Case Study # 5

RUNNING HEAD: Case Study #5- Briefing Report

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Correctional Facility Briefing Report

Case Study #5

Group 1: Rhonda Boyd, Elias Flores, Fatima Barrie, Erin Hauser

 HMGT 495 6380 Strategic Planning and Leadership in Healthcare  

Professor Shelby Boggs  

October 9, 2022

Introduction 

As the new intern case coordinator of the female prison, you asked that I develop a strategic plan to organize off-site medical appointments without impairing the internal services.  Reports from existing medical staff indicate our facility has 300 patients needing off-site care.  The organization of this care is imperative to the health of our female prisoners. Furthermore, I will highlight the importance of the seminal 1976 Supreme Court ruling Estelle v Gamble ruling because of its provisions relating to inmate health care. To determine the best strategic plan, I will examine the challenges associated with providing healthcare in prison, identify obstacles associated with treating females in prison, and the strategic planning framework I intend to use. 

1. Estelle v. Gamble

            On November 9, 1973, J.W. Gamble, an inmate located in a Texas prison sustained a lower back injury when a 600-pound bale of cotton fell on him (Estelle v. Gamble, n.d.). After several hours of work, Mr. Gamble had pain and requested to go to the hospital. From there he was examined, given pain meds, and sent to his cell. Unfortunately, his pain increased significantly that evening leading him to request another visit to the hospital. The following day Mr. Gamble was examined by another physician who prescribed more painkillers and placed Mr. Gamble on a cell pass, meaning he is confined to his cell. Over the next few months, Mr. Gamble was placed in solitary confinement for refusing to work because of his back pain. Within those months he requested appointments for lower pain but was also diagnosed and treated for high blood pressure and chest pains over multiple appointments and a hospital stay. In February 1974 Mr. Gamble signed a pro se complaint stating he was being subjected to cruel and unusual punishment violating the Eighth Amendment. The district court dismissed the case but was later reversed by the Fifth Circuit recognizing the prison staff failed to diagnose Gamble’s back injury. Additionally, it was argued that a diagnosis of lower back pain was never made, and he was placed in solitary confinement after refusing to work. Unfortunately for Mr. Gamble, the court decided his care was adequately addressed and there was not sufficient evidence of his rights being violated. The importance of Estelle v. Gamble first concluded the Eighth Amendment is violated when a jail official’s deliberate indifference occurs to a prisoner’s serious medical needs (Moore, 2005). In other words, any staff who is knowingly aware of a prisoner’s medical needs and fails to address them, they are being deliberately indifferent. Second, the 8th Amendment established inmates have the right to adequate medical care which equates to the general public (U.S. Courts for the Ninth Circuit, 2021). Mr. Gamble was provided substandard care (considered to be cruel and unusual treatment of a prisoner), which ultimately led to no x-rays or diagnosis for his back pain. Due to the significant challenges identified below, it is best to develop a strategic plan for the organization to move forward in our planning efforts. 

2. Challenges to Providing Healthcare in a correctional environment

            There are many challenges associated with providing care to prisoners. Generally, the overall health of the population within the prison systems is not well, and are often diagnosed with multiple comorbidities. Social determinants and low-income communities often lead to poor lifestyle choices. Moreover, these individuals often lack access to care, funds, and insurance to seek care. According to Faiver (2020), the following list identifies the challenges to providing care in prisons,

· Notifying Staff: Inmates need to be able to notify staff daily without fear or risk of interference or fear of reprisal. Evaluations and treatment need to be timely and conducted by qualified medical staff. Confidentiality must be maintained. 

