Minutes of the Health Commission Meeting
Tuesday, December 4, 2001
1) CALL TO ORDER
The Health Commission meeting was called to order by Vice President Edward A. Chow, M.D., at 3:10 p.m.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF NOVEMBER 20, 2001
Action Taken: The Commission (Chow, Jackson, Monfredini, Parker, Sanchez, Umekubo) approved the minutes of the November 20, 2001 Health Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(3.1) CHN-Strategic Planning - Request for approval of a new contract with The Lewin Group to develop a long range service delivery plan for the Community Health Network, in the amount of $350,000, for the period of January 1, 2002 through June 30, 2002.
(3.2) CHN-SFGH/Pharmacy - Request for approval of a contract modification with Pharmaceutical Care Network, in the amount of $1,500,000, for pharmacy benefits management services targeting CHN indigent clients, and to shorten the contract duration to 15 months ending March 31, 2002, for a total contract value of $9.9 million.
(3.3) CHN-Primary Care - Request for approval of a retroactive multiyear contract renewal with the John Stewart Company to provide fiscal agent services, in the amount of $89,844 per year, for a contract total of $359,376, for the period of July 1, 2001 through June 30, 2005.
(3.4) PHP-Housing - Request for approval of a new retroactive contract with Tenderloin Housing Clinic, in the amount of $200,000, to provide community programs, tenant outreach and tenant stabilization services, for the period of August 1, 2001 through June 30, 2002.
(3.5) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Chemical Awareness and Treatment Services, Inc. (dba Community Awareness and Treatment Services, Inc.), in the amount of $3,108,249, to provide various substance abuse treatment services, for the period of July 1, 2001 through June 30, 2002.
(3.6) PHP-Substance Abuse - Request for approval of a retroactive contract renewal with Horizons Unlimited of San Francisco, in the amount of $1,163,501, to provide day treatment, outpatient and prevention substance abuse treatment services, for the period of July 1, 2001 through June 30, 2002.
(3.7) PHP-Mental Health - Request for approval of a retroactive contract renewal with Jewish Family and Children’s Services, in the amount of $1,129,842, to provide outpatient mental health services to children and youth from the former Soviet Union and consultation to childcare providers and children in childcare, for the period of July 1, 2001 through June 30, 2003.
(3.8) PHP-Mental Health - Request for approval of a retroactive contract renewal with Westside Community Mental Health Center, Inc. in the amount of $5,042,493, to provide various mental health and fiscal intermediary services for the period of July 1, 2001 through June 30, 2002.
(3.9) PHP-Mental Health/Substance Abuse - Request for approval of a retroactive contract renewal with Family Service Agency of San Francisco, in the amount of $5,434,911, to provide children’s mental health, adult care management, geriatric, substance abuse and fiscal intermediary services, for the period of July 1, 2001 through June 30, 2002.
(3.10) PHP-AIDS Office - Request for approval of new FY 2002 Federal Centers of Disease Control and Prevention contracts, for a total of $6,844,978, for the period of January 1, 2002 through December 31, 2002 for services awarded through RFP 017-01, Targeting Defined Behavioral Risk Populations, with the following agencies:
Action Taken: The Commission (Chow, Jackson, Monfredini, Parker, Sanchez, Umekubo) approved the consent calendar of the Budget Committee, with Commissioner Jackson abstaining on Item 3.8.
Commissioner Chow expressed the Commission’s heartfelt sympathy for President Roma Guy and her family for the loss of President Guy’s mother.
4) DIRECTOR’S REPORT
Substance Abuse and Mental Health Services Administration (SAMHSA) Grant
Community Mental Health Services (CMHS), has been awarded a three-year SAMHSA $1.2 million grant, "Transgender Life Care". The goals of the project are: 1) To develop and implement sensitive mental health services at a primary health care setting for MTF transgenders with co-occurring multiple problems; 2) To build service networks among community collaborators in order to assure appropriate assessment, treatment, evaluation, and referral services for the targeted transgender community; and 3) To expand existing community outreach efforts to MTF transgenders.
The project will be conducted by a broad coalition including the Castro Mission Health Center; Health Studies for People of Color (HSPC), Center for AIDS Prevention Studies (CAPS), University of California San Francisco (UCSF); Walden House substance abuse treatment services; four AIDS Service Organizations (ASOs) providing transgender specific programs; and consumers. Wayne Clark, Ph.D. is the Principal Investigator.
