bryan warren - carolinas healthcare system
DESCRIPTION
Safe and Secure HospitalsTRANSCRIPT
HEALTHCARE SECURITY: WHERE SCIENCE MEETS ART
Bryan Warren, MBA, C.H.P.A., C.P.O.-‐I Director of Corporate Security Carolinas HealthCare System
Basic Principles of Proving Your Value
Step One – Document what you do for the organization and why
Step Two – Demonstrate how much you do (metrics)
Step Three – Demonstrate how well you do it (value)
You have to take what you know and translate it into a language that the C Suite will understand and appreciate, typically through metrics, KPIs and dollars.
Keep up to date lists of responsibilities and duties (especially the non-‐traditional and time consuming ones)
Keep a monthly list of accomplishments for security and tie significant activities to the organizations core values and mission
Relationships with other departments are a critical component, and must be maintained for support with Administration
Be prepared and have updated regulatory agency standards and industry best practices available for reference should you need them
Document What You Do and Why
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Second, Document How Much You Do
Rely upon your DARs and other reporting mechanisms to capture your total number of calls for service so they can be tracked and trended over certain time periods
An important component is not just the number of calls, but the type as well since many calls take more time than others, thus rendering that resource unavailable for other duties
If you do not have a suitably programmed electronic incident reporting system, collecting of such information and using it for staffing justification can be tedious and time consuming
Remember, trash in, trash out when recording such info
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Document How Much You Do Name of Facility Here
Security Produc>vity Tool
KPI (Key Performance Indicator) Addi>onal Descrip>on (op>onal) Frequency
Measure
($, %, Score, etc.) Comments
Data
Source Baseline Standard Excellent Metric Goal
Cost
Total Cost per Patrolled SF Total Cost per Full-‐Time
Equivalent for Security Services W,M, Q, A
Total Cost vs. Budget Month & YTD W,M, Q, A
Cost Savings IniHaHve 1 Assessed/Reported per Quarter W,M, Q, A
Quality W,M, Q, A
# of WPV Incidents per 100 Employees Work Place Violence Incidents W,M, Q, A
Validated Complaints vs Dept.
Complaints Involving Security which are Confirmed and
Resolved W,M, Q, A
Care of the Environment Survey Overall Customer SaHsfacHon
score (1-‐5 scoring) W,M, Q, A
Speed ` W,M, Q, A
Response Time to Urgent Calls Panic/Codes/Help StaHon Alarms W,M, Q, A
Calls for Assistance per FTE Workload per Full-‐Time
Equivalent W,M, Q, A
Square Feet Patrolled per FTE Total Internal/External Square
Feet Patrolled W,M, Q, A
Number of Patrols per Shi[ By Zone or Facility W,M, Q, A
Add Specific Calls for Service here DescripHon of AcHvity W,M, Q, A
Add Specific Calls for Service here DescripHon of AcHvity W,M, Q, A
Add Specific Calls for Service here DescripHon of AcHvity W,M, Q, A
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Document How Much You Do
Dept. A Dept. B
Dept. C Dept. D
Dept. E Dept. F Dept. G
Dept. H Dept. I
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Demonstrate Tangible Value • Security personnel completed auto assistance calls for 250 visitors and staff last
year at a cost avoidance of $15,000 (based upon a $60 / per service call rate)
• Alarm monitoring for burglar/panic/fire/POM alarms by our dispatch operations center provided a cost avoidance of $45,000 (based upon a $30 per account per month rate for premium alarm monitoring by a third party for 125 accounts).
• Security provided 522 mental health transports between acute care facilities and local behavioral health facility. Reducing the wait times for local Law Enforcement by approximately 4 hours per patient with and ED room worth approximately $500 per hour in lost revenue opportunity, this resulted in a cost avoidance of $1,044,000
• By providing subject matter expertise on a variety of topics (workplace violence prevention, forensic patient precautions, handling of IVC clients) through presentations and webinars to other organizations, Corporate Security secured $3,500 in charitable contribution to our Levine Children's Hospital in lieu of honorariums or other compensation.
Total of Security cost avoidance/savings /gifts: $1,107,500
Answering Today’s Three Big Ques>ons
What’s Everyone Else Doing?
Do We Have To Do It and Who Says We Do?
What Happens If We Don't?
