​VIRGINIA MASON MEDICAL CENTER in Seattle began as an 80-bed hospital with six physician’s offices in 1920. Now, the center has 336 beds and is home to more than 440 physicians, 5,000 staff members, and 200 volunteers. Located in a dense urban area, Virginia Mason serves as a teaching hospital, hosts a research center on autoimmune diseases, and supports a facility for those with HIV/AIDS.

Virginia Mason’s security department had a successful program but it wanted to make it better. With that in mind, it evaluated its procedures in 2009, and building on what it learned, it introduced new processes in 2010 that were designed to improve the efficiency of the department. The enhancements include online mechanisms for outreach to staff, an incident tracking program, policies designed to increase security awareness among nonsecurity personnel as well as among the surrounding outside community, and a comprehensive training program for officers and employees.

Outreach
Hospital staff members in any urban area face numerous workplace security issues, and it’s important that they trust security and know when and how to report information. The security department had traditionally held roundtable meetings, educational campaigns, and open-house events to share information with employees. A newsletter was also distributed, but the security department still felt there was room to improve communications. As part of the enhanced program, the department updated its Web portal to the hospital’s intranet to improve its outreach efforts. The portal includes an informational section, communication options for reporting and other uses, and an online survey.

Information. The security information provided covers workplace issues, such as badging and ID procedures; advice for home and travel security; and links to other resources, such as local police bulletins and neighborhood crime statistics.

Online communication. The portal also allows employees to communicate with the security department via the intra net. They can report an incident, provide comments on policies and procedures, and request answers to security-related questions. Employees are encouraged to use the online system for nonemergency issues, such as reporting lost items, warning security about broken equipment, and offering alerts about suspicious incidents.

Since the system was initiated, reports to security have gone up significantly. Employees have indicated that they appreciate how the new system lets them send reports from any device that has a Web connection. This means that if employees remember something after leaving work, they can make a report from their home computer or from their smartphone.

The reports have helped security learn about potentially dangerous issues, such as malfunctioning access control devices, in a more timely manner. The reports also help security determine whether policies are working and whether equipment is functioning as intended.

Survey. Another component of security’s enhanced communications is a proactive effort to get user feedback. After any employee interaction with security, such as an online report, officers send an e-mail asking the employee to fill out a customer service survey. The e-mail contains a link to the survey section of the new Web portal. The survey asks employees to rate their interaction with security and the professionalism of the service. Employees are also given space to provide additional comments.

The security director prints out the survey responses without names or identifying information, and officers are asked to read them. The feedback is used to continually refine security’s services to better meet the staff’s needs.

Incident Tracking
A critical part of the overall enhanced program is an incident tracking system. In the system, each task that a security officer completes, including answering phone calls and responding to requests for assistance, is documented and reports are collectively compiled in the Monthly Activity Report Security (MARS).

The MARS documents the time spent on each activity. These calculations include the time it takes the officer to get to the scene, conduct the activity, debrief other officers if necessary, and file a report. For example, escorting an employee to his or her car could take 0.50 hours, while responding to the ER to help with a disruptive patient or visitor could take three hours of total staff time because of multiple officers responding.

Each activity is placed in a category of responses so that all employee escorts are in one column, for example. Then the times in each category are added together and divided by the total hours worked by the department. This creates a final percentage of time spent on each type of security activity.

The data can be used for various analyses. For example, after tracking activities in this manner for X amount of time, and studying the results, the security director determined that when officers’ time on patrol dropped below a certain level, incidents rose. The patrols seemed to help officers focus on prevention and visibility, thus keeping incidents low.

The optimal ratio was for officers to spend 75 percent of their time on patrols and 25 percent responding to other incidents, writing reports, and training. Any less than that and security incidents increased.

With that benchmark as a guide, if a MARS indicates that patrol time has fallen below 75 percent, the director institutes a review of department activities to determine what changes must be made. In some cases, scheduling must be adjusted or additional hours added. In other cases, some duties must be reassigned to other departments. For example, the director found that some routine equipment maintenance and responsibility for unlocking doors in noncritical areas could be taken over by other hospital departments.

The incident reports and tracking data will be used in the future to assess efficiency. For example, if the time taken to escort an employee to his or her car fluctuates, this could be an indication that more training is needed or that some officers are using more efficient methods than others. Similarly, if there is an increase in the number of calls to a certain department, that might indicate a deeper problem. However, not enough of a data trendline is available yet as the program has only been in operation a year.

The MARS program will also be used to protect the hospital against liability. The system can be used in court to prove why security is conducted a certain way and to demonstrate that the hospital has both benchmarks and metrics to back up the security program.

Employee awareness. Another issue addressed by the enhanced program was the need to raise employee awareness of security. This was achieved through several programs intended to increase the profile of security staff and demonstrate security’s commitment.

New uniforms. Part of the visibility campaign was to give officers a less militaristic uniform that would make them appear more approachable from a customer service standpoint. The new outfit incorporates brighter colors for increased visibility at night, not only for officer safety but also for easier identification by employees and visitors.

Bicycle patrol. The security director wanted a way for officers to move easily about the campus, catch the attention of employees, and respond quickly to incidents. After considering both bicycles and Segways, the department chose to develop a bicycle patrol program. Segways were rejected primarily because of cost and maintenance issues; bicycles also seemed the best fit for the Virginia Mason corporate culture.

