Me shelley. I have have the privilege of welcoming will working with commissioner lloyd over a number of years. I have worked at meta fund which is a health and aging foundation located here in San Francisco. My background is actually in the Health Department work. I came from the Philadelphia Department of Public Health before moving to San Francisco. I have really had the opportunity to work deeply and closely with communitybased organizations, but i am happy to be working in the mirrors office as of yesterday. I am catching up. It is very nice to meet you all and i look forward to working with you. Welcome, shelley. Thank you. Next item. Item two is the approval of the minutes. Each will require a vote. The minutes of october third, 2019, which was the joint hearing of the Planning Commission and october 15th, 2019. Commissioners, do we take them separately or together. That is your call. But review them. Any comments you wish to make with regards to them . Any editorials you wish to make, please let me know. I move the approval of october third, but with the correction that the titles under the commissioners present should be corrected. Okay. Is there a second to the october 3rd minutes . I will second. Okay. Any cop other comments about october 3rd . All those in favor of adopting those . Aye. And the next set of minutes . Commissioners, they are before you. I move october 15th for approval. Yes. Second. Any comments or questions . Hearing none, all those in favor signified by saying aye. Aye. Although supposed . All those opposed . None. Item three as directors report. Good afternoon. Just to summarize on one of the key things the department has been very busy with is responding to the kincade fire, which tragically burned over 76,000 acres in nearby sonoma county, destroying more than 282 structures including 141 homes. I will say that thankfully, as the latest data we have is no lives were lost due to the fire. We were responsive with regards to responding to sonoma county, including helping staff medically staff a shelter at stg Behavioral Health support to people suffering from the consequences of the fire. We were also on an Emergency Alert system with regards to the smoke and the fact that the air quality in San Francisco, we reached below optimal levels. We put up Public Health messages to help the public without. I think also very importantly the resiliency and commitment of our staff was really evident in that despite the fact that we had massive Power Outages across the region, people were resilient and committed to coming to work at d. B. H. And we were able, for the most part, to fully staff our systems, including our 24hour systems at the hospital. A tragedy, but also a committed response in helping us continue to improve our response both locally, regionally, and very importantly, across departments. This is really, along with the department of Emergency Services and other departments, this is a group effort. I want to thank the leadership that the Health Department and the people on the front lines doing the work, anywhere from working in medical respite in the serving centres during cases of poor air quality, to actually working in the shelters, the emergency shelter, to going up to sonoma to aid with that. I just want to give you the update with the team effort. Im pleased to reiterate the department has established an office of Health Equity. Mayor breed assigned legislation on october 1st to create the San Francisco office of Racial Equity and this is really historical commitment by our city to address the deep inequities here. We share mayor breeds vision in Racial Justice and insure robust purses precipitation works. We have established the department of Health Equity to align and coordinate with the Human Rights Commission which will be which is where the office of Racial Equity will sit we will be aligned with their work going forward. The new d. P. H. Office will have increased support for training and engagement and monitoring of equity efforts, and the office will sit directly under dr. Bennett who leads who currently who formerly led the inter divisional initiatives and currently leads the black africanamerican Health Initiative. This is going to be an extension of that work. I want to integrate that equity work is the responsibility of each and every d. P. H. Employee, and the purpose of this office is to provide catalytic support to provide the tools, the roadmap, to ensure that we are putting the structures in place across the whole department to move Health Equity forward. I was also really pleased a couple of weeks ago to attend with the mayor the maxine hall Health Centre groundbreaking. This is one of our wonderful Primary Care Clinics and i actually worked there almost 20 years ago as an intern in the Primary Care Clinic and i will say that the mission and the commitment to the staff remains the same. Unfortunately the building also remains the same with regard to needing a serious upgrade. We know the environment i am excited that the hall for the refresh for the centre. We will continue to afford that. The Health Centre is relocating during the reconstruction and we are ensuring that the communities informed there has been a lot of communication about that. I also want to announce some changes in the department with regards to Human Resources changes. Our former director of Human Resources accepted his resignation and effective november 1st. I really want to thank him for his service, along with the rest of the executive team, thanking him for his commitment to the Health Department where