Pres of actually elevating quality to the Network Level so rather than looking at it at each individual section, you will see it up a Larger NetworkDepartment Level. We will be coming to you, the commission, at the Department Level to really present what we are doing in terms of clinical quality, what are the measures, the metrics, and so you will see them. It will not only be those who sit on those panels, but the entire commission will be able to see the full picture of clinical quality. Those will be coming from the network side and we will also incorporate those components of quality that exist. When will those be appealed . In january we hopefully hopefully we will be coming to you within the next six months with a quality report from a Network Department level perspective. Thank you very much for your report. Thank you very much. Have a good evening. Commissioners, the next item is a resolution approving the San Francisco department of Public Health 2020 state and federal legislative plans i have both the resolution on the presentation just for you to know to stay on. Thank you. Good afternoon, commissioners i am the director of the office of policy and planning. Today we will be providing you with an overview of the departments 2020 state and federal legislative platform, as well as a summary of some of the actions that we are taking in 2019 that were taking taken in 2019. Im here with max was a Health Planner in the office who i will be sharing this presentation with. As was mentioned, you have a copy of the resolution before you that approves our platform your consideration today. As i mentioned, well be providing you with some backgrounds on the purpose and the development of the plan, a summary of the actions that happened in 2019, as well as a highlevel overview of the state and federal plans. We prepared two plans. One federal and one state. These platforms are aligned with d. P. H. s priorities and missions and serve as guides for monitoring bills of Budget Proposals and identifying any issues that might come up during the course of the year that may need some city action. The plans are informed using input from Department Leadership , subject Matter Experts throughout the organization, as well as many professional associations that several d. P. H. Staff are members of. The plans are intended to cover a broad range of issues that are important to the department. Additionally, they might serve as helpful tools for staff who are representing the department on other associations when it comes to representing what our position is. Every year we present the plan to the Health Commission annually for your approval. After which the plans are sent to the Mayors Office for review and then they incorporate the plans into a larger city wide legislative plan. I also wanted you to know that if the commission has any additional feedback or input, we are happy to incorporate those thoughts in today. This is a little hard to read up here, but how do we advance positions as we already City Department . There is a process that we have to go through. This starts with the plans which are the ones i just talked about as issues come up and are introduced at the state level or the federal level, typically d. P. H. Staff work with leadership within their division to analyse and review what potential impacts are. Then that policy or proposal will come to the office of policy and planning for review. We may also reach out to other organizations, other City Departments if necessary before developing a specific proposal. And then afterwards, this advances onto the Mayors Office of legislative affairs. When it comes to state legislation, they can meet a monthly meeting that has seven members, seven voting members that are representatives of the board, the Mayors Office, city attorney, and the Controllers Office who approves official positions by any City Department after we receive approval from the office of legislative affairs and that committee, we may engage in advocacy. Typically this is in the form of a comment letter that we can share with the legislature. I also wanted to note that the city contracts with state and from dural lobbyists who will work on behalf of the department and federal lobbyists. We could also provide expert testimony if needed in sacramento. Or provide Technical Support under the high Priority Issues for the department. On the right side, i wanted to note the nature of state and federal process that requires us to be responsive. We are often, you know, coordinating with partners outside of departments such as our associations, the Mayors Office and other City Departments and the City Attorneys Office. Looking back on 2019, we monitored around 100 bills that were relevant to the Health Departments mission or function we officially took positions on 22 bills. Six of which were signed into law by governor newsom, two which were vetoed and 14 which are currently held. They come back as two year bills this year. Some of the key issues included Behavioral Health. Substance use Disorder Treatment this year we sponsored a bill that would have expanded medication assisted Treatment Options were individuals in the jail. Unfortunately this was held this year and it may come back in 2020. We continue to support a bill on Overdose Prevention programs, conservatorship conservatorship was another key issue. We support it along with the Mayors Office which was a followup bill to 1045, which is the new housing conservatorship law, which grates a pathway for conservatorship for individuals who are high users of systems as well and also have Mental Health and Substance Use needs. Another bill that we supported this year was a. B. 1544 which would have permanently authorized our local e. M. S. Agency to transport patients to alternative setting such as a recovery centre. We expect this issue to come back again in 2020. And finally we supported a few prosals that are related to the integration of Mental Health and Substance Use funding for sameday billing when individuals are seen at a primary care setting and Workforce Development really had to introduce loan forgiveness for individuals are practising with the county Mental Health plan. Other key issues this year were related to h. I. V. Prevention. We supported s. B. 159 which is a bill