Transcripts For SFGTV Government Access Programming 20240713

Of the Civil Service roles as you do with the normal the ones that take 253 days. When you do that, that one youve got to get the approvals, post it, then theres an appeal period, then you have an exam, then theres an appeal period and all of that with the exam. You can speed all of that up. To do that we would have to get approval of the d. H. R. And the union. I think they would understand. I would say the other possibility is what is called a Civil Service exemption 12, which is an expert. So we did that with i. T. We now hire some of our i. T. Staff under the Civil Service exemption which is a 12. We hired the project manager in h. R. Hired on average everybody in six weeks using the epic hire using category 12s and category 18s. I would say if you want the speed of hiring for Something Like this, i would go with Civil Service exempt positions, work it out with d. H. R. And the union. The lean process improvement, thats going to take a while. We dont control a lot of whats going to be changed. Its d. H. R. Is the Civil Service roles. But the existing category 12s and 18s, we could do as fast as six weeks. Thats what i would recommend for that. What was your other question . I was wondering if you could give us your assessment. Oh, the assessment. I think that we still have you know, this is really a sensitive area because to say we appear to be overrepresented with certain populations of staff does not make those staff feel very good or are very happy about it. So but i think the numbers sort of speak for themselves. We still have areas. We need to recruit more africanamericans, for example, and we need to recruit them into higherlevel positions. The disparity is we hire them into the lower classifications and they never work up to the higher classifications. I want to work on pay equity. Again i was saying if we want to break up these pathways causing us to be lopsided in our diversity, we take away the managers right to determine where the person comes in at their pay level. I think the only way to break up that is h. R. Has to decide and we have to decide that based on pay equity. Im going to have to staff up to do that. What i would like to do is that payroll would do an analysis before we make the offer what were going to hire you at, i want to make sure we see what we hired everyone else at and bring you in at the appropriate level. Right now its done by the manager and they say step one. Unless someone knows better, he says i want to bring him in at step four and theyll justify it. Lots of people dont know to do that. Thats how we end up with the pay disparities. Can you give us more details about the types of positions that we have the greatest challenges. Its one thing to see the diversity charts and another thing to better understand. We have certain issues hiring nurses versus other employees in the d. P. H. If you break nursing out, which has a whole set of different concerns and brought to us information about the other subcategories of employees and how youre going to approach hiring and diversity in those jobs. We can do that. I know weve looked at it in the past and going to look specifically at each classification. Yeah, we can do that. Thank you. Looking at the new hires chart, page number 11, you mentioned there was a dip in new highers in august and september of this year because trainers were needed to really engage in the epic go live and training there. I know we had reviewed a number of contracts for Surge Staffing and other things related to epic and when to when these needs came up. Was this not anticipated or contemplated in the staffing when you were looking at when you might need folks to come in with Surge Staffing . So i think it was i didnt of course do those contracts, but i think they did look into what they tried to do is make sure we used our money wisely. What they had done is brought in a surge of trainers and said, look, by midjuly, were going to be at the point where everybody is pretty well trained except for new people. Were going to cut loose 100 trainers. Were going to keep the core trainers, but were going to need them to get this launched on august 3. Once thats done they can return to training the new staff. We asked them to get people into the orientations in august and july because there wouldnt be one in september. Whether they anticipated this way back im not sure. It wouldnt have made sense to bring on those extra trainers. It was a dip in our hiring, but we will make that up. Thank you. Looking at that disciplinary table again, it makes me wonder what is the gender parity of our workfor workforce, especially when there is no real way to know from these tables the size of our transgender workforce, you know, in d. P. H. , transgender men and women. Its kind of like a yeah, im just like my head is filled with questions, like where how they placed in those city tables. So we just started tracking based on there was a directive six months ago or so or maybe earlier, they want to give us the option of tracking gender and transgender in all forms. Were starting to track that. We may be able to have that going forward. Were about 75 female and 25 male. Something like that. Its been a while since i looked at those