Summer Bridge 2015 - San Francisco Health Network

Summer Issue
Vol. 01 No. 04
August 2015
e
h
T
BRIDGE
news from around the SF Health Network
We are the San Francisco Health Network
IN THIS ISSUE:
Way Forward Metrics pg 6
New Hospital Opening pg 14
Medical Respite Expansion pg 18
Staff of the Castro Mission Health Center
Castro-Mission Health Center: 50 Years of Service
“Castro-Mission Health Center feels
like home to patients and staff” said
Laurie Lenrow, Mental Health
Manager. Multiple generations of
families receive care and have found
a safe haven at Castro-Mission
Health Center (CMHC), including
communities who felt unwelcome
elsewhere. Staff share a sense of
pride in their ability to provide long
term, culturally competent care to a
diverse patient population.
address the impact of segregation,
racism, and poverty. This led to
the launch in 1965 of such nationwide programs as Head Start,
Medicaid and Medicare. Here in San
Francisco the creation of CMHC was
part of the president’s proclaimed
goal of eliminating poverty and
racial injustice. To this day, through
50 years of shifts in resources and
community needs, the same values
imbue the work of the clinic.
The health center was established
in 1965 following a remarkable
turn of events in U.S. history
with the government’s ‘War on
Poverty’ raising awareness of issues
affecting marginalized people, and
allocating significant funding to
CMHC has always worked hard
to stay attuned to the needs,
expectations and preferences
of our patients. Originally called
“Health Center 1,” in the early days
it hosted a TB clinic, dental services,
women’s clinic, children’s clinic,
» CONT, PG. 4
CONTENTS
CASTRO MISSION 50 YEARS................. 1
MESSAGE FROM BARBARA ................. 1
ROLAND’S REPORT.............................. 1
SCENES FROM THE NETWORK..........2-3
NETWORK NEWS..............................6-7
COMPLIANCE CORNER......................... 9
MANAGED CARE ............................... 11
BEHAVIORAL HEALTH ....................... 12
SF GENERAL..................................13-14
UCSF AT SFGH ................................... 15
LAGUNA HONDA................................ 16
MATERNAL, ADOLESCENT, CHILD...... 17
TRANSITIONS.................................... 18
JAIL HEALTH...................................... 19
POPULATION HEALTH...................20-21
CENTRAL ADMINISTRATION.........22-24
SHOUT OUTS.................................25-26
1
A MESSAGE FROM BARBARA
Black/African American Health Initiative
In our work at the health
department, we know there are
many manifestations of historic,
and current, racial inequality in
our society that impact health
» continued, PG.8
Roland Pickens, Director SFHN
ROLAND’S REPORT
Time of Big Changes
This issue of the Bridge finds us at
a very active time in the Network,
with many changes afoot. A
significant one took place at San
» continued, PG. 10
Scenes from around the sfdph
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❶ Clinicians at Tom
Waddell Urban Health
❷ Larkin Street staff
gather around Michael
Baxter’s memorial plaque
❸ Medical Respite and
Sobering Center staff in
their lovely garden
❹ Eligibility staff from Tom
Waddell Urban Health❺
Welcome board at Cole
Street Clinic ❻ Summer
YouthWorks interns with
social worker Steve Gomes
PRIDE 2015
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❶ Thousands gather Friday, June 26 at City Hall to celebrate the historic marriage equality
decision by the US Supreme Court. #Lovewins ❷ SFDPH staff from many divisions took part
including Applied Research, Epidemiology, and Surveillance, Bridge HIV, Center for Learning and
Innovation, Communications, Community Health Equity and Promotion, Disease Prevention and
Control, Environmental Health, Family Mosaic, Fiscal and Budget, HIV Health Services, Office of
Contracts Management and Compliance, Office of Equity and Quality Improvement, Potrero Hill
Health Center, and San Francisco General Hospital. ❸ The DPH truck was a sight to behold, and
was loaded with condoms, information and staff to hand everything out along the parade route
❹ Our group included dancers and musicians from Maracatu Pacifico Group and Halima Mahdee
which secured us the “Most Fabulous Musical Contingent” award in the parade. ❺ The dancers
❻ L to R: Tracey Packer, Director of Community Health, Equity and Promotion, Wonder Woman
and Dr. Susan Philip, Director of Disease Prevention and Control.
3
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PRIMARY CARE: 50 YEARS OF SERVICE
(continued from page 1)
family services, and housed the
home-visiting Public Health Nurses
and the Environmental Health Food
Safety Inspectors. For decades all
of the clinic’s services have been
bilingual in Spanish and English.
Retired Dr. Fred Strauss recalls
working as a physician in 1984
providing physical exams to gay
men in the area: “At that time it
was unknown why gay men were
coming down with a very rare
cancer, Kaposi’s Sarcoma, and a
rare lung infection, Pneumocystis
Pneumonia. It was the beginning of
the AIDS epidemic.” CMHC became
a leader in HIV care.
In 1993 a pilot project launched
integrating mental health services
into the clinic’s growing primary
care services. It also introduced a
set of principles for working with
substance users - from working
on using more safely all the way
through abstinence. The approach,
later known as Harm Reduction,
was adopted city-wide in 2000.
CMHC became the first SF clinic
to introduce Office Based Opiate
Addiction Treatment (OBOAT),
reducing stigma and offering
individuals the convenience of
coming to their own provider
rather than a treatment program.
provided space and medical and
behavioral health staff. From the
start, participants in the program
helped evolve a new model of
care for gender non-conforming
individuals. Dimensions’ Medical
Director Dr. Debbie Brown
passionately spearheaded the
development of protocols and
services to meet these needs.
Sadly, she recently passed away
after a long illness, but a significant
part of her legacy is CMHC’s lasting
commitment to advocacy and to
safe, informed, competent care that
supports transgender and gender
non-conforming people to thrive.
Over time CMHC’s Mental Health
Team has become a leader in
developing SFDPH-wide policies,
trainings and experiential learning
opportunities for how to provide
appropriate services to transgender
and
gender-nonconforming
individuals.
Today, CMHC continues to
demonstrate adaptability and
innovation. The center has the
distinction of being the first
primary care site to participate in
Lean, an improvement method that
focuses on minimizing waste and
maximizing value. Value is based
on optimal patient experience and,
in Castro-Mission’s case, this means
all staff commit to providing a care
experience that increases patient
satisfaction and feels motivating
and rewarding for staff.
Building on the deep connections
established with its surrounding
community, CMHC provided a
tattoo removal clinic to help people
leaving gang affiliation erase the
last visible reminders of a previous
life, thus improving their social and This year, we are celebrating
the many achievements of all of
economic opportunities.
SFDPH’s primary care clinics and
highlighting Castro Mission Health
In the 90’s CMHC was part of an inter- Center - the first of the original
agency collaboration that created five public health clinics built in
Dimensions Clinic for LGBTQI the county. As the work of primary
Youth. Under the leadership of then care continues to transform, let
Center Director, Patricia Perez- us celebrate and learn from our
Arce, Castro-Mission participated progress with this important
in the conceptual development, milestone!
❶ L to R Front Row (kneeling):
Deputy Romani, Nancy
Huerta, Laurie Lenrow, Gladis
Steinway, Chris Nguyen,
Cristina Caceres, Mei Xuan,
Harriet Cordon, Heather
Weisbrod, Rose Mun L to R
Back Row (standing): Jacqui
Figueroa, Judtih Mora, Ronny
Estrada, Fred Huang, Celia
Bird, Janine Laiwa, Bill Tarran,
Diana Galvez, Sarah Fong,
Emely Smith, Tim Sasaki,
Lissette Waterman, Sonia
Reyes, Stan Yantis, Guillermo
Hurtado, Alma Olmedo,
Ikhlaus Ahmed ❷ L to R
Christa Duran, Sarah Fong
❸ Children’s Clinic Saturday
with Dr Harlean Donaldson
families and staff ❹ L to R
Laura Feeney, Amelia Gurley,
Ethan Cermeño ❺ Clinic Staff
portrait 2009❻ Dimensions
Clinic Banner ❼ Samantha
Bessega ❽ CMHC Staff
circa 1980’s ❾ Judith Mora,
Jacqui Figueroa ❿R ose Mun,
Martha Maher ⓫ Mayor Art
Agnos addressed the crowd
at the 25th anniversary of
the clinic in1985 ⓬ Gladis
Steinway, Laurie Lenrow,
Deputy Romani, Nancy
Huerta, Martha Vallin, Diana
Galvez, Roger Alvarado,
Harriet Cordon ⓭ Karen
Campos, Cristina Caceres
⓮ 25th anniversary cake ⓯
Launching the SFHN Seated
in front: Jesse Aguirre,
Ivon Padilla, Ronny Estrada
Standing: Laurie Lenrow,
Rose Mun, Guillermo Hurtado,
Carmencita Diaz, Chris
Nguyen, Esteban Rodriguez,
Christa Duran, Vittorio
D’Angeli, Lissette Waterman
4
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5
SF HEALTH NETWORK NEWS
The Way Forward Metrics Update FY14-15 Q3-Q4
This update will provide the
latest information for Quarters
3-4 (January-June 2015) of the
last Fiscal Year 2014-2015. It will
also serve as the last round of
reporting, since these measures
were explicitly chosen to sunset in
June 2015.
