University of Medicine and Dentistry of New Jersey University Correctional HealthCare

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1 University of Medicine and Dentistry of New Jersey University Correctional HealthCare Why We Should Measure Patient Satisfaction in Correctional HealthCare Jeff Dickert, PhD, UCHC Vice President Lisa DeBilio, PhD, UCHC QI Director Marci Masker PhD, UCHC Clinician Administrator

2 Patient Satisfaction A routine performance measure, can be seen in almost all healthcare settings; from doctors offices to medical centers. Rarely are they used in correctional settings. Correctional settings instead focus primarily on remedying inmate complaints in order to ensure that healthcare services meet their constitutional rights NJ Department of Corrections (NJDOC) initiative (beginning in 2005) includes providing a means for inmates to express their degree of satisfaction with healthcare, while reducing inmate complaints with healthcare services.

3 Rationale Correctional systems are unique; they are the only setting where healthcare delivery is a constitutionally guaranteed right. Demonstration of quality healthcare systems have become e an imperative in order for correctional o facilities to demonstrate inmates basic rights to treatment have been met.

4 Rationale National Commission on Correctional Health Care (NCCHC) notes that the failure of correctional officials to honor these rights has resulted in protracted litigation, the awarding of fdamages and attorneys fees and the issuance of injunctions regarding the delivery of health care systems. (NCCHC, 2008) Inmate satisfaction surveys provide a unique opportunity to obtain feedback about services including ways to improve them while simultaneously providing inmates with another vehicle of communication aside from the standard administrative remedy or grievance.

5 Rationale When inmates are asked about their opinion regarding healthcare, it stands to reason that they will then be less likely to file a formal complaint. This benefits not only the inmate but also the correctional facility as a whole by staving off potential costly litigation. Many correctional systems have been or are at risk of being under some form of court monitoring for failure to demonstrate provision of adequate healthcare. The measurement of patient satisfaction i with hhealth hcare in prisons and jails can reduce such risk.

6 Rationale A benchmark of inmate perceptions of quality correctional healthcare can be established, serving as a natural element of a continued quality improvement program. PLAN DESIGN MEASURE ASSESS

7 Review of Literature Despite the importance, only a few published articles on the assessment of patients satisfaction with mental health services in prison settings could be found. Linquist and Lindquist (1999)-Southern City County Jail Brodey et al.(2000)-wa Spudic (2003)-GA Melnick et al. (2004)-CA, GA, SC and PA Way et al. (2007)-NY Haken et al. (2009) Norway

8 Lindquist and Lindquist (1999) Examined the physical health care status of inmates in a large southern city county jail Included inmate evaluations of the accessibility and quality of the medical services they received. 74% of the respondents rated accessibility as somewhat difficult to very difficult 75% perceived the quality of medical care as 0 (poor) to 2 (fair).

9 Brodey, et al. (2000) Studied patient satisfaction with remote telepsychiatric consultations Comprised of 43 patients at the King County Correctional Facility in Seattle The Group Health Association of America Consumer Satisfaction Survey was used. Overall satisfaction scores found was 3.5, on a scale ranging from 1 to 5.

10 Spudic (2003) Comprised of 47 inmates in a mental health unit of a Georgia Sate Prison. Their satisfaction survey included 11 items, with a 5- point Likert Scale ranging from 1 to 5, where 5 indicated the highest level of satisfaction. An average satisfaction score of 3.2

11 Melnick et al. (2004) Included a sample of 1,059 inmates residing in 13 prisons located in California, Georgia, South Carolina and Pennsylvania. The Multimodality lit Quality Assurance Instrument t (MQA) was utilized and included a 5-point Likert scale Only 355 (33.5%) respondents completed all of the satisfaction items Mean score of 3.0

12 Way, et al. (2007) Data from 2004 Comprised 7.3% of the population in 21 New York State Prisons. Addressed patient involvement in treatment, the content of the treatment process, access to treating clinicians, perceived benefit of treatment and overall satisfaction. On average, 79.3% of the respondents were satisfied with the mental health services they received. Individual item satisfaction ranged from 65.2% to 95%.

13 Hakon, et al. (2009) Comprised of 1,450 inmates in 29 prisons in Norway. A modified version of The Psychiatric Outpatient Experiences Questionnaire (POPEQ) used in general psychiatric settings was used. The survey included twelve questions and a Likert scale ranging from 0 (lowest) to 100 (highest) Total satisfaction mean score was 38.4.

14 Literature Review Findings Most studies involving inmate satisfaction with health care services included: One time administration Small sample sizes Little mention of the use of the satisfaction data to motivate improvement of services and increase inmate satisfaction

15 UCHC Experience In 2005, UCHC entered an agreement with the NJ Department of Correction (DOC) to provide mental health services to inmates (medical in 2009). One of the first measures implemented was the annual assessment of patient satisfaction with mental health services, with the initial goal of benchmarking inmate satisfaction to demonstrate t the ongoing effectiveness of services provided.