numbers. Thats not unusual for a health department. We can refine that. Thats a good point. I will talk to d. H. R. This is their information, but i think it would be a good point to track that. I was disappointed to see that we dont have those data, especially given the departments work on sogi. Were asking it of the people that we serve, but were not doing the work we need to inwardly as a reflection. Certainly its a priority to work to get this data that youre asking for. Commissioners, other questions . Thank you very much. All right. Thank you. All right, everyone, we move on to item 9, which is the epic post go live update. Commissioners and directors. I am the chief Information Officer for d. P. H. Id like to start by sharing a number with you. 8,800. More than 8,800 people have gained credentials and used epic since our go live on august 23, 2019. That includes over 1,500 of our clients. My takehome message for you this evening is we had a great golive experience, everything from the support of your commission all the way down to all 7,500 people who participated in classroom training and took proficiency exam to be able to effectively use the new tools. It was across the board an outstanding effort. We had support from across the city. We had support from a number of vendors in addition to epic. And of course we had the support of all of our organization, as we know that it takes attacks on any company, any agency, to make a transformative change such as we have. All of our consumers as users of epic are getting accustomed to the system and day by day are getting proficient with its use. It takes a little bit of time and were not even three months in yet. I do want to assure you that we have a systematic process in place, a goodgovernance program, so we can monitor and improve based on the information we glean from epic. What i mean by that is epic is not just a system we put things in, were seeing a return on information and not just in the form of reports, but information about how were using epic, some of this in nearreal time, so we can understand how were making best use of this very large investment. So a handful of Cocktail Party starters. I maybe lead you to the fourth ring, next to the last on the right, and that 21 systems were consolidated that bring wave one of epic to life. Thats important because thats a really large number of systems. Its also important because it speaks to our readiness in the coming year to decommission those systems, which has been part of our financing plan. So what did we implement . I think you have all sat through several briefings. Across the top row of items is our traditional electronic charting infrastructure, the support systems like lab, pharmacy, radiology, how we handle the revenue cycle, as well as scheduling. The first one on the bottom is Health Information exchange which may not have come to mind. Thats the bidirectional sharing from and to our organizations and others. As a result of epic, we are now part of an Industry Consortium of two or three dozen other organizations that make Electronic Health records. We all agree we are able to share information with one another. I will show you some statistics for that in a few minutes. I also mentioned briefly that theres a lot of information were getting out of epic, and its beyond the standard analytical tools. It is striking the progress that Electronic Health record systems have made in my 20plus years of working with them. Where we are today is that we are really starting to learn not just about how we can improve in real time by giving managers dashboards to use, but as i mentioned in my opening remarks, how were actually using the software. It tells us how well were doing and it provides areas where we can say focus enhanced training and other learning experiences to help our teams become as expert with epic as they can. Ill keep saying it, weve given access to our clients and patien patients access to their own Health Records. Im glad to say were off to a good start. Where did we implement . No real surprises. I draw your attention to the lasting point and that we have gone mobile. We have gone into is is a new place with being able to access the capabilities that epic provides for us. I mentioned that over 1,500 of our clients are now using the mychart application. If any of you are getting your health care in the bay area, you are likely using epic mychart. That is the same tools our clients are using. For the providers, they can chart on a mobile device using hayku. For Business Partners and many others, you can log into epic and share in the Care Experience that were providing. Were letting a lot of Business Partners in to have and to share in the experience that we have launched. We have, for a number of years, have been able to do the same thing the other way. So i mentioned how we know how were doing. I wanted to just take one moment to share a slide with you. The numbers in the slide arent terribly important at this time. This was a first cut at an epic leader dashboard. This one is for primary care, but i wanted to share with you that we dont have to do anything special to create a dashboard like this. Its something that we get more or less out of the box, and all we have to do is tune it to our needs. In