Although this particular set of
metrics will no longer be reported
out Network-wide, there will soon
be a new set developed that
further refine the scope and
are more closely aligned
with the San Francisco
Health Network and its
core purpose. These new
measures will be developed
through a management
initiative
known
as,
premise of Hoshin Kanri is to
empower front line staff and to
develop people as future leaders.
Hoshin gets strategy deployment
into the front line through
problem-solving exercises and
activities practiced at all levels of
an organization.
More to come around this exciting
new adventure… but without
further ado, here are some Way
Forward Highlights from FY 20142015 Q3-Q4 that we would like to
At the end of this summer a large share with you!
group of leaders spread across
the different sections of the SFHN Metric # 2: Achieve Primary
will have a Hoshin Kanri retreat
Care support staff ratio
per unweighted active
patient panel = 4.5 FTE
In
Quarter
Ambulatory
3,
Care
had a positive change
of 4.8 percent. These
additional support staff
will benefit the patients
and the clinics they visit
by ensuring that there
will be more time to have
meaningful interactions,
while also providing the
necessary support for
clinical operations.
“Hoshin Kanri.”
In case you don’t speak
Japanese,
‘Hoshin’
essentially translates to,
“compass,” while ‘Kanri’
means,
“management,”
This approach is utilized by
Lean organizations to strengthen
their ability to identify and plan
initiatives that are key to reaching
their goals.
By clarifying the
fundamental goals and mission
of the organizations, resource
requirements become clearer
and decisions are able to be more
methodically prioritized.
Even
more importantly, the fundamental
of what really matters: ensuring
that SFHN patients receive the best
possible care.
to discuss these future plans and
priorities of the Network. This will
help organize all of the efforts
and initiatives that services are
involved with into one cohesive
and strategic plan. A key outcome
will be these newly developed
metrics, which will be used
as a driving force to allow for
identification and improvement
6
Metric #3: Improve by 5 percent
over baseline, patient placement at
the appropriate setting and level
of care in acute and skilled nursing
facility institutional operations
San Francisco General
Hospital had a positive outcome
in decreasing the average number
SF HEALTH NETWORK NEWS
(continued from page 6)
at Home services.
of days when
In Quarter 3,
patients
were
Increasing the Value of Services to:
Health at Home
Our Patients - Our Workforce - The Residents of SF
categorized
also met and
By July 1, 2015 we will:
as
non-acute
exceeded their
low level of
❹
target! For SFGH
care (LLOC) by
Meet or exceed
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❸
budgeted performance
Improve Patient
and Primary
❷
in revenues and
Achieve a Primary
4 percent in
Placement at the
expenses
Care Panel Size =
appropriate
setting
and
Achieve Primary
❺
Care, the survey
1,350
Quarter 3, and
level of care in Acute
Care Support Staff to
and Skilled Nursing
Provider Ratio = 4.5
Improve Workforce
asked the patient
an
additional
Facility Operations by
FTE
Experience/Satisfaction
5%
Scores
for their overall
1.8 percent in
by 5%
❾
rating (1-10) of
Quarter 4. This
Achieve a 75%
❽
❻
mammogram screening
the provider who
reduction means Improve Civil Service
50% of Staff should
rate for eligible primary
know the “Way Forward
Hiring, From Form 3
care clients
treated
them.
that
patients
Plan”: Increasing the
submission to start
❿
❼
Value of Services
work date = 90 days
The Way Forward
Provided to our Patients,
Increase the
who are ready
or less
Improve Patient
Workforce and SF
number of clients seen in a
Metrics
were
Experience/Satisfaction
Residents
Behavioral Health Center
to be discharged
Scores by 5%
who have established care
only interested
with a Primary Care
are able to return
Provider by 25%
in answers of 9 or
back to their lives
10, and did not
outside of the
count anything
hospital
much
lower. We are happy to report
sooner. It also allows hospital
staff to continue providing care This information is gathered that in Quarter 4 both SFGH and
and necessary attention to other through a survey that asks the Primary Care met and exceeded
patients being treated at SFGH. patients to agree or disagree with this target!
In Quarter 3, Transitions had comments such as, “I liked the
a positive outcome in decreasing services I received here” and, “I Thank you to everyone across
the average length of stay (ALOS) would recommend this agency to the Network who dedicates so
by 0.7 percent. The longer a a friend or family member.” After much time and effort to constantly
patient is institutionalized in a care the latest results, we are happy improving the services we provide
setting, the less likely they are to to hear back from our patients to our patients. You are the reason
be discharged, which is why it is and share some of the positive why these goals have been met!
important to improve this measure. feedback we received! In Quarter Please look out for the next set
In Quarter 4, Laguna Honda 3, Behavioral Health met and of metrics. More information
Hospital had a positive outcome exceeded this target for those will be provided once they have
in increasing patient placement two survey comments. Health been developed and tracking
by improving the total average at Home’s survey had different established.
of appropriate discharges to the questions that asked the patient
community LLOC by 33 percent.
to rate the care they received from
their home health provider, and
Metric # 7: Improve Patient whether they would recommend
Experience/Satisfaction Scores by their family or friends to the Health
5 percent over the baseline
7
MESSAGE FROM BARBARA
(continued from page 1)
work groups focused on workforce
development, collective impact
and cultural humility.
Director of Health
Barbara Garcia
outcomes. For example, African
American men and women in
our city have higher rates of
premature death than other
groups, with leading causes
including heart disease, cancer,
diabetes, HIV/AIDS, kidney
disease, COPD, substance abuse
and violence. It is well documented
that health outcomes are tied to
social and economic inequity.
We are determined that the
glaring and appalling disparities
in the health status of African
Americans in San Francisco will
not continue on our watch. We
can do better.
Getting there requires a multiyear and multi-pronged approach.
We started the Black/African
American Health Initiative (BAAHI)
to focus on health equity and
express our commitment to the
Black/African American community.
The initiative includes both the
Population Health Division, led
by Tomás Aragón, and the San
Francisco Health Network, led by
Roland Pickens. The BAAHI
planning group contains about
100 staff members, who developed
San Francisco
Department of Public Health
Black/African American Health
Initiative
Our employees are tremendously
talented and dedicated. We need
also to ensure that our workforce
reflects our patient population as
much as possible. We are working
to further our HR processes to
that end. This includes creating
career paths for African American
employees, expanding recruitment
efforts and providing education on
identifying and avoiding bias in the
hiring process.
8
We will use the collective
impact model to boost clinical
outcomes in the African American
population by involving the
affected communities. We need
to increase our vigilance about
African American health status
and standardize care across
the department to eliminate
inconsistencies.
And,
we
are
having
conversations with and among
staff about race and the impact
of race on our behavior and our
understanding of one another
and of our patients. We have
undertaken a rigorous course
of racial humility trainings, led
by nationally recognized expert
Dr. Ken Hardy. To date, 70 DPH
leaders have participated in the
intensive four-day trainings, and
another 125 have been selected
to begin in October.
We are pleased to make this
investment in our workforce.
It will continue to expand with
future trainings at Laguna
Honda Hospital, San Francisco
General Hospital, 1380 Howard
and at several population health
programs. As a result, our DPH
staff will be supported, and better
equipped to work together to
deliver care to our diverse patient
and client population, and to
contribute to improvements
in the health of San Francisco’s
African American community.
