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tv   Government Access Programming  SFGTV  October 17, 2019 10:00pm-11:01pm PDT

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my team will look at how we're working together in this intense focus so we can know how to sustain this. we will be evaluating it probably in february and then course correcting on it. i'm happy to answer any questions, but i think i'll turn it over to dr. hammer and i'll be back if you have questions. >> thank you. good afternoon, commissioners. it's such an honor to stand before you on this exciting day for public health in san francisco and tell you about an important new initiative that we're working on that's directly linked to whole person care and is an important part of the care delivery system for the people that were just described. so why whole person integrated care? this is an idea which has been
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in evolution for over five years. as i'll show you today, whole person care is specifically maria and her team's work to look at the data -- to gather data to help us coordinate care for this population. is what's key to sort of laying the programmatic foundation and groundwork for us to be able to bring previously really disparate clinical services together so that we are integrated and coordinated in our work to serve this population. so what we have had in the d.p.h. are different services which were developed to still perceived gaps, but not this overall population-based strategy. so our urgent care services,
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clinical services in the supportive housing on the streets and shelters, but not really coming together to talk about individuals, to plan our services to take this population-based approach. in addition, we had different clinical models. so everywhere from an episodics or urgent care model to see people when they come in, to more of a longitudinal model like we have in street medicine and shelter health. also inconsistent coordination with behavioural health. so whole person care really provides this programmatic foundation that we needed to ground our work to indicate these clinical services. so basically what we're talking about is these basically five different clinical programs and
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bringing them together under a new clinical service and ambulatory care called whole person integrated care. there is tom woodel and then also our permanent supportive housing nursing services. this very simplified organizational chart of the health network gives you some idea of where the services sit. some in the transitions division, some in primary care, and then also working with programs that are located in behavioural health services. so the new whole person integrated care program is as i mentioned in a section of
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ambulatory care incorporates all of these services and brings together specialized staff who for years have been working across practice settings to work together to more effectively care for the population. we're really excited that, as was mentioned, we will be -- as we're doing this programmatic integration work, bringing together our staff, our leaders, our clients to develop the care model, we'll also be planning for our new home in the homeless health resource center at 7th and mission. so here, next slide is a timeline that shows how we've gotten to this point, where, again, building on the work of whole person care, looking at our different disparate clinical
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services, and then given this exciting opportunity to team up with the mayor's office of housing and community development, with episcopal community services, with mercy housing, with the homelessness and supportive housing department, come together and -- i'm sorry, as well as the h.s.a. in a new building where there will not only be housing, but also on the first and second floor this whole person integrated care homeless services hub. so that's whole person integrated care. i'm happy to answer questions. >> commissioners, there is a public comment before we get -- >> public comment from former commissioner romagiey. >> short people have to practice
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doing this. good afternoon, commissioners. first of all, i just wanted to say to commissioner gerardo, welcome to an interesting time. it's a new era and we're focused a lot on behavioural health because that's why we're listening today. i just want to say welcome to it because today is a good day. thank you for the resolutions on the arf because it really got us agitated. you did come together. thank you. now we need to move from here and what i want to say is it's wonderful. usually i come with lots of challenges and criticisms and
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whatever. today is a day that i want to say thank you to ms. martinez, dr. hammer, and the whole team who has been working on this whole person care for years. i've met with you and asked lots of questions and whatever. a slide presentation is not everything, so i do have some questions. i'm going to leave that for another pay perhaps to understand it better. thank you very much because from our perspective, from taxpayers for public safety, this is not trying to better an old way that isn't working anymore, no matter how successful it was in the past, but on a new pathway and taking evidence to bring to a new opportunity which always has a cautionary risk to it, but with monitoring and evaluation inside and out. so we want to thank you for
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that. we want to thank you for the leadership. we want to thank you for all the teams at the management level and at the frontline. i would just like to add that we would love you to also do public forums so we don't get so agitated because we don't know what's going on. we want to be a part of it because we are a part of it. we are a part of it as advocates, we are a part of it as past policy people, past consumers of your services, and current ones. we just want to be a part of it. we don't think it's okay when you don't share with the stakeholders and the taxpayers who are bringing our part of the contribution to your work. so i want to thank you for that. on the jail, because i'm interested in the jails, i thank you for integrating a part of
