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Revitalizing Health Care in Corrections

California Health Care Facility. Revitalizing Health Care in Corrections. California Health Care Facility . Lessons Learned in Leadership & Safety. Agenda. CHCF Mission & Overview Program Analysis Management Implications Recommendations . Mission.

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Revitalizing Health Care in Corrections

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  1. California Health Care Facility Revitalizing Health Care in Corrections

  2. California Health Care Facility Lessons Learned in Leadership & Safety

  3. Agenda • CHCF Mission & Overview • Program Analysis • Management Implications • Recommendations

  4. Mission • The California Health Care Facility (CHCF) provides: • Medical Care & Mental Health Treatment to inmates who have the most severe & long term needs.  • CHCF is licensed as a Correctional Treatment Center: • Intermediate level care & long term care • To complement less acute treatment provided in other California state prisons

  5. Overview • 1.2 million square foot facility • 1,818 total beds (196 designated permanent work crew) • 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

  6. Collaboration of Agencies • CCHCS • CDCR • DSH

  7. Long Term Impact • Improved Patient Care • Fully electronic health record • Integration and consolidation of services • Community: • Jobs – 3,000 total positions • Utilization of local vendors; • collaboration with local colleges

  8. California Health Care Facility– A Response to Identified Deficits • Cost efficiency • Accessibility of services • Resources & Policy Support from HQ • Exceed Community Standards – • Licensing & Accreditation

  9. Services • Full programming • ADA ready – 50% wheelchair housing • Bariatric and elderly considerations

  10. Services • Medical Outpatient Clinic • Standby Emergency Services (SEMS) • Physical Medicine & Rehabilitation • Pharmacy • Specimen Collection & Processing • Diagnostic Imaging & Procedure Center • Dialysis Clinic • Patient Management Unit • Dental Clinic • Additional Inmate Services (i.e., Visiting, Legal Library, Education Programs, Religious Programs/Activity Therapy, etc.) • Staff Services (i.e., Training, Staff Dining & Snack Bar, Program Management Facilities, D&T Center Management,

  11. Services • Medical Outpatient Clinic • Specialty Care • Optometry, ophthalmology • Orthopedics • Podiatry • Telemedicine • Neurology • ENT • Exercise stress testing • Cardiac ultrasound • Dermatology • HIV/Hepatology • Urology

  12. Services • Rehabilitative Services • Speech Pathology • Physical Therapy • Electrotherapy Treatments • Occupational Therapy • Respiratory Therapy • Hydrotherapy

  13. Services • Procedure Center • Transesophageal Echocardiography • Larynogscopy • Pace Maker Insertion • Colonoscopy • AV Shunt debridement • Needle Biopsy, with or without imaging • Local anesthesia, Regional anesthesia, conscious sedation • Gastrostomy tube insertion

  14. Integrated Program Analysis Challenges Threats Opportunities Strengths

  15. Opportunities Acculturation Innovation Integrated & Improved Patient Care

  16. Acculturation • Definition • Cultural modification of an individual or group; • The restructuring or blending of cultures

  17. Acculturation • Advantages • Effectiveness • Collaboration • Cultural Identity • Behavioral Shifts • Contact Participation • Cultural Maintenance

  18. Integrated Patient Care • Centralized Services • Coordinated Care • State of the Art Facility • Wireless nurse call • Piped medical gases

  19. Strengths • Facility Structure • Commitment- Shared goals • Therapeutic Environment • Vision & Mission

  20. Facility Structure • State of the art facility. • 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)

  21. Dietary Services • State of the art therapeutic kitchen • Complete nutritional assessments • Unique re-therm system • Food Nutrition Management System (FNMS) –ATG • Nutrition education • Medical diets

  22. Facility Structure • Material Services Center • State of the art warehousing • & support system • AIMS/WMS System • MUTs, HUTs & trams

  23. Program Goals • Coordinated Care • Interdisciplinary Treatment • Multi-departmental/ • Multi-disciplinary Collaboration • Chief Executive Officer & • Health Care Warden • Utilization of Telemedicine • Onsite specialty services and procedure center

  24. Therapeutic Environment • Integrated correctional aspects by • non-evasive means. • Recovery Model: • Emphasis on space, light, • Greenery. • Healing environment. • Designated treatment • teams.

  25. New Culture • Collaboration • Synergy • Acculturation • Dynamics

  26. Culture Quality Healthcare

  27. Challenges

  28. Higher Acuity Licensed Facility • Challenging work environment • Complex organization • Unique problems & patient variability • Unpredictable workloads & case mix

  29. Activation Process • Fluidity of Processes • Complex medical mission with largest disease burden compared to all other CCHCS facilities. • Multifaceted issues require multi-disciplinary approach. • Need time to smooth out processes. • Need controlledinflux of patients during this critical period. • “We are only able to function as effective as our weakest link”

  30. Activation Process • Continuity of Care – Transfers • Inter-Facility -Weekly transfer conference continued to be streamlined. Manyarriving 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.

  31. SEMSFulfills a CriticalNeed • The mission of the Standby Emergency Medical Services is to provide a safety net for facility, provide observation level to critical care servicesin 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

  32. LOGISTICS • Access to care: • One officer to each unit. • Need for healthcarestaffto have access to many sets of keys, including FolgerAdams Key. • Delays to patient care. • Hindrance to flow of processes.

  33. Threats Staffing Training

  34. Staffing • Physicians: • Lack of qualified staff, medically underserved • Minimal salary competitive advantage vs. community • Markedly increased clinical expectations vs. other CCHCS positions • Unique challenges during activation period; impact on recruitment and ancillary staff training needs

  35. Staffing • Mid-Level Providers: • Shortage of providers • Non-Competitive Salaries • Competence to handle complex medical patient loads • Registry Staff: • Temporary relief staff from locum tenen agencies; however still faced with shortage.

  36. Training • Challenges with staff being new to CDCR & unfamiliar with workflow processes. • Training issues significantly impede process flow • Experienced providers have to provide training and do work-arounds to facilitate care • Adequate supervisory model is needed to facilitate hands-on training.

  37. Recommendations & Management Implications • Leadership • Safety Culture • Organizational Practices • Management Systems “At the organizational level, there is only so much capacity for change”

  38. Committed Leadership • Empowers workers • Team building • Recognizing achievements & contributions • Teaches and mentors • Develops future leaders

  39. Effective Leadership • Maintains Shared Desire for Excellence • Maintains Shared Values & Beliefs

  40. Effective Safety Culture • Leadership & Culture are the pivotal factors for success in improving patient care • 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. • Leadership & Culture must encompass: • Collaboration • Communication • Professionalism

  41. Management Systems

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

  43. 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.

  44. Conclusion • HighlightCHCF’s unique mission/challenges • Recruitment Examinations & Open Positions can be accessed via: California Prison Health Care via http://www.cphcs.ca.gov • “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”

  45. California Health Care Facility Revitalizing Health Care in Corrections

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