much for your report. i would also like to say that it looks like there is some outcomes expected of the strategies that you are going to employ and i will look for to have a deeper discussion about what the outcomes of these

strategies the strategies actually are. [please stand by] in favor. aye. thank you everyone have a good night. >> is there a motion to disclose

or not disclose what was discussed in the session? >> motion to not disclose. >> second. >> second. >> those if favor signify by aye. >> move to adjourn. >> those in favor signify by saying aye. >> thank you.