1. San Francisco, CA

2. 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

3. 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

4. Since the last CHILA, we are excited to share what we are most proud of….
National Night Out at Boeddeker Park: 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)

5. 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.

6. 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

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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?

15. Best way to contact us: Jennifer Kiss Director
Tenderloin Health Improvement Partnership
900 Hyde Street
San Francisco, CA 94109
(415)