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it. i notice that the jail is part of the service group, but i think also you're going to find that there are some real systemic issues in terms of immigration -- yes, immigration, but integration. i think maybe you want to look at putting someone on the systems group too. okay. thank you very much. >> seeing no other public comment, commissioners? >> thank you for the presentation. we in the beginning -- i also know about all the challenges to house the homeless especially those who have behavioural health issues. the challenge back then, and i anticipate this might be the challenges once they're housed, they don't necessarily open the
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door for you anymore. so the issue of engaging them kind of shifted, but i'm glad to see that don nursing is part of the plan. they won't open the door for the case managers, but they will for the nurses. glad to see it's integrated and this is not just like one specific program, but this is a system-wide approach, you know, a new approach to things. so i am very hopeful with some, like, measured optimism. i look forward to hear your progress and the successes so we can celebrate with you on them. >> thanks for your comment, commissioner. i would like to say one of the exciting things about whole person integrated care is bringing together these really different teams and giving them the forum to learn from each other. i completely agree with you, i
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think the don nurses have a lot to teach us all about engagement, opening doors, trust, and that continuity relationship that really is the cement that allows them to do such really effective work. thank you for saying that. >> commissioner chow. >> yes. thank you very much for actually helping to be so clear about what the whole person care project is and where you're all going. some of it is probably driven by current events, but the fact that you've been working on this for a number of years and we've all tried different ways to deal with the most vulnerable populations. the fact that you're able to bring these agencies together and have also the force of the city's structure to say the
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agencies will work together has been part of the challenge. i had several just sort of clarifying questions. if we looked at the opportunity amongst the 17,600 in the surveys you all have been doing and perhaps i need a clarification -- in the coordinated entry assessment, on the 11,000 that are on your red lane, are those people who have chosen not to take it or they're people we haven't reached out to? >> it could be both. >> okay. >> because the system that we have integrates all the information from the emergency room, these could be people coming in quickly and exiting the city. so the 2,400 people who have not
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been assessed who have a history of psychosis and substance use disorder, the lower left, those are going to be the people we prioritize with the homeless department to get assessed. now that we have this sort of tacit agreement that this is how we're going to prioritize people, what i hear is music to my ears. has he been assessed yet? if not, let's get him assessed. so it is -- all paths are going to go through this filter. then we have 5,266 folks who did go through that process somehow did not get prioritized. so the director and myself will be working with the homeless department to figure out how to get them re-evaluated or re-think this or have an ability to do a secondary assessment. maybe it's possible also that we begin over time to think about
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how to prioritize people without expecting them to sit through a 20-minute interview. so there may be people that as we work together and fine-tune this, i would say a year from now we will figure out how to get folks assessed and prioritized in maybe an alternate way. >> i read that while we're working at the 237 level, we think there may be another 3,000 or so who might, in fact, use this type of process in order to improve their lives and be able to treat them too. >> we're working together from the street to home. the 3,735 is the 4,000 that you hear about rounded up. >> right. no, that's very good. i think that helps at least define for me what you're looking at and what this is a
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cohort of. then i looked at the street to home, but the home ends at the navigation center. we know that the navigation center is not a permanent home. what are we proposing as item 6? because ultimately a year goes by and we will now have used up a year in navigation, right? >> so -- well, 6 would be home. so that would be getting to their home and the right, safe place. >> i see. >> we need to have six there. >> it looks like navigation is the -- >> no. >> sorry. >> so that's a visual problem there. the navigation center is probably the path to getting them to the home. so the 1,000 people who got prior -- we saw that we're
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serving them, we assessed them, we prioritized them, the 1,000 people doesn't necessarily mean that the other folks are not vulnerable in any way, but what it says is it's a very complicated department of homelessness with h.u.d. methodology for how many beds or homes they project to be open with some sort of like how you book a plane, they assume people will drop off, which is true, some people have dropped off. that's where the 1,000 comes from. >> good. thank you. i'm looking at a client standpoint. we have a nice chain that's put together to integrate and understand the client, often it seems to me the client actually responds better if there is sort of an individual that they feel is their advocate or their person or their doctor or their -- is that how we're going