that passed and allows for emphasis to dispense drugs. It also prevents Insurance Companies from requiring prior authorization. Maternal childhood and analysing health. We supported the pregnancy in childhood and childbirth act which recognizes maternal morbidity and births are highest among africanamerican mothers across the state. This requires hospitals, primary care clinics and other centres to implement implicit bias trainings. I will talk about the medical eligibility and Expansion Proposal on the next slide and longterm care. There are efforts of the state to expand these systems, which would allow medical beneficiaries to be placed in care homes in lieu of more costly nursing facilities. This year the governor was able to advance several healthcare proposals. The first was already mentioned in the opening remarks around expansion of medical to undocumented adults aged 19 to 25. There was additional expansions for coverage california premium support for individuals between 40600 of federal between 400 and 600 federal policy poverty level. This is going to require all californians to have insurance or they can potentially face a penalty of up to a minimum of 695 per addled. This year, the government also issued an executive order with the goal of controlling Prescription Drug costs. There are two key proposals in this executive order. One is the transition of Pharmacy Services for medical managedcare to free service. Would you expect this proposal to reduce savings for Public Healthcare systems. The executive order also included a goal to expand the states bulk purchasing program, which would essentially allow us to collectively purchase drugs for the state to lower drug prices. The other key issues that i know you heard a little bit about from our Behavioral Health division earlier or in the fall of 2019 is california advancing medical which is the states process to renew its current waivers with the federal government. There will be a lot of attention and focus on that this year. And finally the governor is planning to release his budget this friday, so we will be monitoring that and we will provide the commission with an update regarding this proposal. I will hand it to max to talk about some of the federal issues on the platform. My name is max and i am a Healthcare Program planner with the policy planning office. For this section of the presentation i will provide a brief overview of the federal issues that we monitored during and were engaged in and provide an overview of the departments proposed 2020 state and federal platforms. This past year, the federal administration engaged in various actions to undermine before able care act, immigration protections, womens rights and lgbtq rights. Many of these issues have been ongoing from the previous several years and we will continue to monitor these into 2020 as they progress through the court system or through the rulemaking process and a more complete overview of these issues are available in the table that was provided to you. At the start of 2019, your appeal of the individual mandate became effective. The california new statelevel individual mandate and also the affordability initiatives are projected to help protect the state from impacts from this repeal. In addition to the mandates, other efforts were made to weaken aca related a form reforms including an ongoing challenge to the constitutional legitimacy of the aca. The federal administration also continue to undermine the health and safety of our San Francisco immigrant communities with attempts to change charge rules which govern how the use of Public Benefits could impact immigrants or individuals with immigration status. In august of 2019, the state attorney, in coordination with Human Services agency of the department of public Public Health office in the Mayors Office, filed a legal challenge to the newly finalized public charge rule. Fortunately in october of 2019 following that challenge, the board indefinitely delayed his limitation of that rule and is continuing to make its way through the courts now. If the rule does go into effect, it could significantly impact immigrants use of publicly assisted programs like medical. At the department has developed Public Awareness materials informing residents that they are welcome at all city clinics and hospitals regardless of their immigration or insurance status. This past year the administration also implemented new restrictions on title x Family Planning grant plan. These restrictions would restrict clinicians and other clinical staff from being able to provide a complete and unbiased Reproductive Health information and a full range of services to their patients. Last year, the departments funding planning coordinator provided an update on the Health Commission on these changes in the following august. These changes officially went into effect, at which time the department withdrew from the grant program. The departments maternal child and adolescent Health Section is committed to could tuning to provide Financial Support to the Family Planning program, which had administered the grand. Before withdrawing from the grant program, the program had worked with the City Attorneys Office to provide official comment on the rule and provide testimony in a lawsuit filed by the california state attorney general. The board of supervisors also provided a resolution by opposing these regulations. Finally, the federal administration implement the changes that would allow providers to refused to provide services, but they have a religious or moral or religious objection to like abortion or gender reassignment surgery. These changes are referred to as conscience rights in healthcare, and under these changes, federal funding would be taken away from the state from state to do not comply. D. P. H. Formally submitted written comments to the rules citing concerns with the rules discriminatory effects in the California Attorney general and San FranciscoCity Attorneys Office filed lawsuits against this rule. In november of last year, a judge blocked these changes from taking effect. So next i will provide an overview of the departments state and legislative platforms for 2020. For the developed of this years plans, we worked with leadership and experts from across the department to