he served as h. R. Director since 2013. We are committed to continuing to improve our h. R. Functions and i am pleased also to announce that Michael Brown started this monday as our new d. P. H. Director of Human Resources. Michael has a storied history in his work both here previously at the department and as recently as the director of the Civil Service commission. He has more than 20 years of Human Resources experience. I think he is very committed. I talked to him about prioritizing and improving our hiring process and also focusing on equity issues both from the perspective of improving bringing staff, recruiting staff who will help us with Health Equity goals, but also looking at internal equity issues with regards to the department and staffing power. I am really thankful for rons service and i would like to welcome Michael Brown. That summarizes my report. There was quite a bit of press and communications in the last few weeks, so you have an extensive list that has the links to those, and i am here for any further questions or qualifications of the commissioners that the commissioners may have. Thank you. Thank you. Commissioners . Commissioner child . I am just going to ask, but i thank you answered it, there were sufficient staff that was able to come into the department so that, in general, the departments work was able to continue during these fires. Is that right . That is correct. We were open for business and with possibly very few exceptions, we were able to provide the right services at the right time for people. Very good. Thank you. Shall we move on, commissioners . Yes. Called the next item, please. There is no Public Comment request for that item. Item four, general Public Comment. We have quite a few. I am the Health Commission secretary, everyone. Each of you will have two minutes to speak and i have an egg timer. When it goes off, know that is your time to finish her sentence and step aside so the next person can come forward. I think you names will be called i will call four names right now and those of you who have you names called, come to the front row. [calling names] if i have mispronounced your name, please understand it is not on purpose. One final comment from me, for those of you are new to the Health Commission in terms of culture, Public Comment is a oneway communication. You all make comment in the commissioners receive that. They will not be discussion and back and forth, just expectations are all aligned. Hi, you guys have seen me before. I am here for two things. One thing i just wanted to followup on and i didnt add to what you were saying, dr. Colfax , but we sent you an email. I have a copy of it. We just would like to follow up on that email and have a discussion with you regarding bilingual services to our patients regarding the Racial Equity. I think those kind of go handinhand. So we could talk for a couple of minutes that would be great. The other thing i wanted to talk about was, i think there is a confusion. Back on october 22nd, the e. R. Came into the j. C. C. And we kind of expressed a whole bunch of things to you about our concerns about safety and violence in the e. R. But we think it goes in aligned with a lot of issues in the department across the city and it all boils down to staffing. I thought i might just clarify, kind of like what is happening with our is how many beds really are being left open because of staffing in the e. R. So i have taken the liberty of getting these assignments that we have, just a couple from over the last few months. I picked them randomly, i didnt pick the worst one, and it basically shows that we have an average of 13 to 22 open beds in the e. R. At any given time, which is ultimately due to staffing. That is scary. That is the underlying cause to some of the violence going on in our department and the services that we are not able to give to our patients. So i will hand this to you guys if you want to review it. It also has what was originally staffed versus what ended up being that day on this. So you can review it. I have tonnes of other ones that we have been collecting, but it may clarify kind of what is going on. And on average, the psych Emergency Services is also continuously at max capacity every shift. That trickles into our e. R. I will hand this over. Thank you. I am julie. I also work in the emergency room. I am a nurse there. When she talks about the 13 to 22 open beds, that is out of the 58 we are supposed to have open. Also, many of those beds have people sitting in them for 15, 20 hours waiting for their unfunded bed upstairs. That is becoming very common every day we go in. Theres 15, 20, often 30 people there for more than 15 hours, many for more than 20. I had a patient who was there for 26 hours on sunday waiting for a bed that was unfunded for him because he also had behavioral issues. Our staffing and our safety are at risk. We also started a survey about our Mental Health of the staff. And 92 of the staff say that they are having anxiety symptoms that are new in the past two years related to work. There is 80 2 to her who are having ptsd symptoms, and almost 50 degree that because of the hospital Work Environment or violence, that they quit, retired early, or about to take a leave of absence because our safety is at risk. We have had multiple assaults, and people are not being trained as is required annually. Theres people who are new who dont know how to deal with the ask lighting violent and psychotic people. This residency dont have the same training. We are begging for some help with our safety and our staffing because