Work on a but a sentence or two will help me understand and iron with the rest of the commission, but help me understand what that means. Because right now it could mean anything this oldtime unassociated with it and i dont know whether this is an important issue for the work that you do but i would suggest that given the fact that its being reported out it is very important to the work you do and that being the case, we need to lift up in a narrative form explanation of that. Thank you for saying that and you should know we actually struggle with that. Because when we first put this together we actually did the expiration of one by one and what we found it booked it was kind of gobbledygook because of basically for reasons. One was either either the Key Stakeholders still cannot come to consensus on a measure but agree with was not a national benchmark. Second was just the ability to validate the data get as you know we have 16 67 different iis systems and some of these have been required to in order to get the reporting youve got people from different systems. So much any apples to apples and oranges to oranges. Then the other particularly the case of Behavioral Health because you know we been recruiting for new Behavioral Health director. So there just wasnt the cohesion there to really bring those together. So thats why you will see the more robust the more mature parts of the organization like laguna and zuckerberg we have more of their did the other parts of it are just coming onto their still struggling to really get up to that point given the variables you just described in terms of those between data points, it will be useful just at that distinction. There are too many data points which we have to pull together given an answer to this particular one we just say in progress were to be determined. But if you can say that exactly it would be very health. Will do. Thank you. I had a few comments in question. The first is that i really want to congratulate the team here at sort of the network and at the institution adopting lean. This a very heavy lift. It requires a lot of training and you have quote your day jobs at the same junk so it really seems like we made a progress adopting that powerful management tool. The caution and maybe suggestion i have for you in reporting out to this group is that we know you are doing this already. We hear about it at the jccs good we heard about it for years but we are interested in results. To the much later we can go on the process and the more time we can spend on these here are the areas that youre focused on. I think that would be more helpful to us to understand okay, how are we doing. And i will come back to that but i did , in looking over the metrics i would just give you a sense of how i think about them. So when we want to reduce patient time in the er we just open a billiondollar hospital with er much larger than we have and we talked about it this a lot and you guys are struggling with the changes in process and workflow for people but to see er times like this go out and for me to think, and i sit here and i look at this and i think, well if i took my cue to the er or if any one of the commissioners took their cue to the er or anybodys employed by the health department, took their wife or kids to the er, on their Insurance Plan and they had to wait this long they would blow their top. So i think that is the same lens and motivation with to think about the people who work spots for taking character likewise, i mean it is Good Progress duo from 44 days to 39 days on access to primary care but a target of 14 days. We would also kick and scream about that and be frustrated. I think weve got to remember that at the end of these numbers we have a lot of our citizens and most honorable and they ought to expect to have the same sort of care that we get. Sometimes these numbers i think are not ambitious enough. I know we are on a journey but i really want you to be ambitious which leads to my question. Which is, you said before that you are frustrated that some things are not going fast enough. What exactly is not going fast enough . Number one, just the development of visual Strategic Plan and the various a. I think the command and control manager was trained to be would say all these things should be done. We should all 55 of these metric should either be read or green. In the old days, make it so. But as we are learning to be this learning organization where we really try and define our problems, have multiple stakeholders involved in helping us number one identify with the real problem but also in terms of the countermeasures it takes time. Youll notice a lot of these athree have various version to summer and version 10 summary version four. The fact that thousands athree waiver to valuebased it just takes more time so thats the part thats frustrated you i like to say, okay, everybody has this done next week but in order to be true to the process, i cant force that kind of thing. That is fair but only out. As you look at all these metric second got a couple i was first it would pick out a couple that youre critically frustrated with. He was number one, the ed one. Number one that you wont get i think we all hoped and expected with the opening of the new ed that the times would go down. That is one. The other would be increased to Client Satisfaction rates for health at hunter ideally you think would want off 100 Client Satisfaction. Even though we are at 75 or rather at 72 , we actually went down from 75 but you would think we would be able to have 100 . So whenever we have those kinds of gaps degree in terms of service delivery, thats frustrating because we think we are equipping our employees and staff to provide Great Service as a why arent we seeing that reflected back in the responses from our patients. Thats always frustrated. As a person in charge, like in the lean methodology, if you pick out a few things that you are just like among no, we have to fix this, what other tools do we have two kind of motivate so that you can get the results you are trying to have . So within the lean methodology to actually go to that process under review the process owners a great. Here are your metrics which ones are green . Which ones are red . Once a red tommy what the issues are. What are the barriers . Can i help you resolve the barriers . Thats go take a look and see what this is really about. But you and i take a field trip and you can to meet in the real place. So that in the er for example, what should be our expectations about the ability to hit a little under a is 3. 