NEW INNOVATIONS IN HEALTHCARE SECURITY TO REDUCE WORKPLACE AGGRESSION

By Ross Judd, Security Services Manager, St Vincent’s Hospital

78%

of retailers believe that abuse towards workers is increasing.

Across many industries, workplace or occupational violence (OV) exposure for client-facing staff is being identified as increasingly harmful. It potentially may cause both physical and psychological impacts, resulting in significant economic and social costs to individual workers, their family, the organisation where they work and the wider community. Staff may be exposed to work related violence from a range of sources.

As with all identifiable risks, it must be managed. For example, the National Retailers Association cite a recent survey of their members indicting, “78% of retailers believe that abuse towards workers is increasing.”

Safework Australia define occupational violence as, “any incident in which someone is abused, threatened or assaulted in circumstances relating to their work.”

LEGAL AND COMMERCIAL RISKS

Employers bear legal responsibility under various State Occupational Health and Safety and anti-discrimination legislation to minimize foreseeable risks within the workplace. They are generally obliged to provide a safe workplace, inclusive of a broader duty of care for employee health and wellbeing while staff are at work.

Workplace violence incidents that are not managed effectively are likely to incur direct and indirect costs including: f recruitment and training costs whenever high turnover occurs f salary costs when employees are absent from work f

f

downtime for supervisors and managers in addressing underperformance and absenteeism, cost of lost time for supervisor reduction in staff and customer satisfaction impacting on morale, productivity and attendance.

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HEALTHCARE WORKPLACE AGGRESSION

It is well understood that Healthcare facilities can be violent places. In 2013, United States healthcare reported 80% of all serious injuries towards health care workers occurred through an interaction with a patient.

NSW healthcare staff typically grossly under report aggression and violence in the workplace. In 2018, NSW Bureau of Crime Statistics and Research reported only 521 incidents of violence across the health system. Our own security incident reporting surpassed that number for the violence incidents responded to by the security team during the same year.

Hospitals are places of healing and caring for unwell members of the community and this is a source of conflict for many staff. Jacqui Pich, Nursing Lecturer UTS identified the conflict many Healthcare facilities face in balancing the environment and needs of staff, patients and visitors, “If we have a lot of high-security presence in hospitals, then we’re creating almost a prisonlike environment rather than a healing and a caring environment.” “We have to be careful to manage that.” A skilled security workforce, combined with effective electronic security infrastructure needs to understand and meet fundamental operational imperatives within the values of the organisation they service.

ST VINCENT’S – DEVELOPING A SAFE AND SECURE ENVIRONMENT FOR PATIENTS, STAFF AND VISITORS

A number of key personnel contributed in various workshops to develop strategies to improve the work listed below: 1. Develop a unified and integrated approach to incident management (which builds on training already delivered). ‘Everyone plays a part in our response’ 2. Build brand reputation on the ability to provide a safe and secure environment for all who use its facilities in the hospital and community environments. 3. Forge productive partnerships across the range of ‘services.’ Critical to managing organisational duty of care and facilitating entrepreneurial approach to security and public safety challenges. 4. Concentrate on ‘duty of care’ to provide effective security and public safety responses.

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Audit ‘the state of preparedness’ for all services that respond to incidents of a nonclinical nature – health check operational plans and arrangements. Develop a full program of exercises, testing incident command as well as operational response: Testing the organisational state of readiness.

If we have a lot of highsecurity presence in hospitals, then we’re creating almost a prison-like environment rather than a healing and a caring environment. We have to be careful to manage that.

Jacqui Pich, Nursing Lecturer UTS

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Hospital design incorporates safety and security principles including open areas and public facing environments. Consider existing staff capabilities to ensure both the consistent spread of expertise and experience in managing and responding to security and public safety issues. Further develop the Incident Response Clinical / Security model across the network; review of position descriptions and resourcing and training.

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Ensure key operational staff receive specialised training focused on de-escalation and managing incidents from both scene management and command and control perspective.