OFFICE OF COMPLIANCE & PRIVACY AFFAIRS
Staff must notify their supervisor and their privacy officer (see below) immediately of
any suspected breach of patient privacy. If you work at a DPH site other than LHH or SFGH
please contact Maria X. Martinez at 415-554-2877. Notices, inquiries, concerns
or questions about privacy may be directed to the Office of Compliance and Privacy Affairs
Confidential Hot Lines:
Privacy & Compliance Hotline (toll-free):
1-855-729-6040
email: compliance.privacy@sfdph.org
Preventing an
Unauthorized
Disclosure
How to prevent an unauthorized
disclosure of Protected Health
Information (PHI)
Definition of Disclosure: Disclosure
includes all releases, transmissions,
dissemination or communications,
whether they are made orally, in
writing or by electronic transmission
[Health and Safety Code Section
120980(k)]
We must protect patient’s
personal and health
information that is:
Created, received, or maintained by a
health care provider or health plan
Written, spoken, or electronic
Ways to prevent an
unauthorized disclosure of
PHI:
ƒƒ Be sure you have the patient’s
permission before discussing
confidential information in front
of family members, friends, or
caregivers
ƒƒ In some situations, it may
be appropriate to ask family
members or friends to step out of
the room before speaking with a
patient about his or her medical
condition
ƒƒ Avoid discussing patient
information in the elevators,
hallways, cafeteria, and waiting
rooms
and the authority to issue
administrative penalties.
Additionally, these agencies
have the authority to fine
individual violators (example:
up to $250,000 per incident)
and to report them to the
appropriate licensing board.
ƒƒ Type “secure:” in subject lines of
emails that contain phi
ƒƒ Never email phi from your private
email address
Report Privacy
Breaches Immediately:
ƒƒ Discuss confidential matters in
private area
Scenario of an
Unauthorized Disclosure
Scenario: A patient is in an exam
room with a friend. A doctor walks in
to explain test results to the patient.
After giving a polite greeting, the
doctor begins disclosing the test
results. Is this a Privacy Violation? YES!!
Explanation: The physician was
lacking sensitivity of the patient’s
privacy. Be sure you have the patient’s
permission before discussing
confidential information in front of
family members or friends. In some
situations, it may be appropriate to
ask a family member or friend to step
out of the room before speaking with
a patient about his or her medical
information.
Fines & Penalties
SFDPH is required to report privacy
breaches to multiple federal and
state agencies. They have the
responsibility to investigate breaches
9
Office of Compliance and
Privacy Affairs
San Francisco Department of
Public Health
101 Grove Street, Room 330,
San Francisco, CA 94102
Office email:
compliance.privacy@sfdph.org
Confidential Compliance and
Privacy Hotline:
1-855-729-6040 (toll-free)
Calls may be made
confidentially and
anonymously.
Always remember: SFDPH has
a non-retaliation policy.
ROLAND’S REPORT
(continued from page 1)
Director SF Health Network
Roland Pickens
Francisco General Hospital and
Trauma Center in July, when Sue
Currin announced her retirement
after more than 30 years of
outstanding service. In the spirit
of shared understanding, let me
acknowledge that leadership
changes can be hard. But we are
fortunate that she left the hospital
on sure footing going forward.
Let’s do our best to come through
this transition with a heightened
sense of camaraderie and focus on
the work ahead.
CEO during the transition. In that
role, it will be my primary mission
to work hand-in-hand with the
current SFGH leadership to ensure
stability during this period and
delivery of our ongoing priorities,
including the move into the new
hospital, the continuation of the
Lean management system and roll
out of a new strategic plan.
I will continue to serve as Director of
the San Francisco Health Network,
Sue Currin was an
exceptional CEO
and we thank her
for her many years of
contribution
to SFGH
Sue Currin was an exceptional CEO
and we thank her for her many
years of contribution to SFGH.
As she moves on, the hospital
is on the right track to meet our
goals for the future. I also am
glad at this time to appreciate our
extraordinary SFGH line staff and
leadership team who work every
day to deliver the highest quality
care with compassion and respect.
We are in good hands.
ably joined by my executive team,
Dr. Alice Chen, Chief Medical
Officer, and Dr. Marcellina Ogbu,
Deputy Director. They will ensure
continuity of operations while I
share time with the hospital.
I am honored to serve as interim
Looking toward the future, I
have appointed Dr. Chen to
chair a hospital CEO search
committee, which will conduct
a national search to identify the
best candidate to lead SFGH
going forward. The committee
will have broad representation
of all constituencies including
SFGH and SFHN leadership
and staff, UCSF and medical
staff leadership and SFGH
Foundation leadership. The
committee will begin its work
immediately with a plan to
have a new CEO on board in
early 2016, at which time my
tenure in this role will conclude.
I also am excited to embark on
a strategic planning process
for the entire network, and
we will begin with a session in
September to help chart our
course for the coming years.
If you take only one message
from this note, let it be that this
is a hopeful and exciting time
for the San Francisco Health
Network. I thank you for your
continuing creativity, hard
work and dedication toward
the fulfillment of our mission
of service to the people of San
Francisco.
10
MANAGED CARE
This new streamlined process
also allows OMC to track
submitted requests to prevent
duplication.
Covered California
Partnership
In addition to improving
our existing managed care
operations, OMC is working
to establish a Covered CA
L to R: Diana Guevara, Jackie Haslam, Alice Kurniardi, Stella Cao, Kathleen Abanilla, and Denise Lopez.
SFHN Managed Care
Operations Committee
External Report Request
Process for Health Plans
The Office of Managed Care
(OMC) has accomplished
several projects since our last
update. In April, OMC officially
established the SFHN Managed
Care Operations Committee to
identify and to collaborate on
the resolution of operational
issues related to managed care
populations across various
functional areas within SFHN. The
committee meets monthly and
has two subcommittees: the UM
(Utilization Management) and
SFHN Primary Care committee,
formed to focus on these specific
areas.
Working together with IT and
San Francisco Health Plan (SFHP),
OMC developed and launched the
External Report Request Process
for Health Plans. Users who need
data from SFHP or Anthem Blue
Cross can now submit a request
via the SFGH, LHH or COPC
intranet pages after receiving
management approval from their
department. Look for the logo that
looks like this
11
Or click here
partnership so SFHN will
become a Covered CA
provider. This would mean
individuals, including current
HSF participants, who purchase
insurance through Covered CA
will have an option to continue
with SFHN as their provider.
We are targeting to become a
Covered CA provider in time
for Open Enrollment for 2016,
starting this November.
BEHAVIORAL HEALTH
Trauma Informed
Systems
Letter from Barbara Garcia
sent to all staff in March 2014:
In light of the current events in our
nation, we are acutely aware of the
pervasive impact of trauma. Violence
leaves in its wake a lasting impact that
has the power to destroy our health,
rupture relationships and change the
trajectory of entire communities.
requirement for all employees) will
ensure that nearly 9,000 employees
within our DPH system will have a
shared understanding and shared
language to respond to the impact
of trauma.
Through workforce
training and other components
designed to embed knowledge
Out of our mission to protect and and principles of trauma informed
promote the wellness of our city, systems, SFDPH is preparing and
SFDPH is responding to trauma as
a public health issue through an
innovative approach. SFDPH has
been recognized nationally by the
US Substance Abuse and Mental
Health Services Administration for its
leadership in creating a coordinated
public response to trauma and
leading the way in the response of
public systems in building trauma
informed communities.
supporting its workforce in realizing,
recognizing and responding to
the effects of trauma that show up
in our clients, our work with one
another and our systems.
For more information about the
Trauma Informed Systems Initiative,
our trainings or how to get involved,
contact our coordinator at kaytie.
speziale@sfdph.org.
A foundational training (now a
12
San Francisco Public Health
employees have long had
a commitment to serving
vulnerable populations in
the city, many of whom are
affected by trauma. Trauma
is being recognized as a
serious public health issue,
and linked to a number of
chronic dysfunctions over the
lifespan including disease,
disability,
and
serious
social and mental health
problems.