·   Communication: Staff must be able to adequately understand and be understood by patients.  Employing bilingual staff and using translation services and programs will be necessary

·   Culture/Ethnic/Religious Competence: Staff must be aware of and respect the culture, ethnic, and religious preferences of prisoners

·  Health Illiteracy: Literacy is often limited which may lead to misunderstanding, the ability to self-identify and report symptoms, and overall poor health outcomes

·   Initial Health Screening: Screenings should be conducted upon or before arrival. They should be thorough to identify the patient’s risks and early intervention of the disease

· Medications: OTC medications should be available in the commissary to prevent unnecessary travel and medical appointments. Keep-on-Person (KOP) Medications can be used to alleviate costs and time. Medications should be distributed with state laws and regulations. 

·   Appointments: Larger facilities often need patients to be escorted by guards, and smaller facilities require written passes. Appointments need to be scheduled so patients can be seen. Patients needing a specialist need to be arranged off-site or coordinated to come into the facility. Providers must consult to ensure that patients’ treatment plans can be accommodated within the facility. Additionally, when multiple appointments are needed arrangements should be made for the same day to limit movement and the need for costly transportation details. Patients may miss appointments for lack of notification or faulty systems. 

· Chronic Care: Patients with chronic conditions should be thought to be treated routinely versus episodic. Routine care should decrease costs and improve patients’ conditions.

·  Emergency care: needs to be planned in advance. On-call physicians should be made available to avoid unnecessary movement of inmates. Emergency personnel needs to be familiar with the facility and both parties need to agree on standards. AEDs need to be placed in the facility and staff need to be trained on the locations and how to use them. 

· After Hours Care: If there is no around-the-clock medical staff, officers should receive extra training for life-threatening signs and symptoms inmates may develop. On-call physicians should be made available to avoid unnecessary movement of inmates.

·   Solitary Confinement: Prisoners on lockdown need to be medically evaluated to ensure their physical and mental health does not deteriorate. 

Evidence reveals there is an abundance of challenges when it comes to providing healthcare in prisons. More importantly, is the need to provide care on a tight budget. 

3. Challenges to Providing Healthcare to female offenders that may not exist in a male prison 

            Women make up a small portion of the incarcerated population yet have greater health needs that often go unaddressed and accommodated. Although the challenges addressed above apply to men and women, Faiver (2020) explains the additional challenges pertaining to women, 

· Screening Procedures: Women need to be screened for pregnancy, sexually transmitted diseases (STD), menstrual difficulties, pap smears, breast cancer, and cervical cancer. Inquiry about care for children that are left behind. 

· Obesity and Eating Disorders: Obesity is common among incarcerated women. Meal plans should consider the female calorie intake and counseling should be made available. Anorexia and Bulimia are common disorders that staff should look out for. 

· Contraception: Considerations of contraception should be available depending on whether sexual intercourse is allowed. Family planning services should be made available prior to release. Counseling and advice should also be available for abortions.

·  Pregnancy: Prenatal, postnatal, and perinatal services need to be available, including counseling regarding childbirth, perinatal loss, postpartum depression, and legal counseling regarding child custody after release. 

· Aging Women: Menopause may require hormonal replacement therapy and endometrial screening. Planning for elderly women with frailty and disabilities.

· Mental Health: Women are more susceptible to mental health disorders than men. Physicians should diagnose women with careful consideration because disorders are often misdiagnosed. 

Some females are victims of physical and sexual abuse, which can put them at risk for high-risk pregnancies and other illnesses that are considered life-threatening, i.e., HIV/AIDS, Hepatitis C, and other gynecological infectious diseases. Although women make up a smaller portion of the incarcerated population these challenges are real and must be addressed.  

4. Strategic Planning Framework Applied and Why

Given the present challenges associated with providing care to female prisoners, I will utilize the Balanced Scorecard (BSC) to plan. The BSC will allow us to identify the objectives, measures, initiatives, and actions necessary to coordinate care with off-site physicians (Atlassian, n.d.). Furthermore, it illustrates an examination of an organization through four perspectives: financial, customer/stakeholder, internal process, and organizational capacity. Additionally, because of the various challenges present, the strategic mapping step explains the cause-and-effect relationships with objectives demonstrating how the organization will achieve organizing offsite care without disrupting internal processes. 

