Indian Health Service has strengthened patient protection policies but must fully integrate them into practice and organizational culture
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Reports-in-brief (Promoting Women in Development (Project))
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, December 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- American Natives Alaskan Natives Child Abuse, Sexual -- prevention & control Patients Sex Offenses -- prevention & control United States United States. Department of Health and Human Services United States. Indian Health Service
- Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. In recent years, the Indian Health Service (IHS) has had a number of cases of healthcare providers abusing patients under facility care, including a pediatrician who was convicted of multiple counts of child sexual abuse. In February 2019, the Deputy Secretary of the Department of Health and Human Services requested that the Office of Inspector General (OIG) assess IHS policies and procedures for preventing, reporting, and addressing patient abuse. In the same month, the Senate Committee on Indian Affairs also requested that OIG review applicable IHS policies, procedures, standards, and other requirements intended to prevent and address misconduct. This study identifies strengths and gaps in IHS policies, and progress and challenges in their early implementation. How OIG Did This Review We based our findings on document reviews and interviews with 45 officials and staff at IHS headquarters and Area Offices, conducted in July-August 2019. We also reviewed IHS policies and other relevant documents and compared them to similar policies from three benchmark organizations: the American Academy of Pediatrics, the American Medical Association, and the National Council of State Boards of Nursing. Topics for our interviews with IHS officials and staff included implementation of IHS patient protection policies and procedures, strategies for and challenges to implementation, and other IHS improvement efforts related to preventing and addressing patient abuse in IHS facilities. What OIG Found. OIG found that IHS policies to prevent and address child sexual abuse included similar elements of policies developed by benchmark organizations. Sufficiency of Policies. IHS included provisions for provider-patient boundaries, medical examination precautions, reporting responsibilities, and protections for patients and staff. In a few cases, IHS policies were stricter and more detailed than those of other organizations. However, IHS policies do not explicitly address other types of abuse, adult victims, or perpetrators who are not healthcare providers. Implementation of Policies. Some IHS-operated healthcare facilities are early in implementation and have not updated their individual facility policies, largely due to staffing shortages and turnover of facility leadership. IHS has trained staff on its updated policies and provided outreach to Tribal communities, but faces challenges that may discourage reporting of abuse, including difficulty ensuring anonymity, fear of retaliation, and communication barriers (e.g., language, stigma), among others. In addition, we found significant shortcomings in IHS systems for storing and tracking patient abuse reports and confusion about roles and responsibilities related to such tasks. IHS has initiated efforts to strengthen systems and oversight. What OIG Recommends and How the Agency Responded. To address these issues and further protect patients from abuse, we recommend that IHS: (1) extend policies to address more types of perpetrators, victims, and abuse; (2) ensure that the new incident reporting system is effective and addresses the risks identified in the current system; (3) designate a central owner in IHS headquarters to ensure clear roles and responsibilities for shared ownership in implementing patient protection policies, and managing and responding to abuse reports; (4) continue to actively promote an organizational culture of transparency, and work to resolve barriers to staff reporting of abuse; and (5) conduct additional outreach to Tribal communities to inform them of patient rights, solicit community concerns, and address barriers to reporting of patient abuse. This evaluation also provides additional support and urgency to a prior OIG recommendation that IHS has not yet implemented. In July 2019, OIG recommended that IHS, as a management priority, develop and implement a staffing program for recruiting, retaining, and transitioning staff and leadership to remote hospitals. IHS concurred with our recommendations, and reported actions taken and planned to implement the recommendations, as of December 2019.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (41 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918266194806676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918266194806676