as needed, even though by state law and federal law, we must supply breakfast and lunch every day to students, and every day, they came to work as an as-needed employee. and these types of abuses are wrong, i think we can all agree. when it came time to see how we could make them permanent civil service employees, again, the question of the test came up, and many of them were very concerned, that even though i've been doing this job for 30 years, and i have been called back every single day to do this job for 30 years, if i don't pass this test, this means that i'm not qualified to do this job, i think there's a disconnect here, so i just want to mention here, also, to miss ng, from the civil service commission, that i understand what our charter says, and it doesn't guarantee them a job, however, i think it is

imperative upon to understand these people that have done these jobs many, many years, actually granting them some expertise that could be a qualifying factor to retaining these jobs. i would love to see a recent analysis, also, about those people in temporary and exempt positions by race and wage levels. because when we took a good preliminary look at this, we saw that many people in management positions that were exempt were actually white individuals, while we see in the temporary positions, very lower positions that were paid much, much less, they were primarily people of color and african americans and latino. so i think we're in agreement, mr. ponder, that that is absolutely not acceptable. and i would just want to say that i would suggest to you and

also to miss ng from the civil service commission, that we are putting people into training positions, that we should be also allocating a pathway to permanent civil service. that anyone that comes into a training position, that they are quite aware that this is a training position, that there is a pathway to permanent employment with us at the city because we have heard many times in this chambers that they have been in this position 25 years, and i think that is unacceptable to all of us. i would like to also add my voice to request this hearing be continued to the call of the chair as we have brought up many issues today that need some data and also some follow up. but, again, mr. ponder and local 21, i just want to commend you on coming together with an agreement that, in recognition, also, there are many other public union -- public unions that actually

have some of the same complaints and some of the same problems within our system. thank you very much. >> chair mar: thank you. so, yeah, i just wanted to also thank supervisor fewer for calling for this hearing on -- on such an important topic, the misuse and, really, overuse of temporary positions in our city and how in t, in the future, w ensure that our city and temporary workers are treated fairly, and ensure high quality services for the public. thank you so much, mr. ponder from d.h.r., and, also, miss ng from the civil service commission for sharing your updates and engaging the discussion. i think as my colleagues have highlighted, this is something that we -- this committee and the board want to continue to

oversee and engage and ensure that we move -- move the -- particularly the negotiations with the other unions forward. so -- so thank you, and we -- colleagues -- oh, supervisor peskin? >> supervisor peskin: i do have one question apropos the hearing that supervisor haney referred to at the government audit and oversight committee meeting yesterday. and this is not a personnel question per se, mr. ponder. and you may or may not be able to answer this, but in this committee yesterday, we came to understand that in the higher echelons of public works exactly half of the senior manager -- actually, more than half, if you count the acting director in public works, which we all understand why we have

an acting director of public works, sadly, but that 13 out of 25 positions were acting. now, this is a form of temporary exempt behavior -- little bit different. not covered by the charter, but the same notion of acting also puts those people, albeit, they're all exempt, at the potential of being unduly influenced or exploited. so the question i wanted to ask, and i did not want to put miss ng on the spot, is when we will have a permanent director of the civil service position. >> i'm not familiar with that position, so i don't have that information, but i will follow up. >> supervisor peskin: if in it a follow-up e-mail or

continuing meeting, we could answer that. i would like to have a permanent civil service director sooner rather than later. thank you, mr. ponder. >> chair mar: well, thanks, everyone, again, for this hearing. colleagues, can we continue this hearing to the call of the chair without objection? great. [gavel]. >> chair mar: thank you. so we have a special order item at 1:00 p.m., so we're actually going to be calling a recess right now and reconvening at that time to call that item. >> supervisor peskin: and, mr. chairman, i will be at a meeting at the bay i'm joined by supervisor matt haney

and ahsha safai who is filling in for aaron peskin. mr. clerk, do you have any announcements? >> clerk >> clerk: yes. please silence all cell phones and electronic devices. copies of completed speaker cards and documents are to be submitted to the clerk. items acted upon today will appear on the march 10 board of supervisors agenda. >> chair mar: thank you. can we excuse supervisor peskin without objection? [gavel]. >> chair mar: i think it's important that we make an announcement for our first

cases of covid-19. mayor breed declared a state of emergency locally, and governor newsom has done the same for california. i don't mean to alarm anyone, and i' i'm grateful for the wo by these departments and their staff. the reality of this public health crisis makes this subject all the more important. the ability of our staff to be well equipped is vital for a good outcome. i visited san francisco general hospital in preparation for this hearing and toured the emergency room. i've met with nurses and labor leaders. i have immense gratitude for their work, and i have questions i hope to raise

during this hearing. i'm grateful for the nurses and public employees here today. we will be hearing from quite a few presenters today, so in the interests -- >> clerk: mr. chair, sorry to interrupt, but at the time, the balance of today's agenda hasn't been called. should we do so now, before -- >> chair mar: sorry. so, yeah, mr. clerk, please call items 2 and 3. >> clerk: items 2 and 3 are hearings to address concerns raised by zuckerberg san francisco general hospital registered nurses standarding staffing, the use of contract registered nurses, hiring time frames, safety, and bilingual

support, and requesting the department of public health, zuckerberg san francisco general hospital, and department of human resources to report. item 3 is a resolution urging the administrative of the department of public health to include front line registered nurses and resident physicians in their decision-making process to implement, to the extent possible, an expedited hiring process to less than 90 days from receipt of application, to aessupplementing staffing requirements with contract registered nurses by implementing, to the extent possible, a ceiling of 5% or less of total staff, to provide annual violence prevention and disaster preparedness training for all staff, and to support its bilingual staff. thank you, mr. chair, for allowing me to call the items. >> chair mar: thank you. supervisor safai, the floor is

yours. >> supervisor safai: thank you, chair mar, and supervisor haney. we called this hearing not because we have a crystal ball, not because i know more than anyone. i called this hearing because the public nurses came out and spoke out in this chamber. it's not often that nurses will come wearing their garb, standing in line, and willing to wait. what they said was they're overworked, there's staffing issues. we'll probably hear some different opinions, but i want to clarify when i say staff. i mean permanent, full-time positions. not temporary positions, not

part-time, but full-time positions that will be there when a crisis is faced. fast forward to today's announcement we just had our first confirmed coronavirus cases. this is a serious public health issue, and in the places in the united states where it's being dealt with, we are seeing that front line first responders are having to self-quarantine themselves. they're having -- asking -- they're being asked to quarantine, and they're being asked in some cases -- in some cases, they're the ones that have contracted the virus. so that makes today's hearing even more important. because if we have a hiring crisis in terms of timeline. we originally asked for terms of 90 days, but i'm going to

push the city and ask them to come up with a hiring plan in 30 days or less. we have to have the appropriate full-time staffing in our department. so we're going to hear a lot from the nurses today. they've taken time from their busy schedules themselves. we're going to ask the departments to come up first so we can hear their initial responses. i'm going to read the initial order of speakers, and as chair mar said, we're only going to have anyone speak for five minutes or less so we can move to public comment. i just want to underscore that this is something that has been asked for for years. not only do we have a crisis on our streets, we have a crisis in the city and county of san francisco. in the opinion of many people that i've heard from and listened to, it has gotten worse and worse. and because of that, these nurses are at the front line of defense in many cases that are dealing with that.