all of the stuff that happens in the community is reflected in the emergency room. As the Mental Health issue escalates, the city is in crisis and you know that more than i do but what i see in the emergency room is people going to the street to the es, to jail, es, and it is not stopping. Thank you. Hello, my name is brian. This is monica and jenna. We are pharmacy students at ucsf we are here to support ordinance 1909804 introduced by supervisor haney that would call on the department of health, Public Health to formally address the opioid addiction crisis in the city of the Public Health emergency. The ordinance at the department asked the department to create a plan that improve streetlevel Crisis Response to assist people who are using drugs in psychosis or are experiencing overdose. The plan would provide regular reporting of overdoses and overdose deaths. Provide support for frontline Emergency Responders and Public Safety personnel and it would help identify successful existing models of detox and dropin centres and a look to how to best expand those services. As pharmacy students weve committed ourselves to improving the health of our patients and we recognize need to not just take actions within the clinic. That is why were here to express our support today. We ask you support this ordinance. Thank you. Good afternoon. My name is elizabeth. This is my colleague, conrad. We are constituents at the city of San Francisco and ucsf student pharmacists. We are here in support of 22 to advise the commission to accept and allocate funding for increasing h. I. V. Services in this city. If it does past, it is now on the senate floor. We believe this measure coincides with getting 20 initiative that it is currently in progress in our city and we also believe that this funding will aid in providing underserved local communities with access to these necessary preventive and treatment care that the population needs. We just ask for your support. Thank you. Thank you. [calling names] good afternoon members of the commission. My name is ron and i am a 62 yearold disabled veteran who was a dedicated worker for your department until last friday. I am unemployed with no medical insurance for myself or my chronically ill spouse. With only enough savings to pay the mortgage for a few months. As an older worker, my chances of finding employment are much lower than younger workers. The manner in which the department and the city handled my separation has drastically reduced my chances of successfully finding employment. On october 17th, examiner ran an article within minutes of my attending a meeting with dr. Colfax. That article included a quote by dr. Colfax stating that dr. Colfax had asked for my resignation. It was obvious that the department had worked with the reporter in advance of the meeting by providing the examiner with that quote, it set the article up to inaccurately make it appear that i was terminated for an unspecified, derogatory reason. That statement will hinder my ability to be reemployed. And if employed, it is likely to reduce my ability to earn the same money or more than a made here. I worked for you for six and a half years. During that time, i successfully provided Human Resources support to implement the Affordable Care act and to do the hiring needed to create our Health Network in 2014. I ensured we were adequately staffed for our move into the new hospital in 2016, and most recently, i negotiated language with our unions to make sure the epic Electronic Medical record system could be implemented smoothly. These and many more accomplishments should have ensured me a respectful and informed separation. Instead, the department and the city opted to work with the examiner to trash my reputation, now and into the future. In their statements to the press , the department placed me in a false light before the public, acting with malice and reckless disregard for my reputation. I find this behavior inexcusable thank you for your time. Thank you. Hello, thank you for having us here today. My name is carissa and this is my colleague vivian. We are ucsf pharmacy students in here to express our support for the opening of a safe injection sight in the city. As you all know, drug use is happening on our streets and it has negative impacts on the city when you see someone shooting up in the street, it causes trauma for citizens. Deadly diseases are transmitted from the waste from drug use and this issue signs a blinding beacon on the criminalization of homelessness and on the injustices faced for our most forgotten parts of society. Safe injection sites address the issues i outlined because a Safe Injection Sites provide homeless drug users a place to use their drugs out of the public view. They also supply sterile supplies and disposable receptacles to prevent transmission of deadly diseases like h. I. V. And hepatitis b. Lastly, Safe Injection Sites sends a message to the homeless drug users that this city accepts them and wants to work with them to solve both of the citys and their problem. Thank you. Thank you. Next speaker, please. My name is andy wong. We are students here in San Francisco and we also want to show our support for senator weiners bill about this Safe Injection Sites which they just spoke upon. I just wanted to review with everything that carissa said and to expand on that. I want to say that if we have a safe injection site, with Healthcare Professionals their monitoring and providing education to those who might need it, that could really help decrease the opioid stigma and everything else. I dont want