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Quality Improvement Initiative at a Correctional Facility

I work with civilly confined individuals in a maximum security facility. One of the most pressing issues in this facility is the rapid influx of inmates which has massive consequences on prisoners’ health, especially during the COVID-19 pandemic. The pandemic has exaggerated the challenges of providing healthcare in the correctional setting due to the inadequate isolation capacity to isolate sick inmates from healthy ones. People in these detention facilities are especially vulnerable to COVID-19 because they live in a closed environment with proximity to each other, and these conditions facilitate the transmission of the influenza virus. The quality improvement initiative that I propose to this facility is the introduction of single-occupancy cells for the inmates as a recommendation to reduce the transmission rate within the facility. The proposal will act as an effective mitigation strategy for the inmates’ physical distancing, quarantine, and medical isolation. This paper explores the purpose of the quality improvement initiative, the target population, the benefits of the improvement, interprofessional collaboration required to implement the initiative, budget justification, and the basis of evaluating the quality of the improvement initiative.

Purpose of the Quality Improvement Initiative

Physical distancing and isolation are some of the most practical ways of preventing the transmission of COVID-19, but these conditions are usually impossible to create in correctional facilities (Beaudry et al., 2020). The proposed quality improvement initiative will ensure that preventive measures are adopted within the facility and promote the individual hygiene of the inmates. Additionally, introducing single-occupancy cells in the facility will significantly limit the spread of COVID-19 and other communicable infections within the facility and reduce the chances of spreading the diseases from the facility to outside communities. Therefore, the quality improvement initiative ensures that inmates’ health outcomes are greatly improved.

The Target Population

Primarily, this quality improvement initiative targets the inmates and newly admitted individuals within the facility. Besides, the initiative targets chronically ill and older inmates who are more vulnerable to infections within the facility. Notably, unnecessary medical isolation negatively impacts the inmates’ mental health; therefore, the quality improvement initiative should not be implemented as solitary confinement of the inmates but as a physical distancing strategy that effectively mitigates transmission of the virus. This initiative is effective for facilities that cannot appropriately perform depopulation as a primary measure to contain the spread of the virus.

Benefits of the Quality Improvement Initiative

Correctional facilities have been major sites for the COVID pandemic due to poor physical designs and ventilation. One benefit of single-occupancy cells is that it eases the service provision and medical care to inmates within the facility (James, 2019). Additionally, the initiative facilitates regular cleaning and disinfection practices within the facility. Notably, implementing the proposal can effectively improve contact tracing of inmates who test positive and asymptomatic testing, which are important mitigation strategies of COVID-19. Another remarkable benefit of the initiative is that it can ensure the safety of communities in which the facility is located since outbreaks in the facility are not isolated from the communities (McLeod & Martin, 2018). In addition, the proposed initiative can reduce the prevalence of other infectious diseases such as respiratory tract infections and psychiatric disorders and reduce hospitalizations of the inmates.

Interprofessional Collaboration Required to Implement the Quality Improvement Initiative

The quality improvement initiative will require interagency coordination for successful implementation. Notably, the program requires the attention of authorities controlling admissions into the facility and the entire board in charge of the structural improvement of the facility. The program will also require the collaboration of decision-makers at state and local levels, such as the Board of State and Community Corrections (BSCC), which inspects jails and other detention homes to ensure that the number of beds meets the stipulated standards. Further, the program will require the services of a professional health provider preferably acquainted with the World Health Organization and the US Centre for Disease Control and Prevention (CDC) guidance for prevention and control of coronavirus in detention facilities. The healthcare provider will give recommendations on the sizes of the single cells practical for physical distancing. Additionally, the program will need the services of authorities from the Bureau of Prisons as the government agency in charge of authorizing allocations for staff and inmates within correctional facilities. It is noteworthy that smaller populations of inmates make it feasible for correctional staff to place inmates in single cells. Therefore, the program will require coordination with court officials and law enforcement to limit overcrowding in the facility and relieve the population pressure. Finally, the program will need support from public health professionals to identify ways of limiting infections within the single cells and provide the inmates with protective equipment and health resources. According to recent research, investing in broader health care within correctional facilities avert infections, hospitalizations, and frequent emergency room visitations (Rubin, 2020). Therefore, the program is justified in its attempts to improve infrastructure and healthcare standards within the facility.

Cost and Budget Justification

The cost of expanding the facility’s capacity to accommodate single cells equipped with beds goes around $43000 per bed, as estimated by the Department of Justice. However, the cost is dependent on several factors, like the state in which the facility is located and the cost of construction materials. Following the considerable depopulation efforts recently made at the facility and utilizing existing beds, the facility will require about two million US dollars to cover the construction cost and purchase necessary cell equipment fully. Much of the quoted amount will settle labor charges buy the construction materials and necessary cell amenities. The remaining portion of the money will be used to intensify cleaning practices in the cells and purchase protective equipment.

The basis for Evaluating the Quality Improvement Initiative

The rate of infection in the facility before and after implementation of the program will be recorded to determine the policy’s effectiveness in reducing COVID-19 infections. Before implementing the program, the transmission rates will be recorded over a defined period, and these values will be compared to the new values after implementation of the program to assess the significant impact of the program. According to the expectations, the transmission rate for a particular outbreak phase should reduce remarkably after implementing the program since it is one of the CDC’s mitigation strategies for containing contagious infections in correctional facilities.


Correctional facilities’ health and legal authorities have not responded adequately or creatively to the COVID-19 pandemic and this increases the risks of infections and health complications in these facilities. Single celling is proposed as one of the most effective ways of separating infected inmates from vulnerable persons within a correctional facility. Additionally, the single cells act as medical isolation rooms for separating inmates confirmed to have an infectious disease from the uninfected population until the infected individuals receive medical treatment and recover. Notably, managing infections in correctional facilities benefits even the surrounding communities since outbreaks from the facility can spread to the community members. Implementation of this program require professional collaboration from different departments such as health officials, correctional facility leaders, court officials and policymakers at local and state levels.


Beaudry, G., Zhong, S., Whiting, D., Javid, B., Frater, J., & Fazel, S. (2020). Managing outbreaks of highly contagious diseases in prisons: a systematic review. BMJ global health5(11), e003201.

James, I. (2019). Strategies for nursing staff working in a correctional facility (Doctoral dissertation, Walden University).

McLeod, K. E., & Martin, R. E. (2018). Health in correctional facilities is health in our communities. CMAJ190(10), E274-E275.

Rubin, R. (2020). The challenge of preventing COVID-19 spread in correctional facilities. Jama323(18), 1760-1761.


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