HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO

Transcription

1 Edward A. Chow, M.D. President David B. Singer Vice President Cecilia Chung Commissioner Judith Karshmer, Ph.D., PMHCNS BC. Commissioner David Pating, M.D Commissioner David.J. Sanchez, Jr., Ph.D. Commissioner Belle Taylor McGhee Commissioner HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO Edwin M. Lee, Mayor Department of Public Health Barbara A. Garcia, M.P.A. Director of Health Mark Morewitz, M.S.W. Executive Secretary TEL (415) FAX (415) Web Site: MINUTES JOINT CONFERENCE COMMITTEE FOR SAN FRANCISCO GENERAL HOSPITAL Tuesday, May 26, :00 p.m Potrero Avenue, Conference Room 7M30 San Francisco, CA ) CALL TO ORDER Present: Commissioner Edward A. Chow, M.D., Chair Commissioner David J. Sanchez, Jr., Ph.D. Commissioner David B. Singer Staff: Barbara Garcia, Sue Currin, Roland Pickens, Lillian Chan, Jeff Critchfield MD, Troy Williams, Will Huen MD, Dave Woods, Jim Marks MD, Terry Dentoni, Iman Nazeeri Simmons, Sue Carlisle MD, Dan Schwager, Valerie Inouye, Yvonne Lowe, Karen Hill, Morton Mangeo, Yunice Kim, Alberto Mejia, Greg Wagner, Terry Saltz, Anson Moon. The meeting was called to order at 3:04pm. 2) APPROVAL OF THE MINUTES OF THE APRIL 28, 2015 SAN FRANCISCO GENERAL HOSPITAL JOINT CONFERENCE COMMITTEE MEETING Ms. Currin stated that on page 7, the minutes should reflect that the goal is to have physician coverage 16 hours a day in the SFGH Emergency Department; currently the coverage is 8 12 hours a day. Commissioner Chow asked how long is the estimated time it will take to reach this goal. Ms. Currin stated that SFGH is hiring physicians in an attempt to meet the goal as soon as possible. 1

2 Commissioner Chow asked for clarification on the statement, located on page 4, which indicates that the Behavioral Health Center has 700 patients; he noted that this number is too high. Mr. Morewitz stated that he will speak to Kelly Hiromoto to correct this number. Commissioner Chow stated that he still hopes to receive a glossary of Lean terms. Action Taken: The SFGH JCC unanimously approved the April 28, 2015 SFGH JCC meeting minutes 3) QUALITY MANAGEMENT AND REGULATORY AFFAIRS REPORTS Troy Williams, Chief Quality Officer and Jay Kloo, Director of Risk Management, reviewed the April 21, 2015 Quality Council Meeting minutes and the April 2015 Regulatory Affairs Status Report. Commissioner Chow asked for more information on the timeline to replace Laure Marshall, Data Center Manager. Mr. Williams stated that Sue Schwartz will cover Ms. Marshall s duties until a replacement is hired; he noted there is an exam for the position and SFGH will hire as soon as possible. Commissioner Singer asked why the SFGH goal for patient satisfaction with receiving a healthy meal is lower than 100%. Ms. Shermineh Jafarieh, Administrator Diagnostics/Wellness, stated that SFGH is striving for a reachable goal; she noted that previously SFGH scores were in the 30% satisfaction range. She noted that SFGH recently began the Lean process with its food service system. Ms. Jafarieh also stated that when the new hospital opens, patients will have more menu and room service options. Commissioner Chow asked for clarity on the average national goal for patient satisfaction with food service. Ms. Jafarieh stated that the national average for this measure is 80%. Commissioner Chow stated that patient satisfaction with food is an issue at all hospitals. He encouraged SFGH to strive for a goal above the national average. Ms. Jafarieh stated that SFGH is building capacity to help patients understand the dietary limitations the hospital can offer. Dr. Critchfield stated food service can impact a patient s overall experience with a hospital. He noted that it is very difficult to achieve high patient satisfaction scores in this area. Commissioner Chow requested information regarding the Laguna Honda Hospital patient satisfaction scores regarding its food service. Mr. Pickens stated that he will provide this data to the Committee at a later time. Commissioner Singer stated that to achieve success for this measure, it will be important to be innovative and creative. Commissioner Chow complimented SFGH on the format of the SFGH Regulatory Affairs Status Report. Action Taken: The SFGH JCC unanimously approved the April 21, 2015 Quality Council minutes. 2