Children and Youth DV FREE
On November 15th and 16th, Children and Youth DV FREE, a project of the Community Health Education section, provided training to 20 youth and their service providers. The training, targeted to Asian and Pacific Islander San Franciscans, focused on popular education and community organizing strategies that can be used to change youth attitudes and values regarding intimate partner violence.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF DECEMBER
Commissioner John Umekubo presented the awards to the following persons.
6) ANNUAL REPORT OF SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER (FY 2000-2001)
Gene O’Connell welcomed the Commission to the hospital. Ms. O’Connell stated that she sees San Francisco General Hospital Medical Center (SFGHMC) as having three separate but integrated parts: it is the only level one trauma center in the Bay Area; it is the only psychiatric emergency center in the city; and a mental health rehabilitation component. The hospital’s vision is to be the best public hospital in the country. The presentation was organized to show how the hospital is meeting the Health Department’s Strategic Plan goals.
Goal: San Franciscans have access to the health services they need, while the Department emphasizes services to its target populations. 91,693 unduplicated patients are served by SFGHMC each year. SFGHMC is the community hospital for this area. 49 percent of patients come from the neighborhood surrounding the hospital. The data indicates that all the efforts to link patients to a primary care provider are working.
Goal: Reduce inappropriate institutional care and approve patient flow. Ms. O’Connell stated that this goal has received the most emphasis, and described the following activities:
She stated that the continued challenges to meeting this goal are that actual census continues to exceed budgeted beds, and there is a lack of appropriate, available community placement.
Goal: Ensure that CHN continues its vital role. Ms. O’Connell highlighted the work done around trauma services and disaster planning. This past year, the Trauma Nurse Practitioner program was instituted, and three nurse practitioners were added to the trauma team. She recognized the work of the San Francisco General Hospital Foundation, which raised over $650,000 during its trauma campaign. With regard to disaster planning, SFGHMC held Earthquake Preparedness Month, and Earthquake Safety Fair and a SFGHMC disaster exercise, and the hospital is participating in the Metropolitan Medical Response System.
Goal: Improve Integration of Physical and Behavioral Health Services. The hospital has emphasized increased collaboration with Mental Health, Substance Abuse Services, and community-based programs, and she highlighted the OZANAM program that was started last year. OZANAM is a 20-bed medically assisted detoxification community-based program. She said that through this service, the hospital is really able to have linkages with community-based service. Another example of furthering this goal is methadone expansion. This was a priority last year, and they where able to increase the slots from 265 to 380, a 43 percent increase. She then discussed the Medical-Behavioral unit on 5C, which allows a cohort of patients to receive integrated services, and highlighted the extremely successful Mental Health Rehabilitation Facility.
Goal: Disease and injury are prevented. Ms. O’Connell highlighted breast cancer services and injury prevention. The San Francisco General Hospital Foundation had a successful fundraising campaign to improve breast cancer services, and SFGHMC successfully completed the accreditation survey and MQSA inspection for mammography. In October 2001, the CDC awarded $4.5 million to the San Francisco Injury Center at SFGHMC to continue its work on injury prevention for five more years.
Goal: Cost efficient and resources are maximized. The hospital is meeting its budgeted FTE per bed. In addition, they have decreased inpatient “bill hold” which has resulted in lower accounts receivable and higher cash flow.
Goal: Address Infrastructure Needs of the SFGHMC campus. Various planning efforts are underway, including long range service delivery planning, DPH/UCSF collocation exploratory planning, UCSF chancellors long range development plan SFGHMC subcommittee, SFGHMC Institutional Master plan and the SB 1953 compliance plan.
Goal: Improve recruitment, retention and training. A Nursing Retention and Recruitment Committee has been formed to develop a retention plan that will guide the hospital in addressing nursing workforce issues over the next several years.
Goal: Partnerships with community. Ms. O’Connell discussed Health at Home, and said that without their work, patients would not be discharged in a timely manner. She also highlighted the collaboration with UCSF, and emphasized that their relationship with UCSF is a true partnership, and that everything presented as part of the Annual Report reflects this collaboration.
Ms. O’Connell then summarized the next steps:
7) ANNUAL MEDICAL STAFF REPORT (FY 2000-2001)
J. Renee Navarro, M.D., Chief of Staff, SFGHMC, presented the Annual Medical Staff Report, and highlighted some of the activities that have taken place over the last year. Dr. Navarro stated that Dr. Philip Hopewell could not be at the meeting, but his comments have been incorporated into her presentation. She stated that there are 20 clinical departments at the hospital. She also previewed some of the bylaw amendments that the medical staff hopes to bring forward in February. She then described the medical staff composition, and the number of new appointments, reappointments and resignations over the past year. She highlighted three new programs that were developed last year. First, the medical direction of the trauma program was formalized, and in July the first Trauma Program Medical Director was hired. Second, trauma nurse practitioners were added. Third, the Traumatic Brain Injury program was established, with the goal of improving the care of the neurotrauma patient. The SF Airport clinic program was discontinued and transitioned to Catholic Healthcare West.