16 UCHC Experience Implementing satisfaction surveys communicated to inmates and the mental health staff that UCHC valued highly the ability to review ongoing feedback from patients and uses the annual data to address emerging issues and improve services. UCHC hoped that by attending to patient perceptions of care it would: Improve the provision of care Improve inmate perceptions over time Decrease the number of complaints Reduce risk of inmate generated litigations

17 Satisfaction Survey Items: 1 to 6 1. Overall, how would you evaluate the quality of mental health services you received. Evaluate-- 2. The helpfulness of the mental health staff. 3. Courtesy shown you by the mental health staff. 4. Attention to privacy during treatment sessions. 5. Professionalism of the mental health staff. 6. The extent to which your individual mental health needs were addressed.

18 Satisfaction Survey Items: 7 to Availability of mental health staff to talk with you. 8. The frequency of appointments with mental health staff. 9. The length of time you had to wait for your first mental health appointment. 10. The helpfulness l of medication and/or other treatment t t that t you received. 11.The degree to which mental health staff respect your confidentiality.

19 Satisfaction Survey Item: The opportunity to participate in decisions about your mental health treatment. Note: The instrument twas adapted dfrom the Satisfaction Survey used by University Behavioral HealthCare which benchmarks with Mental Health Corporation of America (MHCA). This instrument has a 5-point Likert scale, where 5 indicates Excellent

20 Additional Survey Items 1. You have come to the mental health program with certain problem. How are these problems now? 2. Would you recommend the mental health services to someone else? 3. Your age group? 4. Your gender? 5. Which best describes your ethnic background? 6. What was the last grade you completed in school? 7. Your current marital status?

21 Process Once a year during a specified two week period of time, mental health staff distribute satisfaction surveys to inmates on their caseloads. They explain the purpose of the survey, how the findings will be used, that participation is voluntary and information kept confidential. Inmates are instructed to complete and submit their surveys in a sealed envelope, provided to them preaddressed, to the quality improvement (QI) department either during their mental health appointment or in institutional mail.

22 Results The average inmate population is 25, Inmates with mental health needs complete the satisfaction survey, constituting about 3,200 inmates (400 females and 2,800 males) Between 2005 and 2009, 36.6% 6% of inmates receiving mental health services responded to the satisfaction survey. During the 5 years of data collection, the overall mean satisfaction score increased from 3.7 in 2005 to 3.8 in 2009 (statistically significant p=.03), which is comparable to UMDNJ s community mental health program.

23 Results Current status of problems Somewhat Better 46.2% 46.4% A great deal better 34.6% 35.7% Will recommend to others Yes 84.2% 87.3%

24 Satisfaction with MH Services: 2005 to N=1, N=1, N=1, N=1, N=1,240 Mean % Good to Excellent Mean % Good to Mean % Good to Mean % Good to Mean Excellent Excellent Excellent % Good to Excellent 1.Overall % % % % % 2.Helpfulness % % % % % 3.Courtesy % % % % % 4.Attention % % % % % 5.Privacy % % % % % 6.Professionalism % % % % % 7.Needs % % % % % 8.Availability % % % % % 9.Frequency % % % % % 10.Wait % % % % % 11.Confidentiality % % % % % 12.Participate % % % % % Total Mean Score

25 Results Complaints: Between 2005 and 2009 a 71.5% reduction from 1,384 MH complaints to 394 was noted while medical complaints continued to increase. In 2008 when UCHC assumed responsibility for medical In 2008, when UCHC assumed responsibility for medical services, 30% reduction was found, from 5,087 in 2007 to 3,521 in 2009.

26 Patient Complaints About Mental Health Services 2005 to ,000 1,750 1,500 Total complain nts 1,250 1, ,

27 7,000 Complaints 2007 to ,000 Total Grievances 6,170 5,000 4,000 Medical 5,082 4,575 4,144 4,041 Total 3,000 3,819 3,548 3,466 2,000 1,000 0 Mental Health Dental

28 UCHC Strategies to Improve Patient Satisfaction Results are distributed to NJDOC and leadership staff Results are shared with line staff and at QI meetings Staff are encouraged to select at least one item (<3.6) on the survey as their PI project for the year. Staff are challenged to identify behaviors demonstrating Service Excellence.

29 For example: In an effort to improve satisfaction with helpfulness of staff and treatment, staff : Should ask patients what they need help with Answer questions patients may have. Explain to patients what they can expect in treatment Tell them when they will have a follow up appointment Explain how medications work Inform them when they should expect to receive their medications Let them know how/when they will hear about test/lab results Clarify what providers expect from them in the treatment partnership

30 Educating inmates will help to ensure: Inmates have realistic expectations about services. Improve provider/inmate relationships over time Affect health care outcomes of the patient. In 2010, Patient Satisfaction has been incorporated into: Supervisor performance reviews. The strategic plan.

31 Discussion: Risks, Benefits and Potential Implementation ti for Other Correctional Facilities What are the potential risks in instituting Patient Satisfaction? What are the potential benefits?? What is the feasibility? What are some strategies to improve inmate satisfaction? What are some strategies to reduce complaints?