3 4) HOSPITAL STRATEGY UPDATE Iman Nazeeri Simmons, Chief Operating Officer, gave the presentation. Commissioner Singer stated that the Committee has heard that the SFGH diversion rate may reach zero when the new hospital opens. Ms. Nazeeri Simmons stated that complex work is necessary to achieve this goal. Ms. Currin stated that historically, the SFGH diversion rate was between 0 5%. Director Garcia stated that it may be helpful to bring relevant partners such as the Emergency Medical Services Agency since the SFGH diversion impacts other parts of the City system and hospitals. Ms. Dentoni stated that it may be best for SFGH to complete more work in this area prior to inviting in other partners to the process. Commissioner Chow asked how this change oriented work has been successful at SFGH. Dr. Marks stated that one of the exciting aspects of Lean is that it is necessary to involve all staff to achieve success. Commissioner Singer asked how SFGH prioritizes which areas to use Lean. Ms. Nazeeri Simmons stated that brainstorm sessions called Catchball are utilized to gather and explore suggestions. Commissioner Singer stated that a bias to consensus can be a tool, but it can also lower expectations. Commissioner Chow asked whether approval is requested for the plan s matrix. Ms. Currin stated that approval is requested for the themes of the strategic plan; she noted that the other elements are still in development. Commissioner Singer stated that the plan as written seems operational and is missing a vision and overall goals. Commissioner Chow agreed that the plan needs clarity. He suggested expanding on the True North diagram to extrapolate the vision and goals. Ms. Nazeeri Simmons stated that the SFGH staff will revise the plan and will bring it back to a future SFGH JCC meeting for consideration of a vote. 5) HOSPITAL MANAGEMENT SYSTEM UPDATE Iman Nazeeri Simmons, Chief Operating Officer, gave the update. Ms. Nazeeri Simmons stated that a core value of Lean is to develop leaders who can set strategy so frontline managers and staff can make improvements. Dr. Marks stated that the top reason failure occurs is when someone who is a leader is not given a leadership position. Commissioner Singer noted that he likes the idea of less experienced but skilled staff involved in leadership. Commissioner Chow stated that it is important all of SFDPH has the same True North goals. Director Garcia stated that the recent SFDPH reorganization has helped staff to align to SFDPH s overall goals instead of only focusing on distinct unit goals. 3

4 Commissioner Chow asked why Lean has been so effective for SFGH as a change paradigm. Ms. Currin stated that Lean becomes part of staff daily work. She noted that no meetings take place at SFGH between 8 10am so that managers have time to observe and conduct Catchball sessions with staff. REBUILD/TRANSITION UPDATE Terry Saltz and Lillian Chan, SFGH Rebuild and Transition Project, gave the update. Commissioner Singer asked for an estimation of when the new hospital will be open for patient care. Ms. Currin stated that a timeline is still in development. Commissioner Singer asked if SFGH is keeping track of any excess costs related to the project. Mr. Wagner stated that there have been a small amount of savings in the construction costs; he noted future risks include IT contracts and hiring staff. Commissioner Chow stated that each item on the report should have a breakdown of its components, which should also have dots to indicate their status. Commissioner Singer requested a timeline for when all beds in the new hospital and the Emergency Department will be operational. He stated that each item should include a history of what was previously reported. Commissioner Chow stated that transparency is an important goal for reporting this process. Director Garcia stated that relevant SFDPH staff are meeting with the contractor and the Department of Public Works regularly and will keep the Health Commission updated. 6) HOSPITAL ADMINISTRATOR S REPORT Susan A. Currin, Chief Executive Officer, gave the report SFGH Department of Medicine Annual Celebration SFGH Department of Medicine held its annual celebration on Tuesday, May 19. At this celebration, the Medicine Department acknowledged colleagues who were the nominees and recipients of the 2015 San Francisco General Hospital Medicine Service Awards: John Murray, MD Award For Academic Excellence in Internal Medicine & Dedication to the Humanitarian Mission of SFGH Recipient: Dick Fine, MD Nominees: Mike Ansfield, Soraya Azari, Anna Chodos, Reena Gupta, John Imboden, Devora Keller, Annie Luetkemeyer, John Metcalfe, Gabe Ortiz, Edgar Pierluissi, Hilary Seligman, Jackie Tulsky, and Lisa Winston Henry F. (Chip) Chambers, MD Award: Medicine Subspecialty Consultant Award Recipient: John Imboden, MD (Rheumatology) Nominees: Sam James (Renal), Dhruv Kazi (Cardiology), Justin Sewell (GI), and Delphine Tuot (Renal) Robert Lull, MD Award: Non Internal Medicine Consultant Award 4

