James Hughes, University of Connecticut; Timothy Cocozza, University of Connecticut Health Center; Jaime E. Blackmon, University of Connecticut; Rajashree Kotejoshyer, PhD, University of Connecticut School of Medicine; Mazen El Ghaziri, PhD, MPH, RN, University of Massachusetts Lowell; Matthew Brennan, MPH, University of Connecticut School of Medicine; Serena Rice, University of Massachusetts Lowell; Martin Cherniack, MPH, MD, University of Connecticut School of Medicine
Purpose/Objectives
This study assessed the barriers and facilitators of long-term sustainability of a healthy workplace participatory program within the correctional workforce.
Background
The Center for the Promotion of Health in the New England Workplace’s (CPH-NEW) Health Improvement Through Employee Control (HITEC) project has collaborated with the Connecticut Department of Corrections (DOC) and associated labor organizations to develop and sustain a large-scale implementation of the Healthy Workplace Participatory Program (HWPP) (Cherniack et al., 2016). HWPP is a workforce driven approach in which design teams, consisting of small groups of employees create interventions to address health, safety and well-being concerns of their workforce (Dugan et al., 2016; Dugan et al., 2017; Cherniack et al., 2019). In 2021, the HITEC project is transitioning from being researcher guided to being sustained within DOC with limited support from academia. To help with this transition, the research team conducted a series of interviews to determine the barriers and facilitators of sustainability and develop a series of recommendations for DOC leadership, to ensure the survival and success of the program. To our knowledge, this is the first large scale leadership change of a Participatory Action Research project to receive empirical attention.
Methods
Structured interviews were conducted to assess barriers and facilitators to sustainability of the HWPP (n = 22). Participants were recruited based on their familiarity with the HITEC project, knowledge of design team activities, and the organizational environment of DOC. Interviewees represented front-line correctional officers, correctional supervisors, and senior DOC administrators. Interviews were conducted between Nov 2020- March 2021 and were analyzed concurrently using the qualitative data analysis software, NVivo.
Researchers used a thematic analysis process to code de-identified transcripts of the interviews. Two coders independently coded each interview, and final codes were reconciled between coders and the larger research team. Codes were analyzed both in terms of the raw number of codes, and the number of interviews that referenced them. Emergent themes were further analyzed using an iterative constant-comparative method to determine their impact on sustainability.
Findings
While the final thematic analysis resulted in multiple themes, the strongest theme was the universal support for the continuation of the HWPP, with all 22 participants expressing support. However, half of the participants expressed serious concern that activities would cease without urgent action.
The most commonly cited concerns to long term sustainability were:
– Organizational Turnover – this was cited as a concern at multiple levels, including design team members, facility managers, union leadership, and senior DOC leadership
– Time & Space for regular meetings
– Unclear communication structures – this includes communication between design team members, multiple design team sites, and between all project partners
The most commonly cited methods to facilitate sustainability included:
– Formalized, Organization-Wide Policy
– Trainings – This includes both design team member trainings, and trainings for the frontline correctional officers, wardens, and senior DOC administration
Additionally, interviews addressed the importance of the HITEC research team’s role in the project to determine changes in stakeholder responsibilities moving forward. This namely revolved around the value of providing tools and resources beyond the abilities of DOC members, including survey evaluation, subject matter expertise, design team trainings, general resources (including funding), project coordination, and conflict mediation.
Discussion
The HWPP at DOC was found to have been universally supported by participants. However, there remained significant concern over the long-term sustainability of the program without continued DOC leadership and researcher support. The Connecticut Department of Corrections is a complex organizational environment which contains multiple facilities, a multi-tiered hierarchical structure, and multiple labor unions. The Design Teams have utilized different structures with some based in one facility, some engaging multiple facilities, and some engaging union members from all of the DOC facilities. This multi-tiered structure creates challenges to uniformly implementing the HWPP.
These challenges are rooted in concerns over a formalized structure and information sharing across facilities. Results from the interviews strongly suggested that a formalized, state-wide policy and coordination effort that is centered on HWPP training for both front-line workers and facility leadership, would create significant benefits to the long-term sustainability. Additionally, the premium placed on coordinating the time and facility resources for design teams to meet, whether in person or virtually, would provide a noticeable benefit to the process at all sites.
This interviewing process provided a deep insight into the overarching challenges to creating a sustainable participatory program of this size. However, it should be noted that because the sample was of selected potential participants who were knowledge about the current program, there may be biased results in favor of those continuing the program.
Conclusions
Our findings demonstrate the need for formalized organizational structure, not just for project transitions but also for long term sustainability. Specifically, the need for formalized policies and dedicated resources are critical for long term success. Future research should focus on the impacts of formal policy structures.