Demonstrate Your Value – Case Study
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The Problem 2012 and 2013 showed ever increasing numbers of calls for training classes (for both
security and non-security), investigations, SUE assessments and special projects from the existing Investigations and Training Division while staffing levels remained stagnant.
Aim/Goal The goals of this project was to: 1. Demonstrate the increasing trend of calls for service for Investigations / Training 2. Benchmark against prior years and volumes to determine appropriate staffing levels 3. Justify additional FTEs in 2014 using objective methods and projected needs
Team / Resources Corporate Security Director (Bryan Warren) Investigations / Training Manager (Scott Buff) Investigations / Training Staff (Esposito, Rubino, Underwood) Report Exec database and national best practices (IAHSS, ASIS)
The Interventions What changes did you make or plan to make? 1. Add two FTEs, one dedicated to Training and one to SUE / Investigations 2. Dedicate existing training FTE to CHS Security officer academy and in-service
needs and new FTE to non-security staff training programs (CPI, RAD, WPV, etc.) 3. Assign one FTE to SUE project and to assist with investigative functions based
upon need (regulatory issues, criminal incidents, etc.) 4. Allow adequate staffing resources so that special projects, subject matter expert
requests, etc. are handled properly providing for increased innovative research and development and continued brand recognition /creation of national best practices
Graphs and Data
In-service classes denote security personnel only, Security classes denote other CHS staff
Success Measures • Increased customer satisfaction by conducting training, investigations and SUE
assessments more promptly and comprehensively than current resources allow • Allowed for adequate staffing levels during special event staffing, leaves, PTO, etc.
increasing employee satisfaction and reducing overtime costs • Provision of additional research and development of programs to create further national
best practices and increase CHS branding opportunities • Increased security culture and staff safety by providing training program enhancements
Next Steps Determine if additional 2 FTEs will be enough to meet ever increasing requests for investigations and training by:
1. Continue monitoring trends and benchmark against previous requests for investigations and training services
2. Provide quality checks and employee satisfaction surveys to determine impact of FTEs 3. Research potential creation of investigations and training as a revenue source, providing
training for non-CHS agencies and organizations in a variety of topics and subjects
Trai
ning
Vol
umes
Staffing Increase Proposal for Inves>ga>ons / Training
Plan a change or improvement Study the results and examine data
Do the improvement, make the change Act to sustain performance and spread change
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Historical Trending of Training Hours
Tra
inin
g V
olum
es
In-service classes denote security personnel only, Security classes denote other CHS staff
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Projected Trend of Training Hours
* # Training Hours for 2013 / 2014 projection based on current rate of increase and in-service schedule adjustments .
Tra
inin
g V
olum
es
Hours of Security Training by Topic
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Trends of Security Training
Req
uest
Vol
umes
* Security Classes for 2013 are those already planned as of 6/1/13.
Hours for CHS Non-‐Security Staff
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Tangible Value of Security Training
Document How Much You Do
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The Problem 2011 showed an increased number of Workplace Violence
incidents as related to patients restraints creating safety and security concerns for both patients and clinical staff.
Aim/Goal The goals of this project are: 1. Reduce the number of WPV incidents related to patient
restraints in 2012 2. Increase WPV Prevention education for all staff in 2012
Team Name 1 Name 2 Name 3 Name 4 Name 5
The Interventions What changes did you make or plan to make?
1. Implemented monthly trending of WPV incidents
2. Implemented quarterly education on WPV Prevention
3. Modified patrol zones to more effectively utilize staff
4. Areas experiencing upward trends in measured incidents received enhanced security patrol coverage and training in WPV prevention
Graphs and Data
Lessons Learned • Additional education of staff in high risk areas reduced injury
rates and helped staff be more engaged in the security process for their individual work environments.
• Thanks to multidisciplinary process, clinical polices and practices have been updated to provide additional levels of safety for staff working with potentially physically violent patients (behavioral health subjects, forensic patients, etc.)
Act to sustain performance and spread change
Next Steps Determine if need to expand to other areas or rework the cycle
1. Continue providing de-escalation and WPV programs to clinical staff and nursing students as part of clinical education, OSHA and TJC recommendations
2. Will continue to monitor for trends and modify strategy accordingly
Favorable
Workplace Violence Injury Reduc>on Plan Plan a change or improvement Study the results and examine data
Do the improvement, make the change
Workplace Violence Injury Reduc>on Plan
100% Saturation
Document How Much You Do
Why Are You Doing Things (LEAN)
Why Are You Doing Things (LEAN)
Contextual Relevancy (Tell the Whole Story) “…the security officer then prevented Mr. Smith from entering the ER triage area, told him that he was not allowed to speak with the nurse, placed him on the ground and handcuffed him and began a search of his person and his vehicle”….
