San Francisco, CA

TLHIP’s SCALE Team JENNIFER LACSON Improvement Advisor Community Benefit & Emergency Services Manager, Saint Francis Memorial Hospital ABBIE YANT, RN, MA Coalition Leader Vice President, Mission, Advocacy, Community Health, Saint Francis Memorial Hospital PATRICIA ZAMORA Community Champion Area Director, Boys & Girls Clubs of San Francisco PAULA FLEISCHER Navigator, Community Engagement and Health Policy, University of California, San Francisco KRISTENE CRISTOBAL Evaluator/Improvement Advisor Cristobal Consulting JENNIFER KISS Director, TLHIP Saint Francis Foundation

Our Partner Organizations Saint Francis Foundation Saint Francis Memorial Hospital San Francisco Department of Public Health San Francisco Mayor’s Office of Economic and Workforce Development University of California, San Francisco Boys & Girls Clubs of San Francisco

Since the last CHILA, we are excited to share what we are most proud of…. National Night Out at Boeddeker Park: 1000+ residents activating the park and celebrating safety and diverse community. Grantee Workshop: Convened year-1 grantees in facilitated discussion on bright spots and blind spots using TLHIP Action Zone map: “What are your proudest 1-3 accomplishments? What challenges/barriers are you facing now?” and opportunities for alignment and support/synergies: "Knowing what you know now, what additional collaboration, connection, partnering with others in the room might help you move forward? This discussion led to deeper a reflection & exploring the idea of synchronized activities in the upcoming year that add value to the local place based work and brings up the whole of the community (e.g. community calendar)

A story about something we learned since CHILA1…. Incorporating from CHILA a “learning lab” approach that facilitates sharing, feedback loops, especially when we have bright spots and blind spots. This is changing the way we build relationships, process and maximize our collective impact approach from our backbone  to grantees, to community engagement After the grantee workshop, we met with the steering committee and invited the grantees to speak to “bright spots” of their work to implement the initiative’s place-based strategy in the Action Zones. What is one thing that you discovered doing your place-based work? What is one idea that inspired you the most at the grantee workshop that you want to explore next? This discussion led to a deeper understanding among the grantees and the steering committee, focusing on bright spots and the convergence of place-based strategy. Useful tools that led to this meeting was the use of driver diagram in planning meetings to help us focus and zero-in on the aim, introduction of Switch and bright spots into communications.

What we learned about engaging community members with lived experience As the backbone of the initiative, the hospital and foundation are 1-degree of separation from the residents A steering committee member was thinking of ways for others to have the intimate experience of the day in the life of a resident, which led to invitations to go on neighborhood walking tours During some of the tours, residents invited us into their homes and shared their stories first-hand which was key to understanding the bright spots and barriers they face everyday A key driver of these experiences was building and strengthening the relationships with community connectors who have built resident trust through their work

What we learned about engaging the BROADER community in developing our aim During discussion with steering committee about developing aim in July there was hesitation to narrow down population focus to just children. The conversation started going down the slippery slope of wanting to do everything for everybody. From this, we learned you have to zoom in and zoom out in order to come to a decision.

Our aim for SCALE is….. By December 2016, increase positive activation for residents on Ellis, Leavenworth, Jones and Golden Gate Streets to and from Boeddeker Park on Monday to Friday during 2:30pm – 4:00pm. Positive Activation Definition: Background: This aim statement emerged from a series of conversations about Boeddeker Park serving as a community hub/“game-changer” in Action Zone B and how there is a measurement system in place managed by Master Tenant Boys and Girls Clubs of San Francisco. As a community hub, the park is what is generating positive activities on the streets leading to and from it, which is the heart of TLHIP’s theory of change: the saturation of positive activation on the streets can prevent negative behavior/activities from occurring.

A Theory of How to Improve a System Improvement Science in ActionNWIA Building Improvement Capability Session 3NWIA Building Improvement Capability Session 2Improvement Science in Action • April 22-24, 2009 Improvement Science in Action Using Measurement for Quality Improvement A Theory of How to Improve a System Here’s a schematic view of a system – a ‘driver diagram’. On the left we depict the outcome in the yellow box. As we move right we drill down into the network of causes that drive the outcome, from ‘primary’ to ‘secondary’ drivers. On the right we depict the ideas for system changes that might ultimately impact the outcome. This diagram represents our theory about how to modify the system to change the outcome. Effect Cause Drives 9 Using Measurement for Quality Improvement • April 2009 © 2010 R. ScovilleUsing Measurement for Quality Improvement • April 2009 9 9

Metrics we are considering to our track progress Number of children going to Boeddeker Park within 10 block area from 2:30pm – 4:00pm Number of children going from Boeddeker Park to residences within 10 block area from 2:30pm – 4:00pm Staffing along Safe Passage Route Observation of positive and negative activity on the streets Decrease in negative crime activity

What we learned from “Switch” Helps you focus on what is working/bright spots and the drivers you can enhance to make things better The balance of emotional and analytical piece The journey is the process Formerly taboo subjects are now being part of the conversation

Top two things we learned from other communities since CHILA1 Some communities who have a portfolio of projects under their umbrella initiative were also grappling with developing an aim for the entire initiative or developing an aim for just one of the projects. ReThink Framework – interested in diving deeper to understand how to bring systems change to our community.

Our biggest challenge(s) right now are….. Identifying benchmarks that tie program outcomes with long-term health improvement Establishing a clear trajectory linking the upstream interventions to improved Tenderloin community health and better access, coordination and utilization of healthcare services

We hope to learn this at CHILA2… Learn how people are adapting to the CHILA process - what their aha’s are and how they are integrating it into their work Learn more techniques to implement PDSA cycle in community setting The inclusion and involvement of the resident/lived experience Understand whether we have the right tools to engage residents to develop and implement solutions tailored to their needs. Overarching community health improvement – are we getting there?

Best way to contact us: Jennifer Kiss Director Tenderloin Health Improvement Partnership 900 Hyde Street San Francisco, CA 94109 Jennifer.Kiss@dignityhealth.org (415) 425-0378