the past weve had to make a significant investment to deploy a dashboard like this. The nice thing about epic is that there are about five or six dozens of these dashboards that are available for us to use. They are very straightforward, and we are able to customize them to an extent to reflect the kinds of Outcome Measures and Key Performance indicators that are relevant to us to represent our true north strategic goals. Nothing is perfect. Going live with an Electronic Health record that is now in use by more than well, nearly 9,000 people, there are going be issues. We have closed thousands of them since august 3. Where we are now is dealing with some of our more complex concerns. They deal a little bit more with software, but we really deal more with workflow, people, process, technology, that intersection. As an example, weve always been spending a lot of time at sgfg tackling the topic of patient movement. How do they move from the Emergency Department to the intensive care department. In the past we had people and process and the technology didnt tell us much. Today the technology can tell us a lot. Epic can share a lot of information about whats going on and how to effectively manage that transition from one venue to another. When we first saw it, and im in this camp too, i didnt really believe what i was looking at. For the last month or so, theres been a really intense effort to understand how we can get utilize the information that the Information System gives back to us to inform our process and a lot of strides have been made there. Theres a handful of other workflow examples where were diving in deep. Its not about epic, but epic is forcing us to have the conversations and focus on problem solving. The second issue that were having, and this was more or less expected, is our ability to deliver against many types of reports and outcomes measures that we have for regulatory purposes that are in support of valuebased care. When you move from one Information System to another, you are reporting all the way up to the last day that you had that tool. When you start in a new Information System such as we did on august 3, we didnt go into it with a fully populated database. We did it with a mostly new database. So we prepared how we would begin to use the new data as folks come in our doors after august 3. But we have to go through a validation process in order to ensure what were looking at and that all of the prework we did to produce all of these measures is going to be valid and stand up to our data integrity checklist. We are close. Hoping in the next 30 to 60 days to be completely back on course. It was expected that we would have a delay, and we had a bit of a delay. I want to be up front about that. The nice thing is epic is friendly about us taking the data out. That has been a real struggle with our electronic platforms, and thats not the case with what we have today. Weve talked about benefits realizations before. I mentioned decommissions systems. That work is beginning in earnest at the beginning of the calendar year and will take us to july, where we expect to spin down, which is something i. T. People dont like to do. We like to keep old systems on as heaters. But we plan to demission our legacy Health Record system by the end of the fiscal year. The great news about that is we dont need them anymore. The second piece of good news is we wont be paying for them anymore. Thats been part of the budget and Financial Plan for epic since the beginning. Id like to take a few moments, and i know were getting towards the end of our time today, to talk about the our in our records, patient record exchange, something i mentioned at the beginning. Since august 3 up through october 1, we have exchanged Health Information with 215 other Healthcare Organizations across the united states. Its possible there are some international ones in there. I didnt dive deep enough to doublecheck. If you look on the bottom left, you will see who our highestvolume Information Exchange partners are. I dont think there are any surprises there. Whats really powerful is in basically just shy of two months of being live with epic, 43,000 of our clients have had their records appended by Healthcare Information from other Healthcare Organizations. This is pretty powerful stuff. In addition to that, nearly 14,000 of our patients, their information has been requested and sent across this trust framework that i mentioned before with this Industry Consortium that epic is a member of to augment the records of our clients in other places. So really very powerful. We dont have to do anything special for this to happen, it just happens. So our epic journey, we spent a number of years in what i would call a getready phase. Were definitely past that. Were coming up to the tail end of our getgoing phase, where theres been a strong focus on having a really Good Governance program for epic, for having a great go live, which we did. Now were in this period of time which we call stabilization and well be there for the next few months. During this time of stabilization is where we process people, process, and technology, the couple of examples i shared with you before. Whats really exciting is as we march into the new calendar year, were getting ready to