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Growing pains.

Aurora Health Care System, which emerged more than a decade ago from the joining of St. Luke's Medical Center, Good Samaritan Medical Center, and Mount Sinai Medical Center in Milwaukee, today consists of twelve hospitals, more than 125 clinics, three long-term healthcare facilities, a home healthcare service and social service agency, fifty pharmacies, and an array of support facilities throughout Wisconsin. Finding ways to inoculate this diverse group of affiliates against serious security ills is the task of Aurora's loss prevention services department. The goal is to provide security oversight that is uniformly effective but that is flexible enough to accommodate the disparate healthcare environments being protected.

As might be expected, when Aurora began to grow through mergers, the loss prevention services department had to seek out commonalities and impose some order among the competing security practices of the various facilities being acquired. Each site already performed the same basic security services, such as investigations, employee escorts, and assistance to patrons with vehicle problems, yet each facility had its own ways of accomplishing them. For example, patient valuables were handled in different ways at each location. One site kept them in a drawer, while another used a safe; one site kept a log, while another did not. To resolve differences, a best practice was chosen for each security service and that practice was implemented uniformly at all sites. (For example, the storage of valuables in a safe became standard policy.)

When each new affiliate joins Aurora, it undergoes an internal needs assessment of security and safety. Security meets with representatives from all of the satellite locations and tours the facilities to collect information on all aspects of physical security, narcotics and medical records control, and any site- or business-specific security issues. At that time, security and safety at the site must be brought up to mandatory specifications. Affiliates are given cost estimates and suggested vendors. Optional security upgrades that loss prevention recommends or that the affiliate requests are also discussed. For example, a clinic plagued by parking lot break-ins may request CCTV cameras for better surveillance of the lot.

A major question is always how security resources will be paid for. In the Aurora affiliate system, centralized departments such as information services, accounts payable, payroll, and security are charged to the affiliates on an allocation basis set during the budgeting process. As director of loss prevention, I estimate the percentage of security resources that each facility will use based on the previous year's usage and charge the affiliates a flat fee at the beginning of each fiscal year. This fee covers costs for on-site security officers, including their uniforms, educational programs, and materials, as well as security systems maintenance and other expenditures made on the affiliates' behalf.

Coordinators. In general, the security and safety analyses of the affiliates who joined Aurora early on revealed that while few locations needed, wanted, or could afford a dedicated, on-site Aurora security presence, they did want assistance with surveys and audits as well as security-related training for staff. They also wanted assistance when a serious breach of company rules occurred or when an incident required the intervention of law enforcement.

It also became clear that the affiliates needed help with safety issues beyond the standard fire extinguisher training and patrolling for safety hazards such as broken steps, spills, or burned-out lights. For example, they needed assistance with issues relating to indoor air quality and ergonomics.

It was also ascertained that the affiliates needed a dedicated contact at the main office. As a result, two new positions were created in the department: coordinator of safety and coordinator of security for sites outside the Milwaukee metropolitan area. Both coordinators are responsible for addressing the particular needs of the affiliates. Each has instituted numerous initiatives, a few of which are highlighted here:

Roundtable. The safety coordinator has developed programs and semiannual events that assist the affiliates in propagating safety awareness. For example, a quarterly roundtable is held. At these meetings, the safety coordinator and the safety representatives from all affiliate sites gather for a four-hour program that may include updates on changing safety regulations, presentations on workers' compensation, or a demonstration of products and technology. In addition, the safety coordinator travels to sites with specific safety problems to assess the situation and help develop a solution.

One problem solved after being addressed by the roundtable was OSHA compliance regarding material safety data sheets (MSDSs). All healthcare sites must keep information on every hazardous substance on the property, even including substances such as photocopier toner. It was difficult for the sites to amass this information and make it accessible in a crisis. The safety coordinator researched the issue and discovered a CD-ROM containing all MSDSs. Sites in need of a specific MSDS can now contact loss prevention services, which can immediately print the information off the CD-ROM and fax it to the requesting facility.