5 hours waiting which is the goal at the end of year if we do a really well. What is your feel good about that . I feel good about that we have a process to get there. What i dont know is how quickly were going to get there. We are going to have to i think continue with the root cause analysis with the redefining of how they are using the three different pods within the er. Thats the work theyre doing out. How do they optimize pods one, two, and three in terms of making sure we got the greatest patient flow. Having said that, they also simultaneously need to then focus on the diversion rates good because all those things then applied affect how much time an individual patient spends with her within the ee. So its really trying to having said that, its where do we get the bang for our buck given the resources that we have. Do we need to redeploy resources from somewhere else on another lean project to put them on on the ed in or to the big bang affect . That something we will also want to consider in order for us to speed up the time on. So those are the kinds of things we are going to have to do in order to really move the dial i think faster than it might normally go through this process. Right. So if we walk away from this that thinking to under 10 min. Er wait time is a goal by the end of your thats probably can be hard to hit . Is that a fair conclusion from what you just said . Given we are in november now in the next two months come i think we are probably be difficult but i think we are you have until june on this bequest made. 167 and i thought you meant no. By then weve gotweve got enough eyes. The ed is the focal point for cfs g. All weve got other line lean implementation going to thats where the heart of the focus is. So every resource that theyve got is being pulled into that place. And the loop [inaudible] staff are doing interested in doing the change. So i think we will definitely be closer to meeting that goal were mediated by the end of june. Great. I think its important for the public to appreciate the complexity of the problem you are trying to solve. I spend a reasonable amount of time with a moment in the teeming er and it is sounds simple but its a very complicated place. I think the more people appreciate that the more support youre going to have and i also think the more everyone when we remind ourselves about the urgency of solving that one issue. Which requires a lot of other issues throughout the system to be solved. Thats when we are going to get itself absolutely. Any more questions, commissioners . Thank you then much for this report. Thank you and i will take your comments and try to hone this presentation better the next time. He was thank you commissioners i may remind you and Mister Pickett spoken comments when it comes back to you youre doing the best we can to meet your needs on that. Item 9 is other business. Other business, commissioners youd like to bring up to the commission . Lets move on to item 10. Commissioner sanchez can get the report back on the october 25 cfs g jcc meeting. This is identity jcc sfgh the committee reviewed the report approved of the environmental report sparrow care proxy and population for the annual meeting at on november 15. Committee also heard an update on the transfer of the good on a hospital patients were cfs g is sparrow this was discussed with their and also at the jcc at laguna honda. The Committee Also reviewed the records were a report Council Minutes hospital minutes [inaudible]. Committee also approved the ob gyn Community Service roles and regulated reviewed a modification to the permanent [inaudible] internal medicine inpatient units and revisions. Vice the pulmonary privilege list and listed labs that are approved. In closed session the Committee Approved the credentials report and minutes. Unless theres a new additions from our colleagues who were therethat is the jcc minutes great. Thanks. Item 11 is the committed agenda setting. Youre the master calendar investors in a question any questions . A reminder to measure Sanchez Joyce you of the joint meeting with the Planning Commission on november 17. 10 amnoon what time . 10 am until noon mister secretary are there any dates you worry about quorums . At this time there is not so we can move onto item 12 which is consideration of closed session at the receive any Public Comment for this item. Youre welcome to vote will to go into closed session. All those in favor say, aye all those in favor say, aye [chorus of ayes] we will go into closed session and thank you everyone for attending. Commissioners is no time to vote for not disclosing or disclosing could i move that we not disclose the item that was discussed in closed session. Second all those in favor say, aye the course no consideration for a vote for a german move for adjournment. Second all those in favor say, aye [chorus of ayes] thank you everyone. [gavel] [adjournment] good afternoon commissioner and welcome to the regularly scheduled meeting of scheduled meeting of any kind. Please silence any devices that may sound off during the proceedings. And when speaking before the commission, if you care to, do state your name for the record. Id like to call roll at this time. Commissioner president fong commissioner Vice President richards commissioner hillis commissioner johnson commissioner koppel commissioner melgar and commissioner moore. Commissioners commissioners, the first item on your agenda is items proposed for continuance item one at townsend conditional use authorization is proposed to december 8, 2016, item 2, 32 avenue discretionary review is proposed july january 2015 and items 3 ab potrero hill discretionary review and variance have been withdrawn commissioners further in the discretionary review authorization calendar item 13 Market Street discretionary review it has been withdrawn i have no other items proposed continuance and there are no speaker cards. Any Public Comment on the items proposed for continuance . Not seeing any, Public Comment is closed. And commissioner moore. Move to continue. Second. On that motion to continue items as proposed commissioner hillis commissioner johnson commissioner koppel commissioner melgar commissioner moore and commissioner Vice President richards and commissioner president fong so moved, commissioners, that motion passes unanimously 7 to zero and places us under commission matters consideration of drifts for october 2016. Any Public Comment on draft minutes not seeing any, Public Comment is closed. Commissioner moore. Move to continue. Second. Move to approve sorry. Thank you. I appreciate that on that motion to adopt the minutes for thursday, november 10, 2016, commissioner hillis commissioner johnson commissioner koppel commissioner melgar commissioner moore commissioner Vice President richards and commissioner president fong so moved, commissioners, that motion passes unanimously 7 to zero and places us on item 5 for commissioners questions or comments. Commissioner Vice President richards in this morngsz paper the carpenter this urges speed on sf licenses pursue looks like the task force of 22 members came up with several items many of them touch land use that appears it proposing 64 passed its with a majority i think we as a department and Commission Look at this and figure this out and said what the impact is especially given the current regulations im looking for some type of a presentation by the task force or some type of an informational in the near future i dont know what the date is proeblt january so anyways thats in todays paper some items were eye opening and proposing x padded with a majority of soma and Mission Replacement of pdr id like to have an informational on the impact of that what it does to the pipeline of future and on the central soma but touches the mission maybe schedule that two. Commissioner moore. Id like to ask director rahaim perhaps ask mr. Albert if transportation to us about 45 thousand uber lyft licenses for the transit policies into nondesignated Parking Zones and a pattern that is more disruptive at the moment than what is definitely possible under the current unregulated how it causes more hardship than Solutions Like to see mr. Albert in the way he looks at problem solving id like the department to answer some of the questions. Ya just a couple of items support sxhifksz i didnt want on the Cannabis Task force as you recall we asked from this share that task force be formed i think that in hopes some of the results and finding would be deliverable to us before november 8th so i support that if we can get that on the agenda as soon as possible that would be great to for the commissioners, i was a panel lift a local architect former arithmetic held to salon about all the things we suspect transit and housing, etc. One thing that was different and maybe not but to consider the question that new york went through Square Footage versus the number of density for people the large unit for sale condo units are are secondary global homes when you dont have occupancy at night in a few areas of attain when that is happening i encourage this group to look at the towers and see how many lights are on 8 oclock at night and does necessarily want to start a dialogue it is interesting someone mentioned vancouver passed its a vacancy task if youre not a fulltime resident want to bring that up for further thought. Commissioner moore. Im supportive of those and the ones im asking for the work calendar action item and act on in kind of more extinguisher how we move forward and be corruptive having answers to the question that would be great. Commissioner Vice President richards. A followup on your comments commissioner president fong the density issue is a problem weve been talking about coupled with the projects were approving the pdrs as well as the 317 coupled with the average square feet house if in San Francisco that was published a couple of weeks ago and the massive houses in the study or the informational maybe part of 317 or separate well get an understanding my head spins when every single dwelling unit is a singlefamily home. Commissioner johnson. Thank you very much i echo the comments we touched on that briefly we talked about how rentcontrolled is used and other tools vancouver is one example and maybe we need to enclosure those adding into that were at lunch and talking about the same thing in regards to parking we talked about it occasionally in conversation but i think we need to make that more a continuance issue for the exact uses of ground parking structure we share the Ride Services and a decrease in car ownership but yet we continue to approve projects that have one or two floors of ground parking thats fine youre developing that space; right . So a space rather than nothing but we need to now be very active in thinking about what will those spaces be when fewer are utilized by actual cars that we need to turn them into entryways for the services and Delivery Services rather than deliver services on the spaces and other spaces suitable for underground spaces that those things can be used as i think we need to be more active that appears were not about to move in the direction of not approving parking we need to