Providing a Better Chance to Flourish

March 27, 2024

Medical Assistant Isabella Duan sits at a desk in the new exam room at St. Anthony Foundation’s Father Alfred Center (FAC). She logs into the desktop computer and reviews the day’s patient list.

With Registered Nurse Diana Ramos sitting at the adjacent desk, the two of them discuss how this particular Tuesday morning will go considering the needs of each patient – the specific lab work needed, their medical history, and if they had prior visits with the Medical Clinic staff. Then, they wash their hands, wipe down the room, and prepare equipment for the day’s first patient.

“The first week, we had four patients signed up. Last week, we also had four. This week, we now have six,” Duan said.

At the beginning of the year, the exam room didn’t exist. In fact, the room served as the trash room with the city’s compost, recycling, and trash bins lined up along the back wall. Located in the back of the building with a small window providing minimal light, the room was described by St. Anthony’s team members as dilapidated.

With the help of several departments at St. Anthony’s, the room was transformed into a safe, private medical exam room where residents can be assessed and receive direct medical care. While the transformation of the room may seem minimal, it’s an important step toward St. Anthony’s goal of whole-person, integrated care.

“We’re just starting, but it continues to impress me [of] the importance to integrate silos,” explained Dr. Larry Kwan, St. Anthony’s chief medical officer, who was appointed as the foundation’s next CEO beginning April 1. “(These silos) were always broken out into these massive departments of mental health, addiction services, and general medical care. The patients/guests that we serve need all three, so we were missing an opportunity to better serve them if we kept them disintegrated.”

Just a few months ago, integrated care was a concept for St. Anthony’s. The question remained how best to implement integrated care throughout the foundation to better serve guests.

Before the creation of the new exam room, a guest would arrive at Father Alfred Center, St. Anthony’s year-long residential recovery program, and enroll adhering to set criteria. As part of the intake process guests were required to go off-site from Father Alfred Center to St. Anthony’s Medical Clinic at 150 Golden Gate Avenue, eight blocks away.

For guests aspiring to the goal of long-term sobriety, those eight blocks can be an additional barrier and very challenging. According to Director of Clinical Services, Laura Flannigan, guests would check-in and go through the intake process onsite at FAC, but they would not always show up to their physical exam appointments at the Clinic.

“Before we started this project, the Father Alfred Center intake process didn’t necessarily involve the Clinic,” Flannigan explained. “What we’re hoping to change is [that] all guests at FAC will receive a physical exam. This allows us to provide comprehensive care.”

Originally, the idea of onsite medical exams at FAC first developed between former Intake Coordinator, Justin Townsend, and former CEO, Nils Behnke, back in late 2022. Behnke recruited Dr. Kwan to be St. Anthony’s new Chief Medical Officer, who officially joined the foundation in May 2023. At this time, Father Alfred Center came under the direction of Dr. Kwan and the Medical Clinic.

“Justin advocated for some kind of clinical presence at FAC. There was some groundwork that had been done, so they (FAC and the Clinic) were two separate things that grew up in different ways. The idea of integrating a medical perspective and an addiction perspective for our guests at FAC has always been in the DNA of what we’d like to do,” Dr. Kwan explained.

Behnke strived to incorporate health services as a complete entity, meaning primary and specialty medical care, mental and behavioral health, and addiction support all under one umbrella. As Dr. Kwan took the lead of the health services umbrella (the Medical Clinic, Father Alfred Center, and Companionship Model of Care), Flannigan came on board to St. Anthony’s soon afterwards in July 2023.

As the exam room idea evolved, Flannigan and Quality Improvement Nurse Manager, Joan Kosgey, identified Duan to spearhead the project, and from there, the project became much clearer.

“I was hired in November 2022, and coming in, I had a lot of background experience,” mentioned Duan. “Once I got a good sense of my day-to-day work, I started taking on more projects.” When Dr. Kwan and Flannigan mentioned this idea to Kosgey, Kosgey referred Duan to them as an appropriate person to work with and lead the full scope of the project.

Transforming a trash room into a medical exam room meant a lot of moving parts across several departments within St. Anthony’s. First, the Operations team was delegated to provide updates to the room, including clean the entire room, paint the walls, assemble and install medical equipment, technology devices, and relevant appliances along with a whole host of other tasks to renovate the room. Then, the Data and Technology Management team configured the software and hardware so that it synced up with the existing medical records program, Epic.

“We were meeting regularly over the course of a couple of months just in terms of defining what the workflow is so that our team can then marry it to Epic,” says Kara Forman, IT Project Manager, who led the IT effort. “The platform configured properly. They could then schedule appointments, block time for medical providers and other staff to see guests, and we made updates with the lab (Quest Diagnostics) to make sure that the routing was correct on the back end so that results and materials were getting routed appropriately.”

A regular workflow quickly took shape. Every other Tuesday morning, Duan and Ramos arrive at the Medical Clinic, conduct a brief check-in, and then make the eight-block walk to Father Alfred Center. They meet with the guests, take their blood pressure and other vitals, draw blood in tubes, and order lab tests. They also provide guests with a questionnaire to assess further medical needs, including scheduling follow-up appointments with Dr. Mario Rizzo for podiatry/foot problems, Dr. Newsom for psychiatry, Ryan Melone who is one of St. Anthony’s behavioral health counselors, and the Franciscan Friars for spiritual support, prayer, and reflection.

On the following Tuesday morning, Duan and Dr. Kwan visit FAC and conduct follow-up appointments with the previous week’s guests. By then, they have received results from the lab tests. Duan briefly updates Dr. Kwan with each patients’ medical background, and he performs the required physical exam. This particular week, Spiritual Director Brother Rick also accompanies them for the medical appointments to offer spiritual services.

“If I were to do (this project) anywhere outside of St. Anthony’s – in SF, or the Bay Area, or the country – it would be enormously difficult,” says Duan. “It has been relatively easy compared to having to do this from scratch without support from other departments or resources.

“I could not have done this project without the help of the Operations and DTM teams. They’ve been a huge help installing landlines and internet, disposing of biohazardous waste, and other things I have no background in and couldn’t have done on my own. If I wasn’t a part of St. Anthony’s, I would have needed to outsource these things to a third party, which would be very costly, and they wouldn’t understand our needs as well.”

In reality, the transformation of the room defined something much more; the room isn’t just a room. It’s where guests get complete medical care, accurate diagnoses, and begin to heal their physical and spiritual wounds.

Dr. Kwan used an example to further illustrate its significance – if someone you know is diagnosed with breast cancer, “the protocol is that you need somebody who’s managing the surgery, somebody who’s managing chemotherapy, somebody who’s managing radiation in order to fix the cancer. When a patient has a medical appointment, all three doctors are there. They all read the chart. They’re in the same room. They’re talking to each other. That’s very efficient, and for the patient, that’s comforting so that they can focus on their recovery and healing.”

Flannigan summed it up. “The goal is to improve these men’s chances for recovery and give them the best chance of succeeding.”

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