Changing Paradigms In Correctional Health: Process Improvement Behind Bars

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. 1 2 Share strategies for involvement of staff in organizational goals. 3 Share strategies for involvement of staff in the organization’s measures of improvement.

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

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

5. Where Are We Going & How Do We Get There? Employee Assessment Committee Pre-Planning Meeting Essential Ingredients For Change • 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. • Within Department • Set the Vision • Set the Timeline • Recruit Participants • Train Participants • Outside Department • Problem • Vision • Stakeholder Buy In: • Department Director • Medical Director • (current and retired) • Nurse Manager • Senior Analyst 1 2 3 Your Logo

6. Putting Our First Team Together From “Forming” to “Performing” 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 Recruit Participants On site facilitator Stages of Group Development Teambuilding Codes of Conduct Seven Management and Planning tools Train Participants • 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. Facilitate and Empower Participants

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

8. Survey Results Areas of Strength- Overall Quality Maintains a high standard of quality 1 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. 2 The needs of the patient are the top priority of this department. 3

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

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

11. Actions Based on Results Changes Made So Far Within Department Send out monthly updates of Strategic plan to ALL staff members- keeping the momentum going! 1 2 Created sub-committee for highest problem identified • 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. 3 Changed format and increased frequency of pre-set staff meetings making them less rigid and including more spontaneous topics. 4 Your Logo

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

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

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

15. Performance Measurement A sampling of efforts within department • 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. • Training 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 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