Spotlight on the Standards

30 Years . . . and Still Making a Difference

In 1776, the Declaration of Independence was adopted by the 13 British colonies in North America. This declaration is one of the most significant documents upon which our nation is founded. In a sense, our U.S. Constitution became the “procedure” for implementing the “policies” articulated in the declaration.

Two hundred years later, in 1976, the first Standards for Health Services in Jails were developed as part of the American Medical Association’s Jail Project, with funding from the Department of Justice’s Law Enforcement Assistance Administration.

These standards are the foundation for correctional health care, accepted by the courts and the field as the benchmark for constitutional, professional practice that meets national community guidelines for health care in all its variations. In essence, they are the policies for correctional health care.

Fixing the Problems
In 1970, NCCHC cofounder Bernard Harrison, JD, an AMA vice president at the time, served on the American Bar Association’s Commission on Correctional Facilities and Services. He identified inadequate health services in jails as a problem, and he set out to do something about it. His research made it clear that ...

• Correctional health care needed to be defined and organized in such a way that health staff could understand what they should be doing—and why—in an environment inhospitable to treatment and healing.

• Correctional administrators needed to understand their roles and responsibilities in providing health services in accord with inmates’ constitutional rights.

• A neutral, professional guide was needed to help the two components of the system to coordinate services.

By 1983 the AMA project had evolved into the National Commission on Correctional Health Care, an independent, not-for-profit organization governed by a board of 22 directors, each representing a national organization involved with health care, corrections or the law.

Today the board represents 38 supporting organizations, and the Standards for Health Services exist in separate versions for jails, prisons and juvenile facilities. NCCHC’s professional and educational initiatives have grown, but the purpose of the standards and accreditation remains the core of our mission: “to improve the quality of health care provided in jails, prisons and juvenile facilities.”

Past Informs Present
Why the history lesson? Without a grounding in why the standards exist and what purpose accreditation was meant to serve, users may become enmeshed in a cycle of trying to be perfect for the sake of a certificate. Or they may become overly critical and see only what is wrong.

To reinforce the purpose of the standards, I offer four practical points for those seeking to obtain and maintain accreditation:

• Accreditation is not an end in itself, but a beginning for better practice. The goal is to improve the quality of health services, not to achieve a perfect “score.”

• Being cited for noncompliance is not a problem; not taking corrective action is.

• Spend your time and energy to correct, not to defend.

• Focus on essentials, meet the important standards as applicable and weigh the value of recommendations before you change anything.

It is also worthwhile to understand the perspectives of those who survey, interpret and explain the standards:

• The accreditation survey is a sharing of expertise among colleagues, not a “white glove” inspection.

• Almost always, a standard’s Compliance Indicators are the way to achieve compliance. But there will be rare alternatives that succeed in meeting the standard’s intent.

• A facility may be in compliance technically but fail to be accredited because the outcome—timely and professional care to meet inmates’ health needs in keeping with community practice—is lacking.

Finally, let’s consider the perspectives of those who revise, advise, critique and approve the standards:

• Meeting the standards cannot solve every problem. There are no substitutes for solid management and oversight of professional practice. Use of the Standards can, however, raise red flags when something is awry.

• Healthy tension exists between optimal practice (the cutting edge) and what is required (the community standard of basic, solid health care). As the Standards have evolved, some care viewed as optimal in the 1970s later was defined as essential. But as new issues arise (DNA testing, HIV testing and treatment, transplants, dialysis), we often find that they are covered in the standards, at least implicitly. That’s because the standards are founded on principles.

• There’s a delicate balance between asking too much and asking too little. Changing times may call for explicit guidelines for certain issues, and some practices become so common that they don’t need to be monitored. But standards can be neither too loose nor too tight. They also must be as applicable to the 60-bed county jail as to the 7,000-bed prison, as relevant to the urban facility in a statewide system as to the stand-alone structure in a rural setting. Our focus on the intent of each standard is how we maintain an ethical and practical balance.

Ahead of the Curve
Increasingly, the public health system understands correctional health care’s place in the continuum of public health care. As the community system grows to know the challenges and achievements of the correctional system, they may be amazed to find us their equals in some areas and at the cutting edge in others—including widespread use of standards and a time-tested accreditation program.

(This article first appeared in the Summer 2006 issue of CorrectCare.)

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Do you have a question about the NCCHC standards for health services? Contact us at:

Standards Q&A
National Commission on Correctional Health Care
1145 W. Diversey Pkwy., Chicago, IL 60614
Phone (773) 880-1460  •  Fax (773) 880-2424
E-mail accreditation@ncchc.org