A report on the Delaware Department of Correction health system found dedicated staff members and well-run programs but also detected a “siloed” system with communications issues and the lack of a functioning quality improvement program.
The 19-page report came from ChristianaCare, the state’s largest health care provider.
The review comes after long-running criticisms of the corrections health system, lawsuits and the selection of Claire DeMatteis to head the troubled system.
One vendor, Connections, has been the subject of a probe by the state Department of Justice.
“Over the past 34 years, DOC has had seven medical vendors. We have transitioned from provider to provider to provider without assessing how we can improve the delivery of healthcare and clinical quality,” DeMatteis said. “I am grateful to the physicians, nurses, and professionals on the ChristianaCare quality and safety review team for their careful information-gathering, thoughtful analysis, and thorough recommendations. This constructive critique is exactly what we need to move DOC’s correctional healthcare system forward. Not only does it highlight areas where we are doing well, but it provides a roadmap on how to improve the delivery of healthcare services to the 5,100 individuals in our custody. This is a manageable challenge, and the improvements it drives will benefit not only offenders but also our medical and behavioral health teams, counselors and correctional officers.”
The ChristianaCare report praised corrections staff and healthcare personnel, noting, “In general, the review found a passionate, caring healthcare and corrections workforce who work daily to meet the needs of their patients, especially considering the challenges and resource constraints of the work environment.”
The report took note of success stories at corrections facilities, but also found a “siloed” highly centralized system that includes the department behavioral health and pharmacy vendors.
High staff turnover, the lack of a functional quality improvement program and an inadequate health records system are other problems.
The report suggested changes in the corrections health care leadership structure and promoting collaboration in health care delivery among the various partners. Also suggested were forums and “huddles” within facilities to develop solutions and identify challenges.
Improvements to the information technology system and training in identifying trends that show up in the data were also recommended in the report.
Christiana Care does not have expertise specific to prison care but agreed to provide recommendations based on health care industry standards for quality and patient safety.
The review, which began in early September, was conducted by a 15-member team of ChristianaCare staff, which included nurses, physicians, administrators and support staff with expertise in care standardization, change management, emergency medicine, family medicine, internal medicine, juvenile offender health, patient experience and grievances, pediatrics, pharmacy, process improvement, psychology, psychiatry, quality and safety, risk management, social work and women’s health.
The review included interviews with DOC staff and contracted medical personnel during site visits to seven DOC facilities between mid-September and early October and a review of policies, procedures and process documentation.