Inmate grievances are a standard mechanism for prisoners to request changes and express discontent with a variety of conditions of confinement such as housing, officer treatment, and inadequate medical care. Although many in correctional health care see the grievance process as a tedious necessity, inmate medical grievances can be a rich source of information for uncovering system flaws. This patient feedback can actually help improve the quality of your patient outcomes, reduce clinical error, and avoid legal liability. Here are three important ways to use inmate grievances to help provide quality correctional health care.
Fix System Problems
“Last month Doc said I was going for tests about my liver. I haven’t seen my name on the call out list yet. Please help!”
Grievances can sometime unearth major system troubles. A common area of weak systems is the process for outside diagnostic testing. No doubt about it, there is no easy way to get our patients scheduled for a liver biopsy, coordinate officer transport, and the various other arrangements necessary for a successful procedure. The investigation of this grievance revealed that several patient tests had dropped off the log during an extended family leave for the medical unit clerk. Staff turnover can lead to system issues if there are no cross-trained staff to keep processes going. This issue was revealed and resolved through an inmate grievance.
Resolve Staff Issues
“I keep turning in sick call slips but no one will see me in medical. I need some attention right now!”
Sometimes inmate grievances are the result of unreasonable expectations and, after investigation, result in educating the patient about the process of requesting and receiving health care. This request, however, resulted in the discovery that the evening shift nurse, whose post duties included rounding to collect sick call slips, was discarding some slips that she determined were unnecessary to process. Resolving the cause of this grievance may have prevented future patient harm by identifying poor staff behaviors. The immediate result of the investigation was termination of the staff member.
Correct Communication Concerns
“My toe is swollen and infected. I was told I would get better shoes months ago. No one is listening to me.”
This older diabetic inmate rightly needed special foot wear and the state prison system he was in had a good process set up for providing them when necessary. However, the communication between medical and procurement in this particular prison was faulty. Good investigation of this medical grievance revealed the disconnect and initiated a change in communication among facility departments that resulted in faster procurement of medically necessary items such as these shoes.
It can be easy to become tone-deaf to complaints of our patients generated through the inmate grievance process. This is a mistake. Granted, some complaints may be unfounded, but all complaints deserve to be investigated.
To use inmate grievances effectively, a system is needed for investigating grievances, answering them, and tabulating any trends. Here are some tips for a smooth-running grievance process:
- Have a designated individual handle all medical grievances. If you are a one-person department, that would be you; however, if more options are available, pick someone who has a genuine interest in patient satisfaction or quality improvement. A single communication point for grievances means relationships can be built among those in the facility most likely to be regularly handling inmate complaints; thus speeding results. This also provides a consistent contact point when addressing issues with the patient population.
- Make sure your system is set up to address grievances promptly. Consider grievances like sick call request and turn around a first response in 48-72 hours. A complicated issue may take more time to resolve but you patients should to know they are being heard and that the wheels are in motion.
- Categorize grievances related to common quality issues once an investigation of the situation indicates a primary cause. Here are some suggested categories:
o Capacity Issues: Staffing/Supplies
o Patient Information/Understanding
o Staff Issues: Knowledge, Accountability, Skill
o System/Process Issues
- Tabulate grievance themes in your quality improvement program and investigate trending issues with a formal process or outcome study. Once a trend is seen, a quality improvement study will validate a quality problem and provide baseline data for tracking the outcome of system changes.
Inmate grievances can be a useful source of information about your clinical program. How are you using inmate grievances? Share your experiences in the comments section of this post.
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