The Many Benefits of Accreditation

For almost 50 years, the National Commission on Correctional Health Care has been dedicated to improving the quality of correctional heath care services through the implementation of their health care standards in correctional facilities across the United States. NCCHC’s standards are widely regarded as the most thorough and stringent correctional health care standards available and have been upheld as such by the courts in legal cases. NCCHC accreditation, based on those standards, helps correctional facilities improve their health care systems and is recognized as an important endorsement of a facility’s health services.

While accreditation is voluntary, we feel it is essential. We strongly encourage facilities that use our health care services to become accredited, because evidence indicates it improves the quality of care provided, as well as the quality of health care programs, services, and operations. Even in facilities that are not accredited, we operate consistent with the current NCCHC standards to maintain consistency of training and service delivery.

Adherence to Health Care Standards
The most obvious advantage of accreditation is that it verifies compliance with NCCHC’s nationally recognized standards. Developed by a multidisciplinary group of correctional health care experts, these standards outline recommendations for managing medical and mental health care delivery in jails, prisons, and juvenile facilities. Specially selected task forces regularly review and revise the standards to reflect changes in the field and the latest understanding of best practices.

The standards establish a structured operational framework for the proper management of our correctional health services delivery system. Often based on the latest research and evidence-based practices, they help ensure that the most current and effective treatments and interventions are utilized, and they allow our health care professionals to measure their performance and make improvements to the care they provide. We have found clear guidelines and protocols facilitate better communication and collaboration between health care professionals. Disparities in health care are also addressed by promoting equitable access and cultural competence.

Covering a wide range of both clinical and operational aspects of health care delivery, each standard is categorized as either essential or important. To earn accreditation, a facility must demonstrate compliance with 100% of applicable essential standards and at least 85% of applicable important standards.

Compliance plays a crucial role in improving the quality of care and can lead to better patient outcomes. We have found consistent application reduces variability, thus minimizing errors, while efficient processes lead to quicker diagnoses. Patient safety also is promoted by establishing policies and procedures for infection control, medication administration, suicide prevention, emergency preparedness, and more, reducing the risk of medical errors and adverse events. The standards facilitate interoperability in health information technology, streamline administrative processes, and foster accountability.

For each individual standard (more than 50 in all), compliance indicators spell out how to meet the standard, allowing for flexibility that can be adapted to each correctional facility.

Liability and Litigation Protection
We find that accreditation helps our facilities follow legal and regulatory requirements related to health care, and adherence to the NCCHC standards reduces the risk of health care-related lawsuits and legal challenges.

In the event of a legal challenge, being accredited by NCCHC is a valuable asset as it demonstrates a proactive commitment to an objective standard of care, which can be used to defend against claims of inadequate or negligent care. Voluntary compliance with NCCHC’s standards indicates to government officials and the courts a facility’s understanding of the legal requirements of correctional health care. The courts know that an accredited facility has undergone a rigorous evaluation by an independent, third-party organization and view that as evidence of a commitment to providing quality health care services in compliance with legal requirements and federal, state, and local laws and regulations.

Enhanced Safety
In our experience, we have found that accreditation contributes to a safer environment within correctional facilities by creating an overall culture of safety and in several concrete ways (Standard B-08 Patient Safety).

Access to care is emphasized, helping to ensure the prompt receipt of medical attention that can prevent minor health issues from becoming more serious and reduce the risk of complications and emergencies. Access to care is, in fact, the basic principle established by the U.S. Supreme Court in the 1976 landmark case Estelle v. Gamble and the fundamental principle on which all NCCHC standards are based (Standard A-01 Access to Care).

The standards require the provision of mental health services and care, which can identify and address issues that may lead to disruptive or violent behavior. Incarcerated individuals who receive proper care are less likely to engage in violent behavior due to untreated mental health issues (Standards E-05 Mental Health Screening and Evaluation, F-03 Mental Health Services).

