o CHCF Mission & Overview o Program Analysis o Management Implications o Recommendations
The California Health Care Facility (CHCF) provides: o Medical 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 care o To complement less acute treatment provided in other California state prisons
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
Improved Patient Care o Fully electronic health record o Integration and consolidation of services Community: o Jobs – 3,000 total positions o Utilization of local vendors; collaboration with local colleges
o Cost efficiency o Accessibility of services o Resources & Policy Support from HQ o Exceed Community Standards – Licensing & Accreditation
o Full programming o ADA ready – 50% wheelchair housing o Bariatric and elderly considerations
o Dialysis Clinic o Patient Management Unit o Dental Clinic o Additional 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 Clinic o Standby Emergency Services (SEMS) o Physical Medicine & Rehabilitation o Pharmacy o Specimen Collection & Processing o Diagnostic Imaging & Procedure Center
o ENT o Exercise stress testing o Cardiac ultrasound o Dermatology o HIV/Hepatology o Urology Medical Outpatient Clinic o Specialty Care o Optometry, ophthalmology o Orthopedics o Podiatry o Telemedicine o Neurology
Rehabilitative Services o Speech Pathology o Physical Therapy o Electrotherapy Treatments o Occupational Therapy o Respiratory Therapy o Hydrotherapy
Procedure Center o Transesophageal Echocardiography o Larynogscopy o Pace Maker Insertion o Colonoscopy o AV Shunt debridement o Needle Biopsy, with or without imaging o Local anesthesia, Regional anesthesia, conscious sedation o Gastrostomy tube insertion
Integrated & Improved Patient Care AcculturationInnovation
Definition o Cultural modification of an individual or group; o The restructuring or blending of cultures
Advantages o Effectiveness o Collaboration o Cultural Identity o Behavioral Shifts o Contact Participation o Cultural Maintenance
o Centralized Services o Coordinated Care o State of the Art Facility o Wireless nurse call o Piped medical gases
o Facility Structure o Commitment- Shared goals o Therapeutic Environment o Vision & Mission
o 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)
o Nutrition education o Medical diets o State of the art therapeutic kitchen o Complete nutritional assessments o Unique re-therm system o Food Nutrition Management System (FNMS) –ATG
o AIMS/WMS System o MUTs, HUTs & trams Material Services Center o State of the art warehousing & support system
o Chief Executive Officer & Health Care Warden o Utilization of Telemedicine o Onsite specialty services and procedure center Coordinated Care o Interdisciplinary Treatment o Multi-departmental/ Multi-disciplinary Collaboration
Effective Safety Culture Organizational Practices Oversight - Management Systems Committed Leadership Continuity of Care Fluid Processes Training Resources Culture Quality Healthcare
Higher Acuity Licensed Facility Activation Process SEMS Critical Need Logistics
o Challenging work environment o Complex organization o Unique problems & patient variability o Unpredictable workloads & case mix
Fluidity of Processes o 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.
Continuity of Care – Transfers Inter-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.
The 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
Access 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.
Physicians: o Lack of qualified staff, medically underserved o Minimal salary competitive advantage vs. community o Markedly increased clinical expectations vs. other CCHCS positions o Unique challenges during activation period; impact on recruitment and ancillary staff training needs
Mid-Level Providers: o Shortage of providers o Non-Competitive Salaries o Competence to handle complex medical patient loads Registry Staff: o Temporary relief staff from locum tenen agencies; however still faced with shortage.
o Challenges with staff being new to CDCR & unfamiliar with workflow processes. o Training issues significantly impede process flow o Experienced providers have to provide training and do work-arounds to facilitate care o Adequate supervisory model is needed to facilitate hands-on training.
o Leadership o Safety Culture o Organizational Practices o Management Systems
o Empowers workers o Team building o Recognizing achievements & contributions o Teaches and mentors o Develops future leaders
o 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
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
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. 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.
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 CHCFs unique mission/challenges o Recruitment Examinations & Open Positions can be accessed via: California Prison Health Care via http://www.cphcs.ca.gov