get better. Getting better means tuning our governance process even more so we can do two activities in parallel. One of them is beginning the optimization of the epic environment so it can do things its not doing today. We have a straightforward implementation and without violating our principles of sticking to that, we can still make it better. So were going to begin that process. In parallel, we will be locking in the scope and schedule for wave two and three of epic. When were done with that in a few years, well be in a Continuous Improvement environment, where we will bank on everything that we learned and all of the Good Governance thats in place so we can keep Getting Better. So epic is both hard and it has been very rewarding. I just want to share with you the message that were sharing with all of our staff because not every day is a great day with epic. Its okay to feel frustrated. This is the first message that were sharing with our staff because we have really changed a lot. More than a thousand changes were made in order to get ready and learn epic. Sometimes you look at the screen and youre like im not sure i remember how to do this, which is a reminder that were all in this together. When i go in front of epic, i look at the screen and im befuddl befuddl befuddled. The good information is we continue to help and train and build tip sheets which are in the epic users first pane when you log in. You go to a place called my learning home. Thats where you go when you log into epic. We are an organization of helpers. I think during go live this was really evident and a lot of people could see how well everyone reached out and was supporting everyone, and thats the environment that we need to continue to maintain as we move forward with more change in epic. So weve asked staff to be there for one another because some day youre going to need some support as well. With that, im happy to take your questions. I have not received Public Comment request for this item. My question is im an epic user and a frustrated epic user at times were all in this together. Yes. What is your i. T. Or your help line for an epic provider . What is the Response Time for someone to be on the line to be able to help one walk through whatever the issue is . I mean, is it five minutes . Is it ten minutes . I mean and what is do you have the adequate staff to be able to help those that are a bit befuddled, especially with epic going live . So we have a lot of support across the board. A program that we set up for the go live was to establish a super user program, where we could have people much closer to where the value is being generated and the work is being done who are actually super users. We have team of infomaticists who can dive in. With regard to actually calling on the phone, when you call on the phone to our service desk, youre calling the general i. T. Service desk, and the pickup times are less than two minutes now to get you in there and get your issue noted. Many of the items that are coming in are being redirected to analysts on my team who are resolving these items in just a day or two. Thats not all of the items, but weve reached that point where the number of items coming into our service during the day and the number of items were resolving, weve worked down a significant amount of the go live backlog. Okay. Thank you. Thank you. Thank you so much. I dont think we can overstate the significance of this accomplishment, having been through the same epic process, and the potential to improve patient compliance and care coordination. Ive had about six patients almost that ive shared with doctors of the county and at u. C. And being able to reach into these records and really do a much better job for the patient, its astonishing, how having these systems that used to be siloed and vulcanized be all one. It makes such a difference in a great outcome. I want to congratulate everyone involved and say as the few epic go lives that ive seen have been your team is spectacular and awesome. I think theres a show where theres a gold buzzer or something i think you deserve a gold buzzer. Thank you. Ill happily try and accept that comment, having only been here myself only 90 or 100 days. But its obvious what a full court press there was by every part of this organization to be ready for epic and it totally paid off. If i may add to that, i do think its important that we recognize the people who arent in the room and worked on this for many years and no longer with d. P. H. I want to acknowledge director garcias leadership. Alice chen who was committed to this and made a lot of this happen. And also wynona medolovich who was acting c. E. O. For many months. I think its important that as we move forward and go into the next stage that was spoken about, that we recognize the reason were at this point today is the incredibly hard work of literally hundreds, i think in some cases thousands of people to make this work. It was really that leadership, including the leaders i just mentioned, that helped us get to where we are today. Thank you [ indiscernible ] my question was from the patient perspective, when patients come in and theyre told they are able to access their records on their mobile device, for example, is there any kind of orientation