so that if they're overworked, if i'm getting messages on christmas eve, they're being asked to take mandatory overtime. they're not going to say no, especially if an emergency room is full. but this isn't just about the emergency department, this is about all the different divisions within the entire san francisco general. it is the only level one trauma center in the bay area, and we need to treat it as such. lastly, i'll say that it is important, as part of this process, that we hope one of the outcomes will be that there will be much clearer lines of communication between management and frontline staff. because when i went, like supervisor mar, i went and did a tour myself. i just listened to the nurses and the things that they had to

say. and the thing that i listened to was morale was very low. morale was very, very low, and if that's true, they're not going to feel very enthusiastic on their job. again, this is not trying to beat up on anybody, we'. we're trying to have an open and honest conversation. currently, it is about 200 days to hire a nurse in this area. if you ask the average person in the bay area, will you wait seven months to get a job, the answer will be no, i have to work to support my family. so i just want to lay the framework for that. i really want to thank my staff for putting this together, working very closely in particular with the leadership

of seiu 1021, but the frontline staff, julie, krista, heather, they're there every day, put transgender on the line, and they have tried to be a put for -- putting it on the line for -- every day for the people in the city and county of san francisco. so i know the situation that we're dealing with and the crisis that we're dealing with, i don't want to take anymore time. we're going to have a lot of questions, and i know that dr. colfax and others are going to speak, so the first person i'm going to call up is dr. colfax, the head of the department of public health. >> good afternoon, supervisors, chair mar, supervisor safai. >> supervisor safai: five minutes, please. >> fellow committee members, glen colfax, director of public health, san francisco. i just want to emphasize how

much i appreciate the importance of this issue. i trained and worked in the zuckerberg san francisco general, including in the hiv/aids epidemic. i know firsthand that nurses and their care are the foundation of the hospital. staffing, and the quality of that staff, is paramount, as is and always will be worker safety. this is not only an issue in the emergency room at zuckerberg, but an issue in our health care in san francisco, our state, as well as nationally. covid-19, or novel coronavirus, has only highlighted these issues and concerns, and i want to be very clear. there is no space between d.p.h. management and the unions on this -- on these very

important issues. we are taking key steps to address concerns. i have made changes in h.r. leadership in order to address the long hiring process, which i consider completely unacceptable. you will hear about those steps. with regard to workers' safety, we have taken a collective approach to addressing those concerns, and you will hear about some of those data today. but i have ensured that during this challenging time with coronavirus covid-19 that the leadership is here to answer your questions, listen to the frontline staff concerns, and take action together. thank you, and unfortunately for the remainder of the hearing, i do need to turn it over to leadership at the hospital, especially given the recent reporting that we released with the mayor today around the two cases in san

francisco. thank you. >> chair mar: supervisor ronen? >> supervisor ronen: before you go, i know you really have to get out of here. >> sorry? >> supervisor ronen: yeah. i just had a couple of questions. in terms of leadership from d.h.r., is mickey callahan here by chance? >> supervisor safai: i'm sorry. i went over the list of leadership here from d.h.r. >> supervisor ronen: because we've got a crisis, and we have to fix it quickly, but it is happening all over d.p.h. it's not unique, it's in every single program. i've talked to hiring managers in several of your clinics, and every time they hire someone, they embark upon the hiring

process, there's new rules and new inconsistencies. and they expect the fill position will be about 18 months. that's why i'm asking if mickey callahan is here. we have a crisis when it comes to hiring in the city, and so i just wanted to hear from you a little bit more -- first, i wanted to just share that i got a copy of the workers' satisfaction report that shows that 32% of your staff in d.p.h., you ha d.p.h. -- you have about 3,000 staff -- feel that their department is adequately staff. that only about 34% of them feel like management adequately

communicates with each other. these are shocking statistics, and so i just wanted to make sure that you hear the level of urgency we have, not only about this particular situation that this hearing addresses today, but about your entire department, number one. the second thing that i want you to know before you leave is i got a copy of the steps in the hiring process. there are 30 steps in the hiring process, 30 steps. i talked to one manager, who told me to get through steps o 1 through 10, it's taken nine months, and they haven't even taken any information, it's just preliminary steps. i couldn't go through the

endless information i could go through with you today, because i know you have to run, but this is just the very beginning of this process. i'm planning, together with supervisor safai, to hold a number of hearings on this issue, because we not only need to fix hiring at s.f. general, but we need to fix hiring in general. >> supervisor safai: yes, supervisor. we have the deputy director of d.h.r. for mickey callahan. >> supervisor ronen: i think that is great. >> supervisor safai: we had spoke with them in advance because we knew this was going to be a series of hearings. >> supervisor ronen: yes, but supervisor safai, i thought it was very important to send this message to dr. colfax because he is head of the department? and this issue is not limited to nurses in general. it is a sustained problem in

the department, and i want him to hear from me on that. and i believe the problem starts at d.h.r., and i believe that, in the future, mickey calh callahan needs to be here, and i will communicate that to her. >> supervisor safai: dr. colfax, did you want to say anything on that? >> well, i think michael brown is our new director of h.r. we're not only talking about the hiring metrics, which are concerning. but i need to focus on cultural differences, and there also is evident over the years that we were not optimizing our relationship with d.h.r., and i'm very pleased to say with

director brown's help, we're identified places where some of those steps aren't even necessary. so we're clearing out what we don't even need to do in order to focus on what we need to do. and he will go into that detail, but we're making clear progress in that work, and i just want to emphasize clearly with the nursing work -- i've asked michael and the staff to focus on this nursing issue. d.h.r. has been a wonderful partner in that, and i think that's really going to accelerate progress in this area. >> supervisor safai: thank you, dr. colfax. i think before you leave, supervisor walton wanted to ask you a question. >> supervisor walton: thank you, dr. colfax, for being here. i understand we are in the middle of a crisis, but i have

some questions that i have that i feel you as the head of the department to answer. the first is we have break nurses in a ratio of 1:4, and that 1:4 ratio, which is contractual and probably lawful, we get up to about 1:8. how do you deal with that? >> so i have the director of zuckerberg general and the director of nursing -- >> supervisor walton: all of which i've met with and had conversations with, but i'd love to hear from you. >> i know they will make presentations later today, and i assume you will get answers to those questions.

>> supervisor walton: second, is it normal -- [inaudible] >> supervisor walton: versus hiring permanent, full-time workers? >> i have always placed an ' emphasis on hiring full-time workers. >> supervisor walton: i think one thing that is pertinent, and d.p.h. will correct me if i'm wrong, it is wrong in hiring temporary staff in general. we are frustrated with that process, which we know is ludicrous. just the last thing i want to say, because you may have just been getting on board, but over six months ago, i asked the

department of public health to send me a detailed public outreach plan that we can use as a framework that tells me all the additional recruitment strategies, all the recruitment strategies, how you're going to hire faster than six months. i haven't received anything from your department. and i don't understand how that's possible. >> i will speak to the staff and make sure that you get that. it's possible that with the change in leadership, that that's why that didn't happen, but i will ensure that the team gets you something as soon as possible, sir. >> supervisor walton: thank you, dr. colfax.

>> supervisor safai: thank you, dr. colfax. i think that's a good transition because we're going to call up michael brown, head of d.p.h. so if you can go ahead and present, mr. brown, and then, we'll have a series of

questions. [please stand by]. >> -- even though there does show that there's some improvement, you will see later on in one of the slides that i present to you. not sure how fast we can get to that, but we are moving this that direction. so the hiring process overview, just basics, the first part is the position.

making sure the position has funding. there's different processes that go through from our own finance department, and the hiring process. the next is going to be the referral issuance process, where it is controlled by d.p.h. if you see that we have 27 hiring packets ready to go. it doesn't mean that 27 vacancies from disappeared. it may be 15 because we're backfillng because someone was reassigned to one of the vacancies in the special area. and then, there is a candidate selection process, and we're looking at ways we can be

ready. and then, there's the in-boarding process. all of this is making sure that the person has all the information that they put on the application. sometimes, people falsefy information and succeed in the hiring process, and we would have to stall that process, so there's checks and balances that go on. those are the four main components of the hiring process. as i said earlier, this is the graph to show from last year. in 2018, it was 297 days for nonnursing positions. that's from the point of a vacancy to a letter of tentative employment.

so although there are some 117 attributed to h.r., h.r. has more than just processing individuals. i want to make sure that you understand even for just san francisco general hospital or zuckerberg, it is only about 25 people that are assigned to actually doing the process. so i'm asking for more staff, and i'm going to try to make this more quick because we have another person coming up, and i heard the bell. i'm not sure how much more time i have, and you will have more questions, but -- >> supervisor safai: just go ahead and get through your slide. >> i'm going to go through this slide. this is our slide for h.r., and we have our lead who is for staff -- all of staffing. the slide on the left side is only the side that's doing the hiring process for san francisco zuckerberg. we are going to change that so

that we have a focus group for doing that. we are also working with h.r. to identify ways that we can improve the process in the long range. but we have a specific team that's going to be hiring for not only san francisco zuckerberg, but for all hiring. the other teams will be hiring for nonstaffing nurses going forward. we looked for bottlenecks in the beginning. we are looking at having startized questions to -- standardized questions for the interview process. we're going to have staff trained and ready to go, and then, we're also engaged and working with d.h.r., and you'll hear a little bit about our interaction and process that we're doing working with d.h.r. moving forward.