In our effort
to serve and support the
wellness of our community,
we as a workforce and a
public health system are
also affected. It is imperative
that we understand the
effects of trauma and how to
respond in ways that protect
recovery and promote the
wellness of our community
and our system.
In
response,
I
have
commissioned
a
core
workgroup with in SFDPH to
lead the Trauma Informed
Systems Initiative, which has
developed a basic training
on the essentials of trauma
for our
workforce. This
training will be implemented
throughout our entire DPH
system with the goal of
developing a foundational
understanding and shared
language regarding trauma
and
its effects on our
workforce.
SF GENERAL
Food
San Francisco General Hospital
and Trauma Center (SFGH)
announced June 12 that the
hospital will no longer sell or
provide any sugar sweetened
beverages (SSB) on campus. This
action supports our patients and
community by offering healthier
drinks that do not promote
obesity, tooth decay and chronic
disease.
Healthy Beverage Initiative at Summerfest
Consumption of SSB is linked
with increased rates of obesity,
diabetes, heart disease, liver
disease and tooth decay. One
in three children born today,
and half of Latino and AfricanAmerican children, are expected
to develop diabetes in their
lifetime.
“As the hospital for all San
Franciscans, it incumbent on us
to provide a healthy environment
for our patients, staff and visitors,”
said Shermineh Jafarieh,
Director of Wellness. “Our patients
disproportionately suffer from
chronic diseases, and we know
that consuming SSB does not
help. With the healthy beverage
initiative, we are making it easier
for people on campus to make
better choices about what to
drink.”
The policy extends to patient
meals, the cafeteria, vending
machines, gift shop and food
trucks. The hospital will continue
to offer beverages such as water,
carbonated water, flavored waters,
milk, tea, coffee and 100 percent
fruit and vegetable juices. This
action, which will ultimately
extend across the department,
supports patients and community
13
“Science tells us that daily
consumption of sugary drinks
directly contributes to both
diabetes and heart disease,” said
Barbara Garcia, San Francisco’s
Director of Health. “As a health
department, we support efforts
to help people reduce their
Shermineh Jafarieh makes the
announcement
consumption of sugary drinks,
through education, awareness and
action. The hospital’s new policy
aligns with the direction the city
is taking to promote better health
for all San Franciscans. “
Across DPH, sugary beverages will
no longer be permitted at catered
events, or be purchased with DPH
funds.
Nutrition demos
by offering healthier drinks that do
not promote obesity, tooth decay
and chronic disease.
Healthy food samples
dancing, cooking demonstrations
and free food samples from the
hospital’s garden.
The Healthy Beverage Initiative
was kicked off Friday June 12
at the hospital’s Summerfest
celebration, which brings together
hospital staff, patients and
community partners for a variety
of wellness activities including
Three pieces of legislation
regarding sugar sweetened
beverages have been passed
by the San Francisco Board
of Supervisors that ban
advertisements on city property,
require warnings on advertising
in the city , and bar city
departments from purchasing
and city contractors from selling
or distributing sugar sweetened
beverages.
SFGH UPDATE
SF Arts Commission Installs Public Art
Opening Schedule
The entire health department
has been intensely focused on
the construction of San Francisco
General Hospital’s new acute
care and trauma building. From
the planning that started in 2006,
to the 2008 bond measure and
the groundbreaking in 2009, the
exciting project is now nearing
its conclusion.
The new hospital ribboncutting ceremony will take
place on Sat, Dec 5, 2015. There
are several steps that must be
accomplished between now
and then. The California Office
of Statewide Planning and
Development (OSHPD) must
first certify that the building is
safe and meets all construction
inspection
standards.
This
process is ongoing and will
soon conclude. When OSHPD
gives final certification to the
building, the hospital can begin
staff orientation and training,
and stocking with equipment
and supplies. This will prepare us
for the ultimate step of licensing
by the California Department
of Public Health (CA-DPH).
Successful licensing will certify
the hospital is completely
prepared to care for patients on
its very first day, and every day
after that.
provide, as the city’s only trauma
center.
Before moving patients into our
new facility, the hospital staff is
going to be very busy -- installing
equipment and IT, testing systems,
training and orienting 5,400
employees.
Rupert Garcia Mural Main Lobby
We also will complete the stateof-the-art “hybrid operating
room.” This is a new life-saving
feature that brings interventional
radiology into the surgical suite
for our trauma center. There are
very few hospitals with such
advanced technologies, and we
are fortunate to offer this to our
most critically ill patients.
We are on track to deliver a
beautiful new hospital to our
patients, staff and San Franciscans.
The expertise and dedication of
the entire SFGH Rebuild team, DPH
and hospital leaders, DPW project
managers, Webcor Builders, Fong
& Chan Architects, Jacobs, and the
support of San Francisco residents
and the SFGH Foundation have
culminated in an impressive new
building that will improve care for
future generations.
Lena Wolf Mosaic L1 Nurses Station
Cliff Garten Sculpture at Main Entrance
We expect the new building
to open for patient care in the
spring of 2016, targeting a May
date. The schedule has been
adjusted to accommodate the
advanced technologies and
critical care services that we will
14
Alan Masaoka Stained Glass at L7
UCSF AT SFGH
Research Building
The partnership between the City
and County of San Francisco and
the University of California, San
Francisco (UCSF) dates back to
1864, when Toland Medical College
opened across the street from
San Francisco’s county hospital to
provide clinical training for doctors
serving the citizens of the booming
Gold Rush city.
For more than 140 years, the
offspring of those two entities –
UCSF and SFGH – have worked
together to provide the best
care for some of the city’s most
vulnerable patients.
UCSF physician-scientists also
conduct research at San Francisco
General Hospital and Trauma
Center (SFGH) that is shaped by
the health struggles that UCSF
physicians see every day caring for
their patients, many of whom suffer
disproportionately from chronic
diseases such as asthma, diabetes
and HIV.
for initial design and the San
Francisco Board of Supervisors
unanimously approved the nonbinding term sheet.
These approvals allow us to begin
the planning process for the
building and to move forward
with the environmental review
process. Negotiations on the final
ground lease are on going and it
is anticipated that UCSF will seek
final approval of the ground lease
from the Board of Supervisors and
UC Board of Regents in Spring/
Summer 2016. Construction of
the building would begin in 2017
with an anticipated completion in
2019.
The proposed UCSF research
building would provide modern
facilities, centralize the research
efforts that are currently spread
throughout nine buildings at
SFGH, and allow UCSF to comply
with University of California
seismic policies. It would house
As construction of the new hospital many research centers, affiliated
at SFGH is completed, UCSF and the
City and County of San Francisco
are working together on efforts for
UCSF to construct a new research
building on campus. Together,
these capital improvements will
ensure that SFGH continues to
serve San Franciscans for years to
come.
Jim Marks and colleague
programs and major labs that are
dedicated to improving the health
of the SFGH patient population
and individuals worldwide.
“These approvals demonstrate
that the strong and long-standing
partnership between UCSF and the
City & County of San Francisco will
continue to thrive for generations.
The important research done here
will continue to improve the lives
of our patients, citizens of San
Francisco and the world,” said Sue
Carlisle, MD, PhD, Vice Dean of
the UCSF School of Medicine at
SFGH.
On Tuesday, July 21, 2015 two
important
milestones
were
reached: the University of California
Board of Regents approved funding
15
LAGUNA HONDA
Laguna Honda Positive Care Program
The Positive Care Program is a discharge whenever possible.
center of excellence and innovation
For more info contact:
for the care of Laguna Honda
residents with HIV/AIDS who have
skilled nursing needs.
Colleen Riley, CMO
colleen.riley@sfdph.org
The HIV/AIDS Unit (now called
Positive Care) was started in 1989. Over the past 26 years the program
has grown to its current capacity
of 60 beds.
Using a multidisciplinary team
approach, a broad spectrum
of services are offered. These
include: 1) short term stays for
physical rehab, treatment and/
or stabilization of acute medical
problems, complex medication
management; 2) longer term stays
for residents with more debilitating
medical issues or significant AIDS
related dementia; 3) respite stays
for caregiver support; and 4)
palliative and end of life care.
