[land acknowledgment]

next item approval 6 minutes. are there any objections. any motion to approve.

>> yes. yes. >> yes. >> yes. thank you the minutes are approved with the revision. >> wonderful. our honoree is stuck on bart so we will delay that item and move to general public comment. and i believe there is, a statement to make.

at this time public may address the public within the jurisdiction, not on this meeting agenda fpt each member may address the commission for up to three minutes. forbids to discussing any item including those raised during public comment. please note that each individual will allow an opportunity to speak per item. individuals may not return more than once unable to attend the meeting. written public comment will be spent at the following public comment. the word commission, dot dph. if you wish to spell your name for the minutes, you may do so. please note that city policies along with federal state. all right as always i've got a timer when the timer goes off, please note your time is off.

>> sorry, chris is here to make some general public comment. welcome. >> thank you. as every one knows, my name is christopher and i thought i would not be coming back but i had some follow-up items. first i want to thank everybody in the health commission for giving me a venue and voice. there has been some movement. so after two years, public records request and the sunshine ordinance, we got the movement so the one system which was one of the systems that we were talking b lead bit department of homele and supportive housing and participating agencies including the department of emergency management and sf housing authority. there is two missinging and it's not the department of public health. so we're make some movement it took a very long time to get. i had some tough conversations we had to direct. we're talking about corruption and i was over at

the supervisor meeting and they were launching some investigation because of the corruption, we had a senior level person resign, it's happening. i don't know how many people is following what is happening in new york city. they're going through the ranks and that's what we're trying to prevent. we want the people to be on the streets and we don't want to see what is going in new york where they're going to the police department and commission. again, thank you for everything. allowing me to speak here freely. we're making some movement. fingers crossed that the city leaders will engage and close session where we can get movement where this system, what happened when we extended the covid trace contacting, we gave wi-fi to people to take home. so they took the systems home and they were using it to put their wi-fi on surveillance. so we need the restrict that access and get it back to

city hall and allow the leaders including director colfax to push us back in the right direction. thank you and have a great day every one. >> thank you, is there anyone else in the room that wants to make general public comment? all right, is there anyone remote? >> i see no hand. >> wonderful. had a moment to take a deep breath after his travels and we will move to an action item that we really look forward to, which is the resolution to honor belljay and rory and trey williams will be stepping up to the podium. troy chief nursing for the health network. >> so thank you for taking time to honor this is the day

that we've been dreading for many years to come. but it's always good to see mid-careerist move on to greatest things. and we know that the time spent here was instrumental involved progression and he in turn has given so much to the organization. soy know there is a resolution. and i think, secretary march let will take it from there. >> thank you. >> where as mr. sanha began his career at the public health intern as 2009 while enrolled at uc berkeley program. served as director of the services.

csfg and chief experience officer and where as mr., he returns to the san francisco health network in 201 as inaugural chief officer. and served as the covid-19 sponsor for the city and county of san francisco colating a city wide multi health response which champion health equity that resulted in 80 percent vaccination rate. where where he served for medal and medicare of laguna honda hospital as the largest largest funded skills facility. and on going with the u.s. secretary of health.

and san francisco federal commission congressional delegation. where as mr. sangha developed leadership hiring and to be fully integrated to be a fully integrated system that meets best practices. this includes growing in operation with inaugural roles that are focused on improving the workforce. where as he received the 2023 spur good government award for his critical work and leadership during the covid-19 pandemic. and hufpgs award for top healthcare executive in the country under 40. where as mr. sangha motivated his team and propelled organizational success.

he's been dedicated to supporting those from under privileged healthcare and catalyst for change. his empathy and positive outlook and incredible outlook has helped transform the network. now let it be resolved that the san francisco commission honors baljeet sangha great success and wishes him well in his future endeavors. >> thank you and that was a beautifully written resolution. i believe we may have a motion and a second and enter public comment. so i'm sure all hands would be raised who would like the honor of making the motion. >> i move. >> and who will second. ?fm i will second. >> and we'll start with comment from individuals in the room. is there anyone that wants to

step off and say anything about our resolution? >> i wanted to take this want to take this opportunity to thank baljeet, you will be missed but there will be other programs that will now have your services. you'll surely be missed. i cannot say enough about everything that we've been together at laguna honda and other places in your career. i wish you the best, all the great luck and just great,

moving forward. rail' really appreciate you. >> thank you. >> i guess is there anyone on remote comment? >> there is one hand, one person has been permission, hi are you there caller? >> yes. and do you know what item we're on? >> speaker: yes. >> all right, so you've got three minutes. >> speaker: thank you. this is will not be missed. good ridens. thank you. >> wow, okay, that's the last public comment. >> okay, we'll go to commissioner comments. commissioner guillermo. ?i. just want to add my glazesing and deep thanks along with the voices you've already heard as well those those res loosesing. so doubt, we didn't get without

you, your leadership and dedication and example. that you set. and as hard as it was, my sense and i don't know that for sure, you were one of the first to get there and one of the last to leave to make sure that things were in place and serving as an example and the confidence that you, were able to provide us in knowing that you were you know, key and all of that and i, very, reluctant to let you go. but i know where ever you go, next and beyond that, that that the health and well being of citizen that you touched will all be better because of it. so thank you and i wish you well. >> thank you.

>> commissioner . >> i just want to say, you were the regular whether it was in-person or virtual. we were grappling with some very difficult issues at lag no honda. i've got to say, when you were zoom in-person, always gave us confidence because you always were honest, knew what you were talking about and were positive. so i want to thank you, not only for that, but as you move forward, those things to those of us or to those that you work with, were really very, they were great. and inspiring as you move forward in your career. so thank you very much. for the work you've done here

at dph as you go forward. >> commissioner chow. >> yes, thank you for the opportunity to thank mr. sangha for his work. it's been a career that i have followed and particularly during the period of covid and obviously, with laguna honda to see the very fine leadership that you exited and assisted the city and the fact that you are moving on, and reminds me that there are so many that have been called into city service here in our department and have been become exemplary leaders for the rest of the nation. and a few have come back including our own director. so perhaps we'll see you back

but otherwise, everything that the resolution so well speaks to in terms of your accomplishments for us, i would not only second but partly endorse. and i wish you well in your future endeavors, it's wonderful to be recognized as a leader in this nation under the age of 40. for this country, thank you. >> commissioner christian. >> thank you. thank you. i just want to associate myself with all the comments especially the ones setforth for this resolution. an impressive career so far. we'll see what you do next. i just want to thank you so much for the confidence that you en view with us when you present all the work that you were doing and work being done by your colleagues and the

challenges that you face and how you were meeting them is how you did. so thank you so much and wish you the best and it would be great to see you back in san francisco sometime. >> commissioner? >> i didn't get a chance to work with you or hear you speak, i'm new to the commission but i do wish you best of luck and hopefully you do return to san francisco. so good luck on all of your new ventures. >> and i absolutely echo everything every one said. as we were dwg through these crisis, at lag no hon daxer we were so vulnerable and there is ways that leaders don't hold things together and the way that you were data driven, the way these multiple actions were needed were taken through their fruition and the way you can encourage and inspire the staff.

you gave a sense of that in the darkest moments that we can still achieve our goal. it's a measure of leadership that brought us to where we are today with laguna honda. so your potential is incredible and need is so profound so you're so lucky that you germinated here and hopefully when you're in full flower, you will come back to this department in some capacity so thank you very much. i know director colfax will want to make a comment. >> thank you, president green. and i'm delighted for your next step in terms of what comes next.