review the platforms to identify emerging policy issues and areas covered in the platforms are not too different from last year. Modifications have been made based on the issues that the department is likely to engage in. This includes a new section on expanding policy goals for longterm care, as well as furthering Behavioral Health integration. For the 2020 platform, we organized legislative issues based on their intersections to the two additions to the San FranciscoHealth Network and the population addition. Issues are categorized under one division based on who is likely the lead on the issue and to we would first reach out to better understand impacts of the policy those issues both impact both divisions and we will work with experts from across the department to understand the implications of the policy and weigh in on those issues. Rather than reviewing the entire platform, we will highlight several state policies that the department expects to focus on in the upcoming year. Medical and healthcare reform will be significant issues as the state engages in the cal aim initiative. This will impact many different parts of the departments Healthcare Delivery system. We will want to monitor proposals to ensure that Adequate Funding continues to be provided for Public Hospitals in the Health System and that there is continuity in the whole person care system under the condition of longterm care that continues to be a pressing issue in San Francisco and across the stage. We continue to experience issues of Residential Care facility closures and these facilities offer supportive residential living for individuals who no longer live independently. In order to stabilize and prevent the further loss of these facilities, we will support proposals to increase funding to prevent the further loss of these facilities. I like to discuss the department s 2020 legislative platform. Commissioner ciao, thank you for your feedback. I want to note it has been incorporated into this years plans. We added language to support proposals to comprehensively fund hepatitis b services such as education, treatment, screening, and vaccination. If also added a new subsection within the Public Health care section stating that the department will support proposals to ensure that emergency programs and planning are inclusive of the needs of vulnerable populations including those with access to functional needs, those with disabilities, those unable to be selfsufficient for 72 hours following an emergency, as well as other groups that may be disproportionately impacted during an emergency. Given the broader categorization of federal issues, they are not organized by Department Division on this platform. As i mentioned earlier, the department is expected to monitor many of the same issues from the previous years. These include ongoing issues around a. C. A. Healthrelated reforms, immigration issues like public charge, and proposed changes propose changes to patient privacy. Because of our distance from the federal level, will continue to work closely with professional organizations like California Association of Public Hospitals and coordinate our efforts with the Mayors Office and City Attorneys Office for engaging on any pressing federal issues that arise. This concludes our overview of this years plans. Before you for your consideration again is a resolution approving of the 2020 state and federal legislative platforms. We welcome your input on the platforms. Is there Public Comment . There is no Public Comment. Any comments you would like to make . Just to reinforce the breadth and depth of the issues that we were looking at here. It is broad and has brought in several mandates. There are things that are very specific. Really want to acknowledge the policy team in the work they do across the department as well as the Mayors Office and other departments were a lot of these policies intersect. We know they have a further impact on the people in the communities we serve. I just want to appreciate the work. It will be a challenging year. Certainly the department is up to the task with your support. Thank you. We will have a motion for the resolution. Before we do that, i would like to hear from any from you any questions or comments you would like to make. I just want to thank the department for the work that they have been doing. Each it gets even more robust and our issues become even more and the fact that you also have accepted and to explain to my fellow commissioners, that while we were talking about hepatitis c company and civilly, we have omitted, especially in our town, the fact that hepatitis b also had treatment that was available i thank you have its certainly beyond what i would even think about. And likewise, the whole issue of working with the whole vulnerable population. I think it comes up, as even as the director pointed out, in terms of not just the federal level, but within our own programs. I have been waiting for you to tie it all together at the federal and the state level and in our local areas. We do seem to forget that the vulnerable populations are not being treated and cared for or networked into the care because we have this policy of you were on your own for 72 hours in many of these incidents. I know that reports given back to us recently have shown that, especially with our heat days and all, that we have begun to do more in terms of working with the different organizations or areas to try to reach these people. I think too often our local organizations and especially in the Emergency Preparedness, looking at the very large pictures and the need to mobilize for Large Populations forget the individuals. I think therefore, our role is to remind ourselves that they are out there and they are vulnerable, whether it be heat, earthquake, whether it be fire, and that we should be preparing for that. These are people who cannot survive 72 hours on their own. I really appreciate that you will put that in at the federal level. Im hoping that at the state and local level we would begin to really emphasize those areas of preparedness. Thank you. I should also note we included similar language into the state platform as well in our Public HealthEmergency Preparedness section. Thank you very much. Commissioner green . Thank you for the work. It is