offered to them or a guide they might receive, or are they more figuring it out on their own . I cant totally answer your question. Im not sure if anyone is out in the audience who may be able to assist. Doctor, i think you can address this better than i can. In terms of signing up for the Patient Portal, we have Information Support for the patients to get into the portal. Once they get onto the portal and they have access navigating through the site or submitting a quarterback with he have a contract with an outside vendor that specializing in providing the firsttier support. Obviously if they need to ask about lab results, that would be routed back to our desk. Is it an inapp chat function or a phone call . It is a phone call to the service, person to person. They would help the patient navigate real time because they know how to access the portal. Thank you. Thank you. Im just going to ask if presumably the app is better than the ucsf . [ laughter ]. That app is really a problem. [ overlapping speakers ] is there a language capability . Yeah, thats a great question. Right now it is limited in terms of other languages. So no to answer your question. That could be one of the whether they in wave two, three, four, or five, in this community it would be useful with the diverse languages we have. No doubt, as well as other epic communities where they serve large communities of multiple languages. That certainly is a push that all of these epic users is going to be pushing. Especially with my chart and the Patient Portal piece of the technology is being so readily available and enabling to the patient and client, we have to push that. Theres no ifs, ands, or buts about that. No, youre correct. Its a nationwide issue that really would make sense for epic. More towards our own problems and within the time frame and i forget on schedules could you remind us because youve done a great job getting this all together and having the basic epic work. Now in terms of the optimization so to speak, we know that laguna is a challenge. Do you have some time frame upon which you would be able to i guess enhance it and optimize lagunas use on a longterm basis, trying to close the chart out when they talk about in terms of years versus days, right. Secondly, our Mental Health programs and avatar and the timing in terms of trying to unify those records. Maybe ill go backwards. Well start with the Behavioural Health. So Behavioural Health is slated for wave three which is i dont want to commit to a firm schedule. Its after wave two which will likely go live in 2021. So its in late 2022 or 2023 before were fully in place with the replacement to the community Behavioural Health function i mean the Electronic Health record. To your first question about optimizations for laguna honda, part of the process is to be inclusive. We had a domain structure presented several months ago. The idea with that domain structure is its a place that has almost no i. T. People engaged, which is probably a great thing, and its all about the line of business being able to bring items together that can be prioritized that are based on how do we not just get better against our performance outcomes, how are we Getting Better for how folks are engaging in the system. That is the process that weve been using so far. Id be happy to take more information about the laguna honda concerns and make sure that we get that roped into our governance process, so that as we approach making epic better for all of us, that we can address those. Yeah, the thing i raise there is mostly because it is sort of different from most epic acute care, that there seems to be an issue of having it flow in as seamlessly as it does at the hospital. I dont know where all the priorities are. I do think laguna or its joint conference should understand what is happening there so we can understand the challenges staff had in terms of trying to optimize the use of an electronic record over there. Sure. Laguna honda is the largest longterm care facility in epics customer base. Sonch so i think a report back to there would be quite useful. Commissioners, other questions . Thank you very much. Congratulations again. Thank you. Commissioners, item 10 is other business and we have several Public Comment requests for this item. Just so you know making comments, i have a timer. When the buzz buzz ergos off thats time for you to end your sentence. Good evening, commissioners. My name is nathan dang, this is holly and kyle. We have pharmacy students from San Francisco joined by some of our classmates in the back. We are here to bring attention to a current pharmacy related issue, pertaining to reimbursement rates authorized by the 2013 California Senate bill 493. So the services affect patients all over california, but especially in San Francisco. So sb419 had expanded the practice for pharmacists that authorized them to perform Additional Services such as nicotine replacement therapy, as well as participating with other providers in the evaluation and management of various disease states. This bill, however, didnt address payment or reimbursement for these services. My name is kyle merchant. Really what were just advocating for is support in implementing additional codes so that pharmacists can be reimbursed