i think, he want to thank you for coming back to dph for a second time and encourage to you come back for a third back. i think there were things that you had such a broad portfolio there were times when you know, you were asked questions you may not have known the answers but you were very transparent about that. i so respect that, the joy needs to be acknowledged. no matter what the issue was, you always broughted a enthusiasm a positive energy that inspired the team, both the people that you were given the information to and the people that you worked with everyday. i really appreciate that. okay, we'll do this at night and some late nights where you

may have found some key equipment for laguna honda hospital and other such things, you always did that with such enthusiasm and i have to to say in closing, i don't know anybody else who can make a federal regulations interesting as you can. i have to say that on these calls. or if there was some challenging metric or rule, you just woefsh it in this fascinating narrative that gripped everybody even if it was on zoom or teams. i want to thank you for that which is a know that we'll be looking to your on going success. thank you for everything you've done in your department and in san francisco. and i wonder if you will step up and say a few words. >> thank you very much for the kind words.

they're incredibly humbling and encouraging. i would say a couple of things, the work that we all do in this room, that you all do it's hard work. it's very hard work. you're often told all the things that you're doing wrong instead of what you're doing right. but i think the folks here in this room and everybody supports the work is what makes the difference. i think the part that resonates for me, can you leave it better than what you found it. and that's what everybody tries to do. san francisco is a model for the rest of the country, what we're doing here can have an impact across the country. and i think the best part i can leave with is just every one models is never success get to your heard but never letting failure get to your heart. that is what i take away in my

next steps and next journey, you know what they say, you can always come back home. that's something that i will always take with me. yeah for the all the 9910, that's how i arrived and i'm really just thrilled to be able to leave on a note where i'm excited to root for san francisco. i'm excited to see what the future will hold. i will always be a fan, thank you for everything that was said. it's a team effort but i'm incredibly humbled, thank you. >> stay right there. >> we have to take a vote. >> i'll start with you commissioner salgado? >> yes. >> yes. >> yes. >> green. >> yes. >> guillermo. >> yes. >> and before we have you up, i want to say i know him on so many levels and your heart is

so beautiful and i hope that where ever you go, it's met in every way that it's needed. that's what you've given to us. my computer just shut down so i cannot take part but you're all going to come up and do a picture. can you hold this and give that to him. >> yeah. stand in the center. look down so make sure. >> mark, i guess i cannot touch this.

>> all right, one, two, three *. and i'll take one more. all right. >> something to show the grandkids. >> thank you.

>> here you go. >> yes. >> okay. are you the two of you going--how are you going to do this? there we go. got it.

>> wonderful. never say dph does not have a sense of humor. >> i love it. >> the next item is director's report and we'll hear from director colfax. >> i did want to share some good news, it was just released yesterday. with regard to our overdose death numbers, as you know, we continue to have a major overdose epidemic driven by fentanyl. we have redoubled our efforts across our department including

behavioral health. which we know from the data and science that we reduce the death of risk of overdose by 50 percent. so the chief medical examiner, release thed overall deaths for the month and for august, for august and they were down, nearly 50 percent compared to last year, so very positive news in that regard. there are still too many people dying of overdose, i want to emphasize that we're doubling our efforts. so overdose death are down nearly 50 percent and now for the first months of 2024 compared to 2023, overdose deaths are down almost by 20 percent. so some indications that our efforts are paying off in that regard. core dating with that, we're

seeing market increases in people accessing treatment. and the people seeking treatment of methadone has doubled. we're seeing some improvement and at some point, we'll also share with you some of the positive coverage that we've gotten with regard to our street teams going out and offering people treatment on the spot. we'll bring that back to the commission. but i think the point is. that we're grateful that we're starting to see declines in overdose deaths. we know that for the future we'll continue to double our efforts. in other direct news just to go over the written material, the

population health decision was awarded a five-year grant to continue capacity assistance through its program. this is a grant that has gone on for nearly a decade. and this is really this is a very competitive ward and just very pleased that the health decision continues to be acknowledged as h.i.v. and h.i.v. technical assistance and capacity building. so this is really helping jurisdictions and agencies reenforce the four epidemic pillars to reduce infection. so it's been head earlier san francisco a a leader and this grant in developing capacity to respond helps not only san francisco but other areas of the united states.

in other phc news, responded to a outbreak of chagala that prevented spread. our focus has an respiratory and concern about bird flu, it's important that the ph.d team spent a lot of time in other infectious diseases which a disease that causes infection in other complicateds. and outbreak was rapidly contained. in other phc news, and in other, issues we relating to health, we've seen significant progress, on reach out tobacco and smoking program ordinance. so tobacco continues among the

leading causes of preventable death and continues to be a department priority. so, in 2014, the supervisors pass the ordinance. the goal was to reduce to no more than 45. the ordinance revents any new tobacco ordinance to be issued with more than 45 existing permits. so since 2018, we have saoeb a 21 percent increase in a number of tobacco establishments in san francisco. during this time, they have gone from 135 permits to 53 and this year the city reached a mild stone where the first time. just an example, we talked about more up stream

intervention to address public health and this is a real find of that on going progress. and then i'll let you, read through the rest of the direct's report and ask for any other questions. thank you for attention. >> and you and thank you for the news of overdose, that's really good to hear. is there any public comment in the room on this item? is there any remote public comment on the director's report? >> let me see if the hand is still up. i think we're on the director's report, i don't see any hands. >> i do see commissioner hand. >> thank you and i was also very pleased with the report in regards to redubsing of death. i'm wondering if we can hear more.

how no lax inhas been affective. then we may begin to understand thed role that noloxine is playing in reducing the death in overdoses. that was just something that struck me as you were, submitting the very positive report for this month. >> yes, commissioner. we've expanded nooxinand passed out tens of thousands of kids. ensuring that within our clinical providers and contractor, it's provided as a standard of care for people at-risk and we can follow-up with more detail. i'm happy to provide more details.

>> thank you. great news. i wonder if you present long term data, about the reduction hopefully conditioning reduction in deaths. if you can find a way for it to be usefully presented to visually in that presentation, give an understanding of each new intervention, that the department, you and your department have come up with. and to the extent that you can, your sense of what impact those inter vex have on the movement of the numbers so we can see, just the growth and the movement of, innovation and response to the numbers. >> absolutely.

>> yeah, we're seeing some correlations and this is data that is positive and just for the months was a 20 percent almost 20 percent reduction. there is only been one month where we had an increase compared to the month from the year before. so we're seeing again those positive signs. this is data that is preliminary, the medical examiner updates and revises the numbers. but we will continue to work exactly what you're talking about, ensuring that when we come back to the health commission, with updates, with the cornish tiff that-- initiative that they have clear description of many innovations that the department is working on to hopefully continue this downward number of deaths due to overdose. >> any other commissioner questions or comments? all right. well seeing none, thank you so

much and our next item is the committee report from laguna honda. >> thank you president green, there is not much of a report since unfortunately, due to technical problems we were not able to hold a formal meeting and so many of the ytsz that required either a presentation or a review approval vote by the full commission will occur in today's meeting, either in open or closed as appropriate. so we have laguna policies which we were able to review during the committee. is carmen, oh, welcome. oh hi, i don't think i've seen you in-person.

i'm going to quickly go through the updates that we have for receiving comments food from home or outside sources, we added veshage around the recommendation of non facility food. 16 policies were updated but not limited to. we have verbiage that nurse managers will notify the family or decision maker unless it's already done by the position. and medical services 00e referral we have--a-1 l.a. scope of services, we add the op service chief that reports to the c m.o. and the last one is 40-07 rehab

services, we updated the other two medical director. now for the wheelchair policy, i'm going to executive for rehab services. >> thank you, thank you for an opportunity to provide an audience. >> if you can speak louder, we have some from laguna listening, and if you can come closer. >> custom wheelchair policy, these were updated in custom policy 05. the latest version was approved by health commission on february 20th, 2024.