Fleet safety. The safety coordinator has also developed a corporate fleet safety program. Previously, all the affiliates were using various drivers and delivery services to take specimens to other laboratories or to deliver laundry for cleaning. There were no guidelines in place for hiring drivers, nor was there a policy of ensuring adequate insurance coverage in case of an accident. The safety coordinator worked with Aurora's treasury services and its insurance companies to bring all drivers and driving services under one procedural umbrella. The program ensured adequate coverage, instituted records checks and guidelines for hiring drivers, and created a driver education program.

Training. The security coordinator has undertaken similar projects. For example, a review was conducted of non-security staff security training at the affiliate sites. From the analysis of these reviews, training modules were created on aggressive behavior management, violence in the workplace, and other issues.

Escorts. A formal home health security escort program was also developed to benefit the two branches of the Visiting Nurses Association (VNA) that are now affiliated with Aurora. VNA-affiliated nurses are often placed in potentially dangerous situations as they travel to and provide care in patients' homes. They may have to pass through or go into neighborhoods with high crime, or they may be entering a home with a history of spousal abuse.

Before the security coordinator began the formal escort program, the VNA hired law enforcement students and retirees to accompany visiting nurses to the homes of patients. The escorts were hired and placed without the benefit of formal training.

Under the new escort program, the loss prevention services department is responsible for hiring the escorts. It still recruits from among students at local universities and technical colleges with security and law enforcement programs, but all applicants must undergo a background check and special training. Even though escorts are paid by the VNA, they are managed and evaluated by loss prevention services personnel. This arrangement ensures that standards of performance are met. It also helps create a career path for escorts. A number of escorts have gone on to become members of the Aurora security team after graduation from school.

The escorts are trained to watch for potential trouble situations but to intervene only when absolutely necessary. They are also trained in aggressive behavior management.

The nurses now also receive security awareness and aggressive behavior management training. They are free to request an escort for any daytime visit. Nighttime visit escorts are mandatory.

Staffing. The security coordinator has also worked with affiliates to find more cost-effective ways to attend to day-to-day security duties. Consider the Friendship Living Centers and Freedom Village. This affiliate consists of four distinct living communities. The first is a fully independent elder living community (Freedom Village). There is also independent assisted living, a traditional nursing home, and a fully assisted, critical care facility.

Freedom-Friendship had been using contract security for its independent living area and relying on its maintenance department for security in the other care areas. Loss prevention services found that it could save the facility money by using loss prevention proprietary officers to cover both the Freedom Village and the care units. This was accomplished by eliminating the maintenance-cum-security worker on the quiet third shift and a contract officer who was patrolling Freedom Village during that shift. Both were replaced with one proprietary security officer whose hourly pay rate was less than that of the contract agency.

The proprietary security officers at Freedom-Friendship now monitor the entrance points to the gated independent living community and watch over dances and other social functions at the clubhouse in addition to handling more typical security responsibilities.

Reorganization. In late 1997, Aurora reorganized, going from site-based management to a regional structure that included four regions within the state, each with its own executive officers and management. To accommodate the new affiliate regions, loss prevention services also reorganized, retaining the safety coordinator but expanding the security manager position to include one for the metropolitan region, one for the three rural regions, and one for the specialty affiliates such as the Milwaukee Psychiatric Hospital and the VNA.

All the managers are cross-trained so that if an affiliate in a crisis calls and cannot reach its designated contact, the call can be handled by any of the others who have the same rank and authority. These managers also serve as the after-hours emergency contacts for the affiliates in their purview. Once a year, the managers undertake a fresh security assessment of each of their affiliate sites to search out needed changes or lapses in the facility's security and safety program. (Some rural sites are assessed less often because of lower risk, time constraints, and lack of incidents.)

Officers. There are about 100 security officers currently managed by loss prevention services. Of these, about eighty-five are proprietary employees, with the remainder being contract officers. Initially, all officers within the metropolitan region were cross-trained minimally for each site and floated between sites as the need arose. However, this strategy was abandoned when it became clear that officers simply could not remain current with what was happening at the many diverse facilities. Now full-time officers remain at one location and fifteen part-time officers are cross-trained and can be shared between sites.

Loss prevention services has also implemented an improved training program for its officers, who must receive basic officer certification through the International Association for Healthcare Security and Safety. They must also pass classes on defense and arrest tactics and aggressive management behavior. Optional classes are offered on myriad other topics such as covert CCTV operations, interview and interrogation procedures, and keys and locks.