5 Recipient: Jeff Schmidt, RN, MS Director, Clinical Operations; Administrator on Duty Nominees: Joe Clement (Clinical Nursing Specialist), Eleanor Drey, MD (Ob gyn), Diana George (Utilization Management), and Cynthia Wiseman Kelley (social worker) Jane Bailowitz, MD Award: Volunteer Faculty Award Recipient: Joseph Pace, MD (Tom Waddell Urban Health Clinic) Nominees: Lou Lehman (SFGH Pulmonary), Anne Rosenthal (Maxine Hall Health Center), Dan Shin (Inpatient service at SFGH), and Maria Sciammarella (SFGH Cardiology) SFGH Performance/Quality Improvement Award Recipient: Will Huen, MD Nominees: Lukejohn Day, Liz Davis, Seth Goldman, Gabe Ortiz, Edgar Pierluissi, Michelle Schneidermann, Larissa Thomas, and Jinoos Yazdany Inaugural SFGH Department of Medicine Clinical Fellow Award Recipient: Rachel Rutishauser, MD (Infectious Disease) Nominees: Mandar Aras (Cardiology), Kendall Beck (GI), Laura Petrillo (Hospice and Palliative Care), Mitch Psotka (Cardiology), Leticia Rolon (Renal), Erin Wilfong (Rheumatology), and Joe Yang (Cardiology) Skin Cancer Screening Day at SFGH A UCSF provider sponsored Skin Cancer Screening day was held, Saturday May 2 nd, in the SFGH General Medical Clinic It was a great success. 150 people were screened, with 20 screened as having possible melanomas. The event was attended by Assembly person David Chiu. Supervisor Campos to Visit Ward 86 Supervisor Campos will be coming to SFGH Ward 86 on Thursday (May 28) to meet with Dr. Diane Havlir, Chief of HIV/AIDS division and Positive Health Program at SFGH, and the Positive Heath Access to HIV Services and Treatment (PHAST) Team. The focus of the meeting is to discuss Getting to Zero, ambitious goal of no new HIV infections, zero HIV deaths and zero HIV stigma. Hospital Council Innovation Symposium Sue Currin and James Marks attended the Hospital Council of Northern and Central California Innovation Symposium earlier this month. Of particular interest was a presentation by Dr. Robert Wachter on changes that the IT revolution is having on the roles of patients, clinicians and healthcare leaders. SFGH Celebrates Another Successful Year of Schwartz Center Rounds SFGH celebrates another successful year of Schwartz Center Rounds. The SFGH Schwartz Center Rounds program is now in its third year. The purpose of these rounds is to: To provide a forum where caregivers from diverse disciplines reflect together on experiences in our workplace that impact, challenge, and inspire us To receive and give support, gain insight, and improve communication To renew our commitment to compassionate care of ourselves, one another, and those we serve SFGH is the first California public hospital to implement this program. Schwartz Center Rounds occur every second Thursday of the month and between 75 and 95 participants attended each session. Below are a few comments from staff: 5