>> supervisor safai: great. thank you. supervisor ronen, before you ask questions, i would like ana, who's deputy supervisor is of h.r. to speak, and then, we can ask questions specifically. >> okay. good afternoon, supervisors, my name is ana, and i am the deputy director of services for human resources. on a side note, i also wanted to let you know that i also worked for d.p.h. for about 12 years earlier in my career. as michael brown mentioned in his presentation just now, the department of public health

that's partnered with the department of human resources on what we now call r.n. hiring project. the goal of the project is basically to reduce registered nurse hiring from its currently state right now of 195 days to 90 days or less from vacancy to approved letter of employment. to give you an idea of what that entails is basically d.h.r., in collaboration with d.p.h. human resources and nursing, will be going -- will be overseeing an intensive full job analysis process of the registered nurses for 20 specialty areas to determine the requirements in order to be

successful in the job. d.h.r. will also be conducting an audit of d.p.h. current hiring process to find bottle necks and delays in order to find why currently hiring for nursing currently takes the 165.5 days. d.h.r. is planning to revise the continuous testing program for nurses so that the eligible lists are refreshed more frequently. for example, every two weeks, depending on the vacancy rate of nurses. and depending on what we find in the audit, d.h.r., in collaboration with the the department of public health, will implement efficiencies in hiring. with the help of the nursing directors and managers, we are also planning to develop and approve a bank of interview questions, approximately 25 for

each specialty areas, so that they don't have to get approval of their questions prior to each interview, and they'll be ready to go. lastly, we also plan to train a large pool on dher policies. once a vacancy pops, nursing will be ready with a pull ool raiders to pull in for interview without going through the process right now because everything's going to be preapproved. essentially our goal to complete this project because of the 20 specialty areas is six months.

however, due to the emergency of the covid-19, i can tell you that d.p.h., along wi-- d.p.h. along with d.h.r. staff are being deployed, which will most likely delay this audit. we have people working on it, but as covid-19 increases, i'm just letting you know, depending on how d.p.h. staff and d.h.r. staff are deployed, it may difficult in delays. we are starting off the project to decrease the number of days it takes for hiring, but we also plan to look at other

classifications after we complete our end hiring. >> supervisor safai: okay. i'm -- i think you hit a really important point, and it has to do with the convergence in the emergency of our city. i understand you have to shift resources, but if these frontline workers are diagnosed and have to self-quarantine, what are you going to do? i don't think we have time to wait for an identifying of b y bottlenecks and so on. i thought you were going to come today with a very detailed plan of what the hiring process is. i don't think it takes 90 days

to do that. i'm sure you've seen emergency situations before. we need to work with the leadership and the union leadership itself, and we need to figure up staffing aggressively, permanent staffing. this is your area of expertise, but i don't know if we need an audit anymore. let's put that to the side, and once you do, i was hoping you were going to say that d.p.h. and d.h.r., because of the covid-19, you're going to go into even a more aggressive mode, a plan to hire these nurses. >> okay. so i guess i wasn't clear, and michael kind of sped up his presentation, but what's going on right now -- my presentation is all about the future. >> supervisor safai: that's the later. what's the deal for now? >> for now, michael brown has put together an r.n. focus

group for d.p.h. r.n.s, and i will let michael brown provide you with the details of it. >> so unfortunately, i sped through some of my presentation. >> supervisor safai: we have it in front of us. >> you may, but i wanted to speak to some of the things that we are doing. >> supervisor safai: okay. >> i said we are working on hiring r.n.s expeditiously, period. that's not in there, so we're going to convene a time that's focused on hiring r.n.s. we have barriers where h.r. staff have to be at every interview process, but that's not part of the current processing. if we need someone to sit in, it would not have to be someone from h.r. we're in the process of reviewing interview questions. h.r. doesn't need to review them. this is an interview in terms

of your job, so you should know the subject matter for the job that you're doing. so we're going to have a bank of questions that they can rotate for, versus all of the staff has to do it. we have experts looking at that, and that's one of the things. one of the other obstacles we had, we had to have a diverse interview panel, and it had to look a certain way, not necessarily whe necessarily were those people experts on an interview panel, but i need to have people who know what nurses are supposed to be in that particular field. we're also going to have experts looking at the matrix. that's another issue, but we're trying to expedite the process totally so we can do it faster. you may here from some of the

people at zuckerberg, some of the things that we've put in place, as they come forward from susan and also terry. >> supervisor safai: before i call on my colleagues, because they're going to have some questions, this is one question that i want to clear on. in your presentation, is it true that there's 79 vacancies in your division. and is that in the e.r. or is that hospital wide? >> so not here, but in a smaller group, i reported that there were 75 f.t.e. that could still be partial, so it could be .9s and .5s. >> supervisor safai: that's only for zuckerberg, for that hospital. >> yes. >> supervisor safai: so there's 75 nurses that are short from your opinion. >> but it's also 18 specialties, so it's not all from one place. >> supervisor safai: and are you including and do you count,

in your total for staffing, do you count per diem and contract nurses, as well. >> no, these are permanent. >> supervisor safai: these are permanent. so if you were to shift the focus away from -- 'cause again, this is some of the focus that we're thinking about moving away from -- and again, everything we thought about yesterday is yesterday. today is today, and per diem and contract nurses are not as permanent, not as well trained, not as, you know, familiar with the goings on of san francisco general and our environment. what's the ratio that you have for per diem and contract nurses versus nursing staff? >> i'm not sure that i have that figure in front of me nor do my staff today. >> supervisor safai: okay. i'm asking you in front of supervisor ronen, i asked you in my office that this was the start of the conversation in general, we are starting a conversation around nurses. but that is an important piece of information to get back to us. i want to know, and supervisor -- it sounds like supervisor walton asked for it

a while ago, as well. what is the total staffing of nurses, what percentage are per diem, what percentage are contract nurses, and then, how are we getting toward them being more permanent? >> so if we're not able to give that information to you today, i'd be glad to come back and give you that. i presume we'll have a series of meetings to make this work. >> supervisor safai: and in your presentation, you said 90 days. >> i'm hearing less now. >> supervisor safai: well, yesterday is yesterday. we've got to hearing also what your emergency hiring plan will be, as well. supervisor ronen? >> supervisor ronen: yes, thank you. my first question is for ana. thank you. i totally agree that we're moving forward, but i have to ask one question and make one question about the past. mr. brown wasn't there, and so i want to ask you this

question. going back to 2014, where nurses came to the health commission and told you the same stories that they're telling you today. this has been a crisis that has existed and only gotten worse for at least five years. why is it that you're only now starting to take this seriously? how did this not -- pla [applause] >> supervisor safai: folks, just so you understand the rules of the chamber, if you want to express your -- please use your happy hands. not trying to silence anyone, this is a decorum that we have across the board for anyone.

