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SF Health Network
Rebuild San Francisco
General Hospital & Trauma Center

Synopsis of Long Range Service Delivery Planning Process

In January 2002, the Lewin Group was retained by the San Francisco Department of Public Health to assist with Long-Range Service Delivery (LRSD) planning for SFGH.

An essential component of the planning was the broad inclusion of the many diverse stakeholders who would be impacted by the rebuilding of SFGH. To maximize participation, two planning groups (see planning member lists below) were established to help guide the consultants work:

  • An internal SFDPH Committee including SFDPH and University of California, San Francisco (UCSFMC) clinicians, administrators, policy makers, health commissioners, and academicians, and
  • A 45-member community group including community leaders, neighbors, patients, representatives from other hospitals and CBO’s, academia, church groups, neighbors, labor, housing advocates, the Mayor’s Office, various Supervisors’ Offices, UCSFMC, and other local community groups.

The role of these planning committees was to provide information and feedback to the consultants in helping to formulate the program recommendations for the rebuilding of SFGH.

In addition, over 50 interviews were conducted with key stakeholders to gain a greater understanding of the local health care environment and perceptions regarding the current and future role of SFGH. These included:

  • Individual interviews with opinion leaders and representatives from other hospitals, government, academia, and community-based organizations.
  • Focus group interviews with health professionals from the: Emergency Department/Trauma, Operating Room/Surgery, Intensive Care Unit/Coronary Care Unit, Obstetric/Gynecology, Pediatrics, Mental Health, Substance Abuse, Long Term Care, General Medicine, Hospital-based Primary Care, Community-based Primary Care, Specialty and Diagnostic Care and Social Services.

The planning process was guided by several important considerations:

  • There are a number of "givens" and assumptions regarding the role of SFDPH and SFGH in meeting community needs that are widely accepted and understood.
  • There also are numerous open questions and choices that have significant implications for the size and scope of programs to be operated by SFDPH at SFGH. Identifying, analyzing, and discussing these choices have been major endeavors of the LRSD effort.
  • The choices (and consultant recommendations) should be guided by the desire to achieve goals that reflect the mission of the San Francisco Department of Public Health, including:
  • Improving access to care
  • Improving quality of care
  • Meeting future health care needs
  • Implementing best practices
  • Advancing knowledge and health professions training
  • Conserving capital resources and the City’s debt capacity
  • Operating health and public health programs efficiently
  • Meeting the SFDPH Strategic Goals
  • Responding to SB 1953, the Hospital Seismic Safety Act and other regulatory requirements
  • The choices (and consultant recommendations) resulting from the LRSD planning process will continue to be examined and refined through the recommendations of the Health Commission at joint conferences and at the full meeting and during upcoming Institutional Master Planning process, discussions with UCSFMC and the San Francisco community, and through financial analysis that would further inform decision making.
  • The rebuilt SFGH would not be open to receive patients for ten years, given current construction, decision-making, financing, and regulatory requirements.
  • The choices and recommendations described herein will continue to be informed through monitoring developments in the San Francisco and Bay Area health care market, such as changes to area hospital capacity, the clarification of other hospitals’ plans to respond to SB 1953 requirements, and evolving community needs.

Assumptions

Early in the LRSD planning process, the following givens and assumptions were discussed:

  • The SFDPH will continue to operate and maintain a full-continuum of public health and health care programs, including hospital care, long-term care, behavioral health, hospital and community-based ambulatory care.
  • SFGH will continue to maintain a critical safety net role in San Francisco.
  • Problems such as homelessness, mental illness and substance abuse, high numbers of uninsured residents, the need to provide health care for incarcerated individuals and trauma and injuries will not be solved within the foreseeable future.
  • SFGH needs to be rebuilt to comply with the requirements of SB 1953. Skilled nursing beds, acute psychiatry beds, and selected ambulatory care programs are not included in this requirement.
  • SFDPH and SFGH will continue its 100-year affiliation with UCSFMC, which provides clinical, education, and research programs.
  • SFDPH will continue to operate a trauma service at SFGH.
  • Resources are limited – both to finance the rebuild of SFGH and for the ongoing operation of SFDPH.
  • The current SFGH facilities have several deficiencies that can be addressed through the rebuild program, such as parking, access to ambulatory care programs particularly for the disabled and elderly, lack of sleeping areas for interns and residents, cramped quarters for the Emergency Department, and significant need for patient transport within the buildings.
  • The rebuilt SFGH should incorporate a flexible design to accommodate new technologies as they emerge and the ever-evolving practice of medicine.

While these givens and assumptions generally were accepted by planning participants, other issues and choices required significant discussion and analysis.

Choices

The LRSD planning process focused on addressing the following questions that reflect the choices that will need to be made before a bond measure and Institutional Master Plan can be developed:

  1. Should all or major components of SFGH be collocated with programs operated by UCSFMC Medical Center?
  2. Which site options for the SFGH rebuild should be pursued?
  3. How should SFGH’s Behavioral Health services be configured?
  4. How should SFDPH ambulatory care programs be configured?
  5. Should SFDPH seek to increase volume for the trauma service?
  6. Should SFGH increase the physical capacity available for the Emergency Department?
  7. Should SFGH develop programs and services to retain and attract elderly patients?
  8. Should the SFGH rebuild assume the continued provision of inpatient pediatrics and obstetrics services or should beds be consolidated with another San Francisco provider?
  9. Should the SFGH rebuild include skilled nursing beds in new space?