this updated policy reflects our counteder practice and multi disciplinary collaborative approach to meet the needs for residents in a more timely fashion that is 24-40 hours. this is also indicated in our 2702 policy. we appreciate the opportunity to provide this. thank you. >> thank you for that clarification. so, we don't, we have to vote on these, but i don't see. would we take a motion to approve these? >> yes. >> so you have before you the policies, you have the versions here and the questions that were raised by the members have

been answered to our satisfaction is there a motion to approve these policies? >> i so move to approve the policies. >> is there a second. >> i'll second. >> all right now, is there any further public comment on this item? >> is there any public comment o in the room? i don't sigh a hand, folks we're on the lag no policies. item 7? mr. minutechaf i don't see that you're with us. i'll do a roll vote. >> yes. >> yes. >> commissioner green. >> yes. >> commissioner guillermo. >> yes. >> and commissioner chow. >> yes. >> thank you very much, the policies are approved. >> wonderful. the next item is human resources fiscal year update and kim who is our hr director, we

apologize for having to delay this item from our a v problems from the past meeting. >> good evening, thank you so much and working in the world of hr we're a little bit used of things happening and going with it. so happy to be here to provide some information. so i have, as you said before my name is lana kim and i'm the officer for the department. i'm joined by the members of the hr team who individually and collectively make up all the work that i'll be sharing with you. specifically in the room is dr. richard anjou, kim walden, mary gord an, inl and stephanie who are here and others who are joining by phone. i would also like to ache a moment to thank this

commission, in providing resources and constructive feedback which have been instrumental in providing our services. i would like to acknowledge members of the team who put together all of these slides that i'll be sharing today. next, i'm not the agenda slide please. over the next 15 minutes or so, i'm going to go through the work that we've done. we'll look at this achievement. and i'm going to violate the achievements. i'm going to conclude what we see as a priority. as a bit of a background, we have worked hard to have a culture out of ordinary. with this philosophy. we have worked hard to foster strong fellowship with union and leadership and the attorney

city attorney, universities and other counties who help guide us and drive us and expect us to do more for our staff. this includes use of data. we recognize that the work of reflection and improvement is on going and we're proud to share the efforts and improvements that we've made thus far and we will continue to work with our partners so improve. next slide, please. i'm asked to show you where we are within the orange part, we're in the top left corner part of the administrative team. next slide, please. so fiscal year 23-24 was a year busy and productive for us and our department and hr. with a department of over ,000 always great demand for our services. in order to best meet needs of

such a robust community it's been essential to align and anchor our work. last year to promote the health, we asker ored the priority on the feedback of our priority, via the employee engagement survey. which i know you heard about. leadership met to plan a session earlier this year and we said audacious goal to fully staff dph. in order to meet this north star goal, we have key results which i'll talk about more later about. next slide please. a little bit of metrics starting in 2021, we focused on strengthen our data analysis and reporting efforts in order to make better informed decisions. in the past three years, we've moved away from peace meal that would delay our responses.

you would ask us or others would ask, what is the vacancy rate for nurses? and we would have to say to you, that's a great question, we will get back to you and give you that answer. we are now able to answer that question in whatever time it takes us to pull out our phones and get that data. and our hr team who have created dashboard who have utilized everyday. for instance, we have a vacant dashboard that updates on monday at 10:00. we know this because we have our mouses over that dashboard to see our vaik anted see rate. every week. so we're really excited about tha. and our efforts to gather and ap lies data.

this has allowed us to get a better understanding of retention and turnover. this expansion of our use of data has allowed us to pin point to better serve our employees. so we are seeing some positive results. our turnover has decreases and our retention as increased by ten percent. for this commission, we talk about all aspects of hr that contribute to the vacancy rate. for instance, we can greatly improve on the number of people we hire, but if they leave, because of lack of our work culture or lack of professional development, then our work is for not. so we look on stabilizing our workforce. other ways, the data has given

us a holistic by illustrating the share volume and complexity of dph workforce. so we've worked together to for tray that effort. next slide, please. next slide please. thank you so much. so just highlighting couple of areas. the assessment team has nrishd a number of key items. we've increased a number of classification, this means those always posted so that we can meet people where they are. so rather than people waiting for what we're ready they can continual lea mrie for jobs and to better support our nurses, we previously, who previously performed some of the tech functions, we created a new class.

this undertaking, was done by scott to make this happen. the other initiative we had some recruitment challenges, we renamed the job class. this happened through partnership at sciu. another focus is to diverse applicant pool. we have partnered with black colleges and universities. next slide please. we have reduces our vacancy to budgeted staffing level with a position authority of 4.67 percent. we have essentially filled all of our budgeted positions but as i stress to our staff and managers and union partners and others, we have, we strife to fill all of our positions and we work to fill them, we don't stop at our attrition rate.

it times to fill so we don't hold any positions back and we've done, the team has done some wonderful work to get to that budget rate. in all organizations, there is going to be a number of people joining and leaving. we budget attrition, we do not hold back. commissioner green, average time for application to hire? we're currently about 134 days overall. i know that the city, the department was over at about 182 days. so we reduced that. i would like to acknowledge our legal partners who have collaborated and invested time and energy to help us. next slide please.

when i joined dph a few years ago, dph had a team of four people consultation analysis and career coaching. they have made and helped us make a significant investment in this team and i appreciate the vision to drive this work. about two years ago, we didn't have any laider ship and now we have several. we did not have tools and systems.

houston's work as a leader of eeo team.

she has worked collaboratively meeting with city attorney office in dhr. with the employee. next slide please.

non ,z discretionary leave which are, mandatory are f m.l.a. and preg nanlt' leave and ada and workmen's comp. those for educational leave. the top p chart shows approval by hr, not necessarily actual laid taken by employee. so an employee may seek, a request fwoer leave but for whatever circumstances may not take it. like flma, may be one of them. they may be recommended to take time off based on their health condition and they may or may not need it. so just sort context.

so commissioner green you had asked where covid leave ended in december of 2022 within fiscal year 2022. so the leave of absence continue to increase in 22-23 despite the state not allowing for covid leave.

i think that really helped with relationships and we've also provided tracking systems and training. next slide please. we were committed to fill vacancies and promote opportunities and training for employees.

these commitment are in alignment with priorities from employee survey and track to our objective to your results. next slide, please. pay roll, we have a very dedicated team of pay roll staff. who provide, who provide who pay us every two weeks and we strife to have no errors. okay, so now looking forward, next slide please. our goal is to fully staff dph, that is a full goal that can only be out reached. in order to meet our goal we have divided them into three areas which is experience and hiring and each of these have specific goals under them and

each hr team have objective results or okay ours as we affectionately call them. i want to highlight some other areas of focus in us, the physician dentist, veterinarian are important classification for us and we do look at them and it's not because we would agree to look at them but we do that anyway. and part of this presentation, we had an agreement with uapd, is here, taking a picture of the very important slide. which have committed that we would have a slide about uapd and there is a lot more work to be done for this. so they have raised concern in retention. so in our last round of bar

dwining, we have agreed to focus and improve the manner. part of the agreement is to highlight our progress at you're commission meeting which we're happy to do today. this slide shows vacancy raitsz. i don't know whether this is a time for pierre is here and he's a strong advocate for his members. and so i just want to acknowledge him. >> during public comment is time. >> okay, thank you. highlighted is jointly reminder and we meet every month with uapd. so we look forward in providing you. next slide, please.

