Quality is hard to define, but correctional health care professionals are able to recognize the attributes of a quality health care program when they see one. The simplest correctional health care program, as well as the most complex correctional health care delivery system, can project the essence of quality by providing health care to offenders in an organized and systematic manner, which is supported by research-based practices and the proactive monitoring of the health care being provided by using problem-solving methods. How does a quality health care program evolve in corrections? This is a complex question, because correctional health care is a dynamic and unique business. The quality management process of a health care delivery system is especially challenging in a correctional facility.

Health care in the correctional setting is provided in a controlled managed-care environment by medical, nursing and auxiliary staff. A major difference for correctional health care providers from that of community health care providers is that the central and primary mission of the correctional setting is public safety and confinement, not health care. The focus of the correctional setting's mission, thus, becomes maintaining security.

When the concept of confinement and public safety is explored in its totality, is when the legal obligation and vital necessity of providing health care becomes part of maintaining custody. In the correctional setting, care and custody become the model of the correctional environment. Correctional health care practice occurs in a wide berth of unique programs throughout the county, with many different scenarios existing. Yet, with all the different health care programs, there is a common thread. That is the American Correctional Association's performance-based standards, which include an expectation for a quality management process that is used to measure the quality of the health care being provided in the correctional setting.

Quality management is an ongoing process, not an event. ACA's Standards for Adult Correctional Institutions, Fourth Edition, presents a comprehensive mandatory standard (4-4410) that provides a framework for internal review and quality assurance. This standard allows administrators of each correctional health care delivery system the opportunity to develop a meaningful and useful quality management program to measure and monitor the unique attributes of their health care delivery system. Once implemented, the standard provides administrators the tools to evaluate individual correctional health care systems or programs.

The Correctional Quality Health Care Process

The framework of the correctional health care quality management system as specified by ACA standards is based on a system of documented internal reviews and statistical gathering designed by each system's health authority. The basic components of quality and internal review standard (4-4410) include the following:

     A multidisciplinary team of corrections professionals and/or
     correctional health care professionals. This team participates in
     quality review, improvement or assurance activities and committee
     meetings. The activities of the quality improvement
     multidisciplinary team include the collecting, tending and analysis
     of data, which are unique and meaningful to each individual
     facility. The analysis of the data produces a systematic planning,
     intervening and reassessment of the quality and performance of the
     correctional health care program. The quality improvement team's
     activities and documentation of activities should support an
     evaluation of the defined data, which will result in the effective
     maintenance of offender access to health care, the improved quality
     of offender health care and better use of resources, all while
     maintaining public safety and security of the institution. …