Learn how Bon Secours St. Francis Health System is leveraging mission tours to shine a light on the needs of the community and how their health system plays an integral role.
The social safety net in South Carolina is rather thin, and the state did not agree to Medicaid expansion under the Affordable Care Act, resulting in many uninsured and underinsured in the state. Bon Secours St. Francis is a faith-based health care institution, so they turn no one away and in many instances are the first physicians that patients may see in years. Patients often present with advanced illness despite public messaging regarding the importance of screening and proactive management of complex health problems for a variety of reasons, including cost of health care, distance to care centers, and a regard for personal or community safety. This results in a rather complex patient population that urgently needs care.
Developing the Intervention
Culture and faith play a key role in the attitude towards health care in the Greenville, SC, region that Bon Secours St. Francis serves. It is often difficult to discern if these attitudes toward a patient's own health care are a direct result of their spiritual beliefs, or a comforting alternative response to a health care system that has in large part neglected them and their needs or is difficult to access and navigate.
Bon Secours St. Francis strives to address this community's needs by educating their leadership and taking them out of what may be their personal cultural comfort zone. They aim to help leadership understand how their local patients engage the health care system and how the health system makes care available to them. This education happens through a cultural tour of the community led by the Bon Secours St. Francis Mission office team. These tours are offered to leaders, both administrative and medical, within the system. They are not mandatory. Each tour group includes a guide from the Mission office and 3 to 5 system leaders. By keeping the groups as small as possible, one can observe interactions at the community sites without the tour becoming disruptive or the unintended focus of the location's events.
The first stop on the tour is to the free dental van that parks outside local mercy centers on certain days. The dentist and team attend to individuals and families, many of whom have long-standing dental issues and no routine dental care. In many cases, the dental issues exacerbate chronic medical conditions which are already under poor control. By positioning itself in the parking lot of the mercy center, the dental van increases its visibility and accessibility to individuals with otherwise limited transportation options. The mercy center itself is a unique place. It functions as food bank as well as a social and activity center for much of the community's homeless population. Bon Secours St. Francis also embeds a social worker in this otherwise independent faith-based mercy center, which is affiliated with a well-attended contiguous local church.
The next stop is to another church, one that serves nearly 2500 Latino/a/x families. This house of worship serves an immigrant community of limited means and one unlikely to reveal itself to the scrutiny of a formal health care institution given recent trends in immigration policies. Understanding these patients' needs, Bon Secours St. Francis embeds a bilingual nurse and bilingual social worker into space provided by the church, where medical and social services are delivered on site in comforting, non-threatening surroundings.
The final stop of the mission tour is at a childcare center that provides day care and developmental therapies for children with a variety of chronic medical conditions. The center aims to enhance the quality of the lives of the children and free up parents for work and other family responsibilities. Bon Secours St. Francis has also invested in an activities area for this childcare center in support of its mission.
At the completion of the tour, health system leaders are left with a more intimate understanding of their community, its needs, and the role that Bon Secours St. Francis plays in caring for the patients in their community who have limited access to care. In addition to the Mission office, Bon Secours also employs a population health team and has several employees based in various churches, community centers, schools, and free medical clinics where social services and primary medical care are provided.
Despite these efforts, Bon Secours St. Francis recognizes there is still much work to be done. There are areas where there are no outposts for community management of health. Urban populations are denser, and one can interact with more people in a smaller space with fewer team members than one can in more rural areas. Implementation of programs in rural settings requires a completely different approach, which is not as developed as that for programs targeting urban underserved populations. Despite the challenges, Bon Secours St. Francis continues to practice its mission and is hopeful about the improvements that can be made in the future for their patient population.
Bon Secours St. Francis is a faith-based organization committed to serving the urban poor, as well as an extended community of rural poor in the surrounding areas of Greenville, SC.