Disclaimer: Portions of this conversation have been edited for length and clarity, and certain locations and details have been modified for privacy reasons.

As we approach the last few weeks of this series, collaboration has emerged as a subtle but dominant theme across the various work examples shared by our team of subject matter experts. In one sense, it’s not surprising – it’s part of the core ethos of the company. But to see it play out in so many different forms lends a unique texture to these stories that, until observed in print, might otherwise appear disconnected.

For context, L&A utilizes a collaborative approach for a number of reasons, and this includes the more immediately realized benefits of efficiency and cost savings. But additional benefits of employee engagement and cultural change are two other downstream reasons where collaboration creates a positive impact for organizations. With the former, if risk management or mitigation needs are especially complex or a disconnect in SOPs is apparent, employee engagement brings together the strategic and operational worlds, creating a more secure bond between different but equally important pieces of the organization. The culture change, then, that can happen as a result of this can be transformative long-term. However, in the short-term, the department or individual-specific learning and satisfaction that occurs through learning and contributing creates a deeper sense of well-being that employees then associate with their employer.

Nowhere is this more apparent than in #OurStory conversation with Kris Keefauver, as he recounts an investigation experience with a team of security officers that, until that point, were not empowered nor necessarily trained to take the steps required to work through a suspected crime.

You recently represented L&A as the Interim Security Director for a healthcare organization. What did that look like and can you describe some of the issues they were dealing with?

Kristopher L. Keefauver: Our task was three-fold: 1. Complete a security risk assessment of the of the campus. 2. Act as the interim security director. And 3. Be involved in the remediation efforts for any of the findings and recommendations that were brought to light during the assessment. The organization had a staff of about 10 to 12 security officers, and the L&A team was engaged to provide leadership and oversight while revamping the security department. The security team reported directly to us, we’d provide direction and supervision, and then report directly to the healthcare organization’s COO.

Serving in these capacities, a lot of what we found was that the staff that was on site weren’t necessarily aware of the policies, procedures, and processes that the healthcare organization had documented. The organization had done a great job of detailing out all these policies and procedures to be followed, but somewhere along the line, the chain of command or the dissemination of that information didn’t necessarily make it to the guard staff.

One thing we found was that when security was called, in some cases, they didn’t show up. Other times they’d show up, but not deescalate a situation. So, we were called on to help illuminate the issues they were facing, help remediate those issues, and then close the gap between what was being done and what should have been done, based on the policy and procedures. Upon further review, it was determined that the staff had completely lost trust in the security team and their capabilities.

In helping realign SOPs, revisiting hiring criteria and amplifying the need for training, you spent a lot of time on-site with your security officer team. Is there anything about the time or work together that stands out?

Keefauver: The most impactful moment for me happened at the end of a 12-hr shift. I was leaving work, heading down the stairs into the parking lot and ran into one of the security officers. After some small talk, he mentioned that they thought someone had stolen some shirts from the gift shop. I asked what their plan was, and he said, “Well, I’m going to go out in the parking lot to try and find her.” I went along with him to the parking lot.

Needless to say, we didn’t find her, so we came back in and talked to the other security officers, asking what they normally do in this situation. It was mentioned that there was one person that knew how to work the CCTV systems (self-taught), but that individual wasn’t there; so essentially, the team was going to just let it go. I’ve had some experience working with various CCTV systems, so I decided to take it a step further and do a little more investigating.

I talked to the gift shop employee and tried to get a description of the person, went to the CCTV system, and was able to locate the person based on the time she was in the gift shop, what she was wearing and other attributes. I then went back to the gift shop employee with a photo and she confirmed that that was the subject. It turns out that this subject had actually purchased a deck of playing cards. Upon further investigation, I asked the gift shop employee how the subject had paid for those cards, and it turned out she used a credit card.

At that point, I knew we were on to something so I asked if we could pull up the sale records to see if there was a name or any other identifiable information. The credit card transaction returned a gentleman’s name. We were able to talk to different levels of staff in various units to see if there were any patients under that name, and sure enough we got a hit. Digging deeper, since the individual on footage was female, I asked if there was a dedicated emergency contact for this individual. There was, so I took that individual’s name, plugged it into Facebook and it revealed that the patient and our suspected thief were ’in a relationship.’  It also revealed that this couple had three children, which turned out later that the five shirts that were taken equated to the two people and their three daughters.

So, to this point, the original security officer had been with you through this whole process?

Keefauver:  Yes!  So, I asked him, “What would you do at this point?” We ended up calling law enforcement, who arrived promptly on site. I showed them the video and asked what they typically did in situations like this. They admitted that they’d never got a call like this for any type of investigation at the facility.  But there was enough evidence to move forward and asked me what I’d like to do.

We went up to the patient’s room, asked that the subject in question step out of the room to speak with us. Law enforcement spoke to her in a separate room, asking her about the incident that took place. They came out and advised she was very cooperative and then asked me how the healthcare organization wanted to proceed. To which I said, “As long as there’s no more issues, no issues with staff, no issues with the gift shop – and we get the property back – we’re fine with her staying.”  She was very embarrassed and asked if she could return the shirts the following day because she didn’t want her significant other – the patient – to know what she had done. Her plan was to go back and pay for them once she got paid the next day, but I politely told the law enforcement officers that we’d prefer to have the property back, to which she obliged.

The most enlightening part of this story though, was being able to see the look on the security officer’s face, once he realized how to follow through with an investigation and seeing a new confidence in the security officers – it was a realization that they could do this work.

What were some of the key takeaways for the facility?