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to also be assigning that somebody will sort of be your key contact and someone that in case you go into crisis, have an issue where you would like to pick up the phone, there would be somebody they could talk to? there could be an individual assigned point person. >> yes, some of them are already engaged with an intensive case manager, some of them with case management through the h.u.d. team. so there is a commitment that we will have a street-to-home plan for 135 of them, go find them and find out what they really want and what their real needs are because we don't have enough information about them. that's where the high-intensity care team is critical to get those folks. the other folks, there is a commitment through the center agency that they will prioritize case management of some sort. so we have the navigation case
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managers who will help them navigate through it. if they have a higher case manager, this navigator might not be necessary. if they have an intensive case manager, that might be a different route for them. the idea is who is the person and how do they get from here to there. >> you have a two-pronged approach and some are already in a relationship with their case manager. you're thinking there are 135 that you really need to work with and decide what they need? >> right. >> very good. i guess lastly i'd like to know what we'd think would be a good way to be able to track how this is coming if this is such an important program. what would you all be suggesting in terms of a follow up and at the right time? do you think six months would be good to bring something back as to where we are? does that make some sense? >> we show up anywhere and talk
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to anyone about -- and we can talk for ever about it. >> okay. i'd leave that to staff to schedule. >> commissioner green. >> yes, thank you. this is incredible, the work you've done and the effort you've put into this, very optimistic. i was wondering whether you could tell us a little more -- kind of what commissioner chow was asking about when you think you'll be able to gather data. especially on some of your outcomes. for example, you can put people in housing, yet what's your benchmark for how long they stay there? i think that "new england journal" article said there was a pretty impressive percent that stay there one to two years. do you develop your targets in some of the areas you're looking for outcomes, targets for avoiding e.r. targets and quality of life. how long do you think you will
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get data and assessing the data. and correlating that with the center not opening for two years and with the staffing you may need to be successful as well as the physical placement for individuals. i gather the tipping point opportunity is great, but i'm not sure how all the timing of all that fits together. can you elaborate a little more on that? because it seems like you could be facing barriers with regard to the staff that could both give inadequate care for the patients as well as the placement. and then what about, given those things and the potential funding issues, where you think you'll be able to really give back information, you know, on your 237. we don't expect you to boil the ocean, but it would be interesting to know what you think. >> i would say that the 237 we will have the dashboard that
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they were creating in about a month. there's about 29 of the folks who have already been housed in it. so we are trying to, together, get them from here to there and figure out what is stopping them from getting from here to there. the real difference here is that health is showing up and saying that we are there to figure out how to get them services that -- it's a housing-first model, but is there something that they need before they can get in or after they get in to keep them there successfully. so i can't say -- one, we need to know more about the 135, but all the 237, except for three unfortunate folks who've already passed, all the 237 folks have had -- they say, i want housing. they showed up somewhere and
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said, i will answer your questions to try to get into housing. they are definitely motivated to get there, but they're also experiencing psychosis and they're not necessarily always regulated to be able to get from here to there. so we're trying to figure out how to do that and what level of care is needed to help them do that. i don't know if we can say right now that we're going to house all of them. certainly we have three months before we start and get reflective about is this the right approach to it. so i don't know that i can safely say how many of them will be housed. can i go so far to say half? maybe. did i answer all your questions? >> i'm curious to know more about the data you plan to gather, when you feel you might have some results. and again, whether you feel
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there will be barriers in terms of staffing and actually physical placement that might slow down your progress. >> so i think what you're getting at with the whole person care funding ending in 2020 and our target date to open the homeless health resource center, which will be the clinical home or hub of whole person integrated care, that will be in late 2021, so within the next year. i mean, what this really does is it -- i don't want to overuse the word "foundational," but it lays the foundation for us to be working together across clinical services to determine what the need is for people showing up to urgent care repeatedly, but they might have one of the street team members or the hot case
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manager working with them. what it does is brings people together to develop a care model so that they're actually coordinating care for these folks. we're starting now. we've already started this work, so we're already starting the case conferencing and then working across these existing clinical services with the whole person care team on the shared priority list. >> thank you. >> director cofax. >> i want to thank both dr. hammer and ms. martinez for their incredible work on this and just to emphasize that the literature shows that people suffering from these conditions with support and not as much support as some of us might think is necessary can be housed.