Based on interviews and meetings with SFDPH and community representatives, data analysis, and expert judgment, the Lewin Group has developed recommendations that address these important questions and choices. These recommendations and their implications for the size and scope of the SFGH rebuild were presented in a Final Report to the Health Commission on July 16, 2002..



PLANNING MEMBERS

Long Range Service Delivery
SFDPH Internal Group Members

NAME

TITLE / ORGANIZATION

Bindman, Andy (M.D.)

Chief, Division of General Internal Medicine, SFGH

Cabaj, Bob (M.D.)

Medical Director, Community Mental Health Services

Chow, Ed (M.D.)

President, Health Commission

Currin, Sue

Chief Nursing Officer, SFGH

Darney, Philip (M.D.)

Professor & Chief of OB/GYN & Reproductive Services, SFGH

Funk, Larry

Executive Administrator, Laguna Honda Hospital

Garcia, Barbara

Deputy Director of Health, Director of Community Programs

Goldenson, Joe (M.D.)

Director, Jail Health Services

Grumbach, Kevin (M.D.)

Chief, Family & Community Medicine, SFGH

Hill, Terry (M.D.)

Medical Director, Medicine, Laguna Honda Hospital

Holland, Martin (M.D.)

Chief of Neurosurgery, SFGH

Hopewell, Philip (M.D.)

Associate Dean, UCSF School of Medicine

Jacobson, Susan

Executive Director, SFGH Foundation

Kanaley, John

Associate Administrator, Director of Support Services, SFGH

Katz, Mitch (M.D.)

Director of Health, Department of Public Health

King, Talmadge (M.D.)

Chief of Medicine, SFGH

Klain, Judith

Policy/Planning Analyst, CHN Planning

Kronenberg, Anne

Director, External Affairs, SF Department of Public Health

Mackersie, Bob (M.D.)

Chief of Trauma Services, SFGH

Navarro, Renee (M.D.)

Chief of Staff—Elect, SFGH

O’Connell, Gene

Executive Administrator, SFGH

Okin, Bob (M.D.)

Chief, Psychiatry, SFGH

Olson, Michelle

Commission Secretary, Department of Public Health

Paiement, Guy (M.D.)

Chief of Orthopedic Surgery, SFGH

Partida, Jorge (M.D.)

Director of Community Substance Abuse Services

Perez-Arce, Patricia (Ph.D.)

Primary Care Administrator, Primary Care Services

Ring, Ernest (M.D.)

Chief of Radiology, SFGH

Sass, Gregg

CHN Chief Financial Officer

Schecter, William (M.D.)

Chief of Surgery, SFGH

Taeusch, William (M.D.)

Chief, Pediatrics, SFGH

Wachsmuth, Chris

Associates Hospital Administrator, SFGH

Wagner, Anthony

Executive Administrator, Hospital Systems

Zmuda, Monique

DPH Chief Financial Officer

 

Long Range Service Delivery
Community Group Members

NAME

TITLE / ORGANIZATION

Bierman, Sue

Former city supervisor

Bridges, Leona

Managing Director of the Capital Markets Group, Barclays Global Investors

Burgess, Ollie

Chair, Southeast Community Advisory Board

Bustos, Miguel

Executive Director, California Latino Civil Rights Network

Clyde, Janet

Past Consumer/neighbor, Small business owner

Cruz, Larry

President, Board of Director, Bernal Height Neighborhood Center Housing Corporation

Derzon, Bob

Consultant and first HCFA Administrator

Emery, Rae Ann

East Mission Neighborhood

Fiore, Kyle

Mission Planning Council

Fraser, Jean

Chief Executive Officer, San Francisco Health Plan

Gressman, John

President and CEO, San Francisco Community Clinic Consortium

Hansen, Jennie Chin

Executive Director, On Lok Senior Health Services

He, Sarah

Representative from Supervisor Sophie Maxwell's Office

Jacobson, Susan

Executive Director, SFGH Foundation

Johns, Lucy

Independent Consultant, Healthcare Planning & Policy

Johnson, Walter

Secretary--Treasurer, San Francisco Labor Council

Jones, Calvin Reverend

Senior Pastor of Providence Baptist Church

Kinchley, Ed

Member, Coalition to Save Public Health

Licwinko, Mary Lou

Executive Director, San Francisco Medical Society

Low, Julian

Analyst, Mayor's Budget Office

Magid, Cheryl

Health & Nutrition Manager, Childrens Council of S.F.

Martin, Dan

President, SEIU -- Local 250

Milton, Eve

Consumer

Mori, Sandy

Development Director, Kimochi, Inc.

Nayman, Nathan

Executive Director, Committee on Jobs

Parker, Derek

Senior Principal, Anshen+Allen

Petrie, Michael

Administrator, Emergency Medical Services

Portillo, Nerdy J.
Revilla, Edisa G.

Representing Sonia Melara, Executive Director, Arriba Juntos

Roe, Faye

SEIU--Local 790

Sandlin, Gladys

Executive Director, Mission Neighborhood Health Center

Scully, Arlene

Representative from Supervisor Tom Ammiano's Office

Snelgro, Evelyn

Retired Employee/SFGH City and County of San Francisco

Thomas, Michael

Associate Director, Strategic Development, UCSF Medical Center

Vernick, Jonathan

Executive Director, Baker Places

Williams, Bruce

Program Director, San Francisco Planning & Urban Research Association

Wong, Sophie

CEO, Northeast Medical Services

Woo, Kent

Executive Director, NICOS Chinese Health Coalition

Yant, Abby

Senior Director of Ambulatory Care Services, Saint Francis Memorial

Yorker, Beatrice Anne Crofts

Director and Professor, School of Nursing, San Francisco State University