remarkable to be able to read this and see it in the very easy to understand pages. It seems like the states priorities and our own priorities have conflict. Are there any areas that you feel or high priority for us that might not have been adequately emphasized at the state level and are there any areas of unique vulnerability or concerns that perhaps havent been prioritized in the same manner as you might . Nothing that is jumping to my mind right now. I would say a lot of what you saw on the stateside, a lot of our focus was on Behavioral Health. I think that is also because of the synergy with a lot of the efforts that are happening here locally. I think we expect that to continue into 2020. Right of the top of my head i cant think of anything that is potentially missing from the work that we are doing. That is great news. Thinks. Let me just ask the question to followup commissioner green s question. It was just recently put forward on isis and the Adverse Child Experience and i assume you supported it and then it was also just past that medical the medical reimbursement as well. So i know you did mention it, but was that part of it . That was part of the governor s Budget Proposal in 2019 which we did not take a formal supportive position, but we are supportive of. I checked when with our ambulatory care director about that. It sounds like we are still figuring out implementation of that and we are piloting it within a few places in the network. Such as the Childrens Health centre. It will be a process to get that up and running. Unfortunately i think the screening was not part of our wave one tool, so i think it is an ongoing target and goal that we have to meet. Thank you. I would just like to say that i really appreciate two things here. One, the language that is in the narrative that describes exactly what our departments position is on this piece of the legislation both federally and statewide, and the narrative is very explicit and helpful to understand what these pieces of legislation will do and why the department is taking opposition on them or not taking opposition thank you very much for that work. It must be intends to accomplish this in the time frames that you have. Thank you for your Service Today thank you, commissioner. Thank you. The resolution vote. That is right. Will someone make a motion to adopt this resolution . So moved. Second. All those in favor say aye. Aye. Thank you. Thank you. Item 10 is the d. P. H. Strategic priorities. Commissioners, if i make break in here before this could presentation is started, i want to provide some background on this document. Something that stood out for me when i started here 10 months ago was all the great work going on in the department and the size and the scope of the department and the multiple levels of expertise, and for quite frankly, the challenges and barriers that we run into we challenge ourselves to do better there was no one overarching the document that summarized our priorities. I think that this is really an effort. I asked dr. Golden, along with her team, to collate the key priorities that were brought forward to the commission in the last year or so to really develop through the lean process and to remind the commissioners, there are extensive details in those documents with regard to these priorities, including very specific outcomes and timelines for achieving those outcomes. I would also say that for people just starting in the department, and somebody who has been interested in what we are focusing on, perhaps new commissioners and others, those main documents are somewhat challenging to move through, and certainly dr. Golden and her team did a great job of hoping orient us. This is really a document that i expect over time in over the years will evolve, but it is our efforts, for the first time in many years, to summarize our broad brush Strategic Priorities going forward. I will let dr. Golden take it from here, but also note that the subject Matter Experts in these areas are available to answer more detailed questions, or certain as we go forward we can go into the outcomes and the timelines for achieving the specific granular objectives that you listed in the 83. I will turn it over to dr. Golden to provide this. I want to think her for compiling this document with a relatively short notice and the work that her team did. Thank you. Good evening. Im very pleased to be here and honoured to present the departmental strategies, particularly at the beginning of this new year and this new decade, as we embark on this. Dr. Colfax said this is the first time that we have actually put together something, a draft like this. Its actually very exciting. It represents the work and thinking of many people across the department and division. Many of whom are actually in the room today. I want to acknowledge that as well. The process for articulating our priorities really began with the affirming and reaffirming of our mission and vision. You maybe familiar with this, our mission, and it was an opportunity to expand on that statement so that it included all in San Francisco, which reflects our deepseated belief in the importance of actually serving all those who walk through our doors and also in serving the community itself. Our mission is new. Are you familiar with our mission . Making San Francisco the healthiest place on earth. Does that sound familiar in any way . Okay. It might sound familiar because it is very similar to something that disneyland does. [laughter] anyway, it is an aspirational goal, obviously worthy of the challenge. True North Triangle is really a visual representation of our mission, our vision, and true north. And it really builds on the work of many of the sections and divisions before ass. So at the bottom you have protecting our mission, protecting and promoting health and wellbeing for all of San Francisco. What we do, who we serve, and at the top, we have our vision, which is what we hope to achieve and what we are striving for. In the middle is our true north, which is a set of universal ideals which, taken together, are a compass for us that describes our ideal state that we are continually striving towards. We may never get there, but we are obviously, hopefully always moving in that direction. So our true north never changes, but