Changing Paradigms In Changing Paradigms In Correctional Health: Correctional Health:

Process Improvement Behind Process Improvement Behind BarsBars

Chia-Chen Lee, , MSN, FNP-C Nurse Manager, Juvenile Facilities, Santa Clara County, California

Dania Schaffer, BPASenior Health Care Program Analyst, Santa Clara County California

Objectives: Objectives: Share strategies for staff communication across boundaries.

Share strategies for involvement of staff in the organization’s measures of improvement.

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Share strategies for involvement of staff in organizational goals.

•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?Houston, what’s Your Problem?

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:

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• Paradigm of communication changed.

From top down to bottom up.From inside - out

•Direct engagement of line staff to ID problems/issues

Where Are We Going & How Do We Get There?Where Are We Going & How Do We Get There?

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Within Department

•Set the Vision•Set the Timeline•Recruit Participants•Train Participants

Outside Department

ProblemVision

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

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Employee Assessment Committee Essential Ingredients For Change Pre-Planning Meeting

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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 powerNo bad ideas, all ideas are considered equal

On site facilitatorStages of Group DevelopmentTeambuildingCodes of ConductSeven 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 surveySurvey results used to form strategic planRecognized 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

The Survey ContentsThe Survey Contents

Time frame 23 January 2012 – 19 February 2012Time frame 23 January 2012 – 19 February 2012

84% response rate 84% response rate

• CommunicationCommunication•Training needsTraining needs•Quality of Patient CareQuality of Patient Care•Quality of Work lifeQuality of Work life

Areas of Strength- Overall QualitySurvey Results

Maintains a high standard of quality

We are held accountable for the quality of work we provide. We are held accountable for the quality of work we provide.

We are held accountable for the quality of work we provide.

The needs of the patient are the top priority of this department.

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Maintains a high standard of quality

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Survey ResultsSurvey 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 QualityAreas of Strength – Work Life Quality

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Areas of Concern - Work Life Quality

Survey Results

Inter-shift collaboration

Working Environment

Acknowledgement received at work

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.

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Changes Made So Far Within DepartmentActions Based on Results

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Send out monthly updates of Strategic plan to ALL staff members- keeping the momentum going!Send out monthly updates of Strategic plan to ALL staff members- keeping the momentum going!

What’s Up with Correctional Health?Beyond organizational level

• Fragmented medical records

• Broken system

• Fragile health care.

• Buy-In• Leadership within organization • Juvenile Justice Commission• Public Defender• District Attorney• Presiding Judge• Mental Health Administration

Interventions & InnovationsBeyond Organizational level

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

ResultsResults

Performance MeasurementPerformance MeasurementA sampling of efforts within departmentA sampling of efforts within department

•100% of staff 100% of staff involved in sub-committees/teams related to strategic plan involved in sub-committees/teams related to strategic plan within 2 years.within 2 years.

• CommunicationCommunication – change frequency and content of staff meetings based on – change frequency and content of staff meetings based on employee suggested topics.employee suggested topics.

•Training needs- Training needs- 10%-15% of staff attend leadership development training per 10%-15% of staff attend leadership development training per year. Include at least 2 employee identified topics in annual review day each year. Include at least 2 employee identified topics in annual review day each yearyear

•Quality of Patient Care- Quality of Patient Care- maintain above 95% staff sentiment of quality care maintain above 95% staff sentiment of quality care than meets the needs of patients.than meets the needs of patients.

•Quality of Work Life Quality of Work Life – 10% of staff attend conflicts skills training, diversity in – 10% of staff attend conflicts skills training, diversity in the workplace anually . 100% of staff perform self-evaluation via MBTI tool the workplace anually . 100% of staff perform self-evaluation via MBTI tool and attend follow up training.and attend follow up training.

THANK YOU!

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