Relevant Facts: Subject was estranged boyfriend of ER triage nurse Subject had previously been trespassed and arrested and was under a restraining order Subject had just verbally indicated he possessed an explosive device and was there to “kill everyone”
The 3 Why Exercise When asking for resources (staffing, equipment, training, etc.) think of your request in the terms of what I call the “3 Why Exercise”.
If you can answer the question “Why” at least 3 levels deep, then this demonstrates that you likely have completed sufficient research to verify justification or at least enough to pursue further discussion regarding the request . If you cannot answer the 3 Whys,, then you have not done your homework and will likely do more harm than good in making the request.
Example – Request for Addi>onal ED Security Due to IVC Pa>ents
I need additional Security FTEs to provide 24/7 ED coverage due to the increase in IVC boarding.
I need additional access controls to prevent elopements as well as duress alarms for staff
I also need dedicated training for all ED staff that participate in IVC patient management to increase employee satisfaction and reduce overall workplace violence rates and associated DART scores
Boarding of Behavioral Pa>ents For many complex reasons, healthcare facilities, especially emergency departments, are seeing a huge influx of both pre-‐existing and new behavioral and emotionally challenged patients that require such specialized care.
Aside from the obvious issues that this patient population represents, the boarding times are becoming longer and longer as behavioral health facilities have been dramatically reduced due to economic issues and there simply are not as many specialized treatment beds available to transfer these "at risk" patients to.
Boarding of Behavioral Pa>ents The result is that many behavioral health patients are now being kept in emergency department treatment areas for days and even weeks until a behavioral health bed becomes available. The negative results from such an inefficient system are many, including:
A loss of revenue for the time which a clinical bed is occupied by a waiting behavioral patient ($500/hr.)
Increased wait times for others visiting the ED (and therefore an increase in anxiety for staff and patients)
The perception of other patients and staff who have to deal with escalating violent behavior of these patients
Boarding of Behavioral Pa>ents
The longer that such patients are boarded in an area not designed or resourced to meet their unique physical and emotional needs the greater the likelihood of an elopement attempt or an incident of violent behavior.
Because of this issue alone, healthcare facilities are seeing more and more need for a security presence in emergency departments for much longer periods of time, for stand by duty and patient watches as well as an increase of patient restraints and the potential consequences of such interventions.
Boarding of Behavioral Pa>ents Because of this, healthcare security officers today need to be truly integrated as part of the patient care team along with their clinical teammates both in training and certification in disciplines such as conflict resolution, verbal de-‐escalation and patient restraint techniques (as well as all of the regulatory issues that come with these duties and responsibilities). For instance:
On January 1, 2014 TJC introduced the following element of performance: “The hospital measures and sets goals for mitigating and managing the boarding of patients who come through the emergency department” (LD 04.03.11, EOP 6 and 9)
Excerpt from Sea]le Times Ar>cle 10/13 “A lack of space forced those involuntarily detained to wait for treatment 4,566 times in the past 12 months — more than double the number in 2010, according to an analysis of state, county and hospital records”.
“In King County, boarding quintupled between 2009 and 2012. Now nearly two of every three detained patients spend time warehoused”.
“The patients wait on average three days — and in some cases months — in chaotic hospital emergency departments and ill-‐equipped medical rooms. They are frequently parked in hallways or bound to beds, usually given medication but otherwise no psychiatric care”.
Excerpt from Sea]le Times Ar>cle 10/13
Excerpt from Sea]le Times Ar>cle 10/13
Answering Today’s Three Big Ques>ons
What’s Everyone Else Doing?
Do We Have To Do It and Who Says We Do?
What Happens If We Don't?
In Closing Determining appropriate resources for security in a healthcare environment is a very difficult endeavor. Since security does not typically generate revenue and the preventative value of security has few industry standards by which to measure, each facility and / or security practitioner must do his or her best to take existing data and translate it into a language that Administration will understand and value.
Science of data (metrics) + the art of experience (best practices) =
The Craft of Effective Security
Discussion