Flood of new patients forces SF General to innovate

Editor’s Note: This is the sixth part of a series on the Healthy San Francisco program, which provides nearly universal health care for the city’s residents. Each part of the series will examine the program through the eyes of different people in the community, including a patient, a doctor who runs a clinic, two employers with different views of the program, and a hospital administrator. To see the entire series, go here.

Ronald Pickens, chief operating officer at SF General Hospital. Photo by Richard C. Paddock.

For hospital administrator Roland Pickens, Healthy San Francisco offers more than universal health care and coverage for the city’s uninsured. The three-year-old city program also is inspiring new approaches to streamlining medical care.

Pickens, chief operating officer of San Francisco General Hospital, said the city health care program has led to innovations that include evening and weekend clinics, better care of patients with chronic conditions, electronic referrals that speed up the appointment process and a teleconferencing system that has doubled the availability of interpreters.

“That’s the beauty of Healthy San Francisco,” he said. “It has done so much in enlisting ideas of what we can do better in serving our patient population.”

The hospital has come up with new ideas out of necessity. Its caseload has mushroomed with Healthy San Francisco; more than 8,000 patients have chosen the public hospital as their medical home. At the same time, the creation of Healthy San Francisco made the hospital eligible for a state grant of $20 million for innovation in medical care over three years.

“It requires that you not do business as usual,” Pickens said. “Everyone recognizes that our health care system is broken, it’s inefficient, and we need to look at new ways of delivering care.”

Pickens, 47, took over as chief operating officer in October. He says it is the job he has wanted ever since he was a boy and watched his elder brother undergo treatment for cancer. Pickens attended a specialized high school in Houston for medical professionals. His first job was as a nurse’s assistant while he was a high school junior.

“Some people grow up going, ‘I want to be a doctor,’” he said. “I grew up going, ‘I want to be a hospital administrator.’”

Pickens came to California from Texas in 1989 and quickly embraced the philosophy of providing adequate public assistance to those who need it – the approach embodied in Healthy San Francisco.

The challenge now at San Francisco General -– an overcrowded public facility in the midst of a major rebuilding project -– is to make the best use of the hospital’s limited resources.

“It’s so crowded here we have people in offices that used to be bathrooms,” Pickens said.

To maximize space and accommodate its growing caseload, the hospital expanded clinic hours to weekday evenings. Clinics will eventually open on Saturdays too.

The hospital also has implemented several strategies to reduce patient waiting time.

It has redesigned the way it provides care to patients with chronic conditions. Rather than sending all patients with chronic conditions to specialists around the hospital, some specialists are now stationed in primary care clinics, including orthopedists, endocrinologists, and cardiologists. Nurse practitioners trained in various specialties are also on hand to see patients.

Electronic referrals speed up the process of scheduling appointments. And teleconferencing makes more effective use of the hospital’s interpreters, who speak 20 languages.

Previously, interpreters would roam around the sprawling hospital to meet patients for appointments. Getting a doctor and interpreter together at the same time could mean waits of up to two hours for patients.

Now the interpreters remain in their offices two blocks away and join in by video. The system has reduced waits dramatically and increased the number of sessions interpreters can work from two to four an hour.

“By using technology, we take out the inefficiency of the old system,” Pickens said. “The response has been overwhelmingly positive.”

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