Meeting Notes
December 23 Meeting of LHH-JCC

Joint Conference Committee for Laguna Honda Hospital
December 23, 2004 Meeting
Meeting Notes
of Patrick Monette-Shaw

Note: The notes below, though not exhaustive, are those of the author, and should be compared to the version of the December 23 meeting minutes that will be prepared and published by the Health Commission, which will become available during the LHH-JCC January 2005 meeting. Bracketed statements are asides to the notes.

Agenda Item 3: Executive Administrator's Report

Mr. Kanaley, LHH's Executive Administrator, reported that the hospital is working on an 18-month Strategic Plan and is starting to develop a three-year business plan. Kanaley reported that during two retreats of the LHH hospitalwide Executive Committee held on November 23 and December 9, and in consultation during a meeting with Dr. Katz, Director of Public Health, the hospital has begun to solidify LHH's mission. Kanaley reported to the Health Commissioner's present on December 23 (Commissioner Edward Chow, Health Commission President, and Commissioner Jim Illig) that "we needed to agree that we were heading in the same direction" regarding LHH's mission and vision. Kanaley indicated that as part of DPH's safety net, LHH would be providing skilled nursing services to "diverse" populations of San Francisco. Kanaley reported that LHH is changing its mission statement this year, by changing its previous wording from providing "long term care" to "skilled nursing" services instead. LHH will become a "Center of Excellence" by providing integrated care in the least restrictive setting, with a goal that LHH will be building new clinical programs.

Kanaley stated that during the second retreat, clinical programs for LHH's changing patient populations were discussed. LHH is focusing significantly on revenue enhancements, rather than on budget cuts. At the end of January 2005, LHH's Executive Committee will hold a third retreat to flesh out LHH' goals, in order to align [and potentially curtail?] programs given the reality of LHH's budget. Over the next 18 months will be meeting with LHH staff and the community to flesh out LHH's changing mission.

Following Kanaley's remarks, Commissioner Illig indicated he was glad to hear that the three concerns about LHH [usually understood to mean concerns about the patient population mix, the safety of LHH staff and LHH's residents, and the size of the LHH rebuild project] involved differences of opinion. One of the Commissioners raised a question about whether the "differences of opinion" focused only on the "diverse" patient population now being seen at LHH. Following further discussion, Commissioner Illig stated he was glad to hear that the differences of opinion did not revolve around the U.S. Supreme Court's Olmstead decision about providing care in the least restrictive setting.

In concluding discussion about LHH's changing mission, Mr. Kanaley, smiling, asked "Are we all happy now?" Commissioner Chow noted that the mission and vision statements need to keep changing around available resources. Chow then asked if there was a consensus among the Executive Committee about the mission policy change, or whether there were any "minority [dissenting] reports?" Commissioner Illig indicated he believed that the policy change had been introduced by one member of the Executive Committee, there had been minor wordsmithing changes to the proposed mission statement, and that it was "pretty much fully endorsed" by the full hospitalwide Executive Committee.

Commissioner Chow then asked "Is the Nursing staff happy [with the mission statement change]?" Co-directors of Nursing, Mivic Hirose and Gayling Gee nodded their heads in assent. Commissioner chose then asked "Is the Medical Staff happy [with the mission statement change]?" The Medical Director, Paul Isakson, MD, and the Assistant Medical Director Timothy Skovrinski, both nodded their heads in assent.

Following a long discussion about the so-called Targeted Case Management program, in which residents of LHH are being targeted for discharge to other community-based facilities, Dr. Skovrinski noted that the TCM staff have discharged only five residents under the TCM project. Commissioner Illig noted that his "dream" was for clinical issues to be addressed as part of the potential-for-discharge assessments, to be linked with other City databases to facilitate discharges from LHH.

Mr. Kanaley indicated that they will bring the revised mission statement to the next LHH-JCC meeting before it is presented to the full Health Commission. Commissioner Illig noted that "everything is moving very quickly," and that they need to get financial information to inform the process. Mr. Kanaley indicated that LHH will "align its programming with its budget," and that a new "behavioral health model" [read: mental health] services at LHH will be included in the budget process.