our tactics and strategies may change. We have six dimensions can you rattled him can you rattle them off . Im not sure if everybody in the department can rattle them off yet, with that could be a goal that we would strive for. So equity, which is looking at eliminating Health Disparities, safety and security, which is about how do we provide the safest environments for our clients and staff, health and impacts, which is really about improving the health of the people we serve, by providing the highest quality care. Through service experience, which is about the best experience that we can provide for patients and clients, and then workforce, which is a very, very important piece of this, which is really about how do we value, invest, and respect in our staff, and lastly, financial stewardship, which is about transparent accountability for the resources that we have. All right. So we went through a process. It is a japanese term meaning needle or compass and method or management and we put it together and we have Strategic Direction setting. It is a process of identifying and deploying Strategic Priorities. It is not just a single event, but it is a yearlong process for deploying improvement work. There is a series of steps involved in this that includes not just setting the objectives and measuring them so we can focus ourselves, but also to look at how do we measure on a systems level to see how we are performing as an organization, and then having visual management to allow Greater Transparency around the operational environment so that in the end, we can improve the work and develop our future thinking. Once we set our strategies, we then catch ball them. We share them out with other leaders and managers in the division and other levels of the organization through a technique called catch ball. That is where we get feedback to refine our thinking and to refine our plan so that ultimately this becomes a two way communication and there is feedback between not just the owner of the issue he was responsible for delivering on it , but from subject Matter Experts at the same time. That Strategic Plan, which is very broad at the Department Level, then gets taken by successive divisions and factions and as they do their own Strategic Planning, they think about, what is my role, what is my way of supporting the overall departmental goals . And they incorporate that such that the Strategic Plan is no longer just at the top, as a horizontal thing, but is vertically aligned up and down. This allows people not only to understand what the plan is, but also see what is my role in being a part of the most important objective for the organization . As we cascade down our Strategic Plan, it may become increasingly narrow, more concrete, more specific, and this allows everyone to participate in what is hopefully a dynamic and creative environment. All right. The department identified five Strategic Priorities and this represents a double pronged approach which looks at, first and foremost, the development of the infrastructure for doing this work, whether its with this topic or any topic in the future, and focusing in on three key areas. We are looking at process improvements, daily Management System deployments, as well as looking at how do we continuously improve. Were also looking at how do we engage our staff and our people in doing the improvement work. And lastly, how do we provide them with the tools to doing this improvement work, the data tools, and epic is a comprehensive Electronic Health record system that will enable us to provide care across the continuum. The application of those areas focuses on advancing equity, Behavioral Health and homework homelessness health. Theyre five Strategic Priorities. The First Priority is looking at advancing equity which is really about how do we achieve our vision of being the healthiest place on earth through an elimination of Health Disparities. There is work already underway through hypertension control and in a black African Americans through chlamydia screening in youth, through sexual discriminatory health, and on the flip side, we need to look at how do we create an equitable and respectful workplace for everyone such that they feel like they have the opportunities to succeed. At the same time, we look at how do we train staff to recognize racism and inequity through the development of equity skills curriculum training, as well as the equity champions, and then establish the departments infrastructure for doing this work overall through the development of an Equity Council , and the office of health equity. Probably we would like to actually align this work with work that is being done throughout the city with other agencies as well, and with, in particular, the office of Racial Equity at the human rights commission. Our second strategy is about Workforce Development and we acknowledge that an engaged workforce is best able to provide the highest quality care for our staff. Based on a recent Staff Engagement survey, both communication and advancing equity were identified as top priorities. So we are looking at how do we provide a culture of open and respectful communication by training our leaders and our managers tween communication, crucial conversation, critical problem solving, to look at how they can better manage with greater understanding and clarity. We are also aligning this work with the advancing Racial Equity work by developing curriculum that is aligned. For our third strategy, we are looking at the power lying deploying a Performance Improvement system and a Management System, really as a philosophy around how we do the work. We will try to create greater focus that are really important to the organizational organization. Were looking at how do we communicate that out so it is a vertically and horizontally understood and that everybody has a chance to provide input, particularly our subject Matter Experts in these areas. One of the main pillars of this is also looking at developing our people, which is about how do we develop 8,000 daily problem solvers, a fundamental Building Block of doing this improvement work . And then how do we sustain that improvement by employing a daily Management System that involves everybody every day and doing improvement work . Our fourth