Curing What Ails Training
WHEN SENIOR MANAGERS scrutinize security’s budget, their eyes frequently focus on training as a line item that can easily be cut. After all, training doesn’t increase security coverage. In fact, fewer officers in the classroom translate into more officers on posts and patrols protecting the company’s assets. Other than providing the minimum number of hours required by whatever laws apply where you are, why spend money on training?
As both a hospital security director and consultant, I have heard variations on this theme for many years. When I joined Forsyth Medical Center (a subsidiary of Novant Health) in Winston-Salem, North Carolina, seven years ago, our proprietary security force lacked any semblance of a formal training program, partly because the state does not require training for unarmed proprietary security officers. But a regimen of training was badly needed. The officers were ineffective and failed to command the respect of the hospital’s patients, visitors, employees, physicians, and volunteers.
Fortunately, the hospital’s administration recognized the problem, and when it approved the reengineering of our traditional security department into a holistic public-safety team six years ago, training was the first item on the agenda. The enhanced training program helped enormously, but a review last year found that the curriculum was poorly structured and that the program was not cost effective. We went back to the drawing board to ensure that we were getting a better return on our training dollar investments. Ahead are highlights of what we initially required and how we later refocused the program to improve the cost-benefit ratio.
Establishing a Program
Under the original training plan, one-time training of 216 hours was mandated for every officer, new hires and veterans alike. The curriculum was developed after a needs assessment that included interviews with officers; physicians, nurses and other staff members; senior managers; and local law enforcement agencies.
Training included three International Association for Healthcare Security and Safety (IAHSS) certified training courses: basic, health and safety, and advanced. An additional IAHSS supervisory certification was required for shift supervisors and relief supervisors.
Other subjects covered included self-defense, subject control, and baton certification taught by instructors from the Winston-Salem Police Academy as well as fire prevention and control taught by instructors from the Winston-Salem Fire Department. Officers also took a nonviolent crisis intervention course from the Crisis Prevention Institute (CPI), a course on emergency response procedures and the Hospital Incident Command System (HICS), and a federal OSHA Hazardous Materials Operations Level Training course.
Officers were further schooled in first aid, CPR, and the use of automated external defibrillators. They also had to be educated on North Carolina general statutes and elements of crime, detention laws, testifying in court, and terrorism prevention and response.
Employees did not receive the title and insignia of public-safety officers until they satisfactorily completed the training curriculum, which included written and practical examinations. Successful completion was marked by a graduation ceremony attended by the hospital’s CEO and COO and featuring a guest speaker, such as the chief of police or president of the IAHSS.
The improvement in officers’ performance was immediately noticeable in all areas. Forsyth Medical Center saw increased patrol effectiveness; greater responsiveness to routine and emergency calls; better handling of crisis situations; more thorough investigation of accidents, crimes, and other incidents; and more skill in working with patients. The officers also received frequent compliments from employees, patients, and visitors on their customer relations skills.
Refining Our Approach
While our training program was highly successful in developing the professional skills that are essential to an officer’s effective performance in a complex healthcare environment, the program was, as noted, expensive. The cost had to do both with hours spent in training and the overtime required to provide adequate patrol coverage during classes. The cost of the classes was not an issue since it was minimal compared to the overtime costs.
The department also found problems related to the curriculum. The IAHSS courses were too generic and failed to address many of the critical security issues specific to the facility. This often required covering the same subject twice, once to prepare for the IAHSS examination and a second time to cover the medical center’s specific policies and procedures.
Additionally, the training program did not conform to the curriculum of the North Carolina Private Protective Services Board (NCPPSB) for unarmed contract security officers, which Novant Health had adopted as its corporate standard for public-safety officer training for all of its proprietary officers. (Though the requirement legally applied only to facilities with armed proprietary officers, the company decided to adopt the training standards to add credibility to the program.)
Another issue was timing. The program’s content and the time required of instructors, many of whom came from other hospital departments or outside agencies, made it impractical to train a small class of new officers, resulting in some officers waiting up to eight months to begin training and a year to graduate. This was a significant problem, because new officers who had not completed training could not carry handcuffs and batons needed for their protection.
The team also found that some training was wasted. For example, the public-safety team’s assigned functions did not permit officers to serve as members of the hazardous materials decontamination team, so their operations level training in hazardous materials was never going to be put to use.
As a result of these findings, we decided to restructure the training program and to include both public-safety officers and communications technicians—new positions established to staff Forsyth’s new public-safety communications center. The new training program has four phases: orientation, new member training, field training, and additional training and certification for specific job titles.
These phases are designed to impart only relevant information. For example, with regard to hazardous materials, public-safety officers are now only trained to provide skilled support rather than being put through the full specific hazardous materials training regimen.
