Jail Healthcare, Room for Improvement

Incarcerated individuals are entitled to the same level of healthcare as those outside of the penal system. The quality, timeliness, and availability of healthcare is required to be thorough and practiced with reasonable care. To that end, the NCCHC has laid out specific guidelines for Continuous Quality Improvement to ensure that healthcare standards remain high and that healthcare is delivered to inmates in a best-practice fashion.


The Continuous Quality Improvement (CQI) Program monitors and evaluates healthcare quality provided by personnel, subcontractors, and consultants. The CQI program serves to diligently be cognizant of improvement opportunities in the procedures and processes involved in healthcare services delivery.

CQI is geared toward continual healthcare service and outcome improvement with a focus on an objective, continuous approach to monitoring and evaluating healthcare services in jail facilities. This approach allows the CQI program to properly evaluate all aspects of healthcare in the system including patient care improvement, clinical performance, medication usage, and healthcare records. It is through this overall approach that healthcare services are kept up-to-date and healthcare quality is improved.

All jail facilities are different. Population size, current sick population, and infirmary facilities are all factors when considering Continuous Quality Improvement. Because of these variables, one all-encompassing set of rules would be impossible. In order to ensure that quality care is received, CQI requirements are divided by population size – less than 500 inmates and more then 500 inmates.

Facilities averaging 500 inmates or less must complete an annual CQI effectiveness review. In addition, at least one quality improvement study and one outcome quality improvement study must be made yearly which identifies a problem, studies the problem, implements an improvement plan, and tracks the improvement demonstrated as a result of the study.

Facilities averaging 500 or more inmates must have a multidisciplinary quality improvement committee in place which meets quarterly and as needed. The committee is required to design quality improvement monitoring activities, discuss the results of these activities, and implement corrective actions for any areas which are found to be lacking. The committee is also responsible for performing a minimum of two process quality improvement studies and two outcome quality improvement studies annually which identify facility problems, study the problems, implement improvement plans, and track demonstrated improvements resulting from the studies.

In either population CQI category, annual reviews are to include reviews of access to care, receiving screening, health assessment, continuity of care, nursing care, pharmacy services, diagnostic services, mental healthcare, dental care, emergency care, disaster drill critique, environmental inspections, inmate grievances, and inmate grievances. Additionally, hospitalization, adverse patient occurrences, infection, control and the intake process are to be reviewed annually.

A well developed CQI program should include regular meetings with the medical services provider and the correctional authority. These meetings should be focused around integrating the goals of medical and correctional services. These goal may address conflicts among medical and correctional staff, delayed inmate care, staffing, training, and focused areas of improvement.

The medical provider should perform ongoing quality improvement that monitors the access to and quality of inmate medical services. The CQI program should monitor all aspects of healthcare including at least the following: access to health services, chronic disease management, medical records management, medication administration, infection control, and adverse patient events and deaths.

Once deficiencies are identified, the CQI program must develop and implement corrective action plans. The corrective action plan should address the deficiencies and recommend improvements. The effectiveness of the correcting action plan plan should be monitored on a continuous basis.

Continuous Quality Improvement is an important factor in penal system healthcare. CQI ensures that inmates have healthcare that is continuously updated, follows medical advancements, and gives the quality of care afforded them by law.

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