to waste too much of your time those already said, but hopefully when the bill is passed, we hope the commission will quickly and efficiently implement as many sites as possible to help those in need. Thank you. Thank you. [calling names] if any other speakers choose to speak please come up. Hello, my name is allison and this is my colleague natalie. We are also student pharmacists at ucsf and constituents of the city. I would really just like to echo my other colleagues comments about the bill, the implementation of safe injection sights. I definitely dont want to repeat everything they said because i agree with their strong points. I would like to emphasize the strong evidence that has been shown in other countries such as in canada and europe and australia where the Safe Injection Sites have already been implemented. They have significantly reduce bloodborne diseases as well as did not affect the overdose incidences and did not increase it nor decrease it. And lastly, i would like to emphasize the potential for decreasing healthcare costs, especially when reducing h. I. V. And hepatitis b, and definitely reducing healthcare costs in the future if we encourage safer injections and have Healthcare Professionals onsite to help patients. Thank you so much. Thank you. Next speaker, please. Hello, my name is hannah. I am also a student at ucsf school of pharmacy. With me today i have my classmates or classmates christine and daniel. We also have another class late classmate who is running late she is also part of our group. We wanted to talk about a recent report that came out in the chronicle about 14 increased Prescription Drug prices in San Francisco compared to other major metropolitan cities in the country. We understand the cost of living here in San Francisco is high, but we dont believe that costofliving should also translate into higher Prescription Drug prices for patients and citizens here. We would like to encourage more transparency about why exactly those prices are higher here in San Francisco compared to cities in the same state, sacramento, l. A. So we know exactly where that money is going to and what we can do to help bring those prices closer to the national average. Thank you. Thank you. Next speaker, please. My name is christine and these are my colleagues. We are also from ucsf school of pharmacy. We would similarly like to talk about safe injection sights. Currently there are over 100 supervised injection sites operated around the world and we believe it would be in our city s best interest when it comes to health to open one up in San Francisco. In 2014, review of 75 studies concluded such spaces promote Safe Injection Sites and reduce overdoses. And a in a site opened in canada , in 2003, they have supervised more than 3. 6 million injections and responded to more than 6,000 overdoses. No one has ever died there. As students we urge you to support the opening of safe injection sights in the city, providing the service can help eliminate overdose deaths, curb the spread of Infectious Disease , and administer basic healthcare and provide access to Addiction Treatment services when people are ready to get clean. Thank you. Thank you. Is there any further Public Comment . I want to thank ucsf students from the pharmacy division. Welcome. Okay, commissioners, item five is report back to the finance and planning committee. I had the privilege of chairing and the Committee Heard the contract report which were composed of three contracts all related to h. I. V. , the foundation, the aids foundation, and in various services which will be amended in contract with an additional service. Those were all outlined in the package you have all gotten. The committee reviewed it and felt these were worthy for recommendation for the amendments as proposed. There was a new contract with the San Francisco health plan, which is known as the community lets see. It is actually called the San FranciscoCommunity Health facility, which operates the health plan. They do much of the thirdparty administration for us. There was, in the packet, a diagram of the fact that there are four contracts. This is the fourth contract that is being offered before us and will actually handle the city option of several weeks ago, at the last finance committee meeting. It was several meetings ago, it was discussed there was going to be a reformatting of the contract so that they would then fall into line. The four contracts we actually have with the San Francisco health plan includes contracts for provider payments, for thirdparty administration of healthy kids, for the healthy San Francisco program, and this last one, which is a component of the city options and the covered mra. We reviewed the cost of these and are also recommending the contract, which is the fourth one for the San Francisco health plan. Lastly, they heard the proposal for a forthcoming presentation to the Commission Next month on the Healthcare Services master plan. They made some suggestions prior to the commission hearing. This is a master plan that actually is being utilized by the Planning Department to look for whether or not the Health Services being proposed actually would fit into the health needs of the city. It started in 2013. We will be hearing the fiveYear Experience, six Year Experience at this point, and any recommendations that they may have. That will be forthcoming in a month to the Health Commission for your input. At that time they will then be presenting to you the guidelines they are using now part of the midas for this was actually related to the Planning Commission