6 A powerful reminder to consider the emotional impact of physical change/disfigurement. We are often so focused on treatment and cure, do not take into account the challenges of living day to day with these changes. Makes me appreciate the human ness of all patients and staff. To recognize our limitations in moments during our day and be compassionate with myself too. Allow myself the necessary breaks to emotionally re group between stressful daily events. Relay For Life This year's American Cancer Society Relay for Life will be held on June 6th at 1pm in Fort Mason, Great Meadow. The SFGH employee BBQ will be held at noon (1 hour before the opening ceremony). SFGH s goal is to contribute $10,000 to this fundraiser walk. Patient Flow Reports for April 2015 A series of charts depicting changes in the average daily census is attached to the original May 26, 2015 open session minutes. Salary Variance to Budget by Pay Period Report A graph depicting SFGH s salary variance between actual and budgeted by pay period is attached to the original May 26, 2015 open session minutes. Commissioner Singer asked if the staff levels have been adjusted on Ward 7L which has a low utilization rate. Ms. Currin stated that staff levels are adjusted for each shift; she noted that Ward 7L is the forensic locked ward. 7) PATIENT CARE SERVICE REPORT Terry Dentoni, Chief Nursing Officer, gave the report. Professional Nursing for the Month of April 2015 Transition Initiatives: Medical surgical Nursing will hold a 1 day workshop on June 5 to plan for the expansion of the Flex RN role to all medical surgical areas and the care of high acuity medical surgical patients in the new building. Currently, 5D as the model cell unit has been testing both the Flex role and the care of high acuity patients. Medical surgical nursing leadership will participate in the workshop and produce a plan for spread and the training of nursing staff. Awards: The following awards were presented during Nurses Week: The O Connell award is presented to a DPH RN who demonstrates leadership in clinical, administrative or education which advances the care of DPH patients or advances the profession of Nursing. This year s recipient, Debi Hines RN, PHN of the Family Mosaic Project was chosen for her outstanding contributions to the patients and families. 6

7 Diane Jones was presented with the SFGH Friend of Nursing Award for her remarkable work throughout her pre retirement and post retirement career with DPH and SFGH. Diane has been an advocate and trail blazer in HIV related clinical work, advocacy and program development. The inaugural Primary Care Nursing award was presented to Rosaly Ferrer RN of SFGH recognizing her role in advancing the care of patients in the General Medical clinic and throughout the SFGH primary care clinics. Three DAISY awards, recognizing staff nurses for their outstanding contributions which make a significant impact on patients and families were presented to SFGH staff nurses. Yu Chin Huang RN of the Infant Care Center was recognized for her extraordinary work with the family of a deceased infant. Juliet Shih and Brooke Bassett RNs of Progressive Care Unit 4B were also presented with DAISY awards for their extraordinary work with a dying patient when they honored his wishes to be outside for the last hours of his life. Dorothy Washington Scholarships for BSN and Masters education in Nursing were awarded to the following five individuals: Chinasa Chuba RN, from 5E/5R in Critical Care. Chinasa has worked at SFGH since She is an expert clinician who is a charge RN, and a key member of the MERT team. While working full time, Chinasa is completing her BSN from Western Governor s University. Alena Mauder from 4E Trauma ICU. Alena has worked at SFGH since 2008 in Critical Care. She currently works as a relief charge nurse and as a MERT Nurse assisting staff throughout the hospital with medical emergencies. Alena is pursuing her master s degree in Nursing Leadership and Management from Western Governor s University. Rosa Leah Martinez Davis works on 6H, the Infant Care Center. Rosa has worked at SFGH since 2006 and is attending Capella University for her Master s Degree in Nursing Administration. Rosa has been a key member of the LEAN 3P workshops which has looked at the patient centered care delivery model for the birth center and nursery. Susana Castro started her career at SFGH in 2003 as a Medical Evaluation Assistant. She currently works on unit 1M General Medical Clinic. Susana is attending the University of San Francisco BSN Program. Susana completed her Nursing prerequisites through the grant funded SFGH Partners in Care program. Elizabeth Cretti, currently works on 6G the Women s Option Center and has also worked in Psychiatry. Elizabeth has worked with SFGH since Elizabeth is a dedicated nurse that has demonstrated her commitment to the most vulnerable patients served here at SFGH. Elizabeth is currently attending UCSF in there Adult primary Care Nurse Practitioner Program. Events: The annual DPH Nurses week event was held on May 7 at the SFGH cafeteria. The evening reception was attended by more than 400 DPH staff including the Director of Health and Commissioner Dr. 7

