Five Year Strategic Plan For Healthcare In Detention

Running head: HEALTH CARE IN DETENTION

Five -Year Strategic Plan (2014 -2019) for Health Care in Detention Centers

(Name)

International Health and Medical Service

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Strategic Plan for Health Care in Detention Centers

The International Health and Medical Services (IHMS) was launched as a private

provider of primary health care and medical services, until the organization entered into a

contract with the Immigration Department and Border Control in 2009. Offering mental

health services in detainee facilities holding immigrants seeking asylum and refugees, in

addition to primary care extended the scope of operations for IHMS. The changing dimension

to its function, prompted IHMS to make some changes to its internal organization, as well as

its partnership policies. The changes have occurred overtime and others are still on-going, to

position IHMS at excellence in quality care and standard mental health provision. Our

organization is headed by an executive body comprising a number of senior members; the

body oversees both the clinical and corporate governance through designated officials (IHMS

Clinical Governance Procedure 1.1.1, n.d). The current strategic plan covers five years and

includes an overview of mental health care situation among those seeking asylum and

refugees in Australian detention centers. Notably, the approaches to the development of the

strategic plan and the drivers of our organization’s development are discussed. Further, the

organization values’ statement is made, as well as the primary goals under each strategic

priority clearly outlined.

Mental Health Care in Detention

The Australian government has a policy of mandatory detention of all refugees and

those seeking asylum. The mental health of these immigrants has been shown to be at stake in

the detention facilities; existing conditions are exacerbated and first time sufferers exhibit

symptoms of disorders only a few months after being placed in a detention facility (National

News, 2007). Reports have also indicated that with appropriate care and treatment, mental

health is greatly improved. However, by its nature, the detention care setting presents with

complexities. Codes of the care environment and care practices in detention are often less

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developed, the inability to deal with the detention cause of mental distress notwithstanding.

Consequently, as a health care provider representing IHMS, one has to meet the security and

immigration officials’ demand, besides upholding the patient’s best interest. In the end,

compromises are inevitable to avoid role conflict, with the only way of avoiding

compromises being clearly defined ethics and codes of operation. Overall, an independent

body under clinical governance is crucial in aligning the care providers with the goals for

quality mental health provision in detention, while also ensuring their own safety and good

health in the workplace (Becker & Kleinman, 2013). Consequently, for any clinical care

provision strategy to effectively maintain and improve the mental health of detainees, it

should be designed in a way that suits the limiting environment in a detainment facility.

IHMS has managed to win successive contracts with IDBP on health service provision in

detention, but it does not mean our experience has been all rosy.

IHMS Challenges so far

 Inadequate staff in an attempt to cut-on budget

 Failures in reporting of incidents leading to unmet contractual targets

 Sub-optimal quality of care and negligence resulting to even deaths (Doherty, 2016)

 Scandals on breach of the privacy of detainees’ medical data (Farrell, Jabour &

Evershed, 2015)

 Ignorance of clinical existing clinical and governance procedures

The need for organizational development

Following the recommendations from the performance of the previous strategic plan

and the lessons learned from the implementation of the contractual requirement in the year

2009 to 2013, change has been deemed necessary. Specifically, the steers for the

development include: seemingly failing corporate governance lacking an independent

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oversight, Inability to meet several of the contractual targets such a high quality care in

detention and an apparent role strain among the clinical staff relating to differences in

stakeholders’ goals. The overall objective of the change, is to have a more evolved and

aligned clinical governance, enhanced participation of health care providers in the planning

of expected patients’ outcomes and in the actual practice and increased level of participation

of detainees in the care of their own mental health. It follows that this objective currently

cannot be met due to the limitation of the current level of organization paving way for

organization development, in which the current strategic plan is based. The strength in the

current plan lies in the attempt to have an integrative approach towards enhanced quality of

care in detention facilities whereby, IHMS takes the initiative to invite members of the

immigration department and the facilities’ security members into its strategic planning

process.

Organizational Values

Our organization upholds non-discriminatory, medically appropriate, dignified,

humane and sensitive health care delivery. Additionally, confidentiality and the privacy of

our patients are held with high regard (IHMS n.d).

