Today, Commissioner Claire DeMatteis released the findings of an independent review of correctional healthcare that she commissioned to strengthen clinical quality, patient safety, and healthcare outcomes.
ChristianaCare, recognized nationally for its high-quality care and patient safety, agreed in August to complete this independent review as a service to the community at no cost to the state. The Department of Correction (DOC), through its Bureau of Healthcare, Substance Use Disorder, and Mental Health Services, is responsible for contracting medical and behavioral health services in all of its Level V (prison) and Level IV (work release and violation of probation) facilities and behavioral health services provided to individuals on probation after their release from incarceration.
“Over the past 34 years, DOC has had 7 medical vendors. We have transitioned from provider to provider to provider without assessing how we can improve the delivery of healthcare and clinical quality,” Commissioner DeMatteis said. “I am grateful to the physicians, nurses and professionals on the ChristianaCare quality and safety review team for their careful information-gathering, thoughtful analysis, and thorough recommendations. This constructive critique is exactly what we need to move DOC’s correctional healthcare system forward. Not only does it highlight areas where we are doing well, but it provides a roadmap on how to improve the delivery of healthcare services to the 5,100 individuals in our custody. This is a manageable challenge, and the improvements it drives will benefit not only offenders but also our medical and behavioral health teams, counselors and correctional officers.”
The ChristianaCare report on correctional healthcare can be viewed here.
The ChristianaCare report recognized the commitment and effort of DOC staff and correctional healthcare personnel, noting, “In general, the review found a passionate, caring healthcare and corrections workforce who work daily to meet the needs of their patients, especially considering the challenges and resource constraints of the work environment.” Specific successes highlighted in the report include:
- An exemplar model demonstrating transparency, teamwork and communication is at Howard R. Young Correctional Institution, where an inter-professional team created a model behavioral health unit that exemplifies collaboration, including the inmates. Instrumental in the success of this unit is its governance model, which includes the team’s ability to provide feedback for improvement to the Warden with knowledge that reasonable suggestions will be granted.
- The consult center at James T. Vaughn Correctional Center, where quality dedicated staff work in a highly matrixed environment that coordinate healthcare among multiple stakeholders in an environment demanding daily risk-informed decision making.
- At Sussex Correctional Institution, a safety risk was identified in the sharp/instrument count processes. An improvement effort resulted in photos of sharps/instruments being taped to the bottom of the tray, thereby improving the accuracy of the counts, and improving the tracking of equipment and staff safety.
- At Baylor Women’s Correctional Institution the healthcare team and facility leadership collaborated to create a program that enables pregnant women to meet and learn from each other, which promotes healthy pregnancies within the prison system.
- Plummer Community Corrections Center developed a system where medical staff and Correctional Officers developed a “keep an eye out” system to monitor offenders with medical concerns.
- Plummer Community Corrections Center and other facilities initiated Narcan training for Correctional Officers in response to an increase in overdoses, leading to multiple successful Narcan rescues through inter-professional team-based efforts.
- Sussex Community Corrections Center’s Medication Assisted Treatment Program developed a standardized approach to communication with community-based clinic where offenders can continue their treatment seamlessly after release and developed standard documentation templates for intakes, transfers and chronic care.
- Morris Community Corrections Center collaborated with Plummer Center staff to share best practices to mitigate a medication safety risk for inmates transitioning to the community.
The report identified several areas for improvement, including:
- The correctional healthcare delivery system is siloed between the Department of Correction, the DOC’s Bureau of Healthcare, Substance Use Disorder and Mental Health Services and the DOC’s medical, behavioral health and pharmacy vendors, and inconsistent communication among these stakeholders limits opportunities for coordination, shared goal-setting and mutual accountability.
- The correctional healthcare system is highly centralized, with a primary focus on oversight. This centralized structure dampens opportunities to develop strategic partnerships among DOC staff and healthcare administrators and service providers and fails to encourage decentralized responsibilities that could enable site-specific problem-solving and accountability for quality and care outcomes.
- The correctional healthcare system is plagued by persistently high rates of staff turnover and vacancies.
- The lack of a functional quality improvement program creates barriers to coordination and opportunities to develop process improvements that could address the ongoing backlog of cases and other challenges.
- The existing electronic health records system is inadequate to support efficient operations and effective communication between providers.
The report makes several key recommendations, including:
- Engage key strategic partners in prison healthcare delivery to promote collaboration, joint accountability and to set short and long-term objectives to improve prison healthcare in the areas of quality, cost, patient experience and staff experience.
- Establish a three-part leadership structure in each Level V (prison) and Level IV (violation of probation/work release) facility with leaders from the Department of Correction, the Bureau of Healthcare, Substance Use Disorder and Mental Health Services and the DOC’s medical and behavioral healthcare vendors – with mutual accountability to achieve outcome-based goals.
- Engage key strategic partners in prison healthcare delivery to promote collaboration, joint accountability and to set short and long-term objectives to improve prison healthcare in the areas of quality, cost, patient experience and staff experience.
- Launch ongoing quality improvement and process improvement initiatives and initiate regular staff development and training in quality, process and safety improvement.
- Implement facility-based “huddles” and create facility-based forums to engage and empower staff to identify challenges and develop solutions to improve operations and performance.
- Invest in information technology infrastructure, including improvements to the electronic health record system, to increase productivity, reduce waste and improve delivery of care.
- Recruit, retain and reward staff that embrace a safety, quality and performance culture.
- Train managers to analyze healthcare data to proactively identify risks, improve quality and safety of care and implement innovative practices.
“In our ongoing commitment to positively impact health in all of the communities we serve, we are glad to provide our expertise in health care quality and safety to the Department of Correction through this report,” said Ken Silverstein, M.D., MBA, executive vice president and chief clinical officer of ChristianaCare. “We applaud the DOC leadership and staff for taking this important step to improve the delivery of care in its facilities.”
ChristianaCare is recognized nationally for its clinical quality and safety and maintains a strong commitment to serving the community, with a focus on improving health and advancing health equity in Delaware and the surrounding communities. ChristianaCare was ranked among the top 1 percent of hospitals nationwide by U.S. News & World Report. Christiana Care does not have expertise specific to prison care, but agreed to provide recommendations based on health care industry standards for quality and patient safety.
The review, which began in early September, was conducted by a 15-member team of ChristianaCare staff, which included nurses, physicians, administrators and support staff with expertise in care standardization, change management, emergency medicine, family medicine, internal medicine, juvenile offender health, patient experience and grievances, pediatrics, pharmacy, process improvement, psychology, psychiatry, quality and safety, risk management, social work and women’s health. It featured interviews with DOC staff and contracted medical personnel during site visits to seven DOC facilities between mid-September and early October and a review of policies, procedures and process documentation. ChristianaCare did not evaluate or make medical assessments or recommendations in individual diagnoses, treatment plans or other medical services made by individual health care providers or provided to individual patients.
The ChristianaCare review supplements existing quality assurance measures employed by the Bureau of Healthcare, Substance Use Disorder, and Mental Health Services in focus areas of infection prevention, general environment of care, pharmacy and equipment inventory.
Source :DOC