>> supervisor ronen: th >> supervisor ronen: this is why i hope you can bring this message back, that it's extremely important that director mickey callahan can be at these meetings. we have a systemic hiring problem across this city. we're seeing it in ways we've never imagined because of the coronavirus. the relevancy today is just right in our faces in a way that it wasn't previously. but this is not a new problem. and these safety complaints have been brought to the city's attention time and time again. what have we been doing the last five years? >> i have to be honest, i was not at the department of public health in the last five years. >> supervisor ronen: exactly. which is why -- i'm sorry. >> supervisor safai: supervisor ronen, i spoke with director callahan. she was not able to make it today because of the current circumstances. she asked her deputy to be here. i'm not making excuses for anyone. >> supervisor ronen: i just want to go on the record and

say what is the point of having a hearing if the people that are coming and presenting before us were not there and cannot answer our questions? it's insulting, and it's outrageous quite frankly. this is about the coronavirus today. we have a potential pandemic coming, and we have a hospital, a frontline defense that is understaffed and dangerous. and we don't have the respect of the directors of the department -- at least dr. colfax came here and said something to us before he had to leave. it is unacceptable to me that miss callahan is not here, and that she sent you -- and it's not your fault that she sent someone who hasn't been at the d.p.h. and can't answer our questions. it's truly unbelievable, not your fault, so i will move on. but i want to send this message loud and clear to miss

callahan, this is unacceptable. i'll move on. how do you -- clearly, our nursing -- you know, the nursing staff is understaffed, but right now, you have over 1100 vacancies in d.p.h., 1100 vacancies. i can't even begin to wrap my head around that. clearly, you are very understaffed in d.p.h. and d.h.r. just -- wait. just to give you all because i'm studying this issue inside and out, day in and day out. just to give you an example of how severely understaffed d.h.r. is and d.p.h. -- i want to make sure i get these numbers right. the airport, the airport, which has about 1600 employees, and pretty simple job classifications. they have 60 people working in d.h.r. by contrast, d.p.h., which has

8,000 employees, probably more, and we're not even counting ucsf employees, we're not counting all the subcontracts we have with community clinics that work with d.p.h. but basically do. d.p.h.s staff has about 120. that is nuts. i understand that you -- we're not going to fix this problem unless we have a properly staffed d.h.r. i understand that dr. colfax is asking for 20 additional staffers. >> i'm asking -- >> supervisor ronen: you are asking, dr. brown, for 20. because if you compare it to the airport, you're not going to get close to what you need to fix this problem. so what standards are you looking for to have a properly staffed department so that you can fix these -- these crisis level problems? >> and i'm sorry. i understood you said r.n., but

i think you meant h.r. staff. >> supervisor ronen: correct, because you cannot fix the endemic r.n. staffing problem until you fix the endemic h.r. problem. >> i am totally in agreement that we don't have enough staff, and i need to have more, but i don't know how this budget is going to support it in terms of when it goes before the mayor and the board of supervisors. >> supervisor ronen: so what -- how did you make the decision of asking for 20? >> looking at what's happening now and what's missing, there are some key positions in term does of manager -- had a gun a -- terms of manager -- key positions there, laguna, we don't have a manager there. now i don't have a manager for the labor section that's going to be managing the additional

staff that's coming on. there's just a lot of holes that i see. i'm not going to get 100 people, but i could ask. >> supervisor ronen: i'm a believer in ask for what you actually need, not pretending that there's not a problem. and the and then, we go from there. so you have 1100 vacancies, and i'm not sure how many of those are budgeted vacancies. >> supervisor safai: supervisor ronen, can he confirm that? >> i can't confirm that. >> supervisor ronen: well, you are the director of d.p.h. can you confirm that? >> i'd have to ucome back to yu with that. if you're saying all the vacant positions, there could be 1,000. i don't know. i have to be able to report accurate numbers to you. >> supervisor safai: what's the answer to the first question, then? >> supervisor ronen: mr. brown,

i find that unacceptable. you are the director of d.p.h., and you don't know how many vacancies there are in the department? >> well, i have to give you information, and i can't have that information right off the top of my head. >> supervisor ronen: well, how are you going to fix the problem if you don't know the scope of it? >> today, i came regarding the scope of the process. if you give me time to respond, i will do that. i'm hoping i'm not getting attacked. i'm trying to get to where we are and where we need to be in the focus of the hiring. coming -- >> supervisor ronen: mr. brown -- >> could you please let me finish. >> supervisor ronen: yes. >> i believe in what you are saying, and we do need to have the staffing and appropriate staffing, and we do have to have it in h.r.

i was there in the contract negotiations when we talked about staffing, many times, and i'm going to say yes, they are right. i don't know what happened in the meantime. >> supervisor ronen: how long have you been in your position now? >> three months. >> supervisor ronen: okay. do you think it's an attack to ask you -- >> no, i don't. i don't. >> supervisor ronen: do you think that's something i should expect the director of h.r. and d.p.h. to know? >> yes, and you should give me adequate enough time to ask me. >> supervisor ronen: i don't know a more basic question to ask that. i didn't know we have -- i'm sorry. i'm flabbergasted. i will move on. so given that you did prepare to come here to give a step-by-step explanation of the hiring process, what we -- what you actually gave us in the presentation was extremely vague. could you actually go step by

step and tell us what the hiring process is for these nurses in this expedited manner for general. >> i can bring back that step by step flow. i do have it on my desk. i don't have it with me, but it's a flow. it's a long page, and it would take a long process to tell you th that jere that. >> supervisor ronen: wait a minute. you just said you had that information. >> i had five minutes to give you a general presentation. >> supervisor safai: mr. brown, can you give us the steps in the hiring process? >> so it's very close. the only difference is the terms of the announcement, and you can apply at any time. it's basically the same in terms of the budget process, the -- the four things that i listed there. even one of those four areaed

that i had listed in there has -- four areas that i had listed in there has areas -- >> supervisor ronen: i'll walk you through it. you receive, from a hiring manager, a form 3. >> the form 3? they're going to be reviewed with h.r. they're going to make sure it's appropriately filled out. they're going to check with budget to make sure it is a funded position. then, there's going to be -- once there's that information, they go to a request to fill for d.h.r. d.h.r. checks to see if it will be appropriate. then, they check to see if the mayor's office, controller's office are going to approve it. then, they come back to h.r., and they start the next process. >> supervisor ronen: okay. and what's the next process? >> supervisor safai: sorry. can i just ask a question. when it goes over to the mayor's office or budget

office, how long do you wait for it to come back? >> it depends. for management, it may take longer, but for r.n.s, i don't know what the time frame is. >> supervisor safai: i guess if i was going to make some recommendations on top of what supervisor ronen was saying, if we have a follow up, whatever the flow is in terms of hiring a nurse in this particular situation, we have to look at -- and i understand that you wanted to go through -- there was an audit process. but we need to figure out a way to cut out as much as we can. i would assume that you can get a blanket, if it's a nurse, and you all agree with it, why does it need to be sent over and get an additional signoff if you know the money is there. >> supervisor ronen: but my understanding of this process is just the very beginning. >> that's just the very beginning. >> supervisor ronen: that's why i said eight months. no, no, i've talked to hiring managers. they've described that same process, and that takes about

eight months. so then, after that, you get a list -- if there's an existing list for the job classification that you want, then, they will give you that existing list. but sometimes, there's not an existing list, and if there's not an existing list, the hiring manager has to go back and forth with h.r. and ask if we can create a new list -- >> supervisor safai: supervisor ronen, i know you want to get it on the record from him. >> supervisor ronen: perfect. perfect. keep going. what happens with the list? >> as we're talking about u nurses, nurses have a continuous listing, so there should be a continuous list. >> supervisor ronen: okay, y. you send it to the hiring manager and then what happens? >> we have to see if there's a contract that is signed. and if there's a p-103 that's

on the list. if we don't have an assignment, we select a p-103 to be selected off that list before it goes out, and then, managers have that permission in part of that selection. then, if there's interviews that need to be done, we schedule those interviews. but in the process that you described, it used to be they had to talk to h.r., send in their interview questions, have someone review the interview questions, and then have a conversation back and forth about maybe changing the interview questions. then they have to schedule an appointment and have somebody from h.r. sit in the interview process just as observers and then make sure that you had an interview panel that is the rainbow color, basically, sitting in there that not necessarily have any expertise about nursing in terms of asking the questions. there would be no follow-up questions, and so you don't need to know or find out more

information when you find out or ask questions in an interview process. this is the placement, and i believe you need to find out more information. >> supervisor ronen: okay. that's really helpful. that was really helpful. and then, i understand there's this rule of three, so the hiring manager has a choice -- after the reassignment, let's say there's nobody that wants the reassignment, so they have the list. they can either pick the number one person on the list, because the names are redacted, without knowing anything about that person. some of these people have been on the list for years or i don't know how long, and letting them know about the specific position and interesting, and getting them from a smaller pool of applicants, or they can pick from the whole list. >> it's partially right.