Development Areas

The context of the current strategic plan is the 2014 – 2019 Immigration Detention

Health Services Contract (IDHSC), for quality and standard mental health care. Moreover,

this long –term strategic plan is built on the requirement by procedures 1.1.2 and 1.1.1 of the

corporate and clinical governances respectively. The fruitful process of the strategic planning

was possible through the contribution of IHMS clinical staff, representatives of the detention

security staff and those from IDBP, as well as detainees and outsourced experts in the area of

mental health among detainees. Additionally, the organization’s internal data widely

informed the planning. From the consultation, key areas of development were identified as:

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education on ethics and behavior, information sharing, quality of health care, cohesiveness of

operations, and resource stewardship.

Strategic Priorities

Based on the organizations’ standing and changing needs and views on mental health

welfare of detainees globally (Becker & Kleinman, 2013), major priority areas for the

strategy have been set. They include provision of a safe work environment, workforce

development, engagement with the DIBP and other stakeholders, and financial management.

Other important areas are quality management, assets management, and information as well

as technology management (IHMS, n.d). The priority areas are outlined together with the

accompanying five-year goals.

Quality management

Standard and quality care provision in the mental health of detainees is the main term

of duty in the IDHSC signed between IHMS and IDPB. Entire organization systems’ quality

will translate into quality in the main purpose of IHMS; to deliver health care. In healthcare,

quality has to be consistent, persistent and timely. Quality management will involve

overseeing and monitoring the achievement of the following objectives as described by

Hughes (2008):

 Improved mental health of detainees

 Enhanced experience of care for both the detainees and the clinical staff

 Enhanced caring attitude regarding detainees’ mental health among the

security staff and members if IDBP; a triage established for high quality care

 Maintenance of care costs within the budget

With the strong belief of IHMS that each deserves health care that effectively, safely and in

the most humane way possible meets an individual’s health demands as contained in the

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values statement, the above objective will be achieved. Four goals for change targeting

various points of quality improvement will guide the achievement of high quality in IHMS

delivery of care in detainees’ mental health.

Goal I: Improve detainee’s mental and primary health through quality care provision

The goal is within the mandate of IHMS and will specifically involve all the support

to well educated, trained and developed workforce so that each can contribute to the best

outcomes in patient. One of the strategies to achieve this goal will be to decrease the rates of

transfer between facilities regarding trainees and implementing the incentives for clinical

staff maintenance; which will ensure continuity of care and the subsequent positive health

outcomes. Another strategy will be to put accessible systems in place for data measuring and

storage, efficient incidents’ reporting, and other aspects of effective risk communication with

the intention of using the information for risk mitigation. Transparency and systems of

accountability will be implemented and will act and a motivator and safeguard for clinical

staff and a source of hope for detainees (Kaini, 2013). Additionally, transparency is important

in the compliance with IHMS policies.

Goal II: Enhanced experience of care for both the detainees and the clinical staff

One way to assess whether set quality is being achieved is by evaluating how patients

and care providers experience the entire process (Beattie et al., 2015). One way to a great

patient experience is by trust building, which would require warm and understanding clinical

staff. Trust will take time to build since it will also be influenced by other factors such as the

treatment by the security staff and the established distrust of the immigration border. These

two barriers will, however, have been addressed in the goals for the strategic engagement

with DIBP and security staff. Another strategy will be to in make it easy to access health care

and the related information by the patient. Increased access will necessitate employment of

more staff and installation of straightforward as well as friendly systems of access of both

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care and the service providers. A third strategy is giving prescriptions (medications or

lifestyle modifications) that are as patient-friendly as possible. For improved clinicians’

experience, the strategy will be to ensure their psychological wellbeing by limiting the

influence of other stakeholders on their practice and execution of their duties. Organization-

wide systems of accountability and transparent communication among the various

stakeholders will also contribute to enhanced experience.

Goal III: Enhanced caring attitude regarding detainees’ mental and primary health among all

stakeholders

The triage involvement in the welfare of detainees has been identified to hinder

achievement of quality care. While a clinicians’ duty may require a relaxing environment for

better outcomes in a patient, safety concerns may cause the security staff to impede such a

move. In an environment in which such conflicts are daily occurrences, quality care becomes

practically unsupported (Mosadeghrad, A. M. 2014). For all the stakeholders to be on the

same page in terms of upholding a climate of care, communicating the importance of a caring

environment to the security officials and the IDBP through our initiative will be the strategy

used. Training of security staff on how to handle detainees’ identified in the high-risk group

for development of mental disorders and general ill-heath, will also be a strategy in the

creation of a supportive environment.