Patient-created tile mosaic
A-Tshirt worn at AIDS walk 2014
Other services available for
residents on Positive Care include
Hepatitis C clinic and support
group, integrated pain clinic,
behavioral health services and
substance
abuse
treatment
services. There is 24/7 physician
coverage, and the primary care
physicians on the Positive Care
Unit are all HIV specialists with
years of experience.
The goal on Positive Care is
to help each resident achieve
optimal health and functional
capacity, with a goal of community
AIDS Walk 2015
Positive care garden 2008
L to R: Susan Schneider, Carol Baille,
Melanie Bien, Steven Thompson and
Colleen Riley, 2009
16
Susan Schneider and Daniel Berner at
Hep C support group BBQ
MATERNAL, ADOLESCENT AND CHILD HEALTH
Francisco Black Infant Health
Program. The curriculum uses an
Afro-Centric approach to reducing
maternal stress by addressing
three key issues: 1) the impact of
African American infants are three
racism and isolation and healing
times more likely to be born too
historical wounds; 2) self-care
small (under 2,500 grams) and five
and positive self awareness with
times more likely to die
sustainable techniques
San Francisco LARC Access Project
in their first year of life
designed to enhance selfthan white infants.
confidence,
creativity,
self determination and
The San Francisco
personal power; 3) the
Equity Collaborative
impact of social isolation
was formed in 2013 to
and creating positive
address racial disparity
bonds and relationships.
in birth outcomes. The
The curriculum will soon
Equity Collaborative
be piloted at four sites:
(San Francisco Equity
San
Francisco
Black
in
Young
Black
Infant Health Program,
Women’s
Health
the Homeless Prenatal
and Birth Outcomes
Program, the Teenage
Collaborative) recently
Parenting and Pregnancy
delivered a poster
Program and Hunters
session on their LARC
Poster presented at CithMatCH Equity Institute Conference Point Family.
(Long Acting Reversible
Contraception) Access
The
travel
team
Project and OASIS Sister Circle (kycsf.org). Participating clinics and presenters were Equity
Interventions at the CityMatCH increased the number of women Collaborative
Co-Leaders,
Equity Institute Conference in New who had received reproductive Jenée Johnson, and Aline
health services by up to 400 Armstrong, Nurse Manager for
Orleans.
percent.
Field Public Health Nursing and
The Collaborative selected two
SIDS/FIMR Coordinator; Shivaun
interventions that could reduce At these clinics, use of LARC
Nestor, Coordinator of Family
this disparity: 1) decreasing methods increased and use
Planning
and
Preconception
unintented pregancy (considered of withdrawal and other less
Health
Services;
and
Nancy
an important contributor to pre- effective methods decreased.
Frappier, Program Coordinator
term birth) by increasing access More than 90 percent of
for the Homeless Prenatal
to intrauterine contraception and patients who completed a postsurvey
stated Program. Shivaun Nestor will again
contraceptive implants and 2) intervention
represent the Equity Collaborative
intervening to address the chronic that they had received enough
work in a plenary session on
maternal stress that contributes information to make an informed
Equity in Birth Outcomes at the
to inequitable birth outcomes for and independent decision about
national CityMatCH conference in
their birth control method.
African American babies.
September.
The LARC Access Project launched in The Oasis Sister Circle Curriculum
May 2014 at 3rd Street Youth Center is a six-session program developed
and Clinic, Balboa Teen Health by Dr. Joy DeGruy and Jenée
Center, Cole Street Youth Clinic, Johnson, Director of the San
Equity in Young Black Women’s
Health and Birth Outcomes
Collaborative
Potrero Hill and Southeast Health
Centers. The project included
extensive staff training and
technical assistance, proctoring
in LARC insertion for clinicians,
and an outreach component,
Know Your Choices San Francisco
Shivaun Nestor, Ayanna Bennett, M.D., Annelise Goldberg, M.D., Susan Obata, M.D., Aline Armstrong, P.H.N.
San Francisco Department of Public Health (SFDPH), Maternal, Child and Adolescent Health Section and San Francisco Health Network; San Francisco Equity in Young Black Women’s Health and Birth Outcomes Collaborative
More stressors and less access to care contribute to
inequities in birth outcomes:
• 69% of African American women have unintended
pregnancies compared to 18% of White women2.
• African American infants are 6 times more likely to be
born extremely premature and 5 times more likely to
die in their first year of life than White infants.
Why Focus on Long-Acting
Reversible Contraceptives (LARC)?
Photo: Planned Parenthood Federation of America
Preventing unintended pregnancy is a public health
priority in San Francisco (SF).
LARC methods (Intrauterine Devices, or IUDs, and
contraceptive implants):
• Are long-lasting, discrete, and “forgettable”
• Give women control over their reproductive lives
• Don’t compromise future fertility
CityMatCH data suggests that if only 8.5% of the
estimated 11,146 African American women in SF who are
at risk for unintended pregnancy use LARC, it will result
in 101 fewer unintended pregnancies annually and will
decrease the preterm birth rate by 20%.
LARC access is limited in SF safety-net clinics:
• In 2012, only 11 of 21 provided same day LARC insertion
• None of these clinics were in the Southeast sector of
the city where most African American residents live
Focus Groups to Understand
Women’s Needs & Concerns
The project held six focus groups over a two month
period. Participants were recruited via partner CBOs and
SFDPH clinics. The demographic breakdown of
participants was as follows:
• Ethnicity: 33 women were African American, 2 were
Latina and 1 was White
• Ages: 10 participants were between the ages of 14-17,
8 were between the ages of 18-24, and 18 participants
were age 25 and older.
What participants taught us – major themes:
• Friends/media were their main sources of information
• Fear of hormones, loss of fertility, and genocide
influenced their contraceptive choices
• Most experienced judgment or pressure to use LARC
• Most in-clinic education consisted of either an
exclusive focus on LARC or no method education
• Youth feared being judged for their weight
• Youth felt that birth control played a major role in
achieving life goals / going to college
Youth Outreach Efforts
#knysf / kycsf.org
As of March 31, Health education staff at participating
youth clinics developed, piloted, and reached a total of
404 youth, ages 12-24, through an hour-long “Know Your
Choices” workshop that:
• Is interactive and sex-positive
• Is inclusive of male and LGBTQQI-youth
• Focuses on life planning & reviews all contraceptive
methods using a best practices “tiered approach”
• Presents birth control as a tool for achieving life goals
• Links participants to clinic services.
Acknowledgements
We would like to thank CityMatCH for their technical
assistance and the Gold Foundation for financial support.
SOURCES
1 Reiter, R, Stookey, J, & Chan, C. (May 2013). Health and health disparities in San Francisco: Equity in birth outcomes. San
Francisco Department of Public Health, Maternal, Child and Adolescent Health Section. Accessed at
https://www.sfdph.org/dph/comupg/oprograms/MCH/Epi.asp
2 California Department of Public Health (2012). MIHA Snapshot, San Francisco County. Maternal and Infant Health Assessment
(MIHA) Survey. Accessed at http://www.cdph.ca.gov/data/surveys/MIHA/MIHASnapshots/SnapshotCoSanFrancisco2012.pdf
2 Based on Title X data comparing baseline (6/1/13 to 5/31/14) post-Choice Training (6/1/14 t0 5/31/15)
17
3-4 Month Outcome: Changes in Staff
Knowledge, Attitudes & Confidence
Staff were surveyed before the Choice/Bixby Center
Training and again 3 to 4 months post-training on their
knowledge and attitudes about LARC and their
confidence regarding LARC provision. The survey used
validated measures from the Bixby Center.
