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Revitalizing Health Care in Corrections California Health Care Facility

o CHCF Mission & Overview o Program Analysis o Management Implications o Recommendations

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Page 1: o CHCF Mission & Overview o Program Analysis o Management Implications o Recommendations

Revitalizing Health Care in Corrections

Revitalizing Health Care in Corrections

California Health Care Facility

Page 2: o CHCF Mission & Overview o Program Analysis o Management Implications o Recommendations

Lessons Learned in Leadership & Safety

California Health Care Facility

Page 3: o CHCF Mission & Overview o Program Analysis o Management Implications o Recommendations

Agendao CHCF Mission & Overview o Program Analysiso Management Implicationso Recommendations

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The California Health Care Facility (CHCF) provides:oMedical Care & Mental Health Treatment to inmates

who have the most severe & long term needs.

CHCF is licensed as a Correctional Treatment Center:o Intermediate level care & long term careo To complement less acute treatment provided in other

California state prisons

Mission

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o 1.2 million square foot facility o 1,818 total beds (196 designated permanent work crew)o Licensed & Accredited health care facility

1,622 medical / mental health beds: Long-term, sub-acute health care Acute & Intermediate mental health Mental health crisis Beds

Overview

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Collaboration of Agencies

• CCHCS

• CDCR

• DSH

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Improved Patient Careo Fully electronic health recordo Integration and consolidation of services

Community: o Jobs – 3,000 total positionso Utilization of local vendors; collaboration with local colleges

Long Term Impact

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o Full programmingo ADA ready – 50% wheelchair housingo Bariatric and elderly considerations

Services

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ServicesoDialysis ClinicoPatient Management UnitoDental ClinicoAdditional Inmate Services (i.e., Visiting, Legal Library,

Education Programs, Religious Programs/Activity Therapy, etc.)

o Staff Services (i.e., Training, Staff Dining & Snack Bar, Program Management Facilities, D&T Center Management,

o Medical Outpatient Clinico Standby Emergency Services (SEMS)o Physical Medicine & Rehabilitationo Pharmacyo Specimen Collection & Processingo Diagnostic Imaging & Procedure Center

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Serviceso ENTo Exercise stress testingo Cardiac ultrasoundo Dermatologyo HIV/Hepatologyo Urology

Medical Outpatient Clinico Specialty Careo Optometry, ophthalmologyo Orthopedicso Podiatryo Telemedicineo Neurology

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ServicesRehabilitative Serviceso Speech Pathologyo Physical Therapyo Electrotherapy Treatments

o Occupational Therapyo Respiratory Therapyo Hydrotherapy

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ServicesProcedure Center o Transesophageal

Echocardiographyo Larynogscopy

o Pace Maker Insertiono Colonoscopyo AV Shunt debridement

o Needle Biopsy, with or without imaging

o Local anesthesia, Regional anesthesia, conscious sedation

o Gastrostomy tube insertion

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Integrated Program Analysis

Strengths

ThreatsChallenges

Opportunities

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Opportunities

Integrated & Improved Patient Care

Acculturation Innovation

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AcculturationDefinition o Cultural modification of an individual or group; o The restructuring or blending of cultures

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AcculturationAdvantages

o Effectivenesso Collaboration o Cultural Identity

o Behavioral Shiftso Contact Participationo Cultural Maintenance

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oCentralized ServicesoCoordinated Careo State of the Art Facility

Integrated Patient Care

oWireless nurse calloPiped medical gases

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o Facility Structureo Commitment- Shared goalso Therapeutic Environmento Vision & Mission

Strengths

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Facility Structureo State of the art facility. o Full program in each unit.

2 Exam Rooms (1 each side)2 Consult Rooms (1 each side)4 Nurses Stations (2 each side)4 Respiratory Isolation Rooms (2 each side)

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Dietary Serviceso Nutrition educationo Medical diets

o State of the art therapeutic kitcheno Complete nutritional assessmentso Unique re-therm systemo Food Nutrition Management System (FNMS) –ATG

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Facility Structure

o AIMS/WMS Systemo MUTs, HUTs & trams

Material Services Centero State of the art warehousing

& support system

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Program Goals

o Chief Executive Officer & Health Care Wardeno Utilization of Telemedicineo Onsite specialty services and procedure

center

Coordinated Careo Interdisciplinary Treatmento Multi-departmental/ Multi-disciplinary Collaboration

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o Healing environment. o Designated treatment

teams.

Therapeutic Environmento Integrated correctional aspects by non-evasive means.o Recovery Model:

Emphasis on space, light, Greenery.

