The Agilient team of security consultants have many years of experience in providing best-practice security solutions to Hospitals, Health Centres, Local Health Districts, Health Departments and private Health Care Companies.
This article is based on Agilient’s experience in working with the Heath Sector and has been provided to help improve the security and safety of staff and patients in hospitals.
Occupational violence within our Hospitals is a systemic issue, influenced by complex, multi-faceted factors. According to the Health Services Union (HSU) NSW Secretary Gerard Hayes, around 40 Hospital staff are assaulted every month. In the past seven months alone at least two Hospital guards have been stabbed, while in June this year three nurses were attacked by a patient armed with scissors at Royal Prince Alfred Hospital. In 2014, spinal surgeon Michael Wong was stabbed 14 times by a mentally ill patient and is now using his voice to campaign fiercely for those less fortunate, including cardiothoracic surgeon Dr Patrick Pritzwald-Stegmann, who was fatally assaulted in the foyer of Box Hill Hospital in 2017. Hospital staff have had enough, Hayes explains, after seeing “too many people stabbed, too many people shot, too many people who have been spat upon or punched, too many people getting PTSD because they went to work”.
Demonstrating their support, earlier this year over 500 NSW Health Services Union delegates voted unanimously to strike for four hours on August 1. The strike went ahead