Participating Clinics
Chosen because of their location in neighborhoods where
most African American residents live. Among SFDPH
community-based primary care health centers, these
sites see approximately 83% of the African American
women served by the department’s Title X program:
• 3rd Street Youth Center and Clinic
• Balboa Teen Health Center
• Cole Street Youth Clinic
• Potrero Hill Health Center
• Southeast Health Center
Training Program for All Staff
1. March/April 2014: 90% of receptionists, registration
clerks, medical assistants, and RNs completed an
online training, “Family Planning Essentials”
2. May 2014: 20 providers & 70 support staff attended a
two-day Choice/Bixby Center Training with 6 tracks:
receptionists and registration staff; nurses/medical
assistants; health educators; behavioral health staff;
planning track for clinic managers; clinicians track that
included ARMS simulator training with Patty Cason
3. April to December 2014: interactive all-staff in-service
series at Potrero on LARC access as a social justice
issue, confidentiality, working with adolescents,
preconception health, and STI basics; in-services at
Southeast for non-clinicians on LARC access as a
social justice issue and birth control case studies
Follow-Up Training for Clinicians
1. LARC insertion/removal proctoring for clinicians at La
Clinica de la Raza and Planned Parenthood Northern
California; as of March 31, 2015, 10 clinicians had
attended a total of 21 4-hour sessions
2. Floating SFDPH MD providing on-site mentoring and
technical assistance
Follow-Up Clinic Support
1. Clinic Champions met regularly to keep
progress moving and address challenges
2. Clinic celebrations held at 3rd or 4th month
and scheduled for end of year 1 in order to
mark progress towards implementation goals
and to conduct evaluation activities
3. Resources provided to clinics including birth
control demo kits, consent forms, client ed.
materials, protocols, posters, USMEC charts,
and scripts for paraprofessional staff
Survey results showed increases in:
• Knowledge about LARC methods
• Positive attitudes towards LARC methods
• Confidence in ability to counsel patients about LARC
• Staff perceptions of their clinic’s capacity to provide
LARC methods
10 Month Outcome: Increases in
Provision of Family Planning
Services and LARC Use3
10 Month Increase in # of African American Patients Receiving Family
Planning Services per Month at Pilot Sites
30.0
25.6
25.0
20.0
18.8
15.0
BASELINE
10.0
6.5
5.4
5.0
0.0
3.1
1.3
Southeast/3rd St.
Clinics
Potrero Hill Health
Ctr
At 10 Mo
7.2
3.4
Balboa Teen Health Cole St Youth Clinic
Ctr
10 Month Increase in Use of LARC & Concurrent Decrease in Use of Barrier
Methods by African American Patients at Pilot Sites
Potrero Hill
Health Ctr.
African American women are less likely than White
women to have access to:
• Health insurance
• Effective contraception
• Timely prenatal care
Building Clinic Capacity
Southeast/3rd St.
Clinics
1. Understand the contraceptive needs and concerns of
African American women in San Francisco in order to
develop culturally responsive clinic practices
2. Conduct outreach to a minimum of 1000 youth, ages
12-24, in order to provide information on all available
contraceptives, to engage them in reproductive life
planning, and to connect them to youth-friendly clinics
3. Build the capacity to provide same-day insertion of all
LARC methods at 5 community clinics that serve a
high proportion of African American patients
Balboa Teen
Clinic
Project Objectives
African American residents are more likely than
White residents to report stressors such as:
• Wage gaps and housing, food and job insecurity
• Having “a lot” of bills that they cannot pay
• Interpersonal violence, social isolation and depression
Cole St. Youth
Clinic
The Need in San Francisco1
Baseline
At 10 Mo
Baseline
At 10 Mo
LARC
Other Hormonal
Baseline
Barrier
At 10 Mo
Baseline
At 10 Mo
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Steady Increase in LARC Use by African American Patients at Southeast
Steady Increase in LARC Use by African American Patients at Potrero
TRANSITIONS
Medical Respite
Expansion and Sobering
Center
The recently announced 15-16 FY
City Budget included $6.6 million to
create and provide ongoing support
for 30 new Medical Respite beds
for homeless patients with chronic
medical needs. This expansion of
the Medical Respite program will
create a shelter-like environment
to address the medical needs of
clients that cannot be adequately
supported in the existing homeless
shelter system. Medical Respite
provides a period for recovery
and stability for individuals who
might otherwise be on the street
and using emergency services.
This effort is a great example of
how the SF Health Network works
together. Medical Respite is part of
Primary Care, and currently receives
referrals mostly from SFGH. The
expansion is being managed by the
Transitions section and will include
those who may not previously have
been eligible for Medical Respite.
The Medical Respite program
provides
temporary
shelter,
meals and
transportation to
appointments
in addition to
medical and psychosocial services.
Clinical providers and nurses
follow-up acute problems, bridge
and refer to primary care, assist
with medication management
and coordinate with ambulatory
providers.
Social
workers
and case managers address
discharge planning, assist with
benefits, mental health and
substance abuse referrals and
initiate
housing
applications.
Weekly
interdisciplinary
team
Medical Respite and Sobering staff
in their beautiful garden
meetings include reviews of
care plans, intake and discharge
planning, and discussion of system
issues. The staff look forward to
a special section of the meeting
called, “stories of hope.” A few
highlights from a recent meeting
include these inspiring stories
that really capture respite success.
Mr G is 57 year old man referred
to medical respite in early March
2015 after suffering a stroke.
He had many medical issues,
including heart failure, that were
complicated by long standing
substance use disorder. While
in the program, staff supported
his work with occupational
therapy to improve his language
deficit, referred and escorted him
to specialty and primary care
appointments, and helped him
with his substance use through
a harm reduction approach.
During his time in the program,
his heart failure and aphasia
improved dramatically and his
work with the social workers
and case managers secured him
permanent, supportive housing.
Ms B, a 67 year old woman with
a long history of cycling through
emergency departments due
18
to traumatic falls, was referred
to medical respite in May 2015
after a hospitalization for COPD
exacerbation, pneumonia and a
concussion. By providing a safe
place to stay, along with care
coordination
and
supportive
services, the program stopped the
cycle of Emergency Department use.
Staff’s advocacy and collaboration
with primary care and existing
community case management
resulted in a
transition into
senior
supportive
housing.
Excerpt
from
a
care
provider’s
primary
feedback:
“Thank you all so much at respite
for your incredible work with J.
With your help someone who has
been HIV positive for over 20 years
and never on meds is now housed,
engaged in care, on hormone
therapy, off the streets, and no
longer dependent on sex work.”
The work done at Medical Respite
and Sobering has become an
integral part of the homeless
health care services provided by
the SF Health Network. So many
of the most frail and vulnerable
clients of San Francisco have been
given the opportunity to break
unhealthy cycles and begin a real
and meaningful path to a new life.
The program is effective in large
part because of the successful
partnerships with the hospitals
and clinics that share our clients.
The program aims to break
down “silos of care” and provide
a
client-centered
approach.
Staff will continue providing high
quality care for the most in-need
clients by program enhancement
and capacity-building through
innovation
and
expansion.
JAIL HEALTH
Naloxone Pilot Saves Lives
The first few weeks after release
from jail can be the most dangerous
time to suffer a fatal overdose.
Jail Health Services is pioneering
solutions with a Naloxone project
that saves lives.
The pilot project was started in
March 2013. This was a coordinated
effort of HIV and Integrated Services
or HIVIS (a program of Jail Health
Services) The Drug Overdose
Prevention and Education or DOPE
Project (a program of the
Harm Reduction Coalition),
SFDPH,
the
Sheriff’s
Department and the Adult
Probation Department.
components: information on
prevention and transmission
of infectious diseases and on
safer sex and injection practices,
assessment of personal risk,
training in how to use condoms
correctly and the importance
of using condoms consistently,
counseling to address emotional
or practical issues in practicing
safe sex, training in safer sex
negotiation, HIV testing, STD
screening and treatment, referral
study of risk and protective factors”
(Binswanger, 2012) discusses this
issue in depth:
“Studies in the United States and
other countries have shown a high
risk of drug-related death after
release from prison. Overdose rates
peak in the first few weeks after
release. Former inmates return to
environments that strongly trigger
relapse to drug use and put them
at risk for overdose.”
Program
Structure
and
Results:
Between
March
2013
and December 2014, 267
San Francisco county jail
prisoners have watched the
video “Staying Alive on the
Outside” on the dangers of
overdose upon release from
jail.
https://www.youtube.
com?watch?v=QwgxWO4q38
The goals of the SF County
Jail Naloxone Pilot are to:
ƒƒ educate
prisoners
about to re-enter the
community about the
high risk of overdose
ƒƒ offer prisoners the option
of obtaining a naloxone
kit in their property when
they are released
ƒƒ integrate overdose prevention
into the wider array of services
for substance using adults,
including substance abuse
treatment, HIV/Hep C/STD
testing and linkage to care
ƒƒ decrease overdose deaths
among people leaving prison
and re-entering the community
Background:
The Centers for Disease Control
and Prevention recommend that
overdose prevention be a standard
component of integrated services
for substance users. According to
the CDC’s newly issued Guidance,
“persons who use drugs illicitly
should be provided with or referred
to interventions that include some
or all of the following prevention
Access to Naloxone kits and training save lives
to substance abuse treatment
and social services (e.g., housing),
psychosocial support, referrals to
relevant mental health and family
planning services, and training
in overdose prevention and
provision of naloxone.”