5. Identify information and evidence you have to apply to the strategic process steps. Identify appropriate evidence you still need to correctly use the strategic planning process.

Strategic planning entails an in-depth analysis of the correctional institution’s internal

and external environment and challenges. Before the process can be introduced, we must obtain the evidence necessary for a successful planning process for the institution. Keeping in mind that the source of the data collected is key in the planning process.

First, we must demonstrate evidence of effective leadership in the organization. The key to effective leadership is the allegiance to the correctional institution’s mission, vision, and values. The leadership must display transparency, possess good communication skills, and have the ability to problem solve. (Sales & Holack, 2018) Without effective leadership, the strategic planning process will not thrive.

The second important piece of evidence that needs to be applied to the strategic planning process steps includes the correct utilization of a strategic plan, program evaluation, and performance evaluation. (Gaggl, 2019) Management should be able to exhibit their understanding of the correctional institution’s culture and needs. It is imperative that management is knowledgeable of evidence-based protocols, policies, and facility practices.

6. Identify appropriate evidence still needed to correctly use the strategic planning process

It is important when instituting strategic planning, to ensure all stakeholders understand

the planning process and what is required to accomplish the goals. The planning process includes establishing goals, analysis, formation, implementation, and monitoring. A thorough analysis of the current state of the correctional institution is additional evidence still required to correctly use the strategic planning process. This analysis displays leadership awareness of the current state of the institution before moving forward with new approaches to quality improvement.

This planning process is important as it allows the institution to see the short-term and long-term goals to ensure they are continuing to focus on the mission. The planning process requires collecting, collating, and analyzing data to determine the needs of the organization, as well as its strengths, and weaknesses to help guide the decision-making. It is also important to think about the evidence of defining the future state of the correctional institution and to develop strategies and goals to accomplish this plan. Lastly, there must be evidence that the implementation of the strategic plan has been assessed.

7. Identify the sources of needed evidence. Are stakeholders able to provide the evidence being sought?

Continuous monitoring and feedback are important parts of the quality assurance process and should be applied to the strategic planning of the issues found within the correctional institution. The essential evidence includes data on budget, transport costs, security, safety, manifest, and appointments. The table below shows the strategic planning framework.

Table 1. Strategic Planning Framework Evidence Collection

Strategic Planning Framework Evidence Collection Table 

Measure of Success/Category	Data Point	Strategic Objective	Evidence	Source
Budget (BSC - Financial)	Budget for patient transport	Green = On Budget Yellow = Under Budget by 5% (Without compromising security) Red = Exceed Budget by 10%
Transport Cost (BSC - Financial)	Cost per inmate = $40 (50 inmates X $40 = $2000 per Round Trip)	Green = $40 per inmate (100% Full) Yellow = $57 per inmate (70% Full) Red = $80 per inmate (50% Full)
Security (BSC - Stakeholders)	Number of incidents in the prison while 2 guards transport inmates	Green = < 3 Security Incidents Yellow = > 3 but < 5 Security Incidents Red = > 5 Security Incidents
Safety  (BSC - Stakeholders)	Number of incidents per transport	Green = < 2 Safety Incidents Yellow = > 2 but < 4 Safety Incidents Red = > 4 Safety Incidents
Manifest (BSC - Internal Processes)	Number of passenger manifest errors per transport	Green = < 1 Passenger Manifest Errors Yellow = > 1 but < 3 Passenger Manifest Errors Red = > 3 Safety Incidents
Appointments (BSC - Internal Processes)	Number of specialty care appointment scheduling errors per transport (prison staff made the appointment scheduling error)	Green = < 5 Appointment Errors Yellow = > 5 but < 7 Appointment Errors Red = > 7 Appointment Errors

8. Develop decision-making matrix and identify appropriate solutions to the case. Read more about decision-making matrix.

