Edward A. Harrison: Reflections on a Career in Correctional Health Care

Posted May 27, 2014

After 27 years at the National Commission on Correctional Health Care, Edward Harrison retires this summer. The correctional health care field, and the Commission itself, have evolved greatly since he joined NCCHC in 1987. When he started, NCCHC was a relatively small and young organization striving to fulfill a large and important mission. (See the time line of key events in NCCHC’s history.) Over the next several years, Harrison worked his way up to vice president, and in 1993 was appointed president. Here he reflects on his career and on the field in general.

What were you doing professionally before you joined NCCHC?

I had just earned my MBA at Northwestern University. I went to grad school because I was looking for a challenging and stimulating career, and boy did I find it. Prior to that I worked in state government for several years, although my first job after earning my bachelor’s degree was in the marketing department of the Walt Disney Company.

Why did you agree to take the job as president?

It was such a tremendous opportunity. I loved the pioneering work the Commission was doing and its rich history of support from major national organizations. Having a diverse board of directors with health care and corrections experience was unique and a big advantage for what we were trying to do, and my business and management experience and several years of experience at NCCHC would be an asset. Of course, having a personal relationship with NCCHC’s cofounders—B. Jaye Anno and my father, Bernard Harrison, who had retired years earlier—meant that a very strong network could come together to continue the efforts to define and improve the field as well as make it more professional.

What were some of the largest issues or concerns facing the correctional health care field at that time?

Even a decade after Estelle and other court decisions, many correctional systems still lacked the wherewithal to organize adequate health care services. In those years local and state governments, as well as the federal government, were trying to grasp what makes correctional health care so important and different from other corrections or health care activities. I remember looking for people in the Justice Department and Health and Human Services Department to even have a conversation about correctional health care, and various agencies each pointed to the other department as the ones we should talk to.

A breakthrough moment occurred in about 1994. We were able to get an appointment with David Satcher, who was the director of the Centers for Disease Control and Prevention (he later became U.S. Surgeon General). Two of our board members, Doug Mack, a county health department director, and Carl Bell, who ran a community mental health center and knew Satcher, and I were to meet with him, but at the last moment Carl was unable to travel, which was unfortunate because he was instrumental in setting up the appointment. Doug and I met with Satcher and laid out the case as to why the CDC should be actively interested in correctional health care. Perhaps we were having some success but it didn’t seem quite enough to win Satcher over. Then, after about half an hour, Carl called and joined the conversation. Carl is very articulate and passionate about issues that are dear to his heart, and correctional health care is one of those issues. Well, at the end of the meeting Satcher was convinced. “Before you came in here I did not see a strong case for CDC to be involved in correctional health, but now I do,” he told us. He committed to assigning a corrections specialist to help coordinate the CDC’s involvement with corrections-related issues. (That specialist, by the way, was a young man named John Miles, who went on to do a number of great things within CDC and today serves as the editor of our Journal of Correctional Health Care.)

What were your objectives for NCCHC when you became president?

I was the Commission’s third president and by that time the basic structure that we have today was pretty well-established, just much smaller. Accreditation, education, certification … the programs existed but hadn’t caught on as much as they have now. So there was still a lot of “sharing the vision” work to be done. We sought to raise awareness that the unique combination of corrections and health care presents an important public health opportunity as well as patient safety and risk management challenges that require attention at the highest levels of the correctional system. Operationally, the board’s highest priority was to make sure that NCCHC accreditation was as effective as possible. We focused on developing well-trained, highly experienced survey teams that could identify the many acceptable ways to meet the standards, and could educate facility staff members about successful, proven approaches.

Did your vision for NCCHC and its work change over time?

Yes. Although the Commission had always taken on all issues of importance to correctional health systems and professionals, our work evolved to meet the opportunities and challenges that arose. For example, NCCHC has always promoted quality care and systems management, but we had to help change the old culture of corrections to embrace the concepts of performance improvement and patient safety, and then help them to adopt good, nonpunitive programs that improve quality and protect patients. Ever since our landmark study on the health status of soon-to-be-released inmates, our field has become much better at measuring patient outcomes and system performance in meaningful ways. Comparing our benchmarks with those of the free world can go a long way toward seamless care across correctional health, public health and free world health systems. It also shows our elected officials and the courts that correctional systems often provide necessary care at a level of quality and efficiency that is equal to or surpasses what is found in the community.

Certainly the Affordable Care Act presents potentially huge, game-changing opportunities. Still, while much attention today is placed on discharge planning and reducing recidivism, we should never lose sight of the critical need for good care within the walls.

What are some of the most notable accomplishments of the organization?

Today, NCCHC is known to be the leading authority on correctional health care. For many years we worked to get recognition for the importance of high quality care. That work has largely been achieved, as evidenced by the high degree of interest seen in a broad range of organizations, new and old, as well as increased research activity and media attention. Certainly our programs are better than ever, with education, certification and accreditation forming a solid core for our extensive outreach.

The Commission could have created these successes only with the tremendous help of a broad-based network of health and corrections professionals from throughout the country sharing a common vision. Accreditation surveyors, subject matter experts, conference speakers, journal and magazine writers, academic researchers, public health advocates … the list goes on and on. Working with such outstanding individuals is what keeps NCCHC keenly positioned to continue leading the field toward our mutual goal of effective, efficient, quality health care systems for all of our nation’s jails, prisons and juvenile confinement facilities.

[This article first appeared in the Spring 2014 issue of CorrectCare.]