In
the San Francisco jails,
individuals with substance use
histories are at elevated risk
of overdose upon re-entering
the
community.
Providing
incarcerated individuals with
overdose prevention messages
and access to naloxone upon
release to the community is
an innovative way to impact
overdose mortality post-release.
A recently published study “Return
to drug use and overdose after
release from prison: a qualitative
19
The short video includes an
introduction by staff explaining
how to obtain a naloxone kit after
viewing the video. Prisoners then
wishing to receive a naloxone kit
can sign up for training from HIVIS
staff on the use of a naloxone nasal
spray.
Upon completion of the training, a
naloxone kit is placed in property
and is available upon release from
custody. Of those who signed
up for the video, 68 percent have
received a naloxone kit upon
release. Among men receiving
kits, 26 percent had experienced
one or more overdoses, 79 percent
had witnessed an overdose and
16 percent had used naloxone to
revive someone in the past.
POPULATION HEALTH DIVISION
Naloxone: Working with
Providers
In San Francisco, prescription
opioid deaths have replaced heroin
almost 1:1 as the lead cause of
overdose deaths, and in most cases,
the opioids were prescribed.
for
naloxone
prescribing,
how to discuss overdose with
patients and example naloxone
prescribing. To assess impact, we
will collect and analyze MediCal data three months after the
intervention (August, 2015)
to compare changes in opioid
and naloxone prescribing rates
between those who received and
did not receive the intervention.
In September 2014 we received
funding from the California
Healthcare
Foundation
to webinar:
implement a training to prescibers http://www.csam-asam.org/
program to increase co-prescribing naloxone-resources
of the opioid antidote, naloxone,
with opioids among Medi-Cal
providers.
We obtained a list of prescribers
(MD, NP, or PA) who prescribe
opioids to Medi-Cal patients in San
Francisco County and reviewed all
names to ensure they were primary
care providers.
We then randomly selected 40
prescribers for training, adding
additional prescribers as needed
when the intervention was refused.
To assess the feasibility and impact
of the intervention we tracked
process measures and prescriptions
filled through Medi-Cal. We
tracked the refusal rate, number of
contact attempts, duration of the
intervention and topics covered.
It took an average of 2.7 contact
attempts to make contact with
a provider. Forty out of 48 (83
percent) prescribers accepted the
intervention (6 prescribers declined
the intervention, and the remaining
2 were unreachable). The mean
intervention duration was 28.5
minutes and the most frequently
addressed topics were: indications
Dr. Philip
Coffin is the
director of
Substance
Use Research
at the Dept
of Public
Health and
assistant clinical professor
in the HIV/AIDS division at
UCSF.
Emily Behar,
MS, is the
Research
Study
Coordinator
for the
Substance
Abuse
Research Unit, part of the
Center for Public Health
Research within Population
Health Division of SFDPH.
20
Naloxone Background
Naloxone (also known as
Narcan®) is a medication
called an “opioid antagonist”
used to counter the effects
of opioid overdose, for
example morphine and
heroin overdose. Specifically,
naloxone is used in opioid
overdoses to counteract lifethreatening depression of the
central nervous system and
respiratory system, allowing
an overdose victim to
breathe normally. Naloxone
is a nonscheduled (i.e., nonaddictive),
prescription
medication.
Naloxone
only works if a person has
opioids in their system; the
medication has no effect if
opioids are absent. Although
traditionally
administered
by emergency response
personnel, naloxone can be
administered by minimally
trained laypersons, which
makes it ideal for treating
overdose in people who have
been prescribed opioid pain
medication and in people who
use heroin and other opioids.
Naloxone has no potential
for abuse. Naloxone may be
injected in the muscle, vein
or under the skin or sprayed
into the nose. Naloxone that
is injected comes in a lower
concentration (0.4mg/1mL)
than Naloxone that is sprayed
up the nose (2mg/2mL). It is
a temporary drug that wears
off in 20 to 90 minutes.
POPULATION HEALTH DIVISION
Vision Zero Update
U.S. MAYORS SUPPORT VISION ZERO
The U.S. Conference of Mayors took
place in June here in San Francisco.
While here, the mayors passed a
resolution in support of Vision Zero,
an innovative strategy to eliminate
traffic fatalities and severe injuries,
while increasing safe, healthy,
equitable mobility for all.
“San Francisco is proud to lead
among U.S. cities committed to
Vision Zero, and we are excited
to see more cities work toward
these important Vision Zero goals,”
said Mayor Ed Lee, who also cosponsored the resolution. “We look
forward to collaborating with the
growing number of Vision Zero
cities to ensure that our cities’
streets are safe for all those who
move around. “
The City and County of San
Francisco adopted Vision Zero in
2014 as a policy to eliminate traffic
deaths in the city by 2024.The San
Francisco Department of Public
Health co-chairs the city’s Vision
Zero Task Force with SF Municipal
Transportation Agency. DPH
staffers Megan Weir and Ana
Validzic lead initiatives focusing
on
education,
community
engagement, evaluation and
analysis to inform data-driven,
evidence-based investments.
By working with city agencies,
elected officials, community
organizations and the public to
protect our most vulnerable road
users, SFDPH is helping to create
a culture whereby city residents,
workers and visitors prioritize
traffic safety to ensure mistakes
that happen on our streets do not
result in serious injuries or death.
To learn more about Vision Zero
please visit www.visionzerosf.org
SF on track to meet Vision Zero
safety campaign goals - SF
Chronicle, July 17- click here to
read the story
U.S. Conference of Mayors meeting in SF in June 2015
21
Slow Down banners recently went up in
SOMA, the Tenderloin and Mission Bay
CENTRAL ADMINISTRATION
Information Technology
FASTER, STRONGER, BETTER
Works system at Laguna
Honda Hospital, and at
the Women’s Options and
Women’s Health Clinics at
SFGH
Bill Kim, Chief Information Officer
As the Department of Public
Health and the SF Health Network
go through changes in order to
deliver the best possible care to our
patients and community, DPH IT is
evolving to deliver the best possible
support to the Department. The
technologies that IT builds or
installs are only successful when
they are right for the job, so IT
needs your participation to make
sure our current and future projects
succeed.
One month ago, we implemented
a Customer Service Survey to help
us track the quality of our service.
Now, any time a Help Desk ticket
under your name is closed, you will
receive this short survey. So far, 300
surveys were completed and we
are scoring a 4.2 out of 5. But the
response rate is only 19 percent, so
please help us by completing the
survey when you receive one!
Other recent IT successes have
been:
ƒƒ Completing the early stages of
the new SFHealthNetwork.org
website
ƒƒ Implementing
the
eClinical
ƒƒ Launching the MYSFHEALTH
Patient Portal
ƒƒ Improving the reliability of
Avatar, the Behavioral Health
Electronic Medical Record
system
ƒƒ Automating hospital-based
billing processes to help
eliminate errors
ƒƒ Expanding secure access
by providers to key patient
information
All of these projects represent
joint efforts between IT, clinical,
and administrative staff. We want
to thank those who contributed
to these efforts, and we look
forward to continuing to improve
the Health Network with you!
transparency around projects
ƒƒ At SFGH, IT is working hard
to outfit the new hospital
with technologies that will
support of patient care and
set the standard for our clinical
technologies in the future.
We are also extremely pleased to
welcome Albert d’Hoste to DPH
IT, as our Unified Electronic Health
Record (EHR) Program Manager.
His task of implementing a unified
EHR will allow providers across the
Network to use a common system
of clinical documentation to
improve patient experience across
the continuum of care, and will
modernize a central piece of the
DPH IT infrastructure.
There are many exciting challenges
ahead of us and with your
participation and support and DPH
IT is ready to meet them.