everyone on the list is eligible. there is an n.o.i., notice of interest letter that goes out to those people on the list before you do the interviews to find out who's interested. >> supervisor ronen: isn't it true the manager has to choose one of those three ways to conduct that hiring process. >> they have to choose anyone who's on the referral, and it's rule of the list, not tree. >> supervisor ronen: no, no, but my understanding is they can hire from the list in one of three ways. they can choose from one name on the list not knowing them and interviewing them, or they can send out a letter of interest to everyone on the list, and only those that respond they can interview, or they have to hire everyone on the list and get information from everyone on the list. >> not hire, interview. >> supervisor ronen: yes, hire. >> i think ana was going to

explain. >> okay. let me just explain, registered nurses are rule of the list, so everyone is reachable. the civil service rules when a vacancy pops requires us to send out a notice of certification basically sending all eligible, hey, there's this vacant position, etc. and you are correct. if there are only five people on the list, there's a manageable -- that's a manageable pool of people to interview. so that's a scenario. the managers can say, hey, let's pull in all five people to interview. however, if you have two positions and 100 people on the list, the managers will want to screen down. there are different methods of screening down. keep in mind, the civil service rules recently amended its rules to make sure that lists are confidential and to reduce potential implicit bias.

so yes, they are d.i.d.'ed is what we call them, where you don't get the personal information, and the hiring manager can then say here's my job related criteria. so i need someone who has experience or this certain license that's special that they have in one of their specialty areas. yes, it's -- the hiring managers get to review all 100 d.i.d.'ed and look at that criteria in hopes of getting a more manageable pool to interview, and that's when the list will be released, when the interviews occur. another method that we've provided is rank-on list. y yes, if there was only one person on that list, you could interview right away.

but there's situations where, okay, could i interview the top ten ranks or the top 50 people? you could do that, as well. so there are different methods of screening down. it either needs to be job related or it is by the rank on the list. does that help explain? >> supervisor ronen: yes, yes it does. thank you. so after the interviews happen and the hiring manager has chosen the person that they'd like to hire, is there any step in between making the offer? >> yes. the background information, fingerprinting, the medical exam clearance, those kind of things pending that. >> supervisor ronen: so that doesn't happen to everyone on the list? >> so if it's an outside employee, we need to find a

conditional offer of outside employment -- if we're going to talk about registered nurses right now, during the continuous process, the only way to get the nurses on the list right away is we don't check -- we don't require them to provide verification that they have this experience. we just get them on the list, get them interviewed. prior to the interview, the department is responsible to make sure that they have the minimum qualifications. so the first step is can you provide me with verification of experience. we've expedited that process sometimes by saying, you know, prior to you going to the interview, i need you to provide this document. another thing is we have the conviction history program, so

because you're working at a hospital, everybody needs to take this. i think it's a two-week t.b. test, everything, so that's a process within itself. and there are ways -- so for the emergency process that we're referring to, michael has put together a focus group to -- just focusing on nursing. d.h.r., although we're looking at projected planned, we have also offered what we call mass arriving. so for example, you know, we have offered d.p.h., because d.h.r. is responsible for the conviction history program. if they had a mass hire, we can go ahead and go to, for example, general hospital and bring our fingerprint machines

to help fingerprint them versus an appointment each time. so we've offered that and we're prepared to assist the public health with mass hiring of nurses. >> supervisor ronen: last question, and then i'll cede to my colleague. so that was the general hiring process, and there's a million other steps in there, but i will let all of that go. and i will say so what of those processes -- you just mentioned one, the fingerprinting. but what else have you cut out to make it faster to hire nurses for general? >> i -- okay. so prior to michael becoming the h.r. director for the department of public health, we looked to get an outline of what's going on. what he had mentioned earlier was the previous

administration, prior to michael brown and prior to grant colfax, had different processes in place that significantly delayed just being interviewed. one example he gave you was there was a requirement that all h.r. staff be present before an interview can go forward. well, he's correct. we don't have that much staff, and we don't find it necessary to have that requirement, so that was removed. another requirement that was removed was, like michael said, the previous administration had a composite group of people unless you have your raiders. we've changed it to be a good faith effort to diversefy the panel of raiders versus a

formula, so that's two things. the other thing was there was a requirement for a nursing director to be in every interview prior to be -- for it to go on. i'm not a nursing director, i'm a deputy director, and it's hard for me to be at every interview. so that's been removed. like -- like i said in my presentation, we did an overview of the process, and we took out what we could to alleviate some of the time. i do believe, for future purposes, we can identify every

single process that is unnecessary. but without understanding the process every step of the way i can't or michael can't just immediately remove some processes because, again, part of our hiring process, especially with permanent nursing or permanent positioned is governed by the civil service commission rules, and we need to abide by those rules. some of those are the notice of certification or the process where we can have the ability to respond back. it has to be five business days. that's in the civil service rules. there's also a lot of rules

within the examination process, for example, that dictates a period of time that you need to have candidates wait to look at, you know, their scores in the section. we've tried to ask for civil service rule change, and it took us two years to do. >> supervisor ronen: sorry, mr. brown. weren't you the director of the civil service director prior to changing in this role? >> yes. >> supervisor ronen: so why do we need a long audit? you know the civil service rules better than anyone. >> i know the civil service rules. >> supervisor ronen: so why don't you take this 30 steps to hiring and say this is unnecessary? just like the three you just took off, why do you need an

outside audit? it just feels like outside bureaucracy for fixing problems that aren't needed. we have an outside crisis. we are now faced with coronavirus, and you tell me three months into your job, you are faced with an audit to improve your hiring process? >> i truly understand your frustration, but i want to make sure that we all understand that ana's describing and the audit that we're talking about is to fix the systemic things that are in the process itself. we are currently working on changing some of the things that are in the way right now that we can do to expedite the harrington process. but, for instance, not having a job analysis done since 1998 or something, whatever the date is, is not acceptable. you should be updated every five years. that's part of the audit that we're trying to do as well as making sure that we have updated information in all the

specialties. that's part of what we're doing in d.h.r. and making sure my staff is able to do that. not only do we have staff missing and not enough staff, the staff have not been trained in order to do their job efficiently. z so that's something that i'm doing in the d.h.r., even in the labor section, as well as the operations and whatever else i have that's under me. so there are other things other than just hiring that i'm working on, but as you said that for the first three months -- and i did report that i had to see what was going on before i could make changes. i knew there were some things in the way. some of the things i could remove right away, some of the things i was still working on. right now, we're in the middle of covid-19 that's taking all of our staff. not just the clinical staff,

but we are working seven days a week right now. there is a juggling act, and i understand the frustration, but we are going to make sure that the hiring is done quicker for the nurses especially. >> supervisor ronen: okay. i could be here all day, but i'm just going to stop. i'm just going to say that i think this byzantine hiring process is to be able to hide behind excuses and make it so complicated, that we have to ask so many questions, that we have to stop asking questions just so we don't have a hearing that's too long. it is ridiculous, it needs to be changed, and we will be changing it. thank you. >> supervisor safai: so thank you. i want to allow some of my other colleagues to ask some questions. i held back on a tremendous amount. just please bear with us. we really appreciate this process because as supervisor

