Sick of theft: one hospital resolved to reduce thefts in three years through a combination of technology, training, and design. (Healthcare).
In 1998, theft was a problem at King's Daughters Medical Center (KDMC), and security knew that the issue was more than one of lost property. Left unchecked, that problem might have led to others that could result in an unsafe medical campus. The hospital's safety committee decided to make theft reduction an official goal. The goal was then presented to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as part of the hospital's accreditation process.KDMC is a nonprofit 363-bed regional referral center with approximately 2,100 employees. The center offers many healthcare services, including cardiac, medical, surgical, pediatric, rehabilitative, psychiatric, oncological, and neurological care. The center has also been expanding in recent years. For example, KDMC recently opened the $36 million Center for Advanced Care, offering state-of-the-art diagnostics and technology.
Prior to its 1998 initiative, security at KDMC was already tracking the number of incidents that occurred on the campus, such as theft, robbery, and vandalism. The biggest problem was theft; 30 cases occurred in 1998 alone. Thus, when the hospital chose to focus on security improvements, theft seemed the most reasonable first target. After theft was brought under control, security planned to attack other issues such as vandalism, which was an occasional problem, and assaults, which were rare occurrences. (It was also assumed that steps taken to reduce theft might improve security overall, reducing vandalism and other problems as well.)
The joint commission. JCAHO, an independent, nonprofit organization, accredits thousands of healthcare organizations and programs in the United States. The commission reviews and inspects every accredited hospital once every three years. Hospitals can also face a surprise inspection by the joint commission.
The purpose of these inspections is to ensure compliance with JCAHO's Environment of Care Standards. The standards set out requirements for security, hazardous materials handling, safety, emergency management, fire prevention, medical equipment, and utilities, as well as many other issues.
When a hospital undergoes its triennial survey, the joint commission requires that the facility commit to at least one performance improvement initiative within each section of the Environment of Care Standards. The issue chosen cannot relate to an action already mandated by the joint commission, and the performance indicator used for each issue must be a quantitative measure of improvement.
In the security field, issues selected for an improvement initiative could include staff knowledge, level of staff participation, monitoring and inspection activities, emergency reporting, and preventive maintenance and testing of security equipment. In terms of quantitative measures, the hospital staff may determine to reduce thefts and track the decrease of thefts to measure its progress. However, the hospital would not be able to institute generator testing or conduct quarterly fire drills as performance initiatives because such measures are already mandated by JCAHO.
The challenge. After conducting an audit, the security director determined that the new theft reduction effort would focus on theft prevention education for employees, training for security officers, a change in officer uniforms, an equipment upgrade, and more involvement with crime prevention through environmental design (CPTED).
Education. Before the theft prevention effort began, employees were unaware of the problem because no strong communication efforts or awareness programs existed to inform them when incidents occurred. As a result, most employees felt that theft would not happen to them, and they saw no need to be careful.
Hospital staff often left their office doors unlocked and their lockers unsecured. It was not unusual to find numerous purses or valuables unsecured and unattended in a single location. In addition, before theft became a focus, vehicles were often left unlocked in the parking areas. About 80 percent of all thefts from 1998 to 2001 were from unsecured vehicles, unlocked offices, and unlocked lockers.
Because so much theft could be prevented by securing personal items, the theft prevention initiative began with a program designed to educate employees about the need to act more responsibly. New employees were given awareness training as a part of their orientation, and all employees were given annual updates and regular reminders through e-mail and internal hospital newsletters.
The new training included a presentation by the security director that outlined theft prevention tips. The training also included a video describing the methods perpetrators were most likely to use in carrying out their crimes. The goal of the program was to educate employees to lock their items in a secure environment. The theme of the training segment was: "If you don't lock it, you may lose it." Employees often received awareness reminders before summer and before the Christmas season--times when thefts had been highest in the past.
After the training sessions began, security officers would "take" unsecured items that might have attracted thieves. These items were locked in the security office. A security officer then notified the employee in person that his or her property had been taken by security. Most employees were shocked to find out how vulnerable their valuables were.
Security training. Before the theft prevention effort, employees were not the only ones in need of theft awareness training. Security officers were also uneducated. Most security officers were in the dark about the amount of theft and were not taught proven security tips that could be shared with the staff.
The lack of officer awareness was due, in part, to the level of training given officers. Security officers received only basic training and no certification. For the most part, security officers functioned in a reactive mode to theft versus a proactive approach, which was needed to promote good security and deter thieves.
Under the new theft reduction program, all KDMC officers were taught theft prevention tips. Officers were told that theft was a specific problem that the security team should strive to curtail.
During department meetings, security officers were informed about the theft problem, and they were told that a goal had been established to reduce the number of thefts on campus by five for the first year. Patrols were increased, and officers were instructed to emphasize prevention by trying to detect and fix security vulnerabilities before thefts occurred.
In addition, all security officers were trained and certified as healthcare security officers under a program offered by the International Association for Healthcare Security and Safety (IAHSS). As a part of this process, the security director guided officers through a self-directed learning program using the IAHSS training manual. The purpose of the learning program was to study and discuss the topics on the exam, such as report writing, patrols, civil law, self-defense, crisis intervention techniques, and physical security.
To earn the certification, each security officer had to pass a closed book examination with an 80 percent score. (As a senior member of the IAHSS, the security director at the hospital was able to administer the test to his staff.) All 15 security officers passed the exam, resulting in an increase in officer morale.