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i think one of the wonderful aspects of ms. martinez's leadership is she's brought in a number of researchers and clinicians from ucsf, several of them leaders in this field to bring in a health-based aspect to this work. this is an effort that's going to be saving lives going forward. i mean, the specific when we open hub and how that happens are important pieces. i want to emphasize we are doing this now and going forward. this is really a continuation of our modernizing our system of behavioural health care in response to data so we make the investments going forward to get those people in the housing and get them the wrap-around services we know they need. thanks. >> i wanted to add an example of that, commissioner green. so just as an example of this
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sort of working across previously disparate services is we have a psychiatric nurse-practitioner from the behavioural health access team who now basically has jumped and is embedded working with the street medicine team. that's just an example of bringing our staff together who all touch in different ways this patient population, these patients, these individuals -- they're not all patients, and connecting them to services. so he has in a expertise that he can assess people on the street and is an expert in access and how to access our services. >> so first of all, ms. martinez, dr. hammer, i would like to associate myself with the comments made by fellow commissioners about your excellent presentation. thank you. since you're nimble going back and forth on slides, i had questions on three of them
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starting with this slide here. i know our focus is on behavioural health and substance use disorders now, but noticing on the slide that 74% have a serious medical condition, 12% h.i.v./aids, 35% hypertension, 4% renal failure. skipping forward three slides to this slide here and looking at the coordinated entry assessment, i'm wondering at what point do these factors enter into prioritizing people for housing and other things? because as we know, housing stability contributes to better health outcomes, whether it's someone with h.i.v. and adhering to their regimen, blood pressure monitoring, sticking to a diet, those things are very important. does that come into the assessment tool at all? >> yes. >> and also skipping forward a few more slides to the outcomes, is there anything in the
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outcomes that you're measuring when it comes to health outcomes when it comes to these other conditions people have? >> good point on that last question. i would say that when i first looked at the coordinated entry assessment tool, i know all of the 6,000-some people who have been assessed and all the 1,000 of those people who were prioritized. so essentially what i did is i looked at what the data said. did they assess a pretty good representation mix of who we know are experiencing homelessness? yes, on every single count, the representation of the people in the jail, also the people who -- so like 25% of the general population have a jail history, about 25% of those assessed had a jail history. i looked at about 14 or 15 of those vulnerabilities, and all of them were very well represented with the exception of psychosis, and that makes
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sense. then i looked at who got prioritiz prioritized and it was significant higher. one of them was medical. so significant higher of those who did get prioritized showed up. so their tool is identifying through the questions they ask, which does ask about some medical conditions, are identifying and prioritizing them and the way we wish to see it with the exception psychoses, and we will be working with them. >> also, i believe i had seen a previous presentation getting to zero on this assessment tool. do i understand correctly you don't draw the curtain all the way back on what the criteria are because sometimes someone who's working with an individual client, for example, might coach answers to advantage somebody in the -- >> yeah, i think that there was a lot of suspicion around whether or not the tool asked the right question, did the right ranking, whatever. what i have experienced is that
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is sort of set aside. when i said no, i validated the -- how many people were assessed, representative, and their vulnerability, and i don't get those questions as much -- at all, actually. >> all right. thank you. >> so in terms of the impact on their medical stability, i think that it's pretty much assumed that we will be able to begin to address their medical conditions, but i think it's a good idea to measure the impact. >> i would like to see that. >> i don't want to bombard you with more questions, but i think it sounded to me like eventually you're going to set some indicators so that you know how to measure the progress of the program and it's hard to -- like, just being here and pull some numbers out of your head
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and saying this is the goal, so i totally understand that. i'm curious about how you will be integrating harm reduction philosophy into the program, because, as you mentioned, these are clients with lots of different behavioural health issues. some of them may need to access sobering center. even as they're housed, what type of housing would that be? that is another big barriers that a lot of them had challenges with is to stay sober while they're housed. if they're in facilities that are like only in the abstinence model, how are they going to be able to maintain? and also the other issue is how are they going to pay for the housing?