appropriately for services, because not every patient is as straightforward as come in, lets have a discussion, and here is what youre looking for. Sometimes we have more complex situations and medical histories that need to be taken, discussions that need to be had with patients. I think this will be especially important as we move towards the implementation of prep being made available in pharmacies. So as you know, people [ indiscernible ] this is to expand the ability for pharmacists to furnish prep which is proflax sis for h. I. V. We can give a 60day supply in our practice. In the spirit of getting zero, i believe i also have well give you a 30second extension. Thank you so much. I think its paramount that we include reimbursement for the pharmacist counselling because the adherence to these medications is critical and the only way this will be happening is counselling in the scope of the community. Thank you. Hello, my name is manuel and im a pharmacist student as well. This is my first time at this hearing. Thank you for this opportunity. I just want to start by addressing that i know were trying to understand and address Mental Health issues, specifically those that may be untreated, its dr. Hammer and ms. Martinez mentioned in the presentation a while back. I want to bring to light the implicit biases in the government and also officials, the sfpd as well as local security guards, their attitudes they may have towards a subset of our population and those afflicted with Mental Health conditions. Im wondering what kind of steps the condition plans to take in order to mold the attitudes of our city to humanize attitudes to be more empathetic when interacting with the subset of homeless individuals, perhaps less likely to incarcerate them and more so aiding them and escorting them to hospitals, social support systems, as well as shelters. If we start with the city employees, we can expand on that towards the population of our residents. So they will no longer see someone on the streets and think they are crazy, because thats really not the case. But its just that theyre not intentionally being disruptive. Its just some underlying Mental Illness thats not been resolved. Thank you. Hello. My name is jane. Im also a pharmacy student from ucsf. Currently i also intern at the santa clara hospital down in south bay. I have a lot of counselling sessions with the patients there. A lot of them are homeless and they end up being discharged back to the streets. Beyond the counselling sessions, we also talk about go on tangents and about their personal lives. What i hear from patients theyre struggling to access public washroom facilities, theyre not clean or not accessible. A lot of them travel around the city as well. This is something i wanted to bring up because i wanted to bring attention to how feasible it is to increase access public washrooms in the city, that were helping the Homeless Population to improve their health hygiene, but also to increase the cleanliness. I wanted to bring it up and see if it is feasible in the city budget. Good evening, commissioners. My name is franceska okala and i am also a secondyear pharmacy student at ucsf but also expressing some of my concerns. There was a bill signed into law that allows h. I. V. Postexposure proflax sis and preexposure proflax sis to be in pharmacies. My comment today is this access to medication is extremely important to several of the vulnerable populations weve been discussing all throughout the session today, including homeless patients who might be using injectable drugs of abuse. My concern i wanted to bring up to the commission is how exactly the department of Public Health wants to implement these services in the coming year and how its going to be advertised to these vulnerable populations to make sure they get access to these resources. Good evening, commissioners. I am also a secondyear pharmacy student at ucsf and a pharmacy intern. I am also here representing just my own self and concerns and beliefs. As was just mentioned the bill was recently passed, but beyond promoting this new accessibility of two of the most vulnerable populations, i also wanted to ask the commissioners to explore potential ways to help promote training for our pharmacists as well. Under sb159 in order to make preexposure and postexposure proflax sis available, pharmacists are meant to attend training. I would ask that we provide this training in San Francisco department of health as well as make Resources Available to ensure that we have enough resources for that. Thank you. Seeing no other new business, do we have a motion to adjourn . I had one quick comment. Are you sure . Do we have a motion to adjourn . So moved. Do we have a second. Second. All in favour. Aye. Were adjourned. [ ] [ ] homelessness in San Francisco is considered the number 1 issue by most people who live here, and it doesnt just affect Neighbors Without a home, it affects all of us. Is real way to combat that is to work together. It will take city departments and nonprofit providers and volunteers and companies and Community Members all coming together. [ ] the product homeless connect Community Day of Service Began about 15 years ago, and we have had 73 of them. What we do is we host and expostyle event, and we