Keefauver: It brought to light a couple of things, the first being a CCTV system and knowing how to operate it. Every organization should have a quality camera system producing quality images/videos and sufficient retention, meaning that depending on the assets being protected, there’s adequate ability to review quality discernible footage, and for an extended/specified period of time. We want the organization to know how to use the system, to go back and pull up video when it’s needed for investigation purposes.

It was also enlightening, as I said, to see the officers on site go through that whole process. We collaborated on the report and they were able to take a little bit of credit for bringing the investigation to closure. For some of the security officers, it was their first job out of high school or college, for others, they were well into their career. Everyone was sharp, but we had to do a lot of learning on the job. That’s never a bad thing, but that training should be corroborated with certain written formal policy and procedure documentation that benefits both the employee and employer, signed, acknowledged and attested to.

Treating patients is far from the only concern faced by hospitals today. To protect the safety of patients, visitors, and staff, hospitals must now take extra efforts to anticipate and prepare for security threats.

Hospitals are vulnerable to crime and violence from patients, visitors, and occasionally their own staff members. Therefore, security systems in hospitals must include proactive measures to create and reinforce effective security protocols geared towards accountability, readiness, and responsiveness.

The first step to designing an effective security system is understanding the threats themselves.

Here are some of the top security issues concerning hospitals today:

1. Abuse and battery towards medical staff

Assault and battery towards medical staff are the most common types of abuse-related injuries to occur within healthcare facilities. 80% of serious violent incidents reported in healthcare settings were caused by interactions with patients and were usually caused by patients hitting, kicking, beating, and/or shoving medical staff. There are many reasons that contribute to this. For one, patients may be victims of an incident caused by a dispute, creating a hostile or volatile environment inside the hospital. In other cases, patients may suffer from instabilities due to addiction or mental health issues.

At highest risk of patient-inflicted violence are psychiatric aides, who are more than ten times at higher risk than nursing assistants, the second-most affected group. Other high-risk groups include emergency departments, geriatrics, pediatrics, and behavioral health providers.

2. Active assailant attacks

Researchers at Brown University reported 241 hospital shootings between 2000 and 2015. Breaking this down, the majority of in-hospital shootings happened in the emergency room (29%), next to the parking lot (23%), and in patient rooms (19%).

As recent stories exemplify, simply having a plan is not enough. A recent active shooter situation at Dartmouth-Hitchock Medical Center exhibited the need for a much more comprehensive security approach. When the shooter entered the hospital and shot a patient, “Code Silver” was announced to all staff members. However, most staff did not know what the code meant, let alone how to react. The code has since changed to “Active Shooter,” along with other modifications to improve overall hospital security.

Bethesda Butler Hospital in Hamilton, Ohio is working to enhance training. They hired actors to practice emergency response to a hospital shooting. As Ronald J. Morris, the Director of Corporate Security for Tri-Health puts it, “It’s all about preparation and telling people about developing the right mindset so they can be more prepared.”

3. Infant abductions

Infant abduction is the most common type of abduction in healthcare facilities. According to the National Center for Missing and Exploited Children, 317 cases of infant abductions occurred between 1965 and 2017. The majority of cases of infant abduction occur in the mother’s hospital room, with violence inflicted on the mother in 8% of cases. Before more advanced security protocols came to form, many of the perpetrators disguised themselves as medical personnel to steal a child, usually from the hands of the mother.

In response, hospitals have cracked down on security measures and patient education practices that directly address this type of risk. The system does not need to be complex, but it should be effective. For example, access to maternity wards should be limited to qualified personnel or individuals who can prove their relationship to a patient. This can be further reinforced with badges that identify the security clearance of medical staff.

4. Supplies and property theft

From drugs, food, and medical supplies, you could make an A-Z list of items that are stolen from healthcare facilities. In 2009, hospitals reported 272 incidents of theft. By 2015, this number rose to 2,926 – a 166% increase. The result can be extremely costly. As a single example, the Santa Clara Valley Medical Center in San Jose, CA counted 383 stolen pieces of equipment between 2010 and 2014, totaling to over $11 million in value.

Culprits include patients, visitors, and also staff. An employee at the Christus Santa Rosa Hospital-Westover Hills in San Antonio, TX admitted to stealing over $400,000 worth of equipment because “it was easy and no one asked any questions.” Hospital theft is a good indication of a vulnerable security system, and also contributes to unnecessary overhead costs.

5. Pressure to cut costs

While 49% of hospitals reported an increase in crime between 2016 and 2017, nearly 1 in 4 hospitals (23%) reported a decrease in its hospital security budget over the same period. Part of this involves a reluctance to hire more security staff. In an anonymous survey, hospital workers mentioned “more [security threat] incidents, no increase in staff,” as a key challenge for hospitals.

Given its impact on security measures such as employee training, staffing, and security equipment, the pressure to cut costs is one of the most devastating restraints to an effective security solution. With $3.6 billion in federal budget cuts announced for 2018, hospitals need to prioritize security measures that combine effectiveness with cost-efficiency to strive for the best return on investment and highest possible level of security.

Security demands are changing, and hospitals must keep up to protect the security of their patients and staff. To address the increasing risk of in-hospital crime, hospitals must prioritize prediction and prevention of crime just as much as how they respond to and manage incidents. Solutions to achieve this include more advanced technology and data collection, increased security visibility to deter criminals, and bolstering in-house security presence and security response.

Now is the time to examine and refresh whether your hospital is in need of updated practices. Explore our healthcare security and risk mitigation solutions.