Empowering Change Agents in Hierarchical Organizations: Participatory Action Research in Prisons.
OBJECTIVE Sentencing trends have created a demographic shift in prison populations. Greater numbers of inmates are aging and dying in prison, creating a demand for enhanced end-of-life (EOL) care. Changing practice to meet escalating care demands in correction settings is complicated by economic constraints, attitudinal barriers, and organizational features. This study explored perspectives of EOL care held by administrators in a state prison system to reveal challenges to changing practice to meet the needs of inmates suffering advanced illness and dying in prison. DESIGN AND SAMPLE Qualitative interviews were conducted with 12 administrators from the central office of a state department of corrections. MEASURES Semi-structured discussion guide. RESULTS Key influences impacting EOL care services included: local prison culture, treatment versus security focus, case-by-case consideration, public sentiment, budget neutral approaches, and conflicting views of service targets. CONCLUSIONS These findings revealed the organizational structures, attitudes, and beliefs held by the administrative echelon of a state prison system and were used to guide the derivation of discrete approaches to changing practice in this complex system. Contextual evaluation permitted a much deeper understanding of the influences on changing practice in this hierarchical bureaucracy. This type of preliminary evaluation is crucial to infusing new practice initiatives in complex organizations caring for stigmatized, at-risk populations.