wishing to have an understanding of the Health Situation in San Francisco as they were looking at a landuse. And in fact, for those land uses that might be of benefit under what the city would need to, then there could be incentives to help expedite such landuse developments. Very similar to what we are today talking about in terms of helping the homeless. This continues to be for Health Facilities of a certain size. You will hear all of that at the next monthly meeting. It is a very important report and i would encourage that you all take note of it and make our comments and recommendations in order to continue to improve the process. That is the end of my reports. Ill be happy to answer any questions. Commissioners . Next item. There is no Public Comment request for item five. Item six is the consent calendar it includes the contracts report and one new contract request which commissioner chow just explained to you. The committee is moving approval of these contracts report and the new contract. Second. All those in favor signified by saying aye. Aye. Thank you. Again, there is no Public Comment on that item. Item seven is a San FranciscoHealth Network update and Behavioral Health services update. Commissioners and the public, there is a new system we are using. Please bear with us as we in case we have to toggle back and forth or have more time between presentations. Good afternoon, commissioners it is my pleasure to present this fall 2019 update to you on the status of the San FranciscoHealth Network. Before i start, i would like to acknowledge my colleague toby from the Business Intelligence unit to pull together all the slides and worked with all the people for the data that you will see resented. She is in the back. Thank you very much. So in the presentation today, i will start by providing you with updates on our Network Leadership team, followed by an update on our Network Strategic initiatives in the form of our next matrix and true north. Then as is customary when presenting updates to the Health Commission and the network, we will focus on one key s. F. Division or program. Today that focus will be on our ambulatory care division, and particularly Behavioral Health services. That presentation will be given by dr. Fung who is our acting director of Behavioral Health and is the permanent Behavioral Health chief medical officer. As we do with all of our presentations, we start with the d. P. H. Organizational chart to provide a visual reference of the areas we will be discussing. So today we will be focusing on the lower lefthand section, which depicts the San FranciscoHealth Network. This slide provides a little more detail of Network Organization and operations. And particularly, looking towards the right side, it includes important centralized Network Programs and services that are not depicted on the d. P. H. Chart. You will see there, for example, our whole person care program, health and Language Access services, supply chain operations, rehabilitation programs, and our home Health Services. In terms of the leadership update, since my last update to you in april of this year, as many of you know, our chief medical officer and deputy director, dr. Alice chan, left us in september for a position as the deputy secretary of health in the state department of health and state agency of Health Health and Human Services so we are continuing to miss her presence greatly. In addition, another change, a long serving director of transitions stepped down from that position. However, she continues to be a valuable member of the d. P. H. Leadership team working directly with director colfax on special projects particularly those related to Behavioral Health, homelessness, and subacute levels of care. So d. P. H. And the network developed and implemented our Strategic Initiative using lean. As we have discussed here before , it is both a Management System for running an organization or business and it is also a methodology for process improvements. Lean is based upon the toyota Production System that emphasizes the value from the perspective of the customer. In our case, the customers come in the form of clients, patients , residence, and even jailed inmates. Lien also values the expertise and experience and knowledge of people doing the job doing the work on the front lines. As we have discussed before, healthcare was late and a slow adopter of lean starting in the late 1990s. We have been rapidly deploying it since 2005 and here within the department of Public Health and the network, we have been on our journey since 2012 when it started at San Francisco general hospital, and then spread to primary care, Population Health division, environMental Health, and laguna honda, and now mch. It is rapidly now being introduced to Behavioral Health services. So well there are several tools and documents in the lean library, the two primary drivers of an organizations implementation of lean our true north and the exmatrix which you see depicted here. True north can best be described as a precise, concise, and universal set of ideals which, when taken together, provide a compass it that describes the ideal or state perfection that a business should be continually striving towards. True north should involve both our head and our heart and considering both, the strategic hard goals and defined business targets, as well as tightly held beliefs as to our organizational purpose and values. True north pillars, would you see depicted here, safety and security, health impacts, service experience, workforce, financial stewardship and equity are