behavioral health clinicians, we would like to highlight the work that we've done. i'm in a critical. similar to physicians and nurses and dentist they're in great demand. hr have a strong partnership when we're working collectively to invest our resources to reduce retention for behavioral health clinicians much there is a work group they meet regularly to identify conclusions and there is a lost work that is on going here and we are founding members of a bay area hiring comprising of representatives from surrounding counties so we can work together to help encourage us to improve. that is a gallop. i would like to end by saying, we do really appreciate any

feedback and being held accountable, that really helps us improve the work that you do. i'm not sure any of us thought that this was possible. and in such a thoughtful way especially when it relates to equity. we very much appreciate that. i gather there will be public comment in the room. every one's got three minutes. when the timer goes off, please know that that's the time to end the sentence you're in. >> speaker: hello, commissioners thank you. my name is roger woo and i'm an

md and for identification purposes i work for dph and one of the senior representatives. i just want to say that we appreciate kim's presentation particularly in the shortages and key positions that's something that we negotiated in the contract because we thought we should hear about it. you're specific mention of that are that the hr commitment has made a commitment to staff. starting in 2017 our vacancy rate was only 10 percent. by the end of pandemic, it had risen to 0 percent. so i want you to imagine what that meant for day-to-day operations if 7 out of 10 of you were missing 70 percent of the commissioners were missing or 0 percent for dph was missing. these are the folks, these are

the folks responsible for day-to-day scheduling, decisions around crisis and pandemic response all the mechanisms that make dph go on the primary side. we bring it up for two gar bining sessions. we requested a joint management committee to address this issue. the department was willing to meet with us on this and we believe we're making productive advances. where we may need some point is to make it clear to party if we run under brush to getting the hiring process to work. because my fear is that although we're back to about a 450 percent absence and we're trying to climb to get 7 positions still, if somebody happens between now and before we can fill all of those positions, it's going to be bad. it's going to be really bad because you're going to be missing that key level that

handles what happens when somebody with an infectious disease come forward. and it's, notice a nightmare none of us want to live through again and i don't want to live through it when we don't have enough directors. so if we do need your help, i'm sure in a joint action we'll bring it to be and say, please help us clear ways of under brush. all right. thank you. >> thank you. is there anyone else in the room? >> hello i'm the business representative for aupd. as kim mentioned, we did negotiate and bargain to have this where as hr presents on behalf of our member to the

health commission, as dr. woo mentioned, we felt it was necessary. we're looking forward to collaborating to fill these director vacancies. as dr. wu mentioned, it's been crippling for your members and even some of the medical directors that are having to staff two clinics, you should not have to do that. we are like i said, we're looking forward to going to camp commissioner step in. encouraging we i just want to thank you guys and also, >> thank you. >> any other comment in the room?

>> i'm going to refresh very quickly to make sure i'm not missing anybody. commissioner guillermo. >> and thank you for your presentation. --we've been hearing in years past why congratulate, things. and the goal, place else appreciate that information on the vacancies because you know.

license clinician with the givers. in filling those vacancies that we might be able to somehow support or help move. i did have a question around, the leaves data. so you mentioned that rns have the highest percentage of leaves. even though we're fully staffed

with rn, which is saoer other which is an incredible achieve many. do we have sufficient staffing or what is the mechanism for doing that. do we foresee any issues with that that we need to pay attention to? >> thank you for that question. we do, meet there is a team of us that meet with finance, withing administration, and hr. and we look at staffing overall. and one area is on the leave of absence. so part of the numbers, build in a certain percentage, which is roughly 22%. so the work that we do, so that we staff at that level. we're continuing to evaluate and look at whether that is that number is what we're seeing on the leave of absence.

and if we're appropriately balanced. at this point, we think our leave of absence is at 19 percent and we budgeted for about 22 percent. when we first started, we had this big bucket of people coming to work and go into sort of why. we're looking at what is the percentage and what is the actual number. and as we're able to have these conversations and do that, we can start looking at well you're looking at people who are in the leave of absence but what about special assignment somewhere else. if they're not doing rn work and doing other modified duty how does that impact our staffing? so we continue to look critically at this. because we want to make sure that our staff is supported and

appropriately staffed. so i do appreciate that question. i want to assure you that we do have a committee that meets regularly to discuss it. >> that's good information. does that also include when clinicians or nurse or care giving staff are on vacation and coverage so the leaves include that type of? >> so the 20 percent is are you at work or not at work? that's the productability percentage number. we don't in terms of staffing, as i understand it, and my colleagues on the call, i will love to see those that know better than me. in terms of staffing, we just look do we have a clinician providing service or not? not sort of, we don't go deeper into why they may or may not be there. so that's why they built the 22 percent. we need to look at it from a workforce culture in terms of

why, whether they're in patterns or anything like that so we can look at it from employee engagement respective as i understand it, it's a broader bucket. >> great, i also look forward to dig deeper into that. aolt question has to do with i guess, the workforce development and some of the training opportunities that you are providing in order to achieve your fully staffed goal. so there was some numbers in terms of how many people have attended hr workshops and career development information sessions. do those numbers are there a goal for trying to get so many folks into these programs over a period of time? because there is a number that does not provide a good context

of whether that's a good number and what you would like to achieve with those attendants's numbers at the workshop. >> i'm going to ask somebody else to answer that question. she will have a more detailed answer. >> thank you, director of experience and culture. we do have a goal of leadership. we want to make sure that our advisor complete newmanagement orientation which is a new program established earlier this year. we also want to ensure that all our managers complete the 24-plus train thating is advised by department human resource. in addition, we have new programs that we're continuously trying to rollout.

but the because dph has a complex clinical need structure, we are not able to mandate all of our trainings, even though we would like to, we want to be sensitive of how busy our managers are. but one example of how we tried to reach our leadership, to empower them with the skills and tools needed to support the employees is when it's performance appraisal season, after asking managers, mary our lead trainer has started a daily digest. so manager gets an email with all the tools and resources that gives them information on how to go successfully completing performance a phrase al and leaving. in terms of employees, we learned from 2023 survey a that serves about 1 8 percent of

employees said they would consider leasker dph because of lack of career opportunities. and we went from team of one to five. offering on going information session. so they can continue to think about the advancement and promotion and development within dph. we want to reach at least 20 percent of our workforce. we still have to think about how we stratify that data and look for job classes. i think that's going to be our next steps. >> i appreciate your answers and it really does look like as if the efforts that you're, initiating or have initialed, you know, are hopefully really

showing results in the kind of time frame that you're hoping so we don't see 18 percent wanting to leave particularly with the managers and administrators as well. we just know how hard it is in san francisco for folks to afford to live here, to want to stay here even with competitive salaries and benefits and all of that, it's difficult place. not just in courage, really we should be a supporting as much as we can. thanks. >> thank you. >> commissioner chow, your hand is up. >> thank you, and i want to thank ms. kim for the wonderful

work she has done. and it's hard to believe that in one year from the report from the prior year that you've been able to achieve so much data and metrics for us. certainly, the work that you've done. the much lower vacancy rates, down to 0 on our next side was extraordinary work. so the ability to work through many of barriers and to achieve that, i think you deserve a great deal of credit. i do think that the positions had an issue that it's nice to bring before us, because it's sort of a, part that we

weren't watching as much. and i believe that these numbers when i saw them in in review lead me to the same questions that the positions have raised today. and i think it's a small number compared to the thousands that we have in our workforce, the importance of our positions specialist, especially in the health network that are showing up, as you have the data now in terms of the turnover and vacancy rate, we would get a written report as success just as much as we're getting how well we're doing in our other categories. so i look forward to that. it's nice that you've been developing a work group that would be working on these