There are many IT projects we are
currently working on:
ƒƒ Replacing out
workstations
of
date
ƒƒ Improving our Wide Area
Network (WAN), so you can
access files and software faster
and without interruption
ƒƒ Implementing an online
project management tool,
to increase efficiency and
22
Albert d’Hoste
CENTRAL ADMINISTRATION
Human Resources
ƒƒ Support continuing
education and learning
opportunity pathways for
existing African American
staff
Ron Weigelt, HR Director
Black/African American Health
Initiative Project – Workforce
Development Subcommittee
The SFDPH leadership has
recognized the need to make
changes in order to adequately
address and make a significant
impact on the health disparities
among the Black and African
American population in San
Francisco.
Barbara Garcia signed the
project charter for the Black/
African Health Initiative Project on
March 31, 2014.
One of the subcommittees of
this group is the Workforce
Development subcommittee that
is co-chaired by Dr. Toni Rucker
and DPH HR Director Ron
Weigelt. The current charter of
Workforce Development is to:
ƒƒ Promote interest in pursuing
careers in public health
and recruit Black and
African American interested
applicants, students and
volunteers
ƒƒ Develop strategies to retain,
motivate and show value
towards current African
American staff
In order to address those
tasks the subcommittee has
developed four workgroups
focusing on these areas:
ƒƒ Employee demographics
– this group is analyzing our
workforce by classification
and by work unit in order to
determine areas where we
lack diversity. The goal will
be to increase diversity in
work units and classifications
where it is lacking.
ƒƒ
aspects of recruitment and
retention. Nepotism, cronyism,
and other bias are also being
looked at in order to identify
counter measures in the
selection process.
ƒƒ The subcommittees are
co-chaired by Rhonda
Simmons and Ron
Weigelt. Committee
members come from all
around the department.
Jeannie Balido provides
administrative support to
all aspects of the Workforce
Development work groups and
committee.
While we cannot open these
groups up to a number so large
Client population
that it becomes unmanageable,
demographics – the focus of we have some room for expansion
this workgroup is to identify in our groups. If you are interested,
research on the connection
speak with your manager and
between matching client
email jeannie.balido@sfdph.org.
population ethnicity with
health outcomes. The
We meet at least monthly.
group also intends to make
recommendations where
increased diversity can
increase client and or staff
satisfaction.
ƒƒ Training – new employee
orientation, cultural
competency training,
interview panel training,
internship programs and a
supervisor code of conduct
are some of the many
topics being discussed in
this group.
ƒƒ Recruitment and
Retention – this group
has discussed job posting
formats, interview panel
composition, and many other
23
Karen Hill, Virginia Deutsch and Karen
Napitan recruit at the National Black
Nurses Association Annual Conference
Glenn-Milo
Santos
CENTRAL ADMINISTRATION
Travel Security
Basil Price, Security Director
Summer months are ideal for
travel; however, it is also the time
when tourists are targeted for
crime. Here are a few tips to make
your trip safe and secure:
ƒƒ Utilize traveler’s checks or credit
cards, rather than carrying
large amounts of cash.
ƒƒ Use a chair to secure a door,
use a drawer to keep your
belongings out of sight, or
a portable travel lock for
additional security to your
hotel room.
Pickpockets work in teams,
and usually target slow moving
crowds.
ƒƒ Lock hotel balcony doors
or any windows accessible
from the outside.
ƒƒ Sign passport, and fill in the
emergency information: Make
sure you have a signed, valid
ƒƒ Locate fire exits, and develop
passport, and a visa, if required,
an action plan in the event
and fill in the emergency
of a hotel fire.
information page of your
passport.
ƒƒ Take precaution against
pickpockets in a crowd. ƒƒ Leave copies of your itinerary,
passport data page and visas
with family or friends, so you
can be contacted in case of an
emergency.
ƒƒ Do not leave unattended
luggage in public areas, and
do not accept packages from
strangers.
Have a great vacation
and stay safe!
Summer months are ideal for travel, make sure you’re safe!
24
Glenn-Milo
Santos
shout outs
Brent
A n d r e w
Welcome
Eric
Welcome
as the SFGH
Communications
Officer.
He
comes to us
most
recently
from Chevron,
where he served as chief
communications
strategist and
company spokesman. He managed
executive communications during
the Hurricane Katrina disaster,
and has a wealth of experience
in managing communications for
complex organizations.
Wu
to the BIU
(Business
Intelligence
Unit).
Eric
is a new
Analyst with
the SFHN.
B e f o r e
joining DPH, he was with Mount
Sinai Hospital in New York City
leading their cancer clinical trials
enterprise and at UCSF managing
post-award finances. He also
recently earned his Masters
in Public Administration from
Columbia University.
David
S nyder
is our new
manager
of
Rehabilitation.
In this role
he will lead
Rehabilitation
Departments at SFGH, at
Laguna Honda and at Health
at Home. David joined SFGH
Rehabilitation services in 2003.
Please congratulate him on his
appointment.
We welcome Albert d’Hoste as our Unified Electronic Health Record (EHR)
Program Manager. His task of implementing a unified EHR will allow providers
across the Network to use a common system of clinical documentation to improve
patient experience across the continuum of care, and will modernize a central
piece of the DPH IT infrastructure.
Ki
Tom Waddell Urban Health
Tom Waddell Urban Health held it’s second quarterly Women’s
Health Day on Saturday, July 18th. Women living in the Tenderloin and
nearby neighborhoods enjoyed a day of women’s health care services,
healthy snacks, clothing distribution, “make-overs,” nutrition teaching
and cooking demonstrations by AAIMS, massage by Caring Through
Touch, legal advice by the AIDS Legal Referral Panel, needle exchange
and naloxone teaching by the SF AIDS Foundation and more. Thank
you to the Avon Breast Center for bringing the MammoVan to the
event. Over 200 women attended the event which was themed
“Because Women Should be Healthy and Fabulous!”
YouthWorks Summer Interns are winding down as the
summer comes to a close. A huge thank you for all of your help,
and we wish you the brightest and most productive and fulfilling
futures!
25
The SFDPH softball team played once again in the Maye
Louise Mays softball tournament this June along with
teams from SF General and Laguna Honda. Proceeds for the
tournament go to the foster youth program and many city
and county of SF teams play including Sheriff’s office, City
Attorney’s Office, Police and Fire. The DPH team lost only one
game and finished 3rd! Way to go teams!
Laguna Honda has been participating in the AIDS Walk SF for the past 12 years.Many
former staff and volunteers pitch in to make it a great day. This year was one of the
warmest on record with not a cloud in the sky. Thank you to
,
volunteer in positive care at Laguna for the photo.
Daniel Berner
The Heart of the City Combined Charities Campaign will be turning 30 in 2016. To celebrate,
we are going to hold an art contest to solicit original artwork for next year’s campaign. And yes,
there will be prizes! First place $250, second place $150 and third $50. The artwork needs to
demonstrate the rich history that city and county employees have in donating to a broad array of
charities as well as reaching the 30-year milestone. The contest is open to all current and retired
City and County of San Francisco employees. For more information about the Heart of the City
Combined Charities Campaign art contest, including guidelines and submission information,
check out our website at: www.sfgov.org/charity or email: John.Murray@sfgov.org.
Dr. Alice Chen has been selected as a Fellow of the Inaugural class of the Aspen Institute
Health Innovators Fellowship. The goal of the fellowship is to strengthen the leadership of
innovators across the U.S. health care ecosystem and to connect, inspire and challenge them
to create new approaches that will improve the health and well-being of all Americans. In
addition to her role as Chief Medical Officer for the San Francisco Health Network, Alice is
also a professor of medicine at the University of California San Francisco.
Dr. John Brown is the winner of the 2015 Special Recognition Award for the
Department of Emergency Medicine. This award is given in recognition of his valuable
contributions through excellence in teaching and overall contributions in the field
of medicine. The award will be presented, along with the winners from Family and
Community Medicine and Radiation Oncology, at the yearly banquet on Tuesday, October
6, 2015 at the Intercontinental San Francisco.
The SF Department of Public Health is seeking a Marketing
Fellow for a one-year appointment through the Mayor’s Office.
It is an exciting time to help us build a strategic marketing
program for the San Francisco Health Network. Click here
for more details or to apply.
Like us at
SF Health
Network
Send your stories, comments, photos and ideas to linda.acosta@sfdph.org for consideration- Thank you!
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