The department decided to purchase only two bicycles to start the program, but it bought the highest quality bicycles possible. Three officers were then sent to a local police department for training.

Though the bike patrol responds to incidents, the greatest asset of the program is the visibility of the officers. The bike patrol officers serve as public relations for the security department and are meant to be seen.

ER. The emergency room, where tensions run the highest in any hospital, can be the most volatile part of the facility. Prior to the changes, officers patrolled the ER more often than other parts of the hospital, but there was not a permanent security presence there. Now, security has an officer posted in the ER 24 hours a day. This new policy not only ensures a quick response with the first signs of concern, but it also facilitates the formation of relationships between security staff and ER employees. The arrangement has resulted in a reduction in calls for security to send additional personnel to the ER, mostly because incidents are avoided or dealt with early, before they escalate.

Education. The final component in the awareness campaign is education for nonsecurity employees and vendors. The means for that is the Personal Security Training (PST) program, which the department offers to all employees.

In the PST, three trained security officers teach employees how security works at the hospital. Officers review the structure of the department, the responsibilities of officers, and how to contact security in an emergency. The PST also includes important safety information, such as methods for deescalating a tense situation. The training lasts about two hours.

To thank employees for attending the educational session, security gives participants a rugged safety whistle—identical to those used by the U.S. Coast Guard—which has security’s phone number on it. The idea is that employees will wear the whistle and be reminded to call security if necessary.

Since the training began, security has seen an increase in compliance with security reporting procedures. The training sessions have demonstrated that when security is transparent with its mission and uses a holistic security approach, employees are more open to helping security on a daily basis.

Officer Training
Even before the enhanced program was implemented, all officers were required to pass the appropriate training programs established by the International Association for Healthcare Security and Safety (IAHSS), including the Basic, Advanced, and Supervisor modules. These programs provide solid training in issues such as patrols, incident management, emergency response, fire safety, report writing, and investigations. Officers also learned about security issues surrounding patient care, pharmacy management, and pediatric units as well as legal issues and privacy regulations.

The security director took the opportunity to seek further training enhancements. Now, officers also go through new training modules, including one focused equipment-specific training and scenario training were also added. Highlights of those programs include the following.

ER training. Under the enhanced program, all officers are given additional training on ER issues even if they are not based in that department. The bulk of the ER-based training teaches officers to deal with disruptive persons, including the homeless and the mentally ill. In addition, they learn how to calm angry or emotional family members, as well as how to operate effectively during medical emergencies.
 
Equipment training. The new equipment training covers how to use handcuffs and newly purchased protective shields, as well as how to deal with firearms that may be carried by a patient coming for treatment.

Cuffs. Handcuffs are standard equipment, so all officers complete a control and cuffing program to ensure that they can use them properly if needed. To handle the training for this program, the hospital sent one senior officer through the certification course with the Seattle Police Department. That officer then returned to the hospital and trained the remaining officers.

Shields. As part of the enhanced program, security at Virginia Mason purchased protective shields for the officers. Designed for the healthcare environment, the shields are similar in design to those used by riot police, but these are padded and are used in situations where the officers need increased protection, such as in ER incidents. The shields can be an excellent tool and can decrease injuries, but training is critical.

Officers go through up to two hours of shield training. The training is given at the hospital by a security officer who was previously trained by the manufacturer.

Firearms. Though officers at Virginia Mason are unarmed, officers are given the option of completing a firearms safety course. The course is designed to help officers deal with situations where a firearm is brought into the hospital.

Officers are trained on handling guns and instructed in the safest ways to remove loaded firearms from patients who on responding to ER situations. Additional are brought to the ER with a weapon and are not capable of removing it themselves. Though the police can always be called in to handle such a situation, having this important training allows the officer to help the clinical team more efficiently and safely.

Scenario training. Real-life scenario training was added to the program as a way to test the knowledge of officers and employees under stressful situations that simulate what they would really encounter.

Scenarios focus on the ER and on situations that are most likely to occur. One of the scenarios involves a volatile or mentally ill person who walks into the ER with an acute illness. The skills being tested include the initial security response, calming the patient, and implementing restraints. The scenario also tests how employees work together under stressful situations.

In that training exercise, the most important lesson involves who is in charge of certain aspects of the operation. The main concern is that security does not know when to step in and offer help to the clinical staff. At the same time, clinical personnel are hesitant to take control when security is present.

The training offers a way for everyone to become more comfortable with this working relationship. During the debriefing, security works with clinical staff to clarify roles and establish rules. The training ensures that all parties understand that under hospital policy, clinical staff are always in charge but should feel free to turn to security for help if necessary.

In addition to revealing areas that need clarification, the scenario training helps staff learn to trust each other, which builds teamwork. The combined effect of all of these improvements is to help ward off the ills that often beset the healthcare security environment.

Donald Pilker, CPP, is the director of security and logistics for Virginia Mason Medical Center in Seattle. He is also an adjunct professor of criminal justice at IT-Tech. He is the 2011 Washington State Chair of the International Association of Healthcare Security and Safety.