Synopsis of Long Range Service Delivery Planning Process

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

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

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

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

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

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

The planning process was guided by several important considerations:

• There are a number of "givens" and assumptions regarding the role of SFDPH and SFGH in meeting community needs that are widely accepted and understood.
• There also are numerous open questions and choices that have significant implications for the size and scope of programs to be operated by SFDPH at SFGH. Identifying, analyzing, and discussing these choices have been major endeavors of the LRSD effort.
• The choices (and consultant recommendations) should be guided by the desire to achieve goals that reflect the mission of the San Francisco Department of Public Health, including:

• Improving access to care
• Improving quality of care
• Meeting future health care needs
• Implementing best practices
• Advancing knowledge and health professions training
• Conserving capital resources and the City’s debt capacity
• Operating health and public health programs efficiently
• Meeting the SFDPH Strategic Goals
• Responding to SB 1953, the Hospital Seismic Safety Act and other regulatory requirements

• The choices (and consultant recommendations) resulting from the LRSD planning process will continue to be examined and refined through the recommendations of the Health Commission at joint conferences and at the full meeting and during upcoming Institutional Master Planning process, discussions with UCSFMC and the San Francisco community, and through financial analysis that would further inform decision making.
• The rebuilt SFGH would not be open to receive patients for ten years, given current construction, decision-making, financing, and regulatory requirements.
• The choices and recommendations described herein will continue to be informed through monitoring developments in the San Francisco and Bay Area health care market, such as changes to area hospital capacity, the clarification of other hospitals’ plans to respond to SB 1953 requirements, and evolving community needs.

Assumptions

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

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

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

Choices

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

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

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

PLANNING MEMBERS

Long Range Service Delivery
SFDPH Internal Group Members

Long Range Service Delivery
Community Group Members