1. Changing Paradigms In Correctional Health: Process Improvement Behind Bars Chia-Chen Lee,, MSN, FNP-C Nurse Manager, Juvenile Facilities, Santa Clara County, California Dania Schaffer, BPA Senior Health Care Program Analyst, Santa Clara County California

2. Objectives: Share strategies for staff communication across boundaries. Share strategies for involvement of staff in the organization’s measures of improvement. 3 3 2 2 1 1 Share strategies for involvement of staff in organizational goals.

3. Isolated health care Stigma of substandard care; “I want a real doctor!” Communication gaps Team divisiveness and a negative working environment. Houston, what’s Your Problem?

4. Management team began their change efforts with self reflection of their own management style and its effect on the organization. Beginning The Change As a result Intense leadership evaluation. Exploring various new management strategies. Re-evaluation This included: 1 2 2 ✓ Paradigm of communication changed.  From top down to bottom up.  From inside - out Direct engagement of line staff to ID problems/issues

5. Where Are We Going & How Do We Get There? Your Logo  Within Department Set the Vision Set the Timeline Recruit Participants Train Participants  Outside Department  Problem  Vision Mission - develop an employee assessment survey that would be used to help the department:  Develop strategic planning goals and objectives.  Prioritize list of problems  Set a baseline measurement. Stakeholder Buy In: Department Director Medical Director (current and retired) Nurse Manager Senior Analyst 2 1 Employee Assessment Committee Essential Ingredients For Change Pre-Planning Meeting 3

6. Most difficult obstacle – nursing 24 X 7 coverage. Solution – creative working hours without overtime initiated by staff themselves. All meetings occur within working hours. All members have equal power No bad ideas, all ideas are considered equal On site facilitator Stages of Group Development Teambuilding Codes of Conduct Seven Management and Planning tools Members are Ambassadors for Change – members generated face to face conversation with co-workers to seek ideas, suggestions, or solutions.  Use ideas developed by team to build employee assessment survey  Survey results used to form strategic plan  Recognized by senior leadership for their contribution to the overall process. From “Forming” to “Performing” Putting Our First Team Together Recruit Participants Facilitate and Empower Participants Train Participants

7. The Survey Contents  Time frame 23 January 2012 – 19 February 2012  84% response rate Communication Training needsTraining needs Quality of Patient CareQuality of Patient Care Quality of Work lifeQuality of Work life

8. Areas of Strength- Overall Quality Survey Results Maintains a high standard of quality We are held accountable for the quality of work we provide. The needs of the patient are the top priority of this department. 1 2 33 Maintains a high standard of quality

9. Your Logo Survey Results I feel respected by my nurse manager. I feel respected by my co-worker. My ideas and opinions count at work Areas of Strength – Work Life Quality

10. Your Logo Areas of Concern - Work Life Quality Survey Results Inter-shift collaboration Working Environment Acknowledgement received at work

11. Created sub-committee for highest problem identified Changed format and increased frequency of pre-set staff meetings making them less rigid and including more spontaneous topics. Incorporate Process Improvement training into Annual Review Day (for all levels of staff). Developed an internal leadership curriculum. Send staff to Myers Brigg training at University of San Francisco, to become trainers on subject within organization. Send staff to County-Wide process improvement, team building and cultural appreciation training. Your Logo Changes Made So Far Within Department Actions Based on Results 11 22 33 44 Send out monthly updates of Strategic plan to ALL staff members- keeping the momentum going!

12. What’s Up with Correctional Health? Beyond organizational level Fragmented medical records Broken system Fragile health care.

13. Buy-In Leadership within organization Juvenile Justice Commission Public Defender District Attorney Presiding Judge Mental Health Administration Interventions & Innovations Beyond Organizational level

14. One medical record per patient, including mental health, medical, drug and alcohol treatment. Results

15. Performance Measurement A sampling of efforts within department 100% of staff involved in sub-committees/teams related to strategic plan within 2 years.100% of staff involved in sub-committees/teams related to strategic plan within 2 years. Communication – change frequency and content of staff meetings based on employee suggested topics. Communication – change frequency and content of staff meetings based on employee suggested topics. Training needs- 10%-15% of staff attend leadership development training per year. Include at least 2 employee identified topics in annual review day each yearTraining needs- 10%-15% of staff attend leadership development training per year. Include at least 2 employee identified topics in annual review day each year Quality of Patient Care- maintain above 95% staff sentiment of quality care than meets the needs of patients.Quality of Patient Care- maintain above 95% staff sentiment of quality care than meets the needs of patients. Quality of Work Life – 10% of staff attend conflicts skills training, diversity in the workplace anually. 100% of staff perform self-evaluation via MBTI tool and attend follow up training.Quality of Work Life – 10% of staff attend conflicts skills training, diversity in the workplace anually. 100% of staff perform self-evaluation via MBTI tool and attend follow up training.

16. THANK YOU! Your Logo