Dr. Navarro then discussed various performance improvement activities that were done last year by Internal Medicine, Family and Community Medicine, Community Primary Care, Radiology and Obstetric, Gynecology and Reproductive Services, including the very unique Orientation Clinic program that was developed by Internal Medicine for GMC new patients and the Pediatric Asthma Clinic that was established by Community Primary Care.
Dr. Navarro then described the resident training program. 820 residents rotate through SFGHMC per year; 209 per month. Attending physicians provide operational oversight of residents. There is an oversight committee to ensure that each department is following the mandate that residents work no more than 60 hours per week. Dr. Navarro stated that $80 million of research is performed by UCSF faculty members at San Francisco General Hospital.
Dr. Navarro concluded her presentation with a summary of medical staff next steps:
8) SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER POLICIES AND PROCEDURES: HOSPITAL PLAN FOR THE PROVISION OF PATIENT CARE; PERFORMANCE IMPROVEMENT AND PATIENT SAFETY (PIPS); AND UTILIZATION MANAGEMENT
Sue Currin, Chief Nursing Officer, reviewed some of the changes in the Hospital Plan for the Provision of Patient Care policy. The plan describes patient care services, and is based on identified patient needs. The bulk of changes are in Section XIII-Care of Patients section of the plan. The plan focuses on the entire flow of the patient, from before admission to before and during discharge. This document serves as a general outline of how patient care is delivered, and staff is always looking at ways to make this more efficient.
John Luce, M.D., Medical Director for Quality and Utilization Management, discussed changes in JCAHO standards concerning patient safety and reduction of medical errors. Revisions to the previous Quality Improvement program have been made to include these new requirements. One such revision was changing the name of the committee to the Performance Improvement and Public Safety Committee (PIPS), to reflect the new JCAHO terminology. The goal of the committee is to promote a culture toward proactive efforts to reduce errors and reporting of medical errors and adverse events in a manner that has not been done before.
Dr. Luce then discussed the communication pathways and reporting structure. The PIPS Committee, and in turn the Medical Executive Committee and the governing body, receive information about unusual occurrences, clinical risk indicators, adverse drug events and a number of other things from a variety of sources. The PIPS Committee identifies issues and makes recommendations to the Medical Executive Committee. They are instituting an on-line “unusual occurrence” system. The PIPS Committee is responsible for selecting at least one process annually for proactive risk assessment, and that adverse drug reactions has been selected for review in 2002. There are no significant changes to utilization management.
Action Taken: The Commission (Chow, Jackson, Monfredini, Parker, Sanchez, Umekubo) approved the San Francisco General Hospital Medical Center Policies and Procedures: Hospital Plan for the Provision of Patient Care; Performance Improvement and Patient Safety (PIPS); and utilization management.
9) SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER PERFORMANCE IMPROVEMENT REPORT
Hiroshi Tokubo, Director of Quality Management, CHN, presented the Performance Improvement Report. JCAHO requires the governing body to play a role in promoting performance improvement activities and initiatives, which is done through the Joint Conference Committee. Mr. Tokubo highlighted three performance improvement projects that were undertaken last year.
Advance Directives. Mr. Tokubo stated that hospitals are required to provided information about Advance Directives upon admission and document that this has been done. Mr. Tokubo stated that overall compliance increased from 82 percent to 88 percent, which is a remarkably high compliance rate.
Infection Control. Mr. Tokubo said that a two-part audit was done. One part was generic to all units and one was unit-specific.
Patient Satisfaction. SFGHMC voluntarily participated in PEP-C, a three-year survey of patients post-discharge. There were a number of strengths and improvements gleaned from this report. One finding was that after discharge, patients thought they had inadequate information about when they could resume normal activity, what indicated they needed to call the doctor, etc. As a result, staff very quickly developed and instituted new Patient Discharge Instructions.
10) SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER ANNUAL COMPETENCY REPORT (FY 2000-2001)
Rod Auyang, Human Resources Manager, presented the 2000-2001 Annual Competency Report, which insures the competency of all staff involved in providing care to patients and residents. The report identifies training needs and evaluates the effectiveness of the competency program. Competency is assessed by conducting annual performance appraisals and successful completion of required courses and training. Mr. Auyang stated that after receiving a deficiency during the 1999 JCAHO survey for not completing performance appraisals in a timely manner, SFGHMC Executive Committee charged a CQI task force to evaluate the organizational effectiveness of the performance appraisal system. This resulted in a redesigned and simplified evaluation tool. In FY 2000-2001, 98 percent of performance appraisals were completed in a timely manner. Of the 2,755 employees who were assessed in a timely manner, 47.5 percent “exceeded standards” and 51.2 percent “met standards.”
With regard to medical staff competency, all physicians who practice at SFGHMC are evaluated during initial appointment process and every 2 years thereafter. For FY 00-01, 591 physicians were granted privileges through the initial appointment or reappointment process. Registry staff is also evaluated. Volunteers’ performance is assessed jointly by SFGHMC department and the executive director of the Volunteers to San Francisco General Hospital.
Mr. Auyang then described the education and training accomplishments for FY 00-01 as well as the educational needs assessment. He then discussed next steps:
11) SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER ANNUAL ENVIRONMENT OF CARE REPORT (FY 2000-2001)
John Kanaley, Senior Associate Administrator, Support Services, presented the Environment of Care report. There are seven disciplines within the Environment of Care: safety management; security management; emergency preparedness; medical equipment management; hazardous materials and waste; life safety management; and utility management. With regard to security management, overall crime statistics at the campus continue to decrease, but staff perception of their security is low. A pilot program to transfer DPH Institutional Police to the Sheriff’s Department will be implemented. He discussed the hospital’s emergency preparedness activities, and said that communications remains the biggest obstacle in preparedness. Mr. Kanaley highlighted key programs, including the development of an Asset Management Program to plan for obsolescence and replacement of equipment.
Mr. Kanaley highlighted significant life safety and utility management concerns. The JCAHO standards for life safety assess the building based on 1999 standards. The building was built in the 1960s. The staff is developing a compliance plan. The second issue is the Power Plant, which has the following significant concerns:
The Mayor’s energy program is funding the replacement through the Public Utilities Commission.
Mr. Kanaley said the third significant issue is the underground storage tank.
12) SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER SB 1953 COMPLIANCE PLAN
Carlos Villalva, Chief Architect for SFGHMC, presented the SB 1953 compliance plan. SB 1953 concerns the seismic safety of two buildings on the SFGHMC campus: main campus-all acute care functions; and service building - central power plant. The compliance plan, which is due by January 1, 2002, requires an outline of the corrective actions to be taken, and a timetable by which work will proceed. The compliance plan can be amended if necessary until July 1, 2004. Mr. Villalva stated that they anticipate submitting an amended plan after the various planning processes are complete.
Mr. Villalva summarized the various timetable deadlines: life safety work by 1/1/2002; extension request by 1/1/2003; upgrade the Service Building by 1/1/2008; build new acute care facility by 1/1/2013; additional seismic work by 1/1/2030.
Multiple planning processes are in process to determine the best solution for San Francisco, as follows:
Several critical decisions will occur during calendar year 2002 such as the number and types of hospital beds, range of services to be housed in the new facility versus other sites, location of the new facility at SFGHMC or Mission Bay and the cost of proposed project to the city.
13) APPROVAL OF SAN FRANCISCO GENERAL HOSPITAL MEDICAL CENTER GOVERNING BODY BYLAWS
Kathleen Murphy, Deputy City Attorney presented the amendments to the bylaws. The bylaws set forth the duties and responsibilities of the governing body. These include receiving and acting on recommendations for the Executive Administrator and the Medical Executive Committee. There is a new JCAHO standard that calls for the hospital administrator to be selected based on specific criteria, so this is included in the Bylaws. Ms. Murphy discussed the JCAHO standards of Governance. There are two types of changes. One is to reflect changes in practice. The most noticeable example is the change in administrative reporting structure reflecting current practice and the fact that the Joint Conference Committee is now, after Sunshine Ordinance, open to the public. The second type is to update the language in accordance with current JCAHO requirements and jargon.
Action Taken: The Commission (Chow, Jackson, Monfredini, Parker, Sanchez, Umekubo) approved the San Francisco General Hospital Medical Center Governing Body Bylaws.
14) PUBLIC COMMENTS
The meeting was adjourned at 6:10 p.m.
Michele M. Olson, Executive Secretary to the Health Commission