issues and, i would look forward to certainly in the coming quarter or two, understanding how we are going to filmore permanently the positions that are important for i think our quality of healthcare in our health network. so, i'll look forward to those reports and hope that you have the same success that you've had with our nursing categories. >> thank you commissioner. >> eye other commissioner or comments. thank you so much i would echo what commissioner chow and guillermo said, i think you have big challenges with the physical side of things. so i know you've goted challenges ahead and the way

you're approaching this in such a thoughtful collaborative way if we can do anything to add to that effort, we would be honored to do so. i know director colfax wanted to make some comments. >> thank you, i want today appreciate kim and her team for the progress that they've made. i have asked for more data and i think you've seen this and just to again shout out that we got to 0 percent vacancies as of the end of last fiscal year. and given the challenges, it goes to reenforces the shape. it's a cliche for a reason, that that gets measured gets managed and just to embrace that to hr's work. you know not too long ago when

i went and asked managers and supervisors and frontline staff what they most needed across the department and different clinical settings and, and other parts of the department, the universal request was for more hr support and increasing hiring and we are made significant progress on tha. you see where we need to continue to reenforce our efforts with physicians, that is happening so i want to thank the team for their leadership their hard work and focus on moving the ball down the field. thank you so much. >> thank you very much. thank you for your question about cutting con fex behind the data. we do appreciate sort of being able to trend.

i had a phone call saying that our report had a typo because we had 0 percent. and thanks for the call but that's not a typo. and through her leadership and her vision, we are working on helping our managers navigate the administrative programs with our department which admitantly it's not easy. there are different groups needing diva tension and i'm looking forward to providing updates on that.

thank you for your time and your support. >> thank you and thank you for okay knowledging, louie jenny, she is very appreciate hif. --appreciated. our next agenda, directer of network will step up and share with us. >> good evening, director of san francisco health network. i'm excited to share with you today an update on the health network. i'm joined by other members of our executive team and we look forward to catching you up on what we've been doing, as of late and revisiting with you the history of network how we came to be, how we developed over the years and our plans for the immediate future. next slide.

this is an overview, looking at our mission and vision and talk about moving towards the original vision of the network was to have integration across dph with our colleagues for example in hr and we partner with recruitment both the nurses and physicians and our colleagues in finance. what we've come together jointly to tackle some of our vexing issues within department of health. next slide. so you've seen this diagram before, it's been consistently used for the last several years. at the bottom this shows the foundation of our system which is our mission, which is to provide high quality care that allows san franciscans to live

vibrant lives. some of the history, this mirrors the original department of public health, mission and vision that was developed in 2014. in reflects that we really try to cascade down san francisco general and the sections of am bulatory care fm next in the middle, you see our true north which is our safety care experience, people development, by financial stewardship and equity. and you'll hear more of these as we go through the presentation. you also then see, pictures of actual patients, we felt it was important for to remind us of who we serve and why we're doing it. so these are actual network patients that you see here.

and then finally at the top is our vision which is every san francisco's first choice of health being. and we'll talk about why we stress being that first choice because it tells the history of network and what lead to its development. as you can imagine we're many things to many individuals but we're a community of top rated clinics and hospitals and programs serving more than 100,000 individuals annually. also north and san ma teyo county. we also have prehospital care and skilled nursing and homebase nursing and other therapyities.

also serving the western parts of the city. as you know, we care for any san franciscan who needs it, we also care for non san franciscans who might be in need of emerge enter or trauma care. for individuals from other counties if they don't have an urgentr emergent need, we will refer them back to their counties once we know they're stable. we celebrate the diversity including serving individuals from all back grounds. next slide. this slide shows the financial and you see that information

here in terms of the subtle budget for the network. next slide. so the san francisco south network. how did it come about and when did it come about? so essentially the network was born out of desire to make sure that the department of public health was going to be ready for the affordable care account that was passed under the obama administration. around the time of passage of a.c. a, the department joined forces with the city controller's office and had a a.c. a readiness assessment value by an outside consulting agency south management associates. a na came in and worked with the department for almost a year with almost all of our stakeholders and came back with a set of recommendations that lead to the development of the

san francisco health network as a solution and any, to ensure that the stie was aligning its deliberate resystem collaborating within and without and outside of their delivery system and more importantly integrated the previously independent divisions of dph, san francisco general laguna honda, primarily health clinics, the home health agencies, all of these as i prefer to previously as silos of excellent, they did a great jobs in all of their individual work but didn't always focus on the picture of how we ensure that we're delivering the best care throughout the continuium for the patients that we care for. next slide. and now to catch you up in terms of what we've been doing since the era of covid around

2019, i'm dwg to invite troy williams who is our serving officer and also serving as our quality officer to provide you some additional information. >> thank you very much good afternoon, commissioners. as rowland has pointed out with covid and other deployments, we've had some significant challenges. these last five years have been really hard. but in the midst of that we've been able to accomplish a great deal. and so here on the timeline, definitely highlights some of those things. and the first wub is we were able to implement epic which is a fully integrated health record that has really changed the way cares delivered and how we deliver within the organization in the network and this was a huge inter taking and we were able to implement

this in 2019. close to that implementation one of our deployment as every one knows, is focused on the abuse allegations in laguna honda and many of us were deployed and focused on that. and soon after, we went into unprecedented pandemic, the covid pandemic and so many people were deployed during covid and still. but in the midst of that we were still able to make progress on some leadership in infrastructure and we were to realign existing budget to provide new functions, adding any positions over the pasted six years. so some examples, we created after to centralize our quality networks. and in 2021, we created the

inaugural operating officer, budgy celebrated earlier to wrap our arms around the operations in the network and he's been able to do a great job and build a great team and we'll hear more about that later in the presentation. so we as continued on the timeline, we had unfortunately decertification of laguna honda where many of us were deployed straight from covid, but again in the midst of the decertification, we were able to make some significant key restructuring of our operations. we created a v.p. of support services, naughter who we'll hear from in a little bit as we go over resent accomplishments those from areas. we create a v.p. of home and integrated rehab. we have duray who is our

interim v.p. who we'll also hear from. we created a director of the contract and planning development, jonathan lions. we'll hear more about what is happening in this area. under quality management, we created the director of infection and control which is a direct control of gaps and that was really instrumental in helping us to bring infection control into the network. and we also created the director of staff services for the network. now we have this leader in place that can really share all of credentials throughout the network and he's been doing a dwrait job. most resent the inaugural nursing role which is the role that i'm in. the chief clinical workforce development and care coordinator and the chief

experience officer, iayana johnson so we've been able to make some strides which was one of the key aims as roland talked about. this is one of the key aims in 2014 to look for like a true integrated healthcare system. you'll notice many of these title are new to us, we don't hear v.p. but this is the part of the recommendation that we align and work and sound like integrated delivery system. so this is really a exciting time as we continue to evolve as a network. last but not least on the timeline, laguna honda is fully recertified. a lot of work, over the last two and a half years by many people in the room and throughout the department, we have a lot of to celebrate but we still have a lot of really

important work to do to sustain all the improvements that we've put in place over the last two years. next slide. so as you've heard on that timeline, lots of challenges but also a lot to be proud of. and what we'll do is we're going to go through some of these areas and highlight some of our accomplishment and and you'll hear from some of those fantastic leaders and what we've been able to accomplish. so we're going to discuss more resent accomplishments from the group and we're going to start with the nursing division and so from the nursing division, the chief nursing officer went into i was hired in february, of this year and we've been able to accomplish quite a bit. we had some challenge with registries and wub of my top priorities is to ensure that we have regular pc s staff caring