meant to be consistent over time and over a multiyear period and should not change very often contrasting that to the matrix. The exmatrix is essentially our onepage, allencompassing Strategic Plan which incorporates our true north pillars and relates those pillars to our very few focused Strategic Initiatives. The system was developed and revised during an annual Strategic Planning process from a japanese term meaning direction and administration or management. So this is a copy of our matrix for the network. I just want to read refamiliarize you with how it is structured. Starting first with the west quadrant, we have our true north pillars, those that we just talked about, then as we travel up to the north quadrant, we show those three, very few razor focused toplevel organizational priorities. So the network our readiness, which is our implementation, developing our people through lean, where we are actually deploying the daily Management System across the network, and then finally, valuebased care, moving from paper surveys to more value outcomes based reimbursement. And then moving to the east quadrant on the right, this is where we show some of the key metrics that we need to improve in order to achieve those three organizational priorities. And then finally, we moved to the south quadrant or the south box and this shows what our performance targets are and what the annual outcomes have been for those targets. For example, in the south box here you will see that we set a target of meeting 70 of our true north metrics across the various pillars, and you will see in year 1718, we were at 27 moving towards a target of 70 , and last year we ended at 36 , moving towards that 70 . So i want to remind you of our true north evolution in the network. In fiscal year 1516, we had our first Strategic Planning process utilizing the lean methodology. During that process, we identified 49 metrics for which, in the next fiscal year, we would begin to select outcome data and report on that data across those six true north dimensions, quality, safety, Care Experience, workforce, financial stewardship, and equity. Again, you can see here what the experience has been the last fiscal years. First in 1617, we had 27 metrics on target, then in 1718 , 27 and this past year, 36 . Youll also notice we have decreased the number of metrics we were reporting on. That came as a result of a learning process, recognizing that while they were metrics that we wanted to report on, we didnt always have the data systems set up to actually generate the data to report on those metrics. And thus the reduction in metrics reflects that. Now and looking at this slide, you also might be wondering why, in fiscal 1819 we grouped the six true north pillars into the groupings that you see there. And then in fiscal year 1920, which is our current fiscal year , you see we have only highlighted one metric, and that is workforce. There is a reason. In our Network Leadership meeting this summer, as we were discussing plans for implementing this years true north metrics that were originally generated in generated last year, we said we really wanted to begin to focus more as one integrated Delivery System so we wanted to have some standardization across the division so what they are measuring at zuckerberg they should also try and measure at laguna so we can actually have some synergy and learning across the organization. And we also want to have standardization. The more standardized the metric and the process, the more we can compare and hopefully have shared learnings of best practices. And so the desire was, to the extent possible, any metrics that we chose, we want to have them be the same across the divisions. Having said that, we also know that we provide a plethora of Healthcare Delivery services, and not everything is provided within every division. For example, in maternal and child health, they dont provide inpatient services, they dont provide Skilled Nursing services we also need to be flexible enough to allow each division to have some individualization in terms of their metrics. So after this summer, when looking at the true north metrics, we decided to have standardization for those three that you see. We wanted to focus on equity, particularly because a lot of the work we have done with the africanamerican Health Initiative over the last few years we knew a lot of the divisions were working there, and then in terms of quality and Care Experience, thats where we wanted to give divisions the opportunity to develop metrics that were specific to their particular lines of business. But again, the desire was that all of the regions would try to have the same metrics and same data sources. So that was this summer. So that was the best thinking at that time, however, the little thing called epic implementation rolled out on august 3rd of this year. And what we found is all of a sudden in accessed a wealth of new metrics that we didnt have access to before. On the positive side, we found that data definitions and epic was standardized. It was a great thing to deploy throughout this country and around the world. However, on the negative side, we found those epic data definitions did not line up exactly with the data definitions from our previous preepic metric work, and im looking at commissioner greene because you warned us about this about a year and a half ago, and sure enough, it came true. So given the differences in definitions and the increase of metrics that are available to us , we decided to take a slight pause in order to validate this new data within epic so