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Survey: Increased hospital security budgets aren't keeping pace with violence

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Survey: Increased hospital security budgets aren't keeping pace with violence

Survey shows that while half of security directors have seen increased funding,one-third say violence is on rise

Results of a survey conducted by the security equipment manufacturer Guardian 8 offer both a surprising and not-so-surprising outlook on the state of hospital security.

Of the 380 hospital administrators, chief security officers, and nursing and support staff that completed the survey, 46% indicated that hospital budgets had increased in 2014, a surprising statistic considering hospital security departments across the country have long lamented continued cuts to their program. However, one-third of respondents also said that their hospital had experienced an increase in violence and assaults, a statistic in line with the rise in violence that hospitals have been experiencing anecdotally for several years.

These two competing statistics lead to the obvious question: If security budgets are going up, why is violence increasing as well?

The primary reason is that any spike in security funding still struggles to keep pace with the overwhelming rise in violent incidents, says Paul Hughes, chief operations officer at Guardian 8 in Scottsdale, Arizona.

"Even though the budget is larger, you still feel like you're at a disadvantage because the budgets are not increasing at the same pace as the violent activity," he says.

Hughes adds that security funding is frequently reactive, coming in after an event has occurred.

"[Security spending] is always viewed as overhead, but it should be viewed in a different light, more along the lines of risk mitigation as opposed to operational load," he says.

Hospitals increasing their security budgets are likely putting that money toward equipment rather than security staffing, says Tony York, CHPA, CPP, chief operating officer of HSS, Inc., in Denver. Increasing concerns regarding active shooters have led many hospitals to invest in technology to improve access control, with lock-down capabilities that can be executed in just seconds rather than minutes.

"Whether it's through smarter cameras, analytics, or access control systems, it's anything that could supplement or even substitute for people," York says. "That's what every organization is challenging security professionals across the spectrum: How can we do more with less?"

Choosing between patient and employee safety

Thanks to the closure of many mental health facilities due to state funding cuts, hospital EDs have been forced to hold mental health patients, often for 24 hours or longer, until a psychiatric bed becomes available. Hughes and York agree that this influx of mental health patients into community EDs is fueling the increase of hospital violence.

"I think everyone is starting to realize that no healthcare facility is immune, whether they are a level one trauma center, a community healthcare provider, or a critical access hospital in rural America. This is happening in all locations," York says.

Many hospitals are not equipped to manage behavioral health patients or treat other issues like drug and alcohol dependency. Further, regulatory requirements from CMS and OSHA are squeezing administrators and security directors from both sides. Strict CMS regulations concerning restraints act on behalf of patient safety, but OSHA is holding providers accountable for staff safety associated with workplace violence. As a result, hospital administrators are forced into an unenviable position of choosing between patient safety and employee safety, Hughes says. This is reflected in the Guardian 8 survey in which patient safety (57%) edges out officer safety (56%) as a top security concern.

As long as administrators are forced to make decisions that favor patient safety over employee safety, employee morale and quality of service will continue to decline, Hughes says.

"Administration shouldn't be put in that environment," he says. "It's an impossible decision to make, and you can't win."

Combating turnover

Increases in hospital violence coupled with the lack of attention to employee safety make for a dismally high turnover rate in the hospital security industry. The Service Employees International Union estimates that the turnover rate for private security services ranges from 100% to as high as 300%?400%, a figure that rivals or even exceeds that of the fast-food industry. However, only 10% of survey respondents listed employee retention as a top security concern.

"When morale is low, people don't feel safe and there is a higher degree of turnover," Hughes says. "What would be helpful is if the [healthcare] industry saw the security department as a way of mitigating cost in other areas such as HR."

Hughes insists that high turnover rates boil down to an equipment issue. The Guardian 8 survey shows that 28% of security personnel carry firearms, 57% are armed with intermediate, non-lethal equipment, and 15% are unarmed. Of those that carry non-lethal equipment, 41% carry pepper spray, 37% carry a baton, and 28% carry a stun gun.

"Military and law enforcement have equipment coming out of their ears, but the security officer is still expected to go down the hall with [no equipment] and stop an attack from happening," he says.

Hughes says Guardian 8 plans to do more research regarding the correlation between employee morale and the kind of equipment that security officers carry. When asked if this is an observation born out of self-interest, since Guardian 8 manufactures non-lethal security equipment, Hughes says he understands that perception, but argues that the issues surrounding substandard security equipment are what drove the founders of Guardian 8 to start the company in the first place.

"It is an industry that does not have any tools that were built mission specific," he says. "This is someone that is in a defensive role, not a tactical one."

York counters that an officer with the right training, attitude, and aptitude should be able to de-escalate a potentially violent situation. However, he adds that he has seen a growing presence of non-lethal equipment such as stun guns, a tool he prefers over firearms.

"It's changing the presence of the officer and giving them a tool they will actually use if push comes to shove, whereas using a firearm for patient-generated violence is probably not appropriate," he says.

Although he has not seen turnover rates as high as 400%, York says turnover has always been pervasive in the private security industry. Until recently, hospital security was seen as a career stepping stone or a backup plan rather than a lifelong profession. However, an organization's tolerance toward patient-generated violence, along with an emphasis on officer-clinician teamwork, can have a strong impact on officer turnover.

"When they are addressing a patient that is acting out early in that escalation stage, security officers that are seen as part of the team are more likely to stick around for a number of years, as opposed to those environments where the No. 1 job of the care team is to put a hand to the back of the security officer, close the door behind them, and say, 'You figure this out,' " says York.

CMS regulation deters equipment adoption

In many cases, there is still trepidation among hospital security administrators when it comes to adopting stun guns. According to the Guardian 8 survey, 59% of respondents were unfamiliar with state laws restricting the use of stun guns. Furthermore, 17% of respondents listed administrators' understanding of CMS regulations as their top security concern.

One issue many hospital security administrators are not aware of is that CMS requires hospitals to report any event in which the use of equipment changes the behavior of a patient, York says. Even unholstering a stun gun and pointing it at an unruly patient counts under CMS regulation; such an event would be reportable to CMS and the local law enforcement agency.

"CMS doesn't really say we can't use [force], but they are very explicit about what happens if we do use it and the reporting of that," York says. "That's why hospital administrators are really probably still very shy about the use of force and defensive equipment inside their organization."

Hospital security directors also hesitate to adopt any kind of new equipment because of surveyor interpretations of CMS regulations?those interpretations can vary drastically from state to state.

"That's why some colleagues feel like they can't use any type of use of force tool aside from hand-to-hand, even handcuffs, because of those surveyor interpretations," York says.




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