for our patients and we had a lot of registry. so we have develop registry program along with new negotiated registry rates that has ruled in significant increases throughout the network. this number is real, 75 percent decrease in nursing registry throughout the network since march. that's with increase oversight, dalai data, daily data process we've been able to make a lot of progress and that a also aligns with what you heard about the hiring, they're related. and this is been a huge partnership between hr and finance. we won be able to do this work without them and this collaboration is going to serve us well as we continue this work. we also developed standard processes and again i will not

say too much about this because luana did a great job. we meet with hr twice a month and whatever challenges or things are coming up, we're together talking about it, and that has made a huge difference in our ability to high rns. another thing to highlight i've been currently doing an assessment of am bulatory services, collaboration across six departments to improve nursing structures, this has really been amazing and i will say that i've been able to go out in the community and visit a number of sides through maternal primarily care and the work that is happening. and i'm really looking forward in my role to really help support the nursing structures

in am bulatory care. under quality centralizing the network, chief quality officer we developed a centralize infection and control program. we created the inaugural and laguna honda manager of infection prevention and control. we built a team at lag no honda as you recall when covid hit be. we now have a team of five and a manager which is more right sized for that size of a facility. and you know, really the main goal for the network direct of i pc is really to align with industry and best practice around the network and the best practice is laguna honda, we're really looking forward to spreading that out. we developed a central staff

services program. and crated the inaugural medical staff director role and standardizing and privileging and this is critical to ensure provide are appropriately credential. so james is doing a great job and he's really been working with behavioral health and other parts of our health system to and dph to spread his expertise and people have really enjoyed working with him. we've had qm collaboration between laguna honda, we've done survey and laguna honda our c a trainings, investigation trainings and stabilize training and our hips report and other tools that come forward are now standardized and from where we

started there was no action in this collaboration is going to continue to service us well as we recruit for our new network. and finally we implemented the safety and fied back system which you made may have heard of po system so this is also a huge, a huge deal for the network in terms of how we report near misses, safety concerns and such and the safe system is a, is really a model, in terms of our ability to do reports and follow data so it's been great to roll that out. next slide. so, i would normally turn this to terry and tony but terry and tony was unable to do be here today as i chief of workforce development and care coordination. she is doing a great job.

she continues, okay. yeah, she continues to serve laguna honda supporting nursing services, but at the same time, she has been doing some work laiding the network participation to help task force and also formerly partnering with the school of nursing, nurse health equity scholars where u.s. f students are going to be picked. so now i would like to turn it over to nita who is going to talk about cal and qi p*u. >> i'm i'm interim chief officer before i talk in the next slide, i did want to say i'm a proud primarily care physician and i was delighted to hear about the goals that we

share. i was selected as a to lis--facilitator and we've been successful in recruiting. we have primary care physician class that remains to be filled. and i think we can together make strides with this to make a robust director and physical first because that crucial to the goals that we all share for the san francisco health network. i'm excited and happy to answer questions for that. in terms of the next slide, we tall about the cal program which you heard from our cal aim in june at her presentation. it's a state run program so innovate from our for patient centered equitable system.

and the key, work in those initiative is the enhance management as well as the security support and we're going to be embarking a very large program for our justice involved population. it's been a very important program that has been generating over 4. million dollars in revenue and our enrollment rate has exceeded the state average. so we're very excited to excited to expand. and to be able to innovate into work and bring in financial sustainability to the work that we were already doing. next slide, our quality incentive pool and katie, chung dr. katie chung also a primary care physician and will be

coming in november to talk about qip in. we were very successful in our performance in qip last year in partnership with the primary care in laguna honda and able to secure 100 percent of our targeted, metrics to be able to bring in an estimated 65 million dollars for a fiscal year of 2023 performances. so we continue to work on our goals for our current priority metrics fm as we move towards alignment with future cal aim goals like community support and to bring in more work in partnership with our bhs partners. because a lot of future state is about integrated care delivery and service of our population in need. those are my two slides.

>> thank you nita. so we're going to move the presentation along. next you're going to hear about some of the new areas that we talked about that we restructured our budget to bring on to the organization. and it's important to note that we know we've been in financial challenging times the last few years. so in the new positions, three fourth were budgeted positions but as people left, we took a look at what our needs were and retool the positions into the new areas that you see. so very few resources these are current wlaoe budgeted resources. so next we're going to hear from pharmacy. >> good evening, chief pharmacist. pharmacy this year and last year has been access safety and fiscal stewardship.

so along safety, we had a five-year project to replace all our cabinets that sounds relatively simple but each one is its own mini project that required incredible amount and done in patient patient care. we also work on access to really trying how do we buy drugs? how do we get the drugs that we need to buy? increase contract authority. scripps which is a random company but it's the only one that distributes the medicines for overdose prevention to make sure that those have access to medications. and also our organization, they give us better deals on the drugs that we buy. so we have access to better savings so we can continue to make sure that we're using our

taxpayers dollars responsively. we forgot the vaccines, covid vaccine from a free government supply to a especially supply. we did that partnering with our population colleagues, and saved about 30 percent on what we would would have otherwise paid. and with regard to overdose prevention, we were active in getting 3000 doses of maxdoan. we also on the ledge slave side partnering with a team co-authoring to incais methadone access from patients leasker the hospital and our clinics. as well making sure that all pharmacies in the city, stock up sufficient supply. so when we get people out in

the streets, they can go to a pharmacy and the medication is there for them. and lastly, we you know, we worked really hard at laguna honda and worked with all the colleagues in this room and i'm very proud to be one of many that contributed to every certification. thank you. >> next slide. >> can you hear me? >> yes, we can hear you. >> thank you. apologize for being remote. i'll be covering city areas and highlight is synergy as well as throughout the city of san francisco different units. the first is engineering so we're able to implement the

first engineering support program for the department of public health that is including san francisco and population of department. and we were to achieve with that 100 percent compliance with laguna honda. and the goal of this program is simple but extremely important which is to make sure that all equipment is safe and care providers need to focus on care for their patience and not to care for their equipment is functioning or reliable or safe fm that's something that they don't need to worry about and we do this while we're implementing the best practices and doing it at the cheapest way possible because we are using the best practices and to do this, we visited many types and one of the example we were able to achieve is visiting the jail house and identified that that was some equipment that needs to be replaced and we're able to help them to not just replace the equipment but get

reliable equipment but also to give them a program that they will ensure that they always have rely equipment. the second unit is the supply chain. so now looking at the san francisco as a whole unit, we unified all the supply chain and san francisco health network including the ip purchasing as well. this gave us access to the whole data and analysis and this allows us to achieve just a start one million dollars in saving annually, just looking at the data to say hey, this is what we can do with you. and we are working closely to make sure that they have a plan for short-term and long term for emergencies and this will be on going support. the third category is capital equipment so we change and now we're using a tracable process using service which is already

existing in the city. and with that, we developed guide and smooth process for users to make it user not to be worried about them committing is smrimented. and we improve communication and transparency with all different department with divisions and budget office as well as all the way to the office to make sure that every one understand the actual needs of the department health and what that means for us and with that transparency, we're able to achieve more than 10 million dollars in budget approval for the department of public health and while doing this and changing the process and improving it, we were able to address few of the controller's office that we were able to mitigate by appointing this in your process. thank you for listening.