Goal IV: Provision of health care within the budget

Previously, the cost of care provision to detainees has been above budget and

following cuts by the contractor, the provided care should not only be of quality, but also

affordable. To maintain quality care delivery within the budget, proper management of assets,

finances and the people resource is to be ensured. Several strategies can be used; for instance,

all cases of appropriation and misappropriation of finances will be directly reported to the

senior executive management on a quarterly basis the year round. Secondly allocation of

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funds will be done on a priority basis whereby aspects of care that contribute to the highest

enhancement of quality will be given more funds; less priority areas will receive a cut.

Thirdly, incentivizing staff in affordable ways to keep them motivated and pro-active in their

work will enhance performance and reduce the rates of resignation both of which come at a

cost to the organization.

Provision of a safe work environment

Ensuring a safe work environment is a part of the quality management strategic area

and will entail similar objectives. When an environment is characterized by aggression and

limitations that impact workers negatively in the course of their duties, they are likely to

provide poor quality services and eventually may quit their jobs. The goal for safe work

environment provision overarches with Goal I and Goal II under quality management. The

strategies that will be employed for the priority area will be under one goal.

Goal: Removal of identified safety risks and enhanced reporting of risky incidents

Based on the outcomes of previous strategic plan and reported risks to workers in the conduct

of their duties in detention facilities strategies to mitigation safety risks are outlined. Safety of

workers is directly linked to the quality of care they can offer patients. Strategies for risk

removal will include prompt management of patients that show signs of aggression, with or

without appointment. Safety badges that can be used by attending clinicians to swiftly alert

security in case of a potential aggression will also be employed. Another strategy will be the

installation of a database system backed by a telephone line for incident reporting.

Workforce development

The development of workforce involves education and re-organization, and is in support of

IHMS’s organizational values. Considering the nature of healthcare, both clinical and non-

clinical staffs are expected to be knowledgeable on quality, ethical and legal aspects of

primary and mental health care. IHMS has an already established employee code of conduct

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that can be used in guiding the strategies for development. The objective of workforce

development is to instill behavior change in the workforce. The change is expected to

contribute enhanced quality of delivered health care and meeting of the rest of the contractual

targets. One goal will be a guide to the achievement of workforce development

Goal: Enhanced performance in quality delivery of care and in the meeting of targets

Based on previous results on unmet targets, higher performance of workforce is

required in order to fulfill IHMS’s contractual duties. Education will be central to the

employed strategies under this goal. The first will be to establish a performance improvement

program that will run quarterly during the first year (a month-training) of the strategic plan,

and will target all employees. The training package will also include aspects of ethics and

legal requirements in duty. Secondly, a workplace safety program targeting mostly the

clinical staff will be designed and will be run annually for a period of two weeks for every

session. Besides training a re-organization of the reporting chain will be done in order to

align it to the best outcomes in patient care.

Clinical risk management

As outlined in the governance procedure 1.1.2, reporting on clinical risk is required and is

directed to the senior executive office. The goal and strategy of this priority area is

adequately covered under provision of a safe work environment and under quality

management Goal I.

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References

Beattie, M., Murphy, D. J., Atherton, I., & Lauder, W. (2015). Instruments to measure patient

experience of healthcare quality in hospitals: a systematic review. Systematic

Reviews, 4, 97. http://doi.org/10.1186/s13643-015-0089-0

Becker, A. E., & Kleinman, A. (2013). Mental health and the global agenda. New England

Journal of Medicine, 369(1), 66-73.

Doherty, B. (26 December, 2016). Refugee pleaded with doctors on Manus Island for help

before his death. The Guardian. Retrieved 30 March 2017

Farrell, P., Jabour, B. and Evershed, N. (22 July 2015). Immigration department sought

private medical records 'for political reasons'. The Guardian. Retrieved 30 March

2017

Hughes, R. G. (2008). Tools and strategies for quality improvement and patient safety. In An

Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and

Quality (US)

IHMS (n.d). Web. http://www.ihms.com.au/

Kaini, B. K. (2013). Healthcare governance for accountability and transparency. Journal of

Nepal Health Research Council.

Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International

Journal of Health Policy and Management, 3(2), 77–89.

http://doi.org/10.15171/ijhpm.2014.65

National News, (2007). Detention worsens mental health. Australian Nursing Journal, 14(8),

Stone, P. W., Hughes, R., & Dailey, M. (2008). Creating a safe and high-quality health care

environment. Patient Safety and Quality: In An Evidence-Based HandBook for

Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US

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Five Year Strategic Plan for Healthcare in detention

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