Method 1: Establish a rating scale for each criterion. Some options are:

· 1, 2, 3 (1 = slight extent, 2 = some extent, 3 = great extent)

· 1, 2, 3 (1 = low, 2 = medium, 3 = high)

· 1, 2, 3, 4, 5 (1 = little to 5 = great)

· 1, 4, 9 (1 = low, 4 = moderate, 9 = high)

· Importance 1-5

For selecting a problem or an improvement opportunity: 

· Within control of the team 

· Financial payback 

· Resources required (e.g., money, people) 

· Customer pain caused by the problem 

· Urgency of problem 

· Team interest or buy-in

· Effect on other systems 

· Management interest or support 

· Difficulty of solving 

· Time required to solve

Table 2. Decision Matrix Table

Criteria → Solutions ↓	Time (Urgent) 5	4	3	2	1	Total
Access to Care ?
Financial?
Staffing?
Transportation?
Quality of care?

9. List potential implementation challenges and offer ways to offset them

As with any strategic planning process, it is susceptible to challenges that could affect the change and implementation of strategies for the correctional institution. Challenges that could affect the success of the strategic plan are lack of resources, poor communication, training, and funding. (Weberg, 2019) To offset these challenges, the correctional institution will need to determine the necessary resources needed before initiating the planning process, and determine the appropriate communication channels necessary for the open communication with all stakeholders.

Conclusion

This briefing report was designed to provide details of all information considered for the

Correctional institution strategic planning process. The briefing discusses the Constitutional Amendment passed regarding the court case Estelle vs. Gamble and addresses issues faced by women in the prison systems, as well as issues regarding external transport for medical appointments. Due to the increasing number of women in prisons today, and the challenges they face, this briefing offers a list of those challenges, a strategic plan framework, potential ways to address the challenges, and a decision matrix to help determine how to successfully make a difference. The main focus of this briefing was to offer information to support the improvements that can be made in the women’s correctional facility in the future.

	References  American Society for Quality.. (n.d.). What is a decision matrix? ASQ. Retrieved September 24, 2022, from https://asq.org/quality-resources/decision-matrix  Atlassian. (n.d.). Frameworks: The workstream. Retrieved August 29, 2022, from https://www.atlassian.com/work-management/strategic-planning/framework Balanced Scorecard Institute. (2021, December 1).Strategic Planning Basics. Retrieved: December 5, 2021, from: https://balancedscorecard.org/strategic-planning-basics/ Estelle v. Gamble. (n.d.). Oyez. Retrieved September 5, 2022, from https://www.oyez.org/cases/1976/75-929 Evidence-based Practices (EBP). (2021, November 19). Retrieved from: https://nicic.gov/projects/evidence-based-practices-ebp Faiver, K. L. (2020). Correctional health care delivery: unimpeded access to care. Charles C Thomas Publisher, Ltd.  Gaggl, R. (2019). Process-based Strategic Planning. New York: Springer Science & Business Media. Moore, J. D. (2005). Public Health Behind Bars: Health Care for Jail Inmates. Popular Government, 71(1), 16–23. Retrieved from https://learn.umgc.edu/content/enforced/263139-027327-01-2182-OL4-7981/Public%20Health%20Behind%20Bars.pdf?_&d2lSessionVal=26gAmWReBqtJnYhOD32IHxcf9.   Sales, F., & Holak, B. (2018, February 26). Strategic Leadership. Search CIO. Retrieved December 5, 2021, from: https://searchcio.techtarget.com/definition/strategic-leadership. U.S. Courts For The Ninth Circuit. (2021, December). 9.27 particular rights-eighth amendment-convicted prisoner's claim re conditions of confinement/medical care. Retrieved October 3, 2022, from https://www.ce9.uscourts.gov/jury-instructions/node/165

Weberg, D. (2019). Leadership for Evidence-based Innovation in Nursing and Health Professions. London: Jones & Bartlett Learning.