strategy looks at how do we use data effectively on the service of our mission to care for all in San Francisco . That really is our goal in terms of deploying an Electronic Health record system. We started that process, we talked about it earlier. Were happy with how things have gone. We know we have to continue to deploy to other sites and other areas, and also recognized that there are other groups, communitybased partners who we need to connect with in order to create those systems to build better care for our patients. We need to look at how we increase success ability accessibility, align organizational priorities such that we can actually meet the operational demands for data and data sets. And lastly, how do we train our staff to use data more effectively in supporting problemsolving, analysis, decisionmaking, and Continuous Improvement . Our last strategy, certainly not our least is homelessness and Behavioral Health, which is looking at how do we create a unifying vision for the delivery of Behavioral Health services to adults experiencing homelessness and while we know that care is provided individually oneonone , we also need to step back and look at a Systems Approach to doing this work. So a populationbased approach to Behavioral Healthcare. Looking at streamlining housing and looking at increased access to healthcare. Focusing on the 237 highest risk station and building that model and applying it of the population. We are also in Silicon Valley looking at innovative opportunities for doing this work and aligning it with the advancing equity strategy to eliminate Health Disparities and using data and evidencebased practices to inform and guide the decision. So we have learned a lot about doing this and were continuing we are continuing to learn. We know that Strategic Planning is not just planning, it is about deployments. It is a yearlong process. It is not about a oneday event. It is also about horizontal or vertical alignment in the work that we do. So everyone sees their role in the importance of how they can move things forward. We talked about yellows and greens and reds are things that people are usually really afraid of. We need to teach people that read is an opportunity and that the work is not about individuals, but it is about the system and how do we actually worked through that system. And we need to focus. We need to prioritize and think about where we can do you prioritize in order to have the bandwidth to do all this work. So this has been a highlevel summary of our Strategic Plan. I want to thank everyone back here for all of their work in putting this together. Thank you. Thank you. I would like to move to Public Comment. I like to remind you that will be voting on the strategies and priorities. Commissioners . I do have a question. Thank you. Its not really a question. I was looking at the switch the switch. It is a marvellous attempt to pull together everything. We are trying to understand which year we are talking about as this represents because in that case, because you have some bars and also this is trying to get some context on it. You have some examples, but as the director has said, theres a lot of things backing this. What do we then take this as . Is this a 2020 version and that is what we are working on . Or is it the fiscal year that goes from 2019 to 2020 . And where then if we are going to use this as the framework, where do we see the arrows which we want to now soon to be seem to be hitting the bullseye by going to get there , or as you say, if not, what are the opportunities to move forward. Its like the scorecard that we get in the other measures. Will we be seeing there are measures under here that then we could measure your progress and where we are going to go, and that does does that then inform a new program . Im really fascinated by your idea of if we are going to prioritize, we have to do you prioritize. And what does that really mean to a lot of people, and then how does this really affect the poor clinician sitting in the emergency room trying to handle that emergency that just came in and meanwhile, we have these wonderful ideas of what you should be doing . Sorry. I will try to answer all five of those. These are obviously very broad strategies that are not going to be accomplished in one year. It is a multiyear process. Behind each of the strategies there are measures Outcome Measures that are going to be looked at, as well as process measures that are also going to be developed based on what we see are the key drivers for this work. And over the course of the year, we want to present each of these strategies so you can see this in more depth. This is really just an initial overview. Okay. So if i could follow that up, i understand that by doing that, you are seeming to say that this is more than a one year program. So therefore, there was a timeline that stretches this. How do these strategies fit in with all the other ones that we have . I know you have tried, but we have different objectives through quality measures or, you know, targets and waiting times and the work that the network is doing to give us a comprehensive report. And its kind of like one day we are going to hitch that report card. That is where all these are. Where would we want to go after that . I am just trying to get i hear what you are saying. I think that is the challenge of the department because we have a set of regulatory measures and compliance measures that we have to work on, and at the same time we need to focus in on our true north and where we hope to get over time. There is always this tension and balance between that. So we dont stop everything. We still have to do the regulatory and compliance and filled those measures to the extent as we do Strategic Planning that we can align that. I think that that is obviously the perfect goal. Its not always the case. And perhaps because they know the president has asked us to try to weigh in on what we will do with the Planning Session i know this might now become something that could be useful. At one point we were talking about maybe getting educated. But by now we are probably well along our way to understanding the product. Now you have just explained more japanese terms. That is great. Thank you. Perhaps this would be something we could take