Improving health care in Port Augusta Prison
The challenge statement
To improve the delivery of health care services at Port Augusta Prison using an evidence focused design process.
In 2018 Port Augusta prison had grown in capacity by 69% over six years, making it the State’s largest prison. It is a complex environment in a remote area, housing both male and female prisoners ranging from high to low security and has an Aboriginal population of over 35%. This growth in prisoner numbers put significant pressure on healthcare services at the prison which are provided by the SA Prison Health Service (SAPHS).
Over these years of expansion, efforts were made to address the pressure on the healthcare services, however they did not keep up with the extent of change and failed to address the root causes of the issue.
The Innovation Lab was approached by the Department for Correctional Services (DCS) to assist.
- Department of Correctional Services (DCS)
- South Australian Prison Health Service (SAPHS)
- Department for Health and Wellbeing
The core project team was a multi-disciplinary team with representatives from the Innovation Lab, DCS and SAPHS.
The Innovation Lab initially focused the team on problem-grounding and creating a solid evidence base to find a solution to this complex issue.
Operational staff and management from DCS and SAPHS were brought together in Port Augusta for a challenge diagnosis workshop to understand the issue, how it evolved and why attempts to address the issue in the past had not been successful.
The approach of the project was to focus effort and create ownership of eventual solutions. This began with a series of process mapping workshops, led by the Innovation Lab team, documenting how key operations within the prison worked. This garnered input directly from those carrying out their tasks – rather than being relayed via management. These sessions gathered a wealth of information and provided corrections and nursing staff the opportunity to gain a deeper understanding and appreciation for one another’s role in the wider system. This process led to revelations for some team members as well as building a stronger working relationship between DCS and SAPHS.
Having the project working within the Innovation Lab program created an opportunity to approach this problem solving differently. The Innovation Lab team provided an impartial and external perspective to problem solving that could challenge current norms constructively. To draw inspiration and learn from other approaches to the management of healthcare in a detained environment the project saw health care and management staff from the prison visiting interstate prisons of comparable size and prisoner population mix to Port Augusta.
Detailed stakeholder interviews were conducted by the Innovation Lab team, which included interviewing prisoners from across a range of security and wing classifications at the prison; providing the perennially important perspective of the consumer of the service.
The process maps provided structure and clarity, and when the Innovation Lab brought this information together with the data and insights gathered through the interviews and site visits, the project team was able to identify the cause and effect more clearly, dispel past myths and design a proposed future state.
An important aspect to build capability within the team members was to have work responsibilities shared across the team with regular meetings held to facilitate and guide the momentum of the project.
The firm evidence-base focused the direction of the work and accelerated the progress.
The Innovation Lab drafted a project report to capture and clearly set out proposed solutions and recommendations, which was accompanied by a delivery plan that established a series of proposed timescales and actions to help operationalise the solutions – with the Innovation Lab placed to support the lead departments if required.
This holistic approach to understanding the system and the supporting data when designing a solution was commended by the departmental executives, and provided the solid evidence-base for SA Health to commence the process to revise the approach to healthcare across the prison estate.
The Innovation Lab supported the project to deliver an outcome of a higher standard, more quickly and with a greater evidence-base than would have been possible without Lab’s involvement at that time.
- The use of the process mapping tool proved to be extremely effective in the context of this project. Whilst the admissions process was initially highlighted as a problem area, the process mapping showed this to not be the case. Instead the mapping showed the extent of the issues posed by the processes relating to medication and the impact that it was having on other activities within the prison. This highlighted the power of the tool and the way it can be focused to provide the case for change – this learning will shape the approach taken to future Innovation Lab projects and is likely to be adopted by DCS and SAPHS as a means of driving continuous improvement.
- Project progression was positive overall, a key point of learning for the Innovation Lab was the need for a resource within the project team to update, manage and own a project plan and actions register from end-to-end. This responsibility was not explicitly allocated within this project and often shared between those involved, leading to gaps when progress could have been further accelerated.
Capability, mindset and capacity
- Workshopping the findings of the interviews and process mapping with the stakeholders created a shared understanding a new perspective about their work environment.
- The strong authorising environment helped maintain momentum. Initial Chief Executive endorsement followed by senior executive engagement at key points in the process was effective, without creating unnecessary bureaucracy.
- The neutral perspective from the Innovation Lab, and its holistic and data-driven approach to understanding the system provided the solid evidence-base for SA Health to understand the cause of the issues – as opposed to its symptoms – and accordingly revise the approach to healthcare across the prison estate.
Capability, mindset and capacity
- The project shifted the mindset of stakeholders to invest time into making data driven decisions and created stronger and more collaborative relationships between DCS and SAPHS.
- The potential impact of the project is significant, with a number of opportunities for findings to drive change more widely than just Port Augusta, in prisons across the State.