Courses are either taught in-house by employees trained to teach the subjects or are completed online, which saves money and time.
Orientation. Phase one is undertaken during the first week of employment. The goal of this phase is to provide every new public-safety officer or communications technician with the basic knowledge that he or she needs to function as an employee and member of the security team.
During the first two days, employees receive a general orientation session and consult with the corporate education and training department. Over the following three days, the employee undergoes public-safety orientation, which includes subjects required by the NCPPSB as well as the public-safety rules of conduct, post orders and assignments, communications procedures, emergency department orientation, federal privacy laws, behavioral health orientation and commitment procedures, morgue procedures, and uniform appearance.
New-hire training. Phase two consists of 120 hours of training over three weeks and is conducted in a classroom setting, with the last two hours of each day devoted to hands-on training in self defense, subject control (including search procedures and the use of handcuffs), and baton certification. Topics include patrol procedures and how to respond to calls; North Carolina General statutes and elements of crimes, detention for arrest, and testifying in court; preliminary investigations, including investigation of narcotics discrepancies; basic interviewing techniques; report writing; traffic control and parking enforcement; accident investigation; prisoner patients and forensic staff orientation; fire prevention and control; emergency response procedures, including operation of the hospital command center; patient restraint procedures; and the use-of-force continuum.
The tradition of a formal graduation ceremony with participation by senior leaders and local law enforcement officials has continued. It is much appreciated by the graduating officers and their families.
Field training. The goal of field training is to provide structured on-the-job training using a comprehensive field training manual specific to Forsyth. The manual contains an instruction guide detailing numerous tasks that are first explained and then demonstrated to the new officer by an experienced Forsyth officer trained to give field instruction. The new officer must perform these tasks for the training officer. The completed instruction guide then becomes part of the new officer’s training record.
While new public-safety officers undergo field training, new communications technicians undergo similar training in the communications center under the supervision of experienced employees on their assigned watches.
Additional training. Other required training courses that fall outside these three phases are scheduled for new officers whenever the courses are available. For example, CPI Nonviolent Crisis Intervention Course is taught by behavioral health instructors. First-aid, CPR, and AED courses are also taught hospital-wide.
In addition to the training required for public-safety officers, communications technicians must complete the Association of Public-Safety Communications Officials Public Safety Telecommunicator I Course, the same certification required for 911 operators in North Carolina.
New officers are required to complete the IAHSS Basic and Advanced Training Courses by self-study and online examination. When certified, officers wear the appropriate “IAHSS Certified” pin on their uniforms. Hospital culture places great emphasis on certifications and pins, and other employees and physicians have recognized this visual evidence of professional accomplishment.
When a new officer has completed all required training, received IAHSS advanced certification, and completed one year’s satisfactory service, he or she is eligible for promotion to the position of senior public-safety officer. Senior officers are presented with a custom-designed, public-safety team buckle to wear on their uniform belt, which may be worn with civilian clothing when off-duty. The senior public-safety officer position is the first step on Forsyth’s public-safety career ladder that includes promotion to corporal, sergeant, and management positions.
The revised training program has resulted in a 37.5 percent decrease in classroom hours while allowing new public-safety team members to receive all the necessary training sooner. It has also helped us to focus classroom attention on facility-specific policies and procedures and to significantly reduce the need for paying overtime while officers attend classroom training. The required IAHSS-certified courses are now completed by self-study and online examination.
Following its implementation at Forsyth, Novant reviewed the revised training program and judged it so successful that it was adopted as the corporate standard for public-safety training at Novant’s 11 hospitals. This standardization has facilitated joint training programs for officers from various hospitals in the same geographical area, further enhancing its cost-effectiveness.
The revised training model has saved the medical center an average of about $1,100 per new officer compared to the cost of the previous training program. The annual turnover rate decreased from 42 percent in 2003 (the year before a training program was implemented) to 12.2 percent in 2008 (when we were still operating under the previous training system). Last year, after the new training program was operational, turnover was 5.5 percent.
Public safety’s employee satisfaction scores are among the highest at Forsyth Medical Center. We constantly receive compliments about our officers from other employees, patients, and visitors. Three public-safety employees have been named Employee of the Quarter over the last two years.
Forsyth Medical Center’s leadership strongly supports our training program, because they have seen the results over the past seven years. Security budgets are always tight, but our training budget has never been cut because we have amply demonstrated that training doesn’t cost; it pays dividends.
Anthony N. Potter, CPP, is the director of public safety for Forsyth Medical Center, North Carolina’s largest hospital. He has been in healthcare security for more than 20 years. He is the author of the book Considerations When Arming Hospital Security Officers and numerous articles in professional and trade journals. He is a member of ASIS International.