were the very force organization to do this but it worked so well that 250 other cities across the globe host their own. Theres over 120 Service Providers at the event today, and they range anywhere from hygiene kits provided by the basics, 5 to prescription glasses and reading glasses, hearing tests, pet sitting, showers, medical services, flu shots, dental care, groceries, so many phenomenal Service Providers, and what makes it so unique is we ask that they provide that Service Today here it is an actual, tangible Service People can leave with it. I am with the hearing and Speech Center of northern california, and we provide a variety of Services Including audiology, counselling, outreach, education, today we actually just do screening to see if someone has hearing loss. To follow updates when they come into the Speech Center and we do a full diagnostic hearing test, and we start the process of taking an impression of their year, deciding on which hearing aid will work best for them. If they have a smart phone, we make sure we get a smart phone that can connect to it, so they can stream phone calls, or use it for any other services that they need. San francisco has phenomenal social services to support people at risk of becoming homeless, are already experience and homelessness, but it is confusing, and there is a lot of waste. Bringing everyone into the same space not only saves an average of 20 hours a week in navigating the system and waiting in line for different areas, it helps them talk, so if you need to sign up for medical, what you need identification, you dont have to go to sacramento or wait in line at a d. M. V. , you go across the hall to the d. M. V. To get your i. D. Today we will probably see around 30 people, and averaging about 20 of this people coming to cs for followup service. For a participant to qualify for services, all they need to do is come to the event. We have a lot of people who are at risk of homelessness but not yet experiencing it, that todays event can ensure they stay house. Many people coming to the event are here to receive one specific need such as signing up for medical or learning about d. M. V. Services, and then of course, most of the people who are tender people experiencing homelessness today. I am the representative for the volunteer central. We are the group that checks and all the volunteers that comment participate each day. On a typical day of service, we have anywhere between 40500 volunteers that we, back in, they get tshirts, nametags, maps, and all the information they need to have a successful event. Our participant escorts are a core part of our group, and they are the ones who help participants flow from the Different Service areas and help them find the Different Services that they needs. One of the ways we work closely with the department of homelessness and Supportive Housing is by working with Homeless Outreach teams. They come here, and these are the people that help you get into navigation centers, help you get into shortterm shelter, and talk about housing1st policies. We also work very closely with the department of Public Health to provide a lot of our services. We have all types of things that volunteers deal do on a day of service. We have folks that help give out lunches in the cafe, we have folks who help with the check in, getting people when they arrive, making sure that they find the services that they need to, we have folks who help in the check out process, to make sure they get their food bag, bag of groceries, together hygiene kit, and whatever they need to. Volunteers, i think of them as the secret sauce that just makes the whole process works smoothly. Participants are encouraged and welcomed to come with their pets. We do have a pet daycare, so if they want to have their pets stay in the daycare area while they navigate the event, they are welcome to do that, will we also understand some people are more comfortable having their pets with them. They can bring them into the event as well. We also typically offer veterinary services, and it can be a real detriment to coming into an event like this. We also have a bag check. You dont have to worry about your belongings getting lost, especially when that is all that you have with you. We get connected with people who knew they had hearing loss, but they didnt know they could get services to help them with their hearing loss picks and we are getting connected with each other to make sure they are getting supported. Our next event will be in march, we dont yet have a date set. We typically sap set it six weeks out. The way to volunteer is to follow our newsletter, follow us on social media, or just visit our website. We always announce it right away, and you can register very easily online. A lot of people see folks experience a homelessness in the city, and they dont know how they can help, and defence like this gives a whole bunch of people a lot of good opportunities to give back and be supported. He is a real leader that listens and knows how to bring people together. Brought this department together like never before. I am so excited to be swearing in the next chief of the San Francisco Fire Department, ladies and gentlemen, lets welcome, Jeanine Nicholson. applause . I grew up total tomboy, athlete. I