Province wide Review of Health Care Services in Ontario Correctional Services

Action Item Communication Raise profile of health care professionals in corrections: through updates on health care issues, Health Care Manager (HCM) participation in senior management meetings, e-learning programs and training for all front-line staff without a health care background.

Update Corporate Health Care is working with others to improve learning and development opportunities for nurses: o Provincial Nursing Advisory Committee (PNAC) and the Ontario Correctional Services College (OCSC) to focus on learning and development for nurses. The committee will report to the Deputy Minister by Fall 2013. PNAC is chaired by CHC and includes a representative from each of the four regions and the youth ministry. o MCSCS Nurses have been engaged in several nursing research initiatives funded by the MOHLTC Nursing Secretariat. Manager, CHC is a member of Research Advisory Committees for these projects. o The Registered Nurse Association of Ontario (RNAO) has an Ontario Correctional Nurses interest group. Many correctional nurses belong to the RNAO, including Manager, CHC. Will identify joint learning opportunities for Superintendents and health care managers. Fall 2013. Work on an orientation manual and development of a mentorship program is in progress. A report back status report to be submitted to the Deputy Minister by Summer 2013. HCMs to provide medical observation information sheets to correctional staff on an ongoing basis. Spring 2013. Best practices can be shared between HCMs and CHC. Direction to Superintendents to be issued by the ADM IS to ensure that all medical records are properly filed. In cases where the inmate has been transferred, and the record arrives post-transfer, these records are to be forward to the new facility without delay. Where necessary, Superintendents will assign staff to ensure this is completed. Re-enforce existing policy. Spring 2013. Compliance with this directive is to be reviewed on an annual basis by the facility with the results being reported to the ADM IS. Professional and Shared Services (PSS) within the Strategic Operations and Initiatives Branch (SOIB) to review the existing contractual relationship with physicians to examine opportunities to standardize services and improve communication. Ongoing 1 June 11, 2013

Clarify roles and expectations: develop standardized orientation manual, mentorship program for new nurses and medical observation information sheets for correctional staff. Transfer of medical records: Ensure that records that arrive after an inmate is transferred are forwarded to the inmate's health care file as soon as feasible.

Strengthen the contractual relationship between the Ministry and physicians.

Staffing Levels Improve recruitment strategies for health care professionals: outlining core expectations of nurses with a generic job description; HR Ontario to work with superintendents to ensure information on MOHLTC website is current and up-to-date; recruitment campaigns; and, Nurse Practitioners in underserved areas. Address staffing capacity: filling vacant positions and look at adding MCP nursing positions. Examine whether critical care standards can be met by changed reporting times.

A general nurse description with core duties and expectations will be created. Fall 2013. HCMs to continue to discuss targeted recruitment of nurses and to ensure that opportunities for on-line postings, such as on the MOHLTC website are maximized. Current practice. Senior Medical Advisor (SMA) to explore opportunities to recruit for physician care when recruitment through traditional methods are not successful. Ongoing Address staffing capacity within CHC. Fall 2013. Facilities with no HCM, Spring 2014. Examining management vacancies that can be assigned to facilities with no HCM to facilitate implementation of other recommendations, as well as perform management functions in the facility. Superintendents to examine nursing schedules to see if frequency of missed assessments can be addressed by changing shift schedule. Spring 2013. All health care competitions must have a nurse manager involved in the process from engagement with central recruitment, to hiring. Spring 2013 In locations without a health care manager, CHC will need to be engaged or will assist in assigning appropriate support. Spring 2013 All recruitment of health care managers in correctional facilities will include involvement of CHC. Spring 2013 CHC and local HCMs are engaged in examining opportunities to enhance the complement of mental health nurses on an ongoing basis. Identifying opportunities to enhance service delivery to mentally ill inmates. Work to be completed by Professional and Shared Services Unit by Fall 2013. CHC to identify training and development needs for HCMs to assist Superintendents in the development of learning plans. Superintendents to review and develop learning plans for each HCM and support attendance. Superintendents to submit summary and report back to the Deputy Minister by early Spring 2013 on the status. Complete a cross jurisdictional review examining staffing levels, governance, oversight and other best practices. Report to be submitted to the Deputy Minister in Spring 2014. 2 June 11, 2013

Professional oversight in recruitment: mandate oversight of CHC in health care management recruitment processes.