as within the planning retreat and try to understand how this fits in with our partner as a compilation of where they are going and what we might then be expecting, and what the public might expect out of this Strategic Plan and how we then continue it as a living document. It is beyond our knowledge today it is a nice exposition of where we are and obviously a great deal of work in order to do it. It might be something where they need a Planning Session. Theyve not actually done Something Like this. It might be a way to learn how much more they are expecting. If i could just add to that. One of the challenges is we could also link it to the specific parts of the people how does this apply to getting 20 with h. I. V. Infections . These are overarching things. Before the broader detailed pieces, we can attach and link the specificity from this document. I think the goal is to summarize something that people would actually look at when they start having an interest in the department that is readable in 20 pages. Then we have the much more detailed pages and hold ourselves accountable to these. I think the question of the years is really an important one because these are longterm issues that we need to address to hit the bullseye for most of these. It will take a long time. We thought it would be good to entitled this so as to go through the cycle of the year, we can have that conversation about how from hitting that bullseye and are there other things that come in over these five that will display some of these because of an emerging issue or a shifting priority. For right now we were thinking that this would be our anchor and our true north. Im not trying to contradict that. We are anchoring around what true north is going forward. Thank you. I do have a question. I was in a comment i was at a meeting yesterday. One of the issues that is coming up over and over again is not only are we talking about single men out there and large a Large Population of black africanamerican single men out there, but we also have to think about families and transitional age youth and transgender communities. This came up yesterday where the folks at the local homes and the advocates the community were saying loudly and clearly, you cant always mend, but you dont count our families are out there and you do not count our youth. I recognize this is supposed to be a global and highlevel look, but i think they will have some mention of families and transitional age youth and transgender folks in this discussion. It may be in the details somewhere, but it isnt in this. Thank you. I appreciate the feedback on that. We can look at how we incorporate that. Thank you. Dr. Green . Thank you so much. Would it be possible to get this before we have to help with the next meeting . It would create such clarity. I keep thinking about the instruction book and i dont understand those documents. You can actually tell where they keep their market is. That is easier when you are Building Systems and all the other roles we have here. We can do that. That would be very, very helpful. And then we can celebrate and we know we have to rethink. Its really helpful. It would be something we could aspire to. Yes, absolutely. I hope we dont get into some of these problems, a few years ago, we did a structure of the department goals, and then for a while, we were asking that any initiatives or any surfaces coming up get tagged to it. We are almost doing that with some of these icons. I think we have to be careful having experienced that, that that actually doesnt quite work it gets very rigid and then people get very mechanical to it i dont know if the commissioner remembers around that time, but we were trying to do it, but there was that idea that anything we were doing needed to fit. That is what was created. And so people were writing down and saying this was one a, and this is it. I think that while we were working through it, it looks like a good idea to be sure that everything was matching what we were saying, but i think it did not achieve the purpose that i would think we are hoping for and i know it was a lot of work. There then quoting it and i dont think we did the department a service in trying to do it that way. I just now suddenly realized that i dont want us to get back into that mechanical area. The idea that they had with trying to link these, but i dont know how accurate it is, but you can come down and see where we are standing with some of the prospects an understanding, how as they rise, they become part of this. Its probably the right way of trying to do it without it becoming over burdened. Okay. That is good feedback. Thank you for indulging me. Thank you so much for your report. I would also like to say that it looks like there is some outcomes expected of the strategies that you are going to employ and i will look for to have a deeper discussion about what the outcomes of these strategies the strategies actually are. [please stand by] in favor. Aye. Thank you everyone have a good night. Is there a motion to disclose or not disclose what was discussed in the session . Motion to not disclose. Second. Second. Those if favor signify by aye. Move to adjourn. Those in favor signify by saying aye. Thank you. I have been living in San Francisco since 1957. I live in this area for 42 years. My name is shirley jackson, and i am a retirement teacher for San Francisco unified school district, and i work with Early Childhood education and after school programs. I have light upstairs and down stairs. Its been remodelled and i like it. Some of my floors upstairs was there from the time i built the place, so they were very horrible and dark. But weve got lighting. The room seems lighter. They painted the place, they cemented my back yard, so i wont be worried about landscaping too much. We have central heating, and i like the new countertops they put in. Up to date oh, and we have venetian blinds. We never had venetian blinds before, and its just cozy for me. It meant a lot to me because i didnt drive, and i wanted to be in the area where i can do my shopping, go to work, take the kids to school. I like the way they introduced the movein. I went to quite a bit of the meetings. They showed us blueprints of the materials that they were going to use in here, and they gave us