loved a good crisis, a good challenge. I grew up across the street from the fire station. My dad used to take me there to vote. I never saw any female firefighters because there werent any in the 1970s. I didnt know i could be a fire fighter. When i moved to San Francisco in 1990, some things opened up. I saw women doing things they hadnt been doing when i was growing up. One thing was firefighting. A woman recruited me at the gaypride parade in 1991. It was a perfect fit. I liked using my brain, body, working as a team, figuring things out, troubleshooting and coming up with different ways to solve a problem. In terms of coming in after another female chief, i dont think anybody says that about men. You are coming in after another man, chief, what is that like. I understand why it is asked. It is unusual to have a woman in this position. I think San Francisco is a trailblazer in that way in terms of showing the world what can happen and what other people who may not look like what you think the fire chief should look like how they can be successful. Be asked me about being the first lbgq i have an understands because there are little queer kids that see me. I worked my way up. I came in january of 1994. I built relationships over the years, and i spent 24 years in the field, as we call it. Working out of firehouses. The Fire Department is a family. We live together, eat together, sleep in the same dorm together, go to crazy calls together, dangerous calls and we have to look out for one another. When i was burned in a fire years ago and i felt responsible, i felt awful. I didnt want to talk to any of my civilian friends. They couldnt understand what i was going through. The firefighters knew, they understood. They had been there. It is a different relationship. We have to rely on one another. In terms of me being the chief of the department, i am really trying to maintain an open relationship with all of our members in the field so myself and my deputy chiefs, one of the priorities i had was for each of us to go around to different fire stations to make sure we hit all within the first three or four months to start a conversation. That hasnt been there for a while. Part of the reason that i am getting along well with the field now is because i was there. I worked there. People know me and because i know what we need. I know what they need to be successful. I have known Jeanine Nicholson since we worked together at station 15. I have always held her in the highest regard. Since she is the chief she has infused the department with optimism. She is easy to approach and is concerned with the firefighters and paramedics. I appreciate that she is concerned with the issues relevant to the Fire Department today. There is a retired captain who started the Cancer Prevention foundation 10 years ago because he had cancer and he noticed fellow firefighters were getting cancer. He started looking into it. In 2012 i was diagnosed with breast canner, and some of my fellow firefighters noticed there are a lot of women in the San Francisco Fire Department, premenopausal in their 40s getting breast cancer. It was a higher rate than the general population. We were working with workers comp to make it flow more easily for our members so they didnt have to worry about the paper work when they go through chemo. The turnout gear was covered with suit. It was a badge to have that all over your coat and face and helmet. The dirtier you were the harder you worked. That is a cancer causeser. It casser. It is not cancer causer. There islassic everywhere. We had to reduce our exposure. We washed our gear more often, we didnt take gear where we were eating or sleeping. We started decontaminating ourselves at the fire scene after the fire was out. Going back to the fire station and then taking a shower. I have taught, worked on the decontamination policy to be sure that gets through. It is not if or when. It is who is the next person. It is like a cancer sniper out there. Who is going to get it next. One of the things i love about the Fire Department. It is always a team effort. You are my family. I love the city and department and i love being of service. I vow to work hard to work hard to carry out the vision of the San Francisco Fire Department and to move us forward in a positive way. If i were to give a little advice to women and queer kids, find people to support you. Keep putting one foot in front of the other and keep trying. You never know what door is going to open next. You really dont. [cheers and sustainability mission, even though the bikes are very Minimal Energy use. It Still Matters where the energy comes from and also part of the mission in sustainability is how we run everything, run our business. So having the lights come on with clean energy is important to us as well. We heard about cleanpowersf and learned they had commercial rates and signed up for that. It was super easy to sign up. Our bookkeeper signed up online, it was like 15 minutes. Nothing has changed, except now we have cleaner energy. Its an easy way to align your environmental proclivities and goals around Climate Change and its so easy that its hard to not want to do it, and it doesnt really add anything to the bill. Brown. Bren chair ronen good morning, everyone