Consider leaders having access to specialist training / coaching and advice to prepare for strategic level risk management and serious incidents.

Electronic dashboard identifies and reports incidents, assaults and events (from a safety and security perspective) that are visible to the Executive. In adopting these strategies, St Vincent’s Hospital Sydney now utilise a holistic approach to managing aggression and violence. There is now an increased security awareness culture, supported by a responsive Clinical / Security team that develop individualised patient management plans to better address potential triggers and issues of aggression for each patient.

Each strategy is inextricably linked and is constantly reviewed and modified. Many key staff are involved and are integral to the success of the approach. By working collaboratively, we have improved outcomes that are positive for our patients and improved safety for our staff. Our approach has included improvement in security understanding in the following areas:

SECURITY STAFF

The role of the security officer in a Healthcare setting is specialised and differs to most other security functions. Skills, knowledge and experience learned by each security officer is important within the context of the collaborative Clinical Security hybrid model. The security team have developed and evolved their own practices to better undertake their role within the Hospital multidisciplinary team.

RISK ASSESSMENT

Proactively assessing and mitigating risks – seeking support wherever necessary and encouraging ALL staff to incorporate dynamic risk assessments into their practice.

INFRASTRUCTURE

Comprehensive multidisciplinary training and education. This contributes toward improved understanding and respect for each team member and is inclusive of violence prevention management and team restraint training. Personal safety; risk assessment; situational awareness; understanding patient behaviours with compassion and understanding are the primary training drivers for the team.

REPORTING AND INFORMATION SHARING

Understanding the problem and providing a responsive solution, learning from the experience and communicating to others. Improved analysis of information management system data and sharing the information with key managers. Electronic security infrastructure and the built environment supports staff safety. Adopting emerging technology to support real-time risk assessment.

LEGISLATION, POLICY & PROCEDURE

Working with relevant bodies to ensure that all relevant legislation, policies and procedures are fit for purpose and operationally support staff.

CLINICAL MANAGEMENT

Understanding the clinical drivers of acute behavioural disturbance. Ensuring work practices do not increase the risk of violence and aggression. Including the Security responders in decision making around high-risk patient management.

CLINICAL STAFF

Ensuring mutual understanding of roles and responsibilities and the importance of building trust and collaborative relationships across the organisation. The approach has been adopted from the Anderson report, “The existence of a sound and proven “team” approach will almost certainly contribute to the way in which volatile situations can be

TRAINING

effectively handled in a less volatile manner” (pg 8).

Conclusion

The Clinical Security incident response model continues to develop strategies and systems, incorporate risk profiling and communication; upskill security staff to use available clinical tools to identify potential violence as a means of timely intervention.

This new approach specifically includes the implementation of processes to integrate security in the care of patients. The concept of finding a way to empathise with the person is fundamental in all attempts to deal with the patient in a caring manner regardless of the circumstance.

While we have made positive gains in reducing both the severity and frequency of violence related incidents, we acknowledge there are still many improvements we are yet to develop.

About the Author: Ross Judd

Ross Judd brings a unique breadth and depth of experience in mission-critical security to his role as Head of Security for one of Australia’s largest and most prestigious hospitals. A 15-year veteran of NSW Police, Rod began as a general duties officer in Sydney’s Inner city, before performing senior roles in Crime, Intelligence and Command. He was awarded the Queen’s Medal for Bravery, as well as the NSW Police Valour Medal ‘for outstanding bravery’. He was in charge of Security, Risk and Investigations for Australia’s largest armoured car security company, Brambles, before being appointed as Head of Security for St. Vincent’s Hospital, located at inner-city Darlinghurst in Sydney in 2002. Since that time, Ross has transformed security operating procedures, systems and protocols at St. Vincent’s to profoundly improve security and mitigate risk –a project which included improvements in the management number of ‘Code Black’ (potential violent offender) incidents. Ross sits on numerous advisory & oversight bodies relating to Security and Risk Management issues within the health and general security sectors.