>> next slide. >> i want to thank you for the opportunity to share our experience accomplish manies. but i would like to take a moment in baljeet sangha he was the first xaoernsz officer so i want to thank him. now we were at a place where we're looking at care experience more essentially and the san francisco health network has recognized the need to have a standard approach to ensuring patients receive high quality care and compassionate care while also taking care of our staff and making sure that they have a supportive environment. so that's the care experience unit, it's brand new and we have a focus on patient and staff experience. the care experience instruction

structure and each has leads targeted resources and areas. and we've already been able to centralize key essential function and we believe by centralizing these functions we're able to leverage resources and support and provide that support across the network. and lastly, we were able to improve coordination efficient efficiency by realigning existing care experience senior leader positions that are currently houses at lag no honda and primarily care and now they have world parity and they will be essential to seeing through our care experience vision. so with these structural developments we're strengthening our capacity and provide high quality care experiences across the network. thank you.

next slide. >> good evening, again. thank you for this opportunity to present on kia chiefment for sf health network, we have services and health at home. health at home is trying to survey with a three-star waiting that a marked improvement from precovid. for sucker burge san francisco general hospital we have reduced our waiting time to come in and seek services at our outpatient clinic and it's four days better than national standard of 21 days. from laguna honda hospital we're fully certified and providing support to in coming new admissions.

and lastly san francisco health network, while we continue to invest in our teams through workforce care development, we have initialed such as culture belongings session and health at home and a retreat. because we truly believe the quality and safety occurs at the care of trust as we continue to focus on value base approach to sefsht needs of all san franciscans. thank you. >> next slide please. >> i get to pitch the work on this slide fm it's the tragedy and development. it's a mouthful but our inaugural director is a team of lawn but he's a force.

the products that were discussed earlier, at the placement, bioengineering, we have ro dust for the entire department. nothing can happen without professional services. now there are other tons requirement and checks and balances in place that require sequential movement through various steps in the process. that's really critical it's important for the transparency and trust in government and embrace our if fiduciary on how we do that. there is planning for so there is a lot of stuff that really has to happen and this could be hours and weeks and hours of discussion, reviews with o.c. a and here the health commission, you are a key step in terms of entering into agreement, board of supervisors if we do exceed

ten million dollars or ten years of a particular contract. now the goal is to get ahead of this, so this role is broken up by area, how do we have a contract. so this role sitsz outside of the contracts department in a department *f public health. the goal is for this particular role is to help and ensure that our colleagues have what they need just in time to really embrace and 'em mriment immediately any contracts you have to enter into. so when you think about tragedy how do we enhance the organization and cost controls in the timeline. what are we doing with the registry contracts? partnering with interpreter services, lian johnson, partnering with our leaders you heard from dave smith and other nursing leaders. the policy often times are asked about opining on policy. so you have to know how the

whole system works with you you cannot say that sounds great. so jonathan really has over decade of experience in public service and city government and helps us really elaborate from where we stand with policy. when it comes to planning, really takes a long time so say hey, if we're going to have something to expires in 18 months, we should be starting today. we don't want to make everything a emergency, a fire drill and the idea is how do we dwet ahead of that on very very busy calendar, very very looking through key issues and other crisis that pops up. really doing it so we can come back and say, yes we're still trying our best to plan a said and we're succeeding in some of these things. finally, the contracts development internal, health process to really traem line and really have dedicated meetings. you hear from serious members

of department health of the great work they're doing. when you step back, each individual department will say my contract is number one. eventually, you cannot have 25 number ones and how we partner with them to say and so jonathan's role is to help us coordinate that, really say hey great this is an emerging need but what is deprioritize from one number one now. sd having the conversations to hon the work that everybody is doing but also honoring the work that our colleagues are processing. we're excited about this role and we're looking forward. with that i'll turn it back over toro land. >> great, thank you both and every one else and we can go back to the last slide please. next slide, next slide. and so, one back. so as you can see, we've been

very busy within the network and really are trying to fulfill the original charge which was to develop an integrated system for the department of public health and again i want to mention that the new functional areas that we brought online were done predominantly through repurposing budgeting positions. so recognizing our financial situation, we, took that seriously and tried to be good financial stewarts while also being committed to the original charge and vision. and in terms of where we go next, we're going to continue to sport city wide and dph initiative in terms of reducing ownership use, as part of every division's work within the network. we're going to continue with our integration activities across the network and we'll continue with the cal aim of

the other base payment initiative which is more and more our dollars are coming from in the future. so we thank you for this opportunity and look forward to entertaining your questions and comments. >> thanks to all the presenters for their ex tense explanations. this has been an impressive body of work. by the way thank you for having the questions we submitted in advance. the way the positions have been thoughtfully repurposed. it's remarkable that in the context of massive implementation, a unforeseen pandemic and then thed laguna honda issues, you were able to do this progress and it shows the depth of the individuals that you have within the network and efforts that you made, this is really quite impressive. is there any public comment in

the room? all right, and what about remote public comment? all right, we'll entertain commissioner questions and comes. commissioner guillermo. >> i just want to associate myself with president green's comment sxz congratulations on what you've achieved. i do think though that sometimes it's the challenges and the crisis that va actually sort of promote the opportunities for change innovation and creativity. so all of those things that she mentioned in addition to the budget issues, that we're facing now and in the future, has really i think in some ways, brought out the best of what we have. so i just think that that's again a testament to the department and the talent on the dedication that you all

have have shown. i would love to ask a bunch of other questions about everything that was presented and i know we're short on time. so, and i know that you answered a bunch. a lost questions online. so now that the verbal presentation has happened, i would probably preserve the right to ask a number of questions by email again because it just sounds so sort of exciting to know that the integration after ten years is really seeing a fruition. not only with the network but health division. i think that really makes the department in total realize the promise that you have of san francisco network or the department being the, the provider of choice. not just for sf an franciscan

but also the model that folks want to sort of replicate and question in, in want to know more detail about how it happened, so congratulations. i noi there is a lot more to do. i know it was under duress that a lot of accomplishments were achieved. but again looking more to more of the same in the years to come. in short years to come. thank you. >> commissioner girando. >> i just want to thank you for the questions answered before ahead time. and i hope the next steps for the slide, sf health network is we could have an update because

i think work is so important, i would really like to put that on the calendar. to look at the key initiative. : many thanks. >> commissioner chow. >> yes, thank you for just a very comprehensive review and development of the health network. as you know, there have been a number of attempts prior to the affordable care act to bring together an integrated system for us. and i think this is the further *eft i think we've gone. and trying to understand, you're building a team that

then coordinates, the large element and the small elements that are delivering care in the network or other aspects of medical experience such as through the, population health area also and all. that these new positions are going to be integrated and collaborative rater than competitive with the already established similar types of functions that have been as earlier spoken of, you know, you know, silos of excellence. and it would be very interesting as you already demonstrated that some of this coordination and bringing together as a network has leveraged bitter pricing. so the the ability to then

allow the larnler organizations particularly the two hospitals, to be able to continue to function, and yet be able to collaborate and take advantage of the opportunities that a larger network can actually leverage, will be i think a important report back to us that would then justify having a number of new leadership positions that as i'm glad you claim were actually to a great extent a recasting of some of already existing physicians. i think that would be a for me, a a next step to understand how then we've been able to achieve all the way from the different chiefs pharmacy and support services and so forth that

we're able to then integrate and work with the large organizations that have already have had this. now of course at laguna honda that has been a build out as you know, have demonstrated and you're already there doing it. so the whole question that general has built up it would be interesting and important to know that we're not trying to be competitive but actually being supportive of the, of the leadership that is over there already for example in pharmacy oer in contracting and supporting. so i look forward in understanding in the next report how well you have done in that and i guess in november as i think you heard, i mean that you said, you're going to

be presenting the results from at least the am beau tory system, that's something that we've been lacking at the full commission. and i think the important for us to understand how that has integrated with the of work that is also being dub at the other facilities in order to achieve 100 percent of the qip. so i would be interested in that and in your next report also. so thank you very much. correcter for having moved the agenda to a real network that you have and i look forward to the, successful integration of all the elements.