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i think that's the other issue that is commonly faced by this population which in my old days it was the program. if they don't have the money manager that sets the money aside, then it's really difficult for them to exercise their own independence because of some of the co-occurring issues that they're facing. >> so one aspect of the street-to-home plan for everyone will be around benefits. so we are talking to our ssic program that was set up in the mental health department so we can get these folks into s.s.i. advocacy so they can get the income that they need. i think the system response team which met again on friday is getting ideas and issues from
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the provider team that are working with the 237 and they're developing their street-to-home plan. that's getting in the way of them getting there could very well be that they need a level of care in housing that we don't yet have. so that's a recommendation. it could be that they need a service where there are not enough slots. that's a recommendation. it could be that we have slots, but being there tuesday at 4:00 p.m. just does not work for this -- so there could be very many things that are coming to that system response team of people who are going to say this is the way we need to proceed. so do we need a different kind of service or a different kind of housing that we don't have? a number of the people have sex offender histories where we can't -- so what are the hurdles and the challenges of getting
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people from here to there? we may not be able to solve all of them, but we are trying to figure out what we can empower the provider team to solve on their own, versus where they need someone to unjam that, versus what needs to come to grant in the health commission and think about long term. >> thank you. i think that's helpful. >> commissioner chow. >> yes, as we were looking at the serious medical conditions, i was just wondering how we were going to be connecting for -- these. i'm sure you're going to have substance abuse programs and psychiatric programs. there are clinics that would be managing some of the worst of the worst. what would be the connections
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that we would be doing or encouraging? would we actually be putting them into those or we're going to have this as sort of a self-contained medical system that's doing primary care and -- and i'm not sure then where some of the more serious issues requires secondary or tertiary consultation would come in. >> the integrated approach for whole person care is based on the work of the medical director of street medicine. what we've been working on is what he's termed a transitional primary care approach. so we have excellent brick-and-mortar primary care centers all over the cities, as you know. yet, these programs that we're bringing together as whole person integrated care are really built to serve the needs
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of people who are less likely to engage in that sort of traditional primary care model. so we see them in shelters, we see them in supportive housing sites, we see them on the streets or in urgent care. the goal is really to -- as we're engaging them and treating their whole person from things we didn't mention, dental, podiatry, as well as their chronic medical conditions, identifying what their needs are. and we have a lot of expertise in our system, figuring out what -- how we get them to the care that they need. so i have a lot of confidence in our ability to be innovative and creative in getting people into the care they need. as we started out by saying the first step is really engagement and a continuity relationship with a caregiver from this
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robust team. >> thank you. >> commissioners, other questions? >> i should also mention, i mean, we didn't talk much about -- there's a lot of work being done in h.i.v. and aids and taking the care to people experiencing homelessness. so i think we have a lot to learn from that team, the team that -- starting at positive health program ward 86, how can we take the care to the people who need it and then slowly engage them in ongoing primary care as well as specialty care. i think zuckerberg san francisco general, their specialty services are experts in providing that sort of care. >> i think actually it would be very interesting how with the director looking to see how it's best to engage so that we get
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them to accept care first and get them to be able to obtain the expertise that's needed to really improve some very complicated cases. that would be very interesting. thank you. >> item 8 is the human resources update. do you need any assistance getting the presentation up? >> let me take a shot at it here.