that we could decide upon new metrics that would be supported by our new epic data system. So doing this current fiscal year, 1920, we are calling this an and epic data stabilization period. During that process, as our various divisions are working to validate the reliability of the data that is out there, we decided that we wanted to have a focused and synergy been washed just one particular True North Network network. The one that rose to the top was the one around workforce. That became obvious because the d. P. H. Workforce experience survey is the one thing that was standard across the entire department and the network. Every employee, every division received the same workforce experience survey, and so thats why we decided we get the biggest bang for our buck. We are doing all this work to vet to validate a lot of our clinical metrics, we could really focus on workforce metrics. So during this current fiscal year, as were transitioning we are transitioning from those 60 plus disparate data systems, now to our one epic system, each of the divisions will continue to work on most, if not all of their previous true north pillars, but we are giving them a little bit more leeway in terms of the reporting of that data because we are just not completely convinced that we can rely on the data until we have gone to the validation process. All of our analysts, critical administration analysts are working throughout the network to try and validate those Data Elements that are there now and see if we can either keep some of those old metrics or develop new ones. The good thing about ethics is epic is they have Key Performance indicators that are standardized across the epic family of providers and the goal will be to the extent possible to use a. P. I. Because they are already there and available. I would also just like to take a little minute to talk about our equity true north pillar. I mentioned that weve done a lot of work with black africanamerican health the last few years through our initiative and because of that, we decided that each division which. And equity metric focused on improving health within the black africanamerican compilation. But as you might suspect, all of this depends upon data. So even though we have been selecting rich data, we now have a new data system. We will have to validate that data. So all of the work will continue , but this nexus fiscal year we will be focusing on validating the data so that when july 1st of 2020 comes around, we can now have a new set of metrics that have been validated and we can move forward. Again, this is our year of epic standardization. So the next three slides show our 33 current true north metrics. And in this slide, you get to see them all in one page and the two pillars on the top and going across the columns and down from top to bottom with the rows to depict the various divisions. You will see what their metrics are for those particular true north pillars. And then finally, on the next two slides kike, these are our two true north scorecard that ended this past fiscal year in and june 30th of 2019. So these two slides show pillar by pillar and aggregate for every division the results of our true north. So i just want to highlight a few things. Basically youll see between these two slides that we are performing best in the area of equity, that is where we have most of our green, with the next best performance in quality. Then it is followed up by having a little bit more red then green in the areas of Care Experience by natural stewardship and workforce. I think it is important to states that we embrace read, we dont run away from it because we see it as opportunity and a roadmap as to where we should focus our improvement work. It is also important to note that while some of these metrics are indicating we did not meet the target, many of them are just barely red. That lets us know with just a little bit more efforts that we can tip them over and turned them to green. And finally, the last few slides , i call these the dr. Child slides because he is often asking us to make sure we are able to show trends over time and basically these are trendlines for all 33 of the metrics that we just discussed. That concludes my parts of the presentation and im happy to answer questions on this before i turn it over to dr. Song for Behavioral Health. Commissioners, you can choose to have a discussion now or go into the other presentation and have a discussion with both together. What is the commissions desire . I think the other being a different topic, we might want to concentrate on that. I think we might take and ask perhaps some questions on the overall Health Network report card. Okay. We will start with you, commissioner ciao. Thank you. And my question is that you have shown us the true north his year 1819, and you are telling us that for 1920, will working to while continuing to work on these, the key thing is to validate the data you are going to be getting out of epic actually will be able to measure and the use can be comparable as the next line of columns. Exactly. Can they be comparable the way the metrics are written now or do they need to change slightly or significantly. So that work continues. Would it be your intent that you will be able to show us, at least some progress whether it is totally reliable . Because i dont think you will abandon the work that has been done here or the trends that you are showing. Absolutely. But we continue to work on these metrics and many others that are required by regulatory or quality measures from some of our other programs. Absolutely. To