>> thank you, dr. chow and just to answer your question. we've already begun working with each of the divisions so over last year each of these functions have come on board, they meet jointly with their colleagues at zuckerberg, at laguna at ph.d, the other thing when these positions were repurpose, they were given the charge not only do you do it for dhp and the health department as a whole. that process has given and continues. i can give you a example in zuckerberg, they are are interested in using another vendor to purchase their meat. we're happy to have that discussion but because we do group purchasing for our food, we need to have a costa nal sisto see what is the implication and what is the

cost benefit. so that's an example of what happens on a day-to-day basis. and the department. >> well thank you very much and like i said, i look forward to even greater things, having put in place the people that you need. so build even a better department that will serve the public. so thank you. >> okay, commissioner christian. >> i just want to say thank you for such an rich and informative presentation in conjunction with the hr presentation provides a really good basis and ground good basis and structure for understanding the work of the network and as it goes forward. thank you so much. >> thank you, and we look

forward to hearing more especially on the issues that were raided. --raised. and director colfax. >> i just want to thank the great talent for hiring great talent and to say as a provider in the network because i do have a clinic in the network. i have seen how patients have benefited from this disintegration from the increase did i efficiencies from epic to the streamlining of support service availability, to the greater integration of behavioral health into primary care. there is a lot of progress, i want to acknowledge that and assure the commission that

patients are benefiting from this incredible work. >> thank you. wonderful close on this presentation. so we'll go to the next item which is community and update from commissioner girando. >> thank you, i'll try to go quickly. with the promotion group that presented and did a great presentation and helping us further understand the group. the programs are community wellness sexual and drug user health. and the hip and grants and administration. it was interesting that the main focus what they do is to collaborate with the community and community organizations which is wonderful.

there is no cost to the organizations and a big part of the budget of this group. the majority funding is grants 0 percent with state and federal money. they highlighted a number of the different programs including sexual health with h.i.v. prevention and just received from the cdc cin a 6. million to fund all the h convictioner, h.i.v. related staff. they talked about the health access points were started in 2023. where the focus is whole person care with a goal of focusing on

hicv, stis, drug treatment and overdose. within health access point, 16 to 17 agencies have been funded for their work. again the community agencies. the home testing program was launched in 2021 and that provides free home test for h.i.v. and sti and prep panel. the other focus which they spoke about was the community wellness focus which is the programs are newcomer health program which is for newly arrived folks from either asylum or for, or new immigrants. injury prevention for seniors which you thought was quite interesting tobacco free

project and vision zero which is pedestrian safety. so it was, really an excellent presentation in focusing on what the department is doing and partnering with the community and the out reach to the community. i don't know if you have anything more to add. >> that's a great summary. >> thank you. >> is there any public comment on this item? >> there is none in the room and there is nothing online. >> all right, interest any commissioner questions or comments on this report? seeing none, thank you so much for that report and the next item is other business. >> we there is no public comment on that either way, so it's up to you. >> any other business? all right, hearing none. the next item is motion to go into closed session.

so is there a motion. >> so moved to go into closed session. >> second. >> there is no public comment i'll do a roll call. >> commissioner chow. >> yes. >> gi yes, sir month. guillermo. >> yes. >> yes. >> yes. >> yes. >> thank you mr. pickens gives me 30 seconds, folks know that we will not be heard or seen when we're in closed session,

>> in the bay area as a whole, thinking about environmental sustainability. we have been a leader in the country across industries in terms of what you can do and we have a learn approach. that is what allows us to be successful. >> what's wonderful is you have so many people who come here and they are what i call policy innovators and whether it's banning plastic bags, recycling, composting, all the different things that we can do to improve the environment. we really champion. we are at recycle central, a

large recycle fail on san francisco pier 96. every day the neighborhood trucks that pick up recycling from the blue bins bring 50 # o tons of bottles, cans and paper here to this facility and unload it. and inside recology, san francisco's recycling company, they sort that into aluminum cans, glass cans, and different type of plastic. san francisco is making efforts to send less materials to the landfill and give more materials for recycling. other cities are observing this and are envious of san francisco's robust recycling program. it is good for the environment. but there is a lot of low quality plastics and junk plastics and candy wrappers and is difficult to recycle that.

it is low quality material. in most cities that goes to landfill. >> looking at the plastics industry, the oil industry is the main producer of blastics. and as we have been trying to phase out fossil fuels and the transfer stream, this is the fossil fuels and that plastic isn't recycled and goes into the waste stream and the landfill and unfortunately in the ocean. with the stairry step there will be more plastic in the ocean than fish. >> we can recycle again and again and again. but plastic, maybe you can recycle it once, maybe. and that, even that process it downgrades into a lower quality material. >> it is cheaper for the oil industry to create new plastics and so they have been producing more and more plastics so with our ab793, we have a bill that

really has a goal of getting our beverage bottles to be made of more recycled content so by the time 2030 rolls around t recycle content in a coke bottle, pepsi bottle, water bottle, will be up to 50% which is higher thatten the percentage in the european union and the highest percentage in the world. and that way you can actually feel confident that what you're drinking will actually become recycled. now, our recommendation is don't use to plastic bottle to begin w but if you do, they are committing to 50% recycled content. >> the test thing we can do is vote with our consumer dollars when we're shopping. if you can die something with no packaging and find loose fruits and vegetables, that is the best. find in packaging and glass, metal and pap rer all easily recycled. we don't want plastic. we want less plastic.

awe what you we do locally is we have the program to think disposable and work one on one to provide technical assistance to swap out the disposable food service to reusables and we have funding available to support businesses to do that so that is a way to get them off there. and i believe now is the time we will see a lot of the solutions come on the market and come on the scene. >> and is really logistics company and what we offer to restaurants is reasonable containers that they can order just like they would so we came from about a pain point that a lot of customers feel which wills a lot of waste with takeout and deliver, even transitioning from styrofoam to plastic, it is still wasteful.

and to dream about reusing this one to be re-implemented and cost delivery and food takeout. we didn't have throwaway culture always. most people used to get delivered to people's homes and then the empty milk containers were put back out when fresh milk came. customers are so excited that we have this available in our restaurant and came back and asked and were so excited about it and rolled it out as customers gain awareness understanding what it is and how it works and how they can integrate it into their life. >> and they have always done it and usually that is a way of being sustainable and long-term change to what makes good

financial sense especially as there are shipping issues and material issues and we see that will potentially be a way that we can save money as well. and so i think making that case to other restaurateurs will really help people adopt this. >> one restaurant we converted 2,000 packages and the impact and impact they have in the community with one switch. and we have been really encouraged to see more and more restaurants cooperate this. we are big fans of what re-ecology does in terms of adopting new systems and understanding why the current system is broken.

when people come to the facility, they are shocked by how much waste they see and the volume of the operations and how much technology we have dedicated to sort correctly and we led 25 tours and for students to reach about 1100 students. and they wanted to make change and this is sorting in the waste stream they do every single day and they can take ownership of and make a difference with. >> an i feel very, very fortunate that i get to represent san francisco in the legislature and allows me to push the envelope and it is because of the people the city attracts and is because of the

eco system of policy thinking that goes on in san francisco that we are constantly seeing san francisco leading the way. >> kids know there's a lot of environmental issues that they are facing. and that they will be impacted by the impact of climate change. they will have the opportunity to be in charge and make change and make the decisions in the future. >> we are re-inventing the way the planet does garbage founded in the environmental ethic and hunger to send less to landfills. this is so many wonderful things happening in san francisco. i feel very fortunate and very humble to live here and to be part of this wonderful place. ar

>> it my honor to introduce a true patron of the arts our mayor london breed. >> (clapping). >> wow. it is packed house here tonight, i'm so very much excited to be here because this has been a long time coming the process that the committee members have had to go through to make a selection who are an important a poet laureate