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>> good afternoon, commissioners. i'm the dphr director. i'm back with an update from the last presentation, and i believe it was in the spring. i had two people i was going to introduce to you, but they had to leave. one was rachael dan donju and then we have one analyst, his name is nick gonzalez and they helped me put together the data. competing with the priority of this data, we did a3 which we did for the employment engagement survey which i helped to put together. we were finishing up epic and we had to create 5,000 what they call people of interest. it was the people side of the
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system so they could use epic. then we finished the budget reconciliation. so this -- i'm comfortable with the data, but i know in the future, as we continue to do this, we can do better. all right. so the first thing we wanted to look at today was the employee engagement survey. what i wanted to point out about that was that in 2015 we did our first employee engagement survey. the response rate was 40%. so the response rate for this time around was 65%, which is a pretty incredible improvement. i'm very happy with that. the question is what do we do with the information now that we've got it? so if you had a chance to look
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at the a3, i want to talk just briefly about that. so this is explaining somewhat in create detail what we're going to do with the data. it's this document. i'm not going to get into the details of that, but this is one of the tools we'll be using to make sure we have actionable results regarding the employee engagement survey. the a3 is used in lean process improvement. it states the background, conditions, and has attainable count countermeasures and deliverables. so we've worked, we've published this, shared it with the divisions. then the divisions will come up with their own a3 regarding employee engagement. so our strengths were people like the work they do and people are comfortable referring to patients by whatever pronoun
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they request, even if it doesn't match their appearance. the top two areas we chose for improvement were different levels of the organization communicate effectively with each other was low and then adequate staffing was also low. but in the end, the ones we chose for the a3 were communication overall and equity. now, the reason we chose that was that as we looked at the results, we noticed that on the questions of trust and general respect and disrespect, that things were rated differently. on over 96% of the questions, african-americans gave the lowest percent of favorable scores compared to the rest of the organization. when it comes to the lowest scores, the values were, for example, employees from different becomes scored between
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77 and 68% on questions that african-americans averaged 49%. on trust and a work unit where others scored 49%, african-americans scored 41%. these numbers are concerning and we're working on it and taking it seriously. so the next steps for the employee engagement survey are, one, we are taking steps to ensure that the survey data is meaningful and analyzed properly and available. we'll be doing one-on-one meetings with divisions to ensure they can look at the data and creating a dashboard for their use as well. we have the one-on-one consultations. we're doing webinars. currently in the works is a letter to all staff about the survey, focusing on the areas that we talked about. and then developing for the next fiscal year, we're developing an
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effective communication training, which would be crucial communications and training along that line. then we go to hiring updates, which is another item we talked about. so we have -- what this shows is data for the d.p.h. workforce. this is 1920 reflect data to date. for fiscal year 2018-19, we see that we are trending in the directions that we had hoped. so we 7,678 employees. one of the things i noticed when i got here when i first did the demographic report, we wanted to increase the number of african-americans, and we did that going out to different conventions. so that's gone from 11.22% to
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12.12%. there's been a slight reduction in filipino employees or slight reduction in white employees. a slight increase in hispanic employees. and a slight rise in asian employees. so document two that i put in our packet which looks like this, so this in the years past we did demographic reports using pie charts -- in the past years we did demographic reports, so it would show by division, zuckerberg would show employees, asian, black, filipino, hispanic, and white. we were trying to see what does
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it look like. this is a more recent version of that and a little bit more detailed. it shows by unit that same sort of breakdown. so the idea with these in a division, they can look at these and say, okay, if we want to say match the 11 counties where we pulled our workforce from or match san francisco's demographics, then we need to make some adjustments to how we hire. that's what we would use this tool for and that's what we would ask managers to use the tool for. we can't set specific goals. that's not allowed. i believe it was -- i think it's not an initiative, but initiative 200 -- anyway, there was a lot that says you can't use this sort of information setting goals for hire. we can certainly use it as information. what we continue to do is have our recruiters reach out to