the extent possible, we will continue to work on his many of these metrics as possible and report on them with the data that we have. Was not clear is how valid and reliable that data is as we try to crosswalk particularly the data forces from the system to make sure we are doing apples to apples comparisons. Again, also taking advantage of these new epic kpi that are available to us that werent there before because they perhaps obviously they are easier to report on because those are standards that come from epic. So the other part of the work then is that is its it is possible we need to convert some of these measures to similar measures that kpi, as you say, has so there is a transition there. That is part of what we would expect to see in a year, is where that is going, and at the same time, what would be the work time you are thinking of for the workforce, which is what you would then be concentrating on . We have already started that process not only across the network, but across the department. We are currently working with our divisions to begin to communicate back out to the workforce the results of the survey and then each division will be held accountable to developing common measures to really address gaps or areas where they did not score highly on the workforce survey, and then putting together an actual plan in terms of what they will do to address those scores. Okay. So using the basis of the survey , then you will have measures off that and we would be able to see those. And you mentioned, though, that you will still and of course, this is a Big Department issue in terms of equity, so on the equity, though, you are not emphasizing that as your goal under true north. No. Equity is still one of the true north pillars. And right now the focus is still on black africanamerican black africanamerican health. We will continue to track that data. Okay. So you will continue with that one and youre really new initiative here is taking the workforce survey. Yes. Again, standardizing that one across all the divisions because it lends itself for standardization because everyone gets the same survey. And would you say that you are maturing the ability to try to measure across all of our systems . Absolutely. Yes. Right. That is what this slide tries to depict. This current year, this past year, 1819, where we said moving into 19, 20, we want to begin to have the standardization and synergies so it is not so primary care is not doing something totally different than what Behavioral Health is doing, to the extent possible we can have alignment. Okay. I must say, i appreciate that we have moved this far. Were not only did we get reports from each of our divisions regarding their goals, but now we are looking at the entire Health Network and being able to look at their report card. I really appreciate that. Im sure the commission does, too. Thank you. Commissioner green . Yes, i appreciate the clarity of this document. I wonder if youve gotten further into epic to know which of these metrics you think will have the best transition and which you think will be preventing the great presenting the greatest challenge comparing the apples to oranges. I think it would be really helpful also as you present this data for us to understand which areas you really think will be a struggle by way of comparison and which ones you think really will be straightforward. It would be helpful to have some kind of explanation as you get deeper into it. I guess the only other thing i would add is i think you have to decrease Workplace Stress for jailhouse jailhouse services. I thank you will need to do it across the whole network. Maybe put that in every division we have. What do you think about the achievability of some of these transitions . I would want to defer to our data analysts who are doing that work now to really give an informed response, and i will turn around looking to my division leads. I will see if they have a better answer right now, because San Francisco general is doing a lot of work in there. She probably has some details to share. Good afternoon, commissioners so the issue of data is a really important one to us, obviously. Theres quite a lot of data issues to work through and i am not the best person to talk to about this, but i do know that the ones that our data team is focusing on first are the ones, the data that brings us money. For example, prime and qip, being able to report this adequately to the state is a high priority. The other ones are the ones that are regulatory lee required by medicare, so the readmissions program, the different federally required metrics. I know that that is where the data team are focusing on first. That is a huge amount of work in and of itself and not all of it corresponds to the data that we have here, so i would want to defer to the informatics folks and the data folks to tell you exactly the timeline, but i know generally that is there order of priority. When do you thank you might be able to get some insight and what is your sense of timeline . We are shooting for january 2 really have a better sense. They are doing the work now, so we need to have an opportunity for them to collate the data then bring it back to the leadership for us to be able to have some informed discussions and make some decisions. That is great. Thank you. Commissioner guillermo . Thank you for this report. I had a similar question to commissioner green with regards to the ability of in your validation process, which ones would be easier to transition across from. I guess it is a similar question about the process