Officers who will be stationed in specialty facilities receive training pertinent to that environment. For example, officers working at the Milwaukee Psychiatric Hospital receive extra training in handling aggressive patients and in sensitivity issues concerning psychiatric and substance abuse patients.

Security technology. Another aspect of the loss prevention services department's assistance to affiliates concerns the selection of access control and other security technology that is cost effective, easy to operate, and compatible with technology already in use.

For many years, the two largest hospitals in the system - St. Luke's and Sinai Samaritan - used internal alarm monitoring by the hospital's respective security centers. The system at St. Luke's could also receive off-site signals from several of its clinics. The system at Sinai Samaritan had similar, but more limited, capabilities.

As more clinics in outlying areas joined Aurora, loss prevention services learned that many of them had no after-hours alarm monitoring or were using outside alarm monitoring companies that were charging between $20 and $80 a month to monitor the alarms. There were also inconsistencies in what was being monitored. For example, while all of the doors of one affiliate's intrusion system were monitored, another only monitored selected doors for intrusion alerts, and many facilities were not being monitored at all for fire alarms.

In-house security monitoring centers at St. Luke's and Sinai Samaritan were eventually upgraded to accept more card readers and alarm points to monitor and manage the growing number of off-site security and fire alarm systems. Currently, St. Luke's monitors about seventy sites. In the future, Sinai Samaritan will also begin to take on off-site monitoring responsibilities.

Loss prevention services has also developed a mandatory template for basic intrusion and fire protection for all newly constructed Aurora facilities and preexisting ones joining the system. The template was created to provide basic coverage while allowing for specific concerns to be addressed after a risk and vulnerability assessment. For instance, alarms at all entry points are required, as well as motion detectors and fire and smoke detectors commensurate with the size of the facility, but additional fire protection is required if there is a kitchen or significant paper storage at the site.

The template specifies uniform equipment. The advantages of this arrangement are reduced equipment cost due to bulk purchases from specific vendors and consistency of installation and repair personnel. Additionally, loss prevention services staff need only be trained on and familiar with a handful of basic systems.

All alarm testing is currently handled by St. Luke's central monitoring sites. Affiliates can choose to add security and fire safety systems beyond those called for in the template, as their budgets allow. Because of the demonstrable savings to the affiliates from the in-house alarm monitoring provided by St. Luke's and Sinai Samaritan, many now can afford to purchase more extensive security and safety technology.

Optional standards have also been set for other security technology and hardware, such as CCTV, safes and vaults, and infant abduction prevention technology. If security feels that there is a significant vulnerability, it works with the site to mitigate the problem in a cost-effective manner.

In addition, a keying system template was established for all new sites or sites undergoing significant remodeling. For example, the specifications mandate interchangeable cores. This uniformity allows for fast and cost-efficient changing of locks.

As part of the keying system template, all pharmacies, information services closets, and cash handling areas have been designated as sensitive areas. Loss prevention services holds the control keys that allow the locks on those doors to be changed. Other areas at individual sites have been designated as sensitive areas based on the yearly security surveys or input from site managers.

Very few of the affiliates have electronic key systems, but those that do have the option of allowing their system to be managed by the loss prevention services staff. In those cases, security personnel will issue keys and make all changes to access privileges, as well as supply the sites with any needed reports for investigative or other purposes. If an affiliate wishes to add electronic keying, specifications have also been created so that all installed equipment is compatible and cost-effective, and can be monitored by the central station at St. Luke's.

"The wise, for cure, on exercise depend," wrote John Dryden. The loss prevention services department has exercised its good judgment and has found creative ways to stretch Aurora's resources so that they can reach out to a constantly growing base of affiliates and continue to meet their many changing needs.

Michael R. Cummings, CPP, is the director of loss prevention services for Aurora Health Care Systems of Milwaukee, Wisconsin. He is chairman of the ASIS Standing Committee on Healthcare Security.
COPYRIGHT 1999 American Society for Industrial Security
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Copyright 1999 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Aurora Health Care System adopts an internal needs assessment of security and safety for its increasing number of affiliates
Author:Cummings, Michael R.
Publication:Security Management
Date:Apr 1, 1999
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