Table 1.

Tiered Governance Structure of San Francisco Health Systems Collaborative

Domains	Department of Public Health	Health Care Delivery Systems	Examples
• Leadership • Local Policy	Director of Health and Health Officer (Director of Population Health)	Hospital Council (CEOs)	• Overall resource commitments and authority • Memoranda of understanding for operational collaboration • Feedback on local policies
• Medical Surge • Hospital Response	San Francisco Health Network CMO and CNO	CMOs and CNOs	• Proposed surge triggers and hospital-based operational levers (e.g., clinic or operating room reductions outside of health orders) • Detailed resource allocation (e.g., remdesivir or nirmatrelvir)
• Operations • System Access	Covid-19 operational leaders (population health, ambulatory care, hospital)	Operational executives (chief operations officers, chief pharmacy executives, ambulatory care leaders)	• Vaccine site operations (hours staffing, community referrals, vaccine product distribution) • Testing access expansions • Alternative Care site pathways and operations
• Preparedness Planning • Regional Resource Requests	Public health emergency preparedness and response	Hospital emergency management teams	• Medical surge plan reviews, feedback, and additional systemwide supports/gap closure • Scarce resource requests to region/mutual aid (vaccine or medication surplus requests, outbreak resource requests)

This table shows the four primary work groups of the San Francisco Health Systems Collaborative, their domains of responsibility, and examples of the nature of work or decision-making at each level of collaboration. CMO = chief medical officer, CNO = chief nursing officer. Source: The authors