Dr. Isakson noted that wordsmithing of LHH's admissions policy had concluded, and that as of Tuesday, December 21, the LHH hospitalwide Executive Committee had approved final changes to LHH's admissions policy. Dr. Isakson indicated the policy changes had been approved by LHH's Medical Staff and by the Medical Executive Committee prior to final approval by the hospitalwide Executive Committee. The new policy will provide a collaborative process in which Dr. Katz will continue to be involved in any admission disputes not resolved by LHH's Executive Administrator.

Agenda Item 4: Laguna Honda Hospital Replacement Project Update

Over the past four months, the LHH rebuild Project Manager, Michael Lane has not been present during at least two LHH-JCC meetings to present updated status reports about the replacement project. During the December 23 LHH-JCC meeting, LHH's Executive Administrator, John Kanaley, presented a report in Lane's absence. Kanaley noted that the project team is sill waiting on final bids, because the initial numbers concerning bid prices were still too high. They now expect the bid process to be complete in mid-January. LHH intends to present a report to the LHH-JCC meeting in January about the bids received. Although Commissioner Illig believed that Mr. Lane has been meeting with Mayor Newsom regarding the bidding process, Kanaley corrected Commissioner Illig by stating that he (Kanaley) believes Lane has been meeting with the Mayor's Chief of Staff, Steve Kawa, not with the Mayor himself.

Agenda Item 5: Operations Report

LHH's Chief Operating Office, Robert Christmas delivered his report. He indicated that LHH is not allowed to buy furniture, fixtures, and equipment for the LHH replacement project until 2007. Christmas discussed new "value added" aspects of an automated medication dispensing system to prevent medication errors. Commissioner Illig suggested that in order to move the capital expense project for the medication monitoring system forward, LHH should attempt to demonstrate salary savings, possibly either to the Nursing budget or the LHH Pharmacy Budget, because any such salary savings that can be demonstrated by may help move capital expenditure requests more easily, and more quickly, through City Hall.

Christmas asked Hospital Administrator Cheryl Austin to present an update on the new parking fees being imposed on LHH staff. Ms. Austin indicated that a lottery for the limited number of parking spaces would be held on January 4. While Austin noted that application forms to participate in the lottery were "delivered" that morning [on December 23] to LHH department heads, she did not note verbally that the staff was being given a mere four-working-day notice about the deadline in which to submit applications to participate in the lottery.

Agenda Item 6: Clinical Care Report

During this agenda item, Assistant Medical Director Tim Skovrinski announced that LHH's ward known as "G-5" has now become a co-ed unit, [beds formerly reserved for elderly women are now being used for younger men]. [Skovrinski did not discuss concerns raised by others that co-ed units are reportedly extremely disturbing to LHH's female residents. After all, LHH's residents are frail elderly during the last years of their lives, not college-age students who don't mind co-ed college dorms.]

Among other issues, Skovrinski announced ward E-3 will become a "flex" unit of some sort, and will be staffed principally by certified nursing assistants (CNA's) and licensed vocational nurses (LVN's) due to E-3 being housed with patients having less acuity (i.e., their needs are less acute than requiring registered nurses, or RN's). Skovrinski reported OSHPD has approved a permanent move of M-6 residents to D-3, which, in part, will help expand LHH's HIV cohort of patients. HIV patients are now placed throughout LHH, rather than only on unit O-4 that is dedicated to AIDS patients.

Following the Clinical Care Report, which monthly report is jointly delivered by members of the Medical Staff and members of the Nursing Staff, Commissioner Illig noted that he had worked for 15 to 25 years in psychosocial rehabilitation. He congratulated Co-Director of Nursing, Mivic Hirose, RN, on her receipt of a $50,000 California HealthCare Foundation grant to do "social rehabilitation" at LHH.



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