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Relate strategic management principles and decision logic to current complex health care management challenges and formulate effective solutions.
You applied and were accepted in an internship program of a state-level, Female Correctional Health Care Operation in the Southeastern United States and your primary responsibility is to work on the assigned projects related to the provision of inmate health care.

Sample Tool Control Policy
Inmate Sick Call Procedures-Corrections
Case Study Details: For the incarcerated population in the United States, health care is a constitutionally guaranteed right under the provisions of the eight amendments which is the prohibition against cruel and unusual punishment (see Estelle v. Gamble). This particular prison can hold in excess of 1,728 offenders and routinely houses between 1,600 and 1,700 women on any given day. This institution incarcerates all custody classes to include minimum security, medium security, close custody, death row, and pretrial detainees.
The health care operation provides the highest level of care for female offenders in the state. The health care facility is a 101 thousand square foot, 150 bed, three-story building that cost the taxpayers $50 million dollars to construct and is a hybrid of an ambulatory care center, long-term care center, and behavioral care center. The health care facility also houses an assisted living dorm.
The patient demographic includes women who have multiple co-morbidities including substance abuse, seriously persistent mental illnesses (SPMI), diabetes, cardiovascular disease, cancer, morbid obesity, HIV / AIDs, hepatitis, etc. On any given day there will also be 30 to 60 offenders who are pregnant, with 98% of those offenders having a history of substance abuse; all pregnant offenders are considered high-risk. The dental health of this patient population is exceptionally horrendous because of excessive drug abuse coupled with a sugary diet and poor oral hygiene practices. It is not uncommon for a 23-year-old to need all of her teeth extracted.
There are approximately 300 FTEs to include correctional staff that operate the facility and provide care to the offender population. The healthcare facility is comprised of the following directorates: (a) Medical, (b) Nursing, (c) Behavioral Health, (d) Pharmacy, (e) Dental, (f) Medical Records, (g) Health Service Support, and (h) Operations and Security.
Although the health care facility has a vast amount of capability, there limitations: (a) This facility does not have advanced cardiac life support capability (ACLS), (b) no surgical capability, (c) no ability to conduct telemetry, (d) no oral surgery beyond simple extractions, (e) no obstetrical capability beyond out-patient clinics, (f) MRI, (g) level 2 ultrasound, and the list goes on.
Those inmates who have medical needs that cannot be addressed by the health services staff at the correctional facility will need appointments with external health care providers who have a business relationship with the prisons in this area. On any given month, there will be approximately 300 offenders who will go to outside medical appointments, and making certain that these appointments take place is where the challenge lies. Similar to many health care operations, the prison Utilization Review / Case Management Department facilitates all external appointments and form the lynchpin between the correctional facility health care providers who refer offenders for specialty appointments, and the outside organization providing that appointment.

You are the Case Coordinator. You have 300 patients that need to be scheduled for outside specialty appointments every month. You are tasked by the Administrator to develop a strategic plan organizing the out-of-the-facility appointments without impairing internal services.

1. Provide an overview of Estelle v. Gamble and how that 1976 Supreme Court ruling pertains to the provision of inmate health care.
2. Examine the challenges of providing health care in a correctional environment.
3. What are the challenges of providing health care to a female offender population that may not exist in a male prison?
4. What framework would you apply to strategic planning? Why? (Strategic planning frameworks)
Make sure to cite in APA format when appropriate. Support your statements with credible evidence.

 

Sample Solution

 

1. Limited Access to Resources: Correctional facilities often lack the resources of a traditional health care setting, such as access to specialists and sophisticated medical equipment. This can lead to inadequate diagnosis and treatment of medical conditions, potentially resulting in further illness or injury for inmates.

2. Staff Shortages: Corrections staff are typically understaffed, meaning they don’t have enough healthcare professionals to properly provide adequate medical care. This can result in long wait times for appointments and delays in accessing medical services when needed.

Sample Solution

 

1. Limited Access to Resources: Correctional facilities often lack the resources of a traditional health care setting, such as access to specialists and sophisticated medical equipment. This can lead to inadequate diagnosis and treatment of medical conditions, potentially resulting in further illness or injury for inmates.

2. Staff Shortages: Corrections staff are typically understaffed, meaning they don’t have enough healthcare professionals to properly provide adequate medical care. This can result in long wait times for appointments and delays in accessing medical services when needed.

Genetic and environmental factors are both contributor of the predisposition of cancer (10). Knowing the nature of these contributers is important to prevent the diseases ( adapting lifetstyle and behavior to the conditions). Sometimes genetic factors and cancer that are associated with each other affect significantly clinical intervention. For instance, as mentioned before if mutations occur at breast cancer susceptibility gene 1 and 2 (BRCA1,BRCA2) and at the same time if mutations occur at tumor suppressor genes , there is higher risk to develop the breast, ovarian, hematologic and prostate cancers(11). For these reason, regular screening, surgical measures and receive adjuvant therapies would undergo to prevent. Also genetic tests are used to analyse the inherited mutations DNA mismatch repair genes. Risk of advencing of colon cancer is high at the MLH1 and MSH2 genes(12). Under the light of this information cancer can be precluded with early screening colonoscopy to early detect and treat for cancer. Cancer databases that are about mutation types and polymorphisms are updated for public. These resources can be used to identify new biomarkers for screening.(13)

Tumor classification and subtyping

Personalized medicine changes the traditional classification of cancers from histologic scale to the molecular scale. Although histological scale does’nt give more information about prognosis , personalized tretment alternatives and risk of recurrence, molecular scale offers to give a detailed information about diseases processes(14). DNA, RNA, miRNA and protein have been used for molecy-ular analyses to classfy different tumor types into the subtypes. Each of them have an unique prognostic outcome that can not be identified with the traditional morphologic ways(15). Generally molecular scale for classification is used for acute myeloid leukemia, glioblastoma, breast cancer , and renal cell carcinoma , and to differentiate between Burkitt’s lymphoma and diffuse B-cell lymphoma. This classification that offers prognosis and treatment options can help to the patients about management of disease.(16)

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