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o Collaboration

o Acculturation

o Synergy

o Dynamics

New Culture

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Effective Safety Culture

Organizational Practices

Oversight -Management

Systems

Committed Leadership

Continuity of Care

Fluid Processes

Training

Resources

Culture

QualityHealthcare

Culture

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ChallengesHigher Acuity

Licensed Facility

Activation

Process

SEMS Critical Need

Logistics

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o Challenging work environmento Complex organizationo Unique problems & patient variabilityo Unpredictable workloads & case mix

Higher Acuity Licensed Facility

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Activation ProcessFluidity of Processeso Complex medical mission with largest disease

burden compared to all other CCHCS facilities. o Multifaceted issues require multi-disciplinary

approach. o Need time to smooth out processes. o Need controlled influx of patients during this

critical period.

“We are only able to function as effective as our weakest link”

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Continuity of Care – TransfersInter-Facility -Weekly transfer conference continued to be streamlined. Many arriving with no discharge summaries, up to 70% arrive without some DMEs. Specialty medical appointments missed or canceled.Intra-Facility – Process issues; providers have to research all aspects of patient care to ensure follow-through was completed, such as lab, medications, studies, etc.

Activation Process

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SEMS Fulfills a Critical NeedThe mission of the Standby Emergency Medical Services is to provide a safety net for facility, provide observation level to critical care services in a short term

•STAT lab including non-waived testing, (Troponin, WBC, ABGs)•Emergency Medication•After hour access imaging modality such as xray, CT, U/S

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Staffing Training

Threats

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Physicians:o Lack of qualified staff, medically underservedo Minimal salary competitive advantage vs.

communityo Markedly increased clinical expectations vs.

other CCHCS positionso Unique challenges during activation period;

impact on recruitment and ancillary staff training needs

Staffing

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Staffing Mid-Level Providers:o Shortage of providerso Non-Competitive Salarieso Competence to handle complex medical

patient loads

Registry Staff: o Temporary relief staff from locum tenen

agencies; however still faced with shortage.

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Trainingo Challenges with staff being new to CDCR & unfamiliar

with workflow processes.o Training issues significantly impede process flowo Experienced providers have to provide training and do

work-arounds to facilitate careo Adequate supervisory model is needed to facilitate

hands-on training.

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o Leadershipo Safety CultureoOrganizational PracticesoManagement Systems

Recommendations & Management Implications

“At the organizational level, there is only so much capacity for change”

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o Empowers workerso Team buildingo Recognizing achievements & contributionso Teaches and mentorso Develops future leaders

Committed Leadership

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Maintains Shared Values & Beliefs

Maintains Shared Desire for Excellence

Effective Leadership

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Effective Safety Cultureo Leadership & Culture are the pivotal factors for success in improving

patient care o To be effective staff need to be aware of their role in the process;

particularly how they can promote and maintain an effective safety culture.

o Leadership & Culture must encompass: Collaboration Communication Professionalism

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Management Systems• Establish procedures & practices to promote safety and collaboration• Standardization• Reflect Current Practices• Analyze and control workflow• Gather feedback and improve processes

Policies & Procedures

• Identifying standards & requirements • Ensure a quality operation • Ongoing Program Analysis & Corrective Action Plans • Understanding technical basis • Strengthening institutional safety programs

Institutional Structure

• Site specific• Train and quantify workers and managers• Ensure ongoing training & competency

Training

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Management Systems

• Internal/External Reporting• Managing impacts on organizational changes• Ensure budgetary resources• Quality assurance/management practices• Analyze and control workflow

Oversight

“The organizations’ cultural health must be constantly monitored through oversight, & early intervention into identified concerns. “

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CHCF Fellowship Program

in Correctional Health

The California Health Care Facility is proposing the establishment of a Fellowship Program as a subspecialty for internal and family medicine physicians. This would provide a means for introducing physicians to the field of correctional medicine through clinical and didactic sessions through an alliance with SJGH (MGU), Touro University (MPH) under mentorship of CHCF health care staff. These opportunities allow fellows an enriching and varied experience in all facets and spectrum of correctional medicine.

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Conclusion

“In order for CHCF to succeed even at the most minimal of levels, we require more providers, along with greatly increased numbers of skilled nursing and ancillary staff”

o Highlight CHCF’s unique mission/challengeso Recruitment Examinations & Open Positions can be

accessed via:

California Prison Health Care via http://www.cphcs.ca.gov

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Revitalizing Health Care in Corrections

California Health Care Facility