Assessment of the Bureau of Prisons’ Organizational Alignment with Healthcare Mission

BACKGROUND

The Federal Bureau of Prisons (BOP) is responsible for more than 180,000 federal inmates, including approximately 151,000 housed in 122 BOP-operated institutions. As part of its mission, BOP must deliver medically necessary healthcare to inmates in accordance with proven standards without compromising public safety. BOP's Health Services Division (HSD) provides medical, dental, and psychiatric services at BOP-operated institutions, while the Reentry Services Division (RSD) oversees psychologist-provided mental health and drug treatment programs. Although HSD is responsible for healthcare across the system, healthcare staff and resources at individual institutions fall under the line authority of Wardens, limiting HSD's ability to manage healthcare operations as a system. These challenges are compounded by rising costs associated with an aging inmate population and the high expense of outside medical care, the largest driver of BOP's medical costs.

PROJECT DESCRIPTION

In 2018, HSD contracted with Chirality Capital Consulting to conduct an independent assessment of BOP's inmate healthcare system, including its organizational structure, data analytics capacity, cost accounting, and data integration needs. The National Academy of Public Administration (Academy) served as one of three subcontractors on this effort, assessing the alignment of BOP's organizational structure with its healthcare mission and providing guidance on strategic planning and change management.

The Academy Panel of Fellows (Panel) produced two reports. Assessment of the Bureau of Prisons' Organizational Alignment with Healthcare Mission examines opportunities to improve HSD's ability to manage healthcare operations as a system, address support service challenges such as the recruitment and hiring of medical professionals, and strengthen coordination of mental healthcare between HSD and RSD. The Panel offers seven recommendations, including transferring line authority over healthcare staff and resources at BOP's seven Federal Medical Centers to HSD; realigning Regional Health Services Administrators under HSD; incorporating healthcare data analytics into a BOP strategic plan; prioritizing implementation of Title 38 pay authority for physicians and dentists; and establishing a working-level mental healthcare group co-chaired by HSD and RSD.

Effective Practices in Strategic Planning and Change Management for the Health Services Division of the Bureau of Prisons provides HSD with a framework of eight success factors for guiding organizational change, drawn from leading public and private sector change management research. Tailored to HSD's limited staff capacity, reliance on other BOP components, and BOP's risk-averse culture, the report offers practical guidance on demonstrating the need for change, securing top leadership support, building a coalition among internal stakeholders, developing an integrated strategic plan, and engaging employees in implementation. It includes illustrative examples to help HSD put this guidance into practice, including a case for change, sample strategic plan elements and performance metrics, and lessons learned from the Veterans Health Administration's transformation. 

Questions

If you have any questions or comments regarding the study, please contact Brenna Isman, Senior Director, Research and Government Solutions (BIsman@napawash.org).