8 Chow. The reception was an acknowledgement of the dedication and work of DPH Nurses. Multiple awards were presented: the O Connell award, the SFGH Friend of Nursing award, the Primary Care Nursing award, the DAISY award and the Dorothy Washington Scholarships. A second reception was hosted by SFGH Nursing leaders for the night shift staff from 8 10pm in the SFGH Wellness Center which also had record breaking attendance of more than 300 staff. Special thanks to Richard Swart RN from the Cardiac Cath lab. Rich has been instrumental in coordinating Nurse s week activities from unit rounds with treats for the staff to massages in the Wellness center for Nursing staff. Emergency Department (ED) Data for the Month of April 2015 March 2015 Diversion Rate: 41% ED diversion 179 hours (24%) + Trauma override 120 hours (16%) ED Encounters: 5328 ED Admissions: 867 ED Admission Rate: 16.2% Psychiatric Emergency Service (PES) Data for the April 2015 PES had 585 patient encounters in March 2015 and 576 in April2015. PES admitted a total of106 patients to SFGH inpatient psychiatric units in April, an decrease from 113 inpatient admissions in March. In April a total of 470 patients were discharged from PES: 32 to ADUs, 10 to other psychiatric hospitals, and 428 to community/home. There was an increase in Condition Red hours from March to April. PES was on Condition Red for hours during 19 episodes in April. The average length of Condition Red was 8.92 hours. In March, PES was on Condition Red for hours, during 17 episodes, averaging 6.93 hours. The average length of stay in PES was hours in the month of April. This was an decrease from the March LOS of hours. Request for Inter Facility Transfer to PES from other Hospitals A priority of PES is to improve the timeliness and appropriateness of inter facility transfers from referring hospitals. The following three types of PES referrals have been observed: Accepted and Arrived, Accepted and Cancelled, and Inappropriate Referral. Accepted and Arrived Referrals refer to patients that have been approved by PES for admission and are admitted to the unit. Accepted and Cancelled Referrals refer to patients that have been approved for admission by PES, but their transfer is cancelled by the referring facility. This could be because the referring hospital has decided to place the patient on their own psychiatric unit, or because the patient has cleared psychiatrically and the 5150 hold has been dropped. Inappropriate Referrals refer to patients identified through the PES screening process to be inappropriate for further PES evaluation and placement. 8

9 Common reasons for declining transfer of a patient from a referring hospital are medical status (not medically cleared at the time of screening) and insurance status (e.g., private insurance or out of county Medi Cal). PES referral data above suggest that timeliness and appropriateness of inter facility transfers are being achieved. Of referrals between March and April 2015, the percentage of which the patient was accepted and was admitted to PES increased from 52% to 58%. The percentage of which the referral was accepted but cancelled increased from 18% in March to 27% in April This month,15% of the referrals were considered to be inappropriate. These included medically unstable patients, and those with private or out of county insurance. The number of requests increased from 67 in March to 104 in April. Ms. Dentoni thanked Dr. Chow for attending the recent SFGH Nurses Week dinner. Commissioner Singer stated that he continues to be concerned about the high diversion rate. Commissioner Chow noted that the Psychiatric Emergency Service (PES) Condition Red rate continues to rise. Ms. Dentoni stated that PES rates throughout the state have risen. She added that SFGH is meeting with Dr. John Brown, Medical Director of the Emergency Medical Services Agency, to work on this issue. 8) SFGH RN HIRING AND VACANCY REPORT Karen Hill, SFGH Human Resources, gave the report. Commissioner Chow noted that SFGH continues to fall behind its hiring goals but the report shows a green dot indicating achievement. Ms. Dentoni stated that she is pleased with the direction of the hiring. She noted that as new staff are hired, there are existing staff that decide to retire; this impacts the achievement of the hiring goals. Commissioner Singer stated that he understands progress has been made on many levels in regard to the SFGH hiring process. However, he noted that the number of people left to hire continues to grow; this indicates that monthly goals are not being met and the overall hiring goal is not being achieved. Ms. Currin stated that there are lists of qualified people who are interested in SFGH positions; as positions open up, SFGH is hiring as quickly as they can within the constraints of the City hiring process. Director Garcia stated that in addition to hiring, new staff have to be trained which also takes time and resources. Commissioner Chow stated that Human Resources data reported should be accurate and up to date. 9

