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Revitalizing Health Care in Corrections
Revitalizing Health Care in Corrections
California Health Care Facility
Lessons Learned in Leadership & Safety
California Health Care Facility
Agendao CHCF Mission & Overview o Program Analysiso Management Implicationso Recommendations
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
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
Collaboration of Agencies
• CCHCS
• CDCR
• DSH
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
California Health Care Facility – A Response to Identified Deficitso Cost efficiencyo Accessibility of serviceso Resources & Policy Support from HQo Exceed Community Standards – Licensing & Accreditation
o Full programmingo ADA ready – 50% wheelchair housingo Bariatric and elderly considerations
Services
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
Serviceso ENTo Exercise stress testingo Cardiac ultrasoundo Dermatologyo HIV/Hepatologyo Urology
Medical Outpatient Clinico Specialty Careo Optometry, ophthalmologyo Orthopedicso Podiatryo Telemedicineo Neurology
ServicesRehabilitative Serviceso Speech Pathologyo Physical Therapyo Electrotherapy Treatments
o Occupational Therapyo Respiratory Therapyo Hydrotherapy
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
Integrated Program Analysis
Strengths
ThreatsChallenges
Opportunities
Opportunities
Integrated & Improved Patient Care
Acculturation Innovation
AcculturationDefinition o Cultural modification of an individual or group; o The restructuring or blending of cultures
AcculturationAdvantages
o Effectivenesso Collaboration o Cultural Identity
o Behavioral Shiftso Contact Participationo Cultural Maintenance
oCentralized ServicesoCoordinated Careo State of the Art Facility
Integrated Patient Care
oWireless nurse calloPiped medical gases
o Facility Structureo Commitment- Shared goalso Therapeutic Environmento Vision & Mission
Strengths
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)
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
Facility Structure
o AIMS/WMS Systemo MUTs, HUTs & trams
Material Services Centero State of the art warehousing
& support system
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
o Healing environment. o Designated treatment
teams.
Therapeutic Environmento Integrated correctional aspects by non-evasive means.o Recovery Model:
Emphasis on space, light, Greenery.
o Collaboration
o Acculturation
o Synergy
o Dynamics
New Culture
Effective Safety Culture
Organizational Practices
Oversight -Management
Systems
Committed Leadership
Continuity of Care
Fluid Processes
Training
Resources
Culture
QualityHealthcare
Culture
ChallengesHigher Acuity
Licensed Facility
Activation
Process
SEMS Critical Need
Logistics
o Challenging work environmento Complex organizationo Unique problems & patient variabilityo Unpredictable workloads & case mix
Higher Acuity Licensed Facility
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”
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
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
LOGISTICSAccess to care:o One officer to each unit.o Need for healthcare staff to have
access to many sets of keys, including Folger Adams Key.
o Delays to patient care.o Hindrance to flow of processes.
Staffing Training
Threats
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
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.
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.
o Leadershipo Safety CultureoOrganizational PracticesoManagement Systems
Recommendations & Management Implications
“At the organizational level, there is only so much capacity for change”
o Empowers workerso Team buildingo Recognizing achievements & contributionso Teaches and mentorso Develops future leaders
Committed Leadership
Maintains Shared Values & Beliefs
Maintains Shared Desire for Excellence
Effective Leadership
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
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
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. “
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.
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
Revitalizing Health Care in Corrections
California Health Care Facility