Performance-Based Health Care Standards Moving Forward
McKim, Kathleen, Corrections Today
In this past February's Corrections Today, the Accreditation Byline column introduced the American Correctional Association's (ACA) performance-based health care standards. The standards were developed as part of an initiative to provide agencies with the tools to develop higher-quality health care programs while giving them the mechanism to monitor the progress and success of programs. Field testing for the new standards began last November. ACA's Standards and Accreditation Department since has had an opportunity to assess several test sites and the results are encouraging.
Implementation at the site level is imperative to a standard's success. Balance must be maintained between good practice and attainable objectives. Too much or too little in either direction will negate the purpose of establishing the standard. A multidisciplinary committee of health care and corrections professionals currently working within the correctional arena developed the performance-based health care standards. This well-respected team designed the expected practices in the new health care standards to reflect current trends in correctional health care. As officials at each test site prepared for the compliance audit, they compared their current procedures with the expected practices outlined in the performance-based standards. In all cases, staff at the test sites found the new expected practices detailed and instructive. As a result of compliance, most facilities found deficiencies in areas that greatly impacted the overall operation of the medical unit. For example, during the self-evaluation proc ess, staff at one site discovered that their medication administration practice did not meet expected practices, nor did it meet some state pharmacy regulations. Another facility discovered that therapeutic diets were being ordered but not delivered to offenders in the dining hall. Still, at another institution, staff found that their chronic care clinics were not routinely tracking patients and subsequently generated avoidable costs in off-site care. None of the institutions found the expected practices unobtainable. They did, in some instances, require changes in policy, procedure and practice.
The quality assurance and peer review programs defined by the performance-based health care standards were well-received. Some facilities already had performance improvement processes in place prior to self-evaluation; others did not. All the test sites agreed that the requirement for periodic internal evaluations and the resulting corrective action plans were practical and effective.
There was one consistent problem throughout the implementation of the performance-based standards and that involved the terminology used in the expected practices. To assist with the interpretation of expected practices and to define crucial elements, a glossary of terms specific to health care standards has been developed and will be included in the published version.
The second objective of field testing was to determine how audit teams would interpret and assess the standards and expected practices. All auditors participating in the field tests are experienced correctional health care professionals who have performed ACA accreditation audits in the past. The health care auditors were asked to provide detailed information about their findings, the difficulties they encountered, and any suggestions or recommendations.
The audit process varies slightly from the current form being used across the Commission on Accreditation for Corrections (CAC) continuum. File preparation and review were no different than what auditors experienced during past audits. The change to performance-based standards prompted them to concentrate more intensely on actual practices implemented within the facility. More time was spent on visualizing sick call, medication rounds, procedures for shift changes, narcotic and sharp counts, segregation rounds and chronic care services. …