10 9) MEDICAL STAFF REPORT James Marks, M.D., Chief of Staff, gave the report. ADMINISTRATION/LEADERSHIP: Enterprise EHR System for DPH Dr. Neil Powe, Chief, Medicine Service, presented to MEC the letter sent to the Director of Public Health, Barbara Garcia on April 29, 2015 signed by most SFGH Service Chiefs. The letter expressed the Service Chiefs support for a future enterprise Electronic Health Record (HER) system for the Department of Public Health, including the San Francisco Health Network and the San Francisco General Hospital and Trauma Center. The letter also indicated that the Service Chiefs have discussed potential EHR vendors, and were in consensus that EPIC is the EHR that will best meet the clinical needs of SFGH, DPH, health professionals throughout DPH and the SF residents entrusted to DPH providers. Dr. Powe informed members that Ms. Barbara Garcia has acknowledged receipt of letter, and has expressed her gratitude and appreciation to the SFGH Service Chiefs for their formal recommendation. (Copy of letter attached.) CLINICAL SERVICE REPORTS: Orthopedic Surgery Report Theodore Miclau, MD, Service Chief Dr. Miclau highlighted the Service s new mission statement that came about from the recent retreat in spring, To mend the injuries, inspired innovators and empower leaders to restore lives. The SFGH Orthopaedic Service continues to receive national recognition as a center of excellence for trauma care, especially with the services and activities of the Orthopaedic Trauma Institute (OTI) that supports the Service s mission statement. The report provided updates on the following: Faculty Service Scope of Practice Patient Care Productivity Finances Education Research Outreach Electronic Communication, IGOT (Institute for Global Orthopaedics and Traumatology) and its global partnerships, SMART (Surgical Management and Reconstructive Training) Course (a modular skills based curriculum for surgeons in developing countries offered in country and annually in San Francisco). Goals for include: Develop and promote the UCSF/SFGH Orthopaedic Trauma Institute, including programs for referrals, outreach, and fundraising, Improve efficiencies across all service lines, particularly the clinic and OR, and Expand O&P (Orthotics and Prosthetics) Services. Members commended Dr. Miclau for his outstanding presentation, leadership, and entrepreneurial spirit. Regarding the Antenatal Testing Center Standardized Procedures and Protocols Manual, Commissioner Chow made the following comments: Page 9: suggested removing the term, Community Health Network (CHN); Page 23: the manual only refers to written orders; the manual should reflect that SFGH uses both written and electronic medical orders. Page 24: it is no longer accurate to state that Laguna Honda Hospital has a long waitlist. 10

11 Commissioner Chow stated that he is in favor of approving the manual with the understanding that these issues would be updated. Action Taken: The SFGH JCC unanimously approved the following: REVISIONS TO THE RN ANTENATAL TESTING CENTER THE COMBINED OTOLARYNGOLOGY NP/PA/SP STANDARDIZED PROCEDURES RULES AND 10) PUBLIC COMMENT There was no public comment. REGULATIONS FOR THE EMERGENCY MEDICINE SERVICE RULES AND REGULATIONS FOR THE ORTHOPEDIC SURGERY SERVICE 11) CLOSED SESSION A) Public comments on All Matters Pertaining to the Closed Session B) Vote on whether to hold a Closed Session (San Francisco Administrative Code Section 67.11) C) Closed Session Pursuant to Evidence Code Sections 1156, , 1157, and : Health and Safety Code Section 1461; and California Constitution, Article I, Section 1. APPROVAL OF CLOSED SESSION MINUTES OF APRIL 28, 2015 CONSIDERATION OF CREDENTIALING MATTERS CONSIDERATION OF PERFORMANCE IMPROVEMENT AND PATIENT AND SAFETY REPORT AND PEER REVIEWS RECONVENE IN OPEN SESSION 1. Possible report on action taken in closed session (Government Code Section (a)2 and San Francisco Administrative Code Section 67.12(b)(2).) 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Committee approved the April 28, 2015 Closed Session minutes; the May 2015 Credentialing Report; and the Performance Improvement and Patient Safety Reports. The Committee voted not to disclose other discussions held in closed session. 12) ADJOURNMENT The meeting was adjourned at 7:06pm. 11