The certification was then used by the hospital's public relations team as a selling point for the institution in brochures and media releases. Information on the certifications was also included in the medical center's internal publications. A number of nurses, physicians, and employees told the security director that they had more confidence in the security department after the certifications were earned.
A new look. To reflect their new professional status, security officers were given new uniforms. Officers had traditionally worn blazers with ties. These were replaced with a dark blue, highly visible traditional officer uniform. The uniform sports a badge as well as a patch with the hospital logo, which also denotes the healthcare security certification accomplishment.
The officers immediately noticed a difference in the perception of staff members. The new look improved security's visibility and, as several officers reported, resulted in fewer conflicts over security procedures. For example, one officer who had continual problems with a hostile patient reported few incidents with that individual after the uniform change.
Technology. Security equipment was also lacking before the improvement program was implemented. The hospital had a basic black-and-white CCTV system that offered poor coverage and was often unreliable. Employees were not notified that a camera system was in use, so the deterrent element generally afforded by a good security camera system was not present.
In addition, the hospital had no electronic access control system. All doors bad to be checked by an officer on patrol during the day, and at night doors had to be locked manually.
The first step in upgrading security equipment was to replace the old CCTV system with approximately 100 high-resolution color cameras. In addition, high-tech dome cameras were added to the exterior to cover parking areas. The hospital purchased high-speed, high-resolution cameras that allowed for better picture quality. For example, a license plate number could be clearly distinguished with the new cameras, a feat that was impossible with the old system.
The cameras feed back to the hospital's control center, where they are monitored at all times by a security officer. The feeds are recorded and stored for several days. The CCTV system was also integrated with alarms to cover sensitive areas within the medical center.
An electronic card access system was installed to restrict access to security-sensitive areas such as the pharmacy and the emergency department. The electronic access system was initially installed only on outside doors. However, the electronic access system now includes more than 120 readers on internal and external doors.
The card reader system was selected to integrate with existing magnetic stripe badges issued by the hospital for time and attendance. The system allows the security department to track who enters each area and also offers a mechanism for quickly deleting the access privileges of terminated employees or changing access levels for employees who are promoted or change departments.
In addition to increasing security, the new system has helped the security department save time. Instead of having to lock and unlock doors manually, a security officer can now do that remotely. In addition, an officer is alerted by an alarm on the computer in the security office when a door is propped open. The access control system is also used to prevent patients and visitors from wandering into areas that are off limits to the public, such as laboratories or locker rooms.
Security also purchased a vehicle to supplement foot patrols, which had become more difficult to complete as the hospital expanded its campus from 12 acres to more than 18 acres from 1998 to 2001. A golf-cart type of security vehicle was not an option because it would have to be driven on city streets several miles each day to various family care centers owned by the hospital and would, therefore, have to be "street-legal." In addition, size was important because security often hauled equipment. A four-wheel drive was considered optimal because security was often charged with picking up critical staff members during winter storms.
With these considerations in mind, security selected a full-sized, four-wheel-drive pick-up truck. The truck is bright red with top-mounted lights and is clearly marked "Security" for added deterrent value.
CPTED. Before the theft prevention initiative, security issues were only addressed after a structure was completed. Stressing the importance of CPTED on hospital safety and security, the security director is now involved from the design phase on construction and renovation projects.
For example, when a new intensive care unit (ICU) and waiting room were recently constructed, security was involved from the beginning of the project. In the old ICU waiting room, theft was frequent because visitors often stayed for days with a loved one, and during that time, they had nowhere to store purses or other valuables. When the new ICU was designed, safes were integrated into the project. Each family visiting the ICU now has control of its own safe. This change has resulted in a significant reduction in thefts.
In another CPTED issue, a simple change of location for the gift shop cash register provided better visibility by the clerk. The move reduced the number of thefts and other problems in the gift shop.
Cost. While the cost of CCTV cameras and the access control system was substantial, those upgrades were part of an overall hospital expansion program, so the budgetary stress on security was minimized. Moreover, many steps that had the biggest impact on theft were not costly. For example, educating security and hospital staff on prevention techniques and certifying security staff offered many rewards but were inexpensive.
Measurement. When the joint commission visited KDMC three years after the theft reduction initiative began, the commission gave security a positive performance evaluation. The JCAHO representative was especially impressed with security's documentation of the program--including theft grid sheets, management plans, annual evaluations, graphs, and hazard vulnerability analyses. In fact, the joint commission surveyor asked for a copy of the hazard vulnerability analysis to present as an example to other hospitals. (@ The analysis is available at Security Management Online.)
The results were as impressive as the documentation. In 1999, the first year of the initiative, theft was reduced to 22 incidents from 30 the year before. During 2000, thefts were down to 18. And, 2001 saw thefts continue to decrease to 16.
A hospital is a complex environment in which to administer security. However, through education, training, equipment upgrades, and security design, KDMC security met its goals, and with the help of senior executives, created a safer hospital for patients, visitors, and staff.
Scott A Hill, CPP, MS., serves as the director of safety and security and as the privacy officer at King's Daughters Medical Center in Ashland, Kentucky. He is a member of ASIS and the International Association for Healthcare Security and Safety. He serves as a Certified Healthcare Protection Administrator (CHPA) and is a vice president for the Kentucky Society for Healthcare Engineers. Hill teaches security at Ashland Community College and works as a consultant for other hospitals.
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| Author: | Hill, Scott A. |
|---|---|
| Publication: | Security Management |
| Geographic Code: | 1USA |
| Date: | Jul 1, 2002 |
| Words: | 2302 |
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