Department of Family Medicine, McMaster University, Hamilton, Canada.
School of Criminology, Simon Fraser University, Burnaby, Canada.
Int J Prison Health (2024). 2024 Aug 27;20(3):299-312. doi: 10.1108/IJOPH-08-2023-0052.
Governance models are a defining characteristic of health-care systems, yet little research is available about the governance of health-care delivered in correctional facilities. This study aims to explore the perspectives of correctional services leaders in British Columbia, Canada, on the motivations for transferring responsibility for health-care services in provincial correctional facilities to the Ministry of Health, as well as key lessons learned.
DESIGN/METHODOLOGY/APPROACH: Eight correctional services leaders participated in one-on-one interviews between September 2019 and February 2020. The authors used inductive thematic analysis to explore key themes. To triangulate early effects of the transfer identified by participants the authors used complaints data from Prisoners' Legal Services to examine changes over time.
The authors identified four major themes related to the rationale for this transfer: 1) quality and equivalence of care, 2) integration and throughcare, 3) values and expertise and 4) funding and resources. Facilitators included changes in the external environment, having the right people in the right places, a strong sense of alignment and shared goals and a changing culture in corrections. Participants also highlighted challenges, including ongoing human resourcing issues, having to navigate and define shared responsibilities and adapting a large bureaucracy to the environment in corrections. Consistent with outcomes described by participants, data showed that a lower proportion of complaints received after the transfer were related to health-care.
ORIGINALITY/VALUE: The perspectives of correctional leaders on the transfer of governance for health-care services in custody to the community health-care system provide novel insights into the processes and potential of this change.
治理模式是医疗保健系统的一个决定性特征，但关于惩教设施所提供的医疗保健的治理，研究甚少。本研究旨在探讨加拿大不列颠哥伦比亚省惩教服务负责人对将省级惩教设施的医疗保健服务责任转移给卫生部的动机，以及从中吸取的主要经验教训。
设计/方法/方法：2019 年 9 月至 2020 年 2 月期间，8 名惩教服务负责人参与了一对一访谈。作者采用归纳主题分析方法来探讨主要主题。为了对参与者确定的转移的早期影响进行三角剖分，作者使用囚犯法律服务的投诉数据来检查随时间的变化。
作者确定了与此次转移相关的四个主要主题：1）护理质量和等效性，2）整合和全程护理，3）价值观和专业知识，4）资金和资源。促进因素包括外部环境的变化、合适的人在合适的位置、强烈的一致性和共同目标以及惩教方面的文化变化。参与者还强调了挑战，包括持续的人力资源问题、必须在共同责任方面进行导航和定义，以及使庞大的官僚机构适应惩教环境。与参与者描述的结果一致，数据显示，转移后收到的与医疗保健相关的投诉比例较低。
原创性/价值：惩教领导人对监管医疗保健服务在羁押期间向社区医疗保健系统转移的观点，为这一变化的过程和潜力提供了新的见解。