ronen says and i've said all along, this is the beginning of a conversation. we did not know that we would be sitting here on the date that we would announce covid-19 cases in the city. so what i said yesterday was yesterday. it was not to sweep under the rugs comments by the department to listen and hear these issues. i think you're hearing it, and you'll hear more of it when we get to public comment. one of the things that i'm going to say before i hand it over to supervisor walton, is we need a plan. there needs to be a crisis plan, and we are at a crisis situation when it comes to the staffing and many other issues at s.f. general. supervisor walton? >> supervisor walton: thank you, supervisor safai. i do want to start off by saying it's very problematic for you all to be sitting here without information that i know that was requested. there's a purpose of this

hearing, there's a reason for it, and i'm not necessarily putting it on the two of you, but the fact that we don't have people here, representing both departments that can give us that information, particularly since dr. colfax said we have the folks in the room that will be able to answer your questions, is a problem. the first question is for ana. thank you for your presentation. as i look at the r.n. hiring project, and i see the goal is to reduce registered nurse hiring to 90 days from approved vacancy, how long does it take to get that approved vacancy list or from that -- >> my understanding -- and, you know, i don't know the exact dates, but my understanding is when the department of public health submits their position approval because nursing is labelled as, you know, a safety or credible position, it

actually bypasses my team's approval process, and it's automatic. i'm not sure if it goes through the controller's office or the mayor's office, but i do know the d.h.r. portion of it is one it's submitted, nursing is one of those positions that we've made automatic approvals for. >> supervisor walton: mr. brown, do you know how long it takes to get to that approval list? >> i can't tell you, either. >> supervisor walton: anybody with you that might have a ballpark of how long it gets to that approved vacancy list?

that is important for us to know so we know that what's being proposed will get us to 90 days. >> may i make a comment? the reason i put approved vacancy is we have eligible lists already ready, and so if the vacancy isn't approved, it's not like we can fill it. i'm just letting you know that's how i put the language. >> supervisor walton: i understand that part very clearly, and i know there's a timeline for something to get to that approved havevacancy l.

so as i see this list, i don't know that we're going to be hiring by 5.5 months that we're looking today. >> i was just informed that it might be five months. >> supervisor walton: there we go. we're back up to five months. this means nothing. these are slides put in front of us for us to believe that we're going to do something different, but it takes us three months to get to the approved vacancy list plus another three months, which is a little longer than you provided on the graph. that sounds like six months to me. >> to answer your question a little more thoroughly, terry ann tony is here from zuckerberg to answer your question. >> what michael is saying, in his presentation, the lists are

going to be refreshed every two weeks. now the lists are refreshed every two months. people get on the list, we refresh the list, we exhaust that. >> supervisor walton: so we'll be going from three months to around two weeks? >> that's our hope. that's what we -- >> in terms of refreshing the eligible. >> in terms of updated people that want to work there that weren't on -- that supervisor ronen said, for a long time. >>. >> supervisor walton: and what's the specific timeline for achieving this goal? >> that would be h.r. >> yesterday when we were talking about this and trying to get this done within six months, it needs to be put on a faster track. so now that we have a dedicated team, we'll be working on that team on how we can do the refresh sooner. >> supervisor walton: so you

made the statements, mr. brown, that you want 20 staff that will help you be able to process faster and get this done quicker. >> yes. >> supervisor walton: but you provided a slide that says it takes you 9.9 months to hire nonnursing classification sector, so you wouldn't even have that staff till next year. >> i'm sorry. what's the question? once again, all 20 staff are not for processing. they're across the board. >> supervisor walton: whatever the reason you need 20 staff for. i'm not disputing that. i'm saying you show me a chart that says it takes 9.9 months to hire classification staff. so you're basically saying you'd hire that staff the next fiscal year. >> i cannot hear the last words you're saying.

>> supervisor walton: you're basically saying you would hire the 20 staff the next fiscal year. >> that's the ask in the budget. the employees that are in those positions, the expertise, whatever they've learned, they are going to be going out the door. i need stablized staff to work, at least right now. if i have projects going on, at least i can still do projects. but currently, the staff i have are exhausted. they're leaving, they're dissatisfied. long-term employees that i know are going to other departments. and we have, even with a list, people saying not to accept a position here because it's just unattainable. >> supervisor walton: that's the point that we're trying to make, and that's what we need to fix, and we're counting on you to be the person. and i know you don't have to be here. you've made that clear. i am excited to be here to

represent the people of this city. and by the way, none of us have to be here. >> i'm hoping that you do support me in that effort in terms of getting additional staff. >> supervisor walton: as i look at slide five, not all staff are involved in the hiring. you put that on there. >> yes. >> supervisor walton: is there any thought about how to reprioritize since the issue is hiring? >> we are trying to reprioritize the needs we have and the needs on hand right now. in terms reprioritizing staff, they are in different specialty areas, and they're not all h.r. that works in processing. occupational health and safety is under h.r. the labor team that is dealing with the grievances and the discipline, they don't have the processing skills. those are different areas. the mayor team is confined to doing the examinations and the process. >> supervisor walton: so i asked some specific questions to dr. colfax, and he couldn't

answer, and he said the team could. we have break nurses that provide our nurses to get the breaks and lunches that they need. oftentimes, we don't have nurse break nurses on staff, and what happens is, the ratio becomes 1:8. how is this allowable? how does this even happen when we know that the ratio is 1:4? by contract, by law, how is 1:8 even possible? >> so i'm assuming that you're talking about specifically in the hospitals where they have the braeak ratios. is there someone from zuckerberg that can talk about the breaks? >> so we do have breaks as mandated by state. due to sick calls or unforeseen

things, break nurses -- break nurses get pulled to do staff nursing. it's not what we want them to do. we want to have our nurses get breaks and, you know, they work long, 12-hour shifts. >> supervisor walton: so let me ask a question. how do we get to a 1:8 question. i know everybody gets sick, i know everybody needs breaks. how do we have 1:8 scenarios? >> we should not have 1:8 scenarios. >> supervisor walton: but we do. can we agree on that? if a break nurse calls in, and they -- that if somebody goes on break, they don't have a break nurse to cover that? >> not 100%. i have data to look at. i meet with the union monthly. >> supervisor walton: that never happens?

>> i'm not saying it never happe happens. >> supervisor walton: i'm just trying to get us on the same page. >> it doesn't happen every day. it is something that we -- >> supervisor walton: but it does happen, right? >> in unforeseen circumstances, yes, it does. >> supervisor walton: how are we going to fix that? >> we are going to hiring people to work. we have vacancies -- when dr. ehrlich does her presentation, i could answer questions a little bit better so you can better understand where we're coming from. >> supervisor walton: i know i asked dr. colfax a question about it, but i didn't ask it this way. there seems to be a budgetary practice to make sure that we're hiring practice nurses -- i've seen budget line items on this. when are we going to -- instead of prioritizing resources to have travel nurses,

prioritizing staff so that we have a more stable system. >> we're doing that now. that's what i want. every nurse, staff nurse, we have about 22% backfill, and that backfill is utilized by per diem staff or by travelers. when we have a large vacancy, we have to fill in those, and those percentages are higher. what i want is permanent staff with 22% for backfill. that's what i want. >> supervisor walton: and pursuant to administration and labor, we all want the same thing, and that is to be able to hire adequate amount of staff quick as possible so that we can provide quality patient care. >> that's exactly correct. >> supervisor walton: mr. brown, i asked the department over six months ago, and i know you weren't here, but i was promised this, somebody would send me a detailed recruitment plan so that we could see all

the recruitment strategies, all the detailed recruitment. i haven't received anything from your department. when are we going to get that? >> so i'm not sure when our next meeting will be, but i can try to have something for you. that was not related to me coming on board. >> supervisor walton: even before our next meeting because i don't know when that is, either. what's your timeline to put something like that together? >> right now, my priority is the covid-19. >> supervisor walton: i have to deal with the covid-19, too. i've still got a job to do. i hope that's not going to be the response of everybody that comes up here, that we have a crisis and we're not going to do our job. >> i said we had a crisis, not that i couldn't do it. i asked the date of the next