Accredited facilities are expected to have a comprehensive institutional program in place that addresses surveillance, prevention, and control of communicable disease to prevent the spread of illness among the incarcerated population and staff (B-02 Infectious Disease Prevention and Control). Medication management, including medication administration, storage, and record keeping, promotes the correct and safe use of medications, preventing adverse reactions, complications, and misuse (Standards C-05 Medication Administration Training, D-02 Medication Services). All of this leads to a safer, more well-managed facility.

Quality Assurance
Continuous quality improvement is a systematic process designed to ensure health care services consistently meet established quality standards, requirements, and expectations. CQI focuses on preventing errors and deficiencies rather than detecting and correcting them after they occur.

For example, CQI has minimized medication errors in our facilities. Regular audits and reviews allow us to identify errors and trends. When an error occurs, a root cause analysis is conducted to understand why the error happened. Based on those findings, we can then implement effective corrective measures.

Accreditation provides a structured framework for CQI. Through the process of becoming accredited, health staff regularly review and evaluate their services, identify areas for improvement, and implement changes. In fact, there is a CQI-specific standard that requires the facility to have a quality improvement committee, spells out that committee’s role and duties, and calls for at least one process and/or outcome quality improvement study each year (Standard A-06 Continuous Quality Improvement Program).

Professional Development
NCCHC accreditation encourages workforce training and development, leading to a more skilled and competent staff. That encouragement is both explicit – health and custody staff must meet specific educational and training requirements, ensuring they are knowledgeable in several aspects of care – and implicit in the culture of a facility focused on quality (Standards C-03 Professional Development, C-04 Health Training for Correctional Officers, C-05 Medication Administration Training).

We also encourage staff to achieve and maintain certification as a CCHP (Certified Correctional Health Professional). Certification recognizes our employees’ mastery of the NCCHC standards while demonstrating their expertise and commitment to professional development. CCHPs also may opt to pursue Advanced certification (CCHP-A) as well as specialty certification for mental health professionals (CCHP-MH), clinical providers including physicians, NPs, and PAs (CCHP-CP), and registered nurses (CCHP-RN).

Other Benefits
Public accountability. Accreditation signals a facility’s commitment to transparency and accountability. The accreditation process is voluntary, independent, and impartial, ensuring that the facility’s health care services are held to an objective standard and reducing the potential for bias or conflicts of interest. By complying with NCCHC standards, our facilities demonstrate their commitment to providing quality care, and because accredited facilities are resurveyed every three years, they can be held accountable if they fail to continue to do so.

Reduction in health care expenditure. By implementing best practices and focusing on robust screening and preventive care, our accredited facilities have reduced expenditure of health care delivery, benefitting both the facility and incarcerated individuals through additional programs that would not otherwise be possible. It also benefits society as our patients are returned to their communities as healthier citizens.

Among those facilities that contract with us for health care services, the benefits of accreditation are clearly evident. As Warden Mac McDuffie from the Mercer County (PA) Jail says, “Accreditation ensures we comply with and maintain the highest standards of care, leading to a safer and more rehabilitative environment for both staff and our incarcerated population, ultimately reducing recidivism rates, and making our community a better place.”

Major James McGowan of the Monroe County (NY) Jail states, “NCCHC standards allow us to establish baselines for care that we would otherwise have a difficult time achieving. They have been extremely helpful when conducting monthly audits with our medical vendor.
We use these standards to review everything from intake assessments to sick calls.”

Overall, accreditation helps correctional facilities fulfill their duty to provide health care to incarcerated individuals, protects against legal challenges, and contributes to a safer and more accountable correctional environment. Achieving NCCHC accreditation demonstrates a commitment to high-quality correctional health care and overall well-being of incarcerated individuals and staff alike. 

Thomas J. Weber, JD, is CEO of PrimeCare Medical, Inc. Tommy Williams, BSN, RN, CCHP, is the company’s clinical research and informatics analyst.