Inmates with mental illness: re-allocate vacant resources to expand complement of mental health nurses. Increased training opportunities for HCMs and nurses: develop curriculum to address unique needs of HCMs, increase knowledge through conferences and e-learning, facilitate monthly forums using Adobe Connects and maximize telemedicine equipment for education. Comparative study of efficiencies in health care.

Governance Strengthen governance: HCMs attend Superintendents Management Committee meetings; streamline decision approval process. Communication between institutions and CHC: develop measures to outline communication accountabilities. Oversight Improve oversight and compliance: involve CHC at early stage in investigations; ensure that early and effective detection of difficulty or conflict in a HCU is identified and addressed; that the local HCM ensures that critical care standards are meet; that where serious concerns regarding the functioning of a health care unit exists, immediate action is taken; and, CHC improves oversight of Physician Fee for Service contracts. Womens health issues Coordinated care for pregnant inmates: develop standardized practises and procedures for working with female offenders pre- and postnatal. Plan of care for pregnant inmates: multidisciplinary team of correctional staff to engage with pregnant inmates, ensure linkages with local hospitals and support agencies. Support for female inmates likely to self-harm: ensure corrections staff identify and support female inmates at greater risk of self-harm.

HCMs to be invited to regional superintendent meetings on an ongoing basis. Spring 2013 An options paper for streamlining decision approval process for both CHC and health care in the facilities to be presented to ADM OS by Summer 2013. Direction to Superintendents to be issued by the ADM IS to ensure HCMs are in regular communication with CHC without impediment to ensure professional oversight. Direction to Superintendents to be issued ensuring that CHC is made aware through standard reporting mechanisms of all medical incidents. Spring 2013 Direction to be provided to the Correctional Investigation and Security Unit to ensure CHC is involved at an early stage in investigations with health care implications. Spring 2013 / ongoing. Professional and Shared Services to establish a committee to review physician contracts including examination of level of service, remuneration, communication, competitive procurement and other areas. Spring 2013. The Director, SOIB to re-issue direction on the standards of care related to opioid withdrawal. Spring 2013.

A Report outlining best practices guideline and implementation plan is to be completed by Summer 2013.

Each facility housing females to review on an annual basis, beginning in spring 2013, the standard operating policies regarding pregnant inmates and those who have recently given birth. Topics will include, planning for care, breast feeding and contact visits. Spring 2013. Provide materials to inmates to support these initiatives. Fall 2013 / ongoing. Facilities will ensure that multi-disciplinary team will develop a case plan when selfabusive female inmates begin exhibiting such behaviours. The plan will address interventions to minimize risk and creative plans for re-integration. Fall 2013. The OCSC to create training materials to assist correctional and health care staff identify and support female inmates at risk of self-harm. Winter 2014. 3 June 11, 2013

Long Term Planning Items Improve sharing of medical information within and outside of the Ministry. Improve efficiency in service delivery: Identify more efficient and innovative approaches to delivering existing services that could also result in giving nurses more time to dedicate to frontline patient care. Review governance model: examine ways to improve quality assurance and oversight. Other Recommendations Keep on Person (KOP) medication as part of inmate rehabilitation: explore and establish policies, procedures and categories of medication for use as KOP. Improvements in health confidentiality: Management and Union examine Community Escort Agreement to determine if improvements can be made to better safeguard confidentiality without compromising security.

Update information sharing policies and develop strategies for the efficient and secure sharing of medical information, including IT-based solutions. Immediate to five years. Conducting a responsible and methodical review of services and current business models to improve front-line patient care by pursuing greater efficiency in how services are delivered. Immediate to five years.

To review alternative governance structures for health care with the intention of improving quality assurance and improved oversight. Review could be completed by Spring 2014. Review opportunities for further expansion of KOP medication with Provincial Joint Occupational Health and Safety (PJOHS). The feedback from this review to be provided in a report back to ISEC by spring 2014 for consideration. If adopted KOP to be piloted at key sites by Winter 2014. PJOHS to examine with CHC where escort practices can be improved to further safeguard confidential health information. Spring 2013. Committee to also examine impact of the agreement on pregnant inmates. PJOHS to discuss and revise master agreement by Summer 2013.

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