meeting so that i could better manage my time before the next meeting. if i could have a date, i'd love to make that happen. >> supervisor walton: i don't know when that's going to be, but i'd love to get a timeline of when you can get that to me in the next meeting. >> i don't want to be held to that timeline, but i can try to get you something within the next month. >> supervisor walton: that's the response? >> that's the response. >> supervisor walton: if you don't see the frustration we have, it's obvious, the frustration we have. there's so many reasons we're at this place. we want our staff to have the ability to provide quality patient care by our staffs and by our hospitals. a lot of employees within the department have a hard job. if we know the one thing that

is common is we have a lack of staff and a hiring issue in terms of how fast we are hiring people -- which has existed for years, by the way. it didn't just start with you in your role as deputy. there has to be a quicker way to solve these problems, and we are relying on you all to do that and counting on you to do that. dr. colfax is not here, but what i was going to say to him, because of his statements about having a commitment to make sure we do that or to provide quality patient care, is i would rather see a sermon than hear one any day. i don't need to keep having warm, fuzzy conversations about how we're dedicated to doing thing things when we don't have the plans in place to do things, and these are the plans that we've had in place for a long time.

and now we do have a crisis, and going back to supervisor safai's point, if it does go back to a point where we start having the people that we rely on for patient care, and we can't adequately respond to this crisis, then we're really going to be in trouble, and i don't know what we're going to do in that case, which tells me the reason that dr. colfax had to leave so fast is to get those types of answers because we do need answers to those questions like yesterday. >> supervisor safai: thank you, supervisor walton. supervisor haney? >> supervisor haney: well, first of all, thank you for being here and for your work. i just -- many of the things were covered, so i won't go on too much about it. first thing i just want to clarify completely is we all agree that the hiring process that we have right now is far too slow and is not working.

who created that process that we have now? how is it created? who created it? >> i cannot point a finger to a point. >> supervisor haney: not a single person. >> there's different levels that were added over a period of time, which is -- it's now making it ridiculous in terms of the timelines. >> supervisor haney: and if you were to say that there's somebody who's sort of above it all who has the power to influence it most, who would that be? would that be the director of h.r.? >> it could have been the director of h.r., it could have been in tandem with the director of the department, whatever the processes were at that time and the decisions that were made. could have been both. >> supervisor haney: i just wanted to establish that this is something that we've created, that the city has created, that we are looking around saying that this process that is so slow, that is burdensome, that is making it difficult for folks to do their

jobs is outside of our control. that's what makes it so maddening. we've imposed certain processes and inefficiencies that now we're saying are getting in the way of us to do our work. so if we get to the point to say that if we created it, we can fix it, that is within our power. i do think we are talking about a health emergency or a potential health emergency that are here, but people are running outside the door and taking up all their time to focus on that when this has clearly been an emergency for a long time.

and we had a declaration of emergency around the coronavirus. does that give you any special hiring powers? because we have a declaration of emergency and if you needed hundreds more staff immediately, which i think, probably, we need it to happen before, what have you been told in terms of what special authority you have to hire immediately now that we are actually in a state of emergency? >> so at this point, that is

something we need to definitely engage in a conversation with the rest of the city leaders, d.h.r., the controller's office, to see if there is something we can do expeditiously around this process, as well, but i will bring that back. >> supervisor haney: so i know there are all these meetings going on that's taking people from being here. i hope that's something that they're talking about as part of that, and that those types of special powers as they relate to hiring are put front and center not just as it relates to the coronavirus, which is most urgent and taking a lot of people's time, and it's incredible to me, with all the attention of the coronavirus, that there have been no special directives around hiring. >> i will take that back. >> supervisor haney: one of the things that, obviously, people need to wash hands and not shake hands, apparently, anymore, but we also need to

know how we can get people in to help. and, you know, i'm not putting this on you, but if the director were here, that is something that i think we need to take very seriously. we are currently hiring some nurses and other staff as subcontractors. is that correct? >> as category 18 -- or p-103s? is that what you mean? >> supervisor haney: are there nurses coming in as subcontractors, sort of contracted out -- i guess that's what you were kind of referring to as travel nurses? do you know what i mean or would that be part of the presentation? one thing, when we get to that, is when those folks are hired in comparison to the process that we have. last thing i wanted to say, one of the things that would be

really helpful as we think about the process and supervisors ronen and walton touched on this, really get a sense of how long each part of this process takes, and how we can see almost like on a map, by eliminating certain pieces of it or shortening certain pieces of it, how that will shorten the overall process. because if we see that it takes really long, as supervisor walton said, it doesn't show us how each of these things are shortening -- if one thing is taking the large majority of that, and you're doing a bunch of things that aren't actually a huge part of it then that's not going to allow us to reduce the time. the last thing i want to say is there are a lot of people who are expertes in this because they work in the system. how are you working with them? how are you listening to them?

do you have our labor and frontline workers as part of an advisory group? how are you consulting from them, learning from their expertise to how we can do this better? >> so we have the labor meetings with the doctors and nurses, and my labor team is participating in those meetings and working with the management in the different areas that we have, one at laguna, and i think they have one at zuckerberg, as well, and they are working on issues that are brought to their attention. so some things are brought to my attention, like specifically in hiring, and that's where i am involved in trying to do that. but i am not necessarily at every one of those meetings. i have staff that are going to them. in our contract, there is a side letter that said we will be working with d.h.r. in trying to stream line the hiring process. that's why we've been working,

trying to stream line the process. it is not something that just came out of the nebulus, it's something that we are required to do. >> supervisor haney: i would just say, i'm sure in public comment, we're going to hear a lot of good ideas, and hopefully we'll get to that soon. i hope there's a way to more formally take that and work on a collaborative basis. these folks want to see it solved, as well. they're seeing a lot of it, and so i hope as you're coming up with a more detailed timeline of the changes that are going to be made, that it's done in close collaboration with the front line workers and their representatives. >> thank you. >> supervisor safai: thank you. supervisor mar -- chair mar. >> supervisor mar: thank you. i'll keep it brief, and i won't repeat the good points and the general frustrations and points

that my colleagues have made, which i totally agree with. i do want to thank both of you for the presentations and sharing the updates on what the department and d.h.r. are doing to try to -- to really accelerate the hiring processes for -- for nurses and other important critical staff and d.p.h. and i do share the concerns of my colleagues about the references that have been made to the escalation of the coronavirus situation here in the city today. you know, many of us joined mayor breed for the press conference announcing the escalation earlier today. in fact, i just got an e-mail during the meeting that my daughter's high school was just closed today because of the coronavirus situation, so we all are very aware of that. but, you know, clearly, the

situation, what's the timeline to complete that and achieve that goal? >> so we are completing -- like michael said, there hasn't been an update completed in 20 years, so we're projecting approximately six months. the difficulty i'm having is right now, we're still on schedule, but some of the staff is being deployed to e.o.c.,

for example. a job analysis requires that we have nurses there who are the experts to help us with the nurses that do not get deployed, so roughly six mon s months. >> chair mar: and after six months, what is the expectation? >> get, if everything -- again, if everything goes according to schedule, the goal is reducing it to 90 days or even less? >> chair mar: okay. >> so for me, the aggressive goal is to have it before the 90 days from the hiring process, to 90 days or less. may take six months in terms of the job analysis and making sure that it's -- everyone knows what the process is, but in terms of the hiring and

getting the numbers down, i think we can get that down within the 90 days in six months or before that. >> chair mar: great. thank you for that. maybe i'll leave it at that. >> supervisor safai: okay. thank you, chair mar. just before we move onto dr. ehrlich, what we're trying to underscore, before the announcement of this public health crisis that's going to continue to accelerate, i think one of the goals of this hearing was to come up with an aggressive plan. i think that there needs to be a real consideration given, and that's similar so what supervisor haney was saying, and that is what is the plan before we get to crisis? even though many of the people that you're going to hear from public comment, they're going to say it is a crisis, and you've just not been hearing it from the hospital. i think we need to have a plan, an aggressive plan, so i'm glad

that we proceeded with the hearing today, even though many, like director colfax and mickey callahan -- director callahan were not able to be here, i think you need to go back and convey to them. so i think we will have a follow up hearing in 90 days to get back to us, maybe even in 60 days. but in the interim, there needs to be information transmitted to us that would talk about how we're going to move aggressively in this emergency situation. the next person we're going to call up is dr. ehrlich, and if you all can stay around, we might have different questions. >> chair mar: dr. ehrlich, before you started, i just wanted to say that supervisor stefani is now present, who will be filling in for supervisor haney.