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areas where we need to improve. the other thing is to continue to get more involved in the hiring panels. what i'm finding is that it tends to be at the hiring panel level that we start to lose our diversity. even if we get them onto the list, as they go through the panel process, we tend to lose those diverse candidates. there's a couple remedies to that. the most drastic would be for us to say we're going to have an established panel of three h.r. people, a hiring manager, and a subject matter expert. you would have three constant interviewers that would take out a lot of that bias people have whether they know it or not. this line, again getting back to
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some of the things asked at the last presentation, this shows hiring in the various areas that we -- where we hire, and it shows it by fiscal year. so you've got central office, laguna, zuckerberg, and all of them overall, you can see the hiring, it's more or less constant. it went up and dropped, but it's fairly constant. you will see where some of the data on slides 9 and 10 don't match. commissioner green had some great questions which i responded to. i'm thinking i may use some of that information but i'll share that with you in the response because it's a lot of informati information. again, this shows that we are trending in the right direction. in terms of actually -- you know, i used to say it's a big
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ship and it takes a long time to turn it, but it looks like it is starting to turn in terms of we are starting to change the demographic. >> sorry to interrupt. can you tell me why we are counting filipinos separate from asians? >> because that's how they count it with the census data and that's how h.r. collects the information. >> so it's the h.r., how they collect information? >> right. >> so how do we define "asians" in here? like -- because filipino is a nationality -- >> yes. it's the only one they pull out. that is the only one they treat separately, and i don't know why that's done. >> okay. >> i can get you some more information on that -- >> yes, it's kind of unusual to separate the two groups. >> it is. >> because if you look at it and
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add them back together, asian and pacific islander, no offense to my own people, you're talking a really huge percentage of the workforce. >> right. so it's either on the census collection or how the e.e.o., the federal body, makes us collect it. for some reason they make us break it out. i will get you a more refined response, but that's what i recall. this slide, i wanted to show you the impact that epic had on hiring. if you look at that line that starts at 174 and it drops down to 72, that was due to epic. so we had a big drop in hiring. that was planned because we realized we had to stop orientations in july and august because there wasn't anybody to conduct the orientations. the trainers that we needed to train people to do epic were no
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longer available. we took a hit there, but we'll get it back on track. is a a lot of talk has been made about hiring times. i'm going to show you some of the work we did here. we did the initial 2014 value street mapping, trying to get hiring times up to where we think it should be. we did reduce hiring times from 330 to 253 over this period for the whole department, but that's still way too high. we did a new value stream mapping in june, and then we're doing these other lean exercises with the k.p.o. office to try to improve hiring. they're keeping us very busy, but we're intent to speed up the process. this question came up at the last presentation, and it's very
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jarring, as you can see. we are attempting to be very transparent. i have to say that when i got here three years ago, there wasn't anywhere near this transparency on this sort of information and i don't think i would have been standing up here sharing this because it just wasn't something that was done. now because i think of the government alliance on race and equity, we're seeing a lot more willingness to be transparent. i think it's not only the right thing to do, but important to do. this was a good question asked by the commission. this was our initial take at it. again, commissioner green had some questions and i do have some specific answers and i'll provide a little bit of that here in a minute. we're looking at of course continuing to do recruitment, continuing to help applicants in navigating our complex system and doing other work to try to
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improve this. some of the questions that were asked about this slide that i will answer is although it was based on working adults with two children, we're not assuming family size, but we used that just as a way to take some kind of an average. the medium household income in san francisco was $96,265. that was from the u.s. census bureau. so i think what we are trying to do right now is we're trying to do work in h.r. we're starting to look at pay equity. we've always looked at it, but never done it in a systematic way. looking at pay equity. one of the other things we looked at was this premium pay. so just to give you an idea of acting assignment, that's where you get a 5% pay differential if
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you work in a class higher than yours and it has to be a vacant position. so if i am gone and somebody steps into my position temporarily, they can get a 5% increase. supervisor differential, that is under most of the labor agreements, that means if i have people working for me that make more than i do, then the contract allows that i would get a little bit above what they make. these what these pay premiums are. there are others that we thought would be good because they have some degree of discretion. the manager gets to decide who they're going to put into those areas. so i would say with all of this information, this would be not the -- this is the beginning of looking at this information, not the end. so we still have a lot of work to do in looking at this.