the opportunity to choose where we would like to stay while they was renovating. It means a lot. Its just that ive been here so long. Most people that enjoyed their life would love to always retain that life and keep that lifestyle, so it was a peaceful neighborhood. The park was always peaceful, and i dont know. I just loved it. I wanted to be here, and i stayed. Hi. My name is carmen chiu, San Franciscos elected assessor. When i meet with seniors in the community, theyre thinking about the future. Some want to down size or move to a new neighborhood thats closer to family, but they also worry that making such a change will increase their property taxes. Thats why i want to share with you a property tax saving program called proposition 60. So how does this work . Prop 60 was passed in 1986 to allow seniors who are 55 years and older to keep their prop 13 value, even when they move into a new home. Under prop 13 law, property growth is limited to 2 growth a year. But when ownership changes the law requires that we reassess the value to new market value. Compared to your existing home, which was benefited from the which has benefited from the prop 13 growth limit on taxable value, the new limit on the replacement home would likely be higher. Thats where prop 60 comes in. Prop 60 recognizes that seniors on fixed income may not be able to afford higher taxes so it allows them to carryover their existing prop 13 value to their new home which means seniors can continue to pay their prop 13 tax values as if they had never moved. Remember, the prop 60 is a one time tax benefit, and the Property Value must be equal to or below around your replacement home. If you plan to purchase your new home before selling your existing home, please make sure that your new home is at the same price or cheaper than your existing home. This means that if your existing home is worth 1 million in market value, your new home must be 1 million or below. If youre looking to purchase and sell within a year, were you nur home must not be at a value that is worth more than 105 of your exist egging home. Which means if you sell your old home for 1 million, and you buy a home within one year, your new home should not be worth more than 1. 15 million. If you sell your existing home at 1 million and buy a replacement between year one and two, it should be no more than 1. 1 million. Know that your ability to participate in this Program Expires after two years. You will not be able to receive prop 60 tax benefits if you cannot make the purchase within two years. So benefit from this tax savings program, you have to apply. Just download the prop 60 form from our website and submit it to our office. For more, visit our website, sfassessor. Org, i personally love the mega jobs. I think theyre a lot of fun. I like being part of a build that is bigger than myself and outlast me and make a mark on a landscape or industry. We do a lot of the big sexy jobs, the stacked towers, Transit Center, a lot of the note worthy projects. Im Second Generation construction. My dad was in it and for me it just felt right. I was about 16 when i first started drafting home plans for people and working my way through college. In college i became a project engineer on the job, replacing others who were there previously and took over for them. The Transit Center project is about a million square feet. The entire floor is for commuter buses to come in and drop off, there will be five and a half acre city park accessible to everyone. It has an amputheater and water marsh that will filter it through to use it for landscaping. Bay area council is big here in the area, and they have a gender equity group. I love going to the workshops. Its where i met jessica. We hit it off, we were both in the same field and the only two women in the same. Through that friendship did we discover that our projects are interrelated. The projects provide the power from san jose to San Francisco and end in the trans bay terminal where amanda was in charge of construction. Without her project basically i have a fancy bus stop. She has headed up the Womens Network and i do, too. We have exchanged a lot of ideas on how to get groups to work together. Its been a Good Partnership for us. Women can play leadership role in this field. I tell him that the schedule is behind, his work is crappy. He starts dropping fbombs and i say if youre going to talk to me like that, the meeting is over. So these are the challenges that we face over and over again. The reality, okay, but it is Getting Better i think. It has been great to bond with other women in the field. We lack diversity and so we have to support each other and change the culture a bit so more women see it as a great field that they can succeed in. What drew me in, i could use more of my mind than my body to get the work done. Its important for women to network with each other, especially in construction. The percentage of women and men in construction is so different. Its hard to feel a part of something and you feel alone. Its fun to play a leadership role in an important project, this is important for the transportation of the entire peninsula. To have that person of women coming into construction, returning to construction from family leave and creating the network of women that can rely on each other. Women are the main source of income in your household. Show of hands. People are very charmed with the idea of the reverse role, that theres a dad at home instead of a mom. You wont have gender equity in the office until its at home. Whatever you do, be the best you can be. Dont say i cant do it, you can excel and do whatever you want. Thank you all so much for coming. Im really excited about this. No one challenged you, did they . [ laughter ] thank you. Weve got a lot of work to do and we know how important the Public Defenders Office is and im so grateful that mino agreed to take on this incredible challenge. Thank you to your family who has supported you every step of the way. I know that its been a really serious challenge in this office because of the loss of jessica gotty who we all knew and loved tremendously. I still feel his loss everyday and wish he were here to talk to and argue with and have fun with. I think he would be so proud to know that youre following in