>> clerk: that's correct. i just wanted to announce that the house has changed, so it's now chair mar, supervisor safai, and supervisor stefani. >> thank you, chair. i want to say, as always, your support for our workers, our patients, is there, and it's not to be taken lightly, and i appreciate that. i know you've heard some compelling stories at the hospital that are concerning to you, they're concerning to me, and i know they're concerning to dr. colfax and our whole leadership team. just to reemphasize the point that we all have the same goals. we want to make sure that our patients are taken care of, we want to make sure that our staff are taken care of and safe, and we're doing a lot to focus on that at the hospital right now. i know you had some specific questions, so because my time is so belief, i'm going to

focus on those very specific questions, but happy to take -- happy to take questions on any other areas as you would like. so these -- the concerns that you've heard about generally fall into these areas. i'm mostly going to talk about staffing. i have some information also about what we're doing to improve safety at the hospital and i can go into that if there's time or what questions you have. so first of all, i want to say that nurses are at the core of the service we have at the hospital. they makeup about 30% of our d.p.h. staff at the hospital, and we have 900 f.t.e. budgeted nurses hospital wide. that being said, leaves, modified vacancies affect our

staffing. about 10% of our nursing workforce is vacant due to vacancies. in addition, one of ways that we ensure we have qualified nursing staff at the hospital is we have training programs. this is a great way of bringing in nurses that are qualified and have the credentials that we need in the more skilled areas, like the emergency department, the perioperative area and critical needs. when we have nurses in the training program, we couple them with nurses that we have on staff, so that means it limits our ability to provide direct patient care with those nurses. and so we have patients at the hospital. the vast majority of patients we have at the hospital come in

through the emergency department, so we have to make sure we take care of patients no matter what. and in order to ensure that, we take up the leaves and vacancies with temporary staff and overtime. now what i'm going to do is go into specific areas of the hospital and what the staff is there. since january 2018, the e.d. visit volume has been relatively flat. we're seeing about 200 or so patients a day. that does vary about 15, plus or minus, on any given day. before that time, the volume went out a fair amount, about 25% between 2014 and 2018. and so since 2014, we've budgeted about 23 additional nursing positions in order to accommodate that volume. right now in -- this gives you

a sense of that. it's been relatively stable since january 2018, and this shows you in more detail what the current state is in the emergency department. for example, we have 2320 r.n.s, we have 144.41 f.t.e. about 24.1 of them are on modified duty -- vacant, on leave, or modified duty. and we have about 47.1 that are either p-103 -- that's the temporary nurses, registry, or overtime. in spsychiatry, we have a highr

percentage of our staff right now that are on vacancies, leave, or modified -- >> supervisor safai: that's okay. continue. >> 3% of the total staffing. here's the volume data in psych emergency service and in inpatient psychiatry. you can see it goes up and down but more or less stable since 2018. and here in psychiatry, we have the budgeted f.t.e.s. the positions that are either vacant, on leave, or modified duty, and how we have made up with that with the temporary registry or overtime. medical-surgical. so our med-surge census is quite a bit higher on a daily basis than we've planned for. we've budgeted 164 positions,

but we're running at 179 or even more on some days. to accommodate this volume, we opened up a unit that we had planned to be closed. that's h-58, it's been open intermittently and mostly since 2017, and on any given day, we have 8 to 15 patients there. the good news is for this coming year, we've submitted a budget initiative to fund that unit permanently. that will start in july, and that's about 30 additional f.t.e.s. in med surge, again, vacancies and leave account for about 20% of staffing. and in med-surge, we have nurses that -- >> supervisor ronen: dr. ehrlich, i'm so sorry, but i

have to go to another meeting. i apologize for not being able to stay until the end of the hearing. i wanted to thank, particularly the workers for your incredible work and staying power, and let you know i'm going to watch the rest of the hearing tonight on sfgovtv so i can watch the worker testimony. i'm sorry. >> no, not at all. that's fine. >> supervisor safai: please continue, dr. ehrlich. thank you, supervisor ronen. >> and then, here's the rest of the data on the med surgical unit. 54 vacancies, leaves, or modified duty, and then, the p-103 registry that we use to fill those is 77.25. i think i'll stop there on the -- because this is a lot of detailed data that you requested. i'll stop and see what questions you have about that, and then, if you have additional time, i have a couple of slides about what we're doing to address the

issue of workplace violence. >> supervisor safai: actually, can you talk about -- 'cause i know about some of the nurses today and that i've heard from directly are going to talk about workplace violence, so can you speak about that, as well? >> yes. thank you for asking. so first of all, this issue is very much on our minds, and it is a national issue. according to this study from the american college of emergency physicians, 70% of emergency room nurses and 47% of emergency room physicians have been physically assaulted at work, and this situation is unacceptable. at zsfg, we know that batteries and assault account for 85% of reported crime, and there's a high concentration in emergency and psych emergency. so in 2018, we put together a workplace violence committee that was geared towards preventing and improving our

response towards incidents of violence, and the priorities are, as you can see, to ensure that we have better data and reporting so we know how to best address the problem. we wanted to assess and improve the effectiveness of our crisis institute prevention training. this is training that we are mandated to do by state law. we have done it, and we know we can do better at it, and we have a plan for that that i can talk about in a minute. [please stand by]

highest risk for episodes of violence.

in those areas, we have planned a 6.5 hour training. that is different from the lower risk areas where we have just a couple of hours, which is what we've been doing so far. in march, we'll be sending out a frequently asked questions based on the town hall feedback we got. and we're planning, at this time, an improvement event focused on how we respond to episodes of workplace violence. that is planned for the week of march 30. and then you can see we'll be updating staff quarterly in april. that's one of the quarterly times. we have a really nice quarterly equity news letter where we convey information and answer that we're updating the health commission every quarter. so that's the information i have about workplace violence. i'm happy to respond to questions you have. >> thank you. >> supervisor stefani: thank

you, supervisor safai, i'm really happy to be joining this hearing today. i want to thank the nurses for bringing it to our attention and the testimony. thank you for your presentation on workplace violence. it's something i'm glad you're collecting data on. my mom was a psychiatric nurse and had an incident. my sister is also a labor and delivery nurse, not in san francisco, but i'm wondering what happens when there is workplace violence in terms of who is -- i mean i know you're directing the data, but are the police called? what does it look like when a nurse is injured, what happens? >> right, so the first thing to be mindful of is we're doing everything we can first to try to prevent episodes of violence. so all of the training we're talking about hearing from staff, getting their ideas, this is the most important thing is to prevent the episodes to begin

with. when an episode happens, and this can be -- it doesn't have to be a physical assault, it can be a battery, meaning a verbal assault. in fact, we know in the first two months of this year that about two-thirds of the episodes that are reported are verbal assaults. what we do, we encourage the staff to report the incidents. one of the things we want to try to encourage is what we call a culture of safety, where everybody feels comfortable reporting everything all of the time so that we have the ability to respond to it. then what we do we have this detailed questionnaire and tool kit where we do a long series of questions. i think it's 54 questions in total, that is developed by cal osha, so we respond -- we figure out all the details about why that happened so we can address those. and then we provide whatever