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only 23% of the population are receiving the pay premiums. that's the kind of thing we will be looking at. this slide has to do with probationary releases and separations. a probationary release -- you can only be released from that position if you're -- a probation is for an employee who intends to become civil servant. only those category of employees can serve a probation. so a temporary employee cannot serve a probation. we had 173 black african-american staff that were hired in fiscal year 2018-19 and six of those released from probation. 33% of all the probation released in fiscal year 2018-19
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were african-americans and they are only 17% of the staff hired that year. so these are things that the county is looking at, the mayor is looking at, and we are looking at. this next slide is from -- this is from the county. this is their web page. this is the data they give to the mayor's office. they have specific definitions for how they view each of these categories of separation. so c.a. is corrective action and d. is discipline. so, for example, if there are 884 african-americans and 16 receive discipline, it's 1.8% of the total black population at dpah, whereas the white population is a little over double that 1866 and 16% received discipline which is only a smaller number of the
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population. because of the size of the population, the impact was greater on the african-americans. so with all of this, it's great that we have the government alliance on race and equity. we are trying to make all of this visible. again, what are you going to do with it? some of the things we're going to do to address this is offering mentoring, targeted coaching to lower [ indiscernible ] -- classifications, mandatory training for managers, and training on effective communication and working on dashboards. the other thing is that starting about eight months ago, a policy was instituted that i have to review all separations because i wanted to make sure that they are adequately documented. i rejected some. i actually brought one employee back to work because they had gone through and terminated somebody without my knowledge.
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we've got to put more checks and balances in place. i'm serving right now as a check and a balance, but i really don't have the capacity to do the amount of that that we should. it shouldn't just be for terminations. it should be for more than that. i'm looking at setting up some kind of a system where we have a review done by a panel or some other review by more than just the manager and a labor relations person. one of the commissioners at the last meeting asked about feedback on the brown bags and the training we're doing. the staff take the feedback from those summaries and they were able to provide feedback. as you can see the trainings are generally very well received, 80%, 90% ratings. staff seem to really appreciate those trainings. they also added new trainings
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which i've listed here. i would say that just before we close that both -- that h.r. is working with anna and she is working with equity. it is a partnership. we have a key role because we control what we need to make things fair is in our realm, but she provides a lot of information for us. i think a lot of this is reflective of bias and racism. the only way to do it is be transparent about it and call it out and address it. that is my goal to do that. i get the sense from the commission that you have the same goal. with that, i will take any questions you have. >> i have not received any public comment requests, commissioners. >> commissioners, questions? dr. chow. >> i'm trying to understand the
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disciplinary data chart, and that's probably because i don't understand which way the discipline is going. so we just take -- i guess d.p.a.s you have a big arrow, and we come all the way across to female and male. it tells me we have 69% are female employees and 33% are male. what does the next line tell me, that 63% got disciplined? i don't think i'm reading the chart correctly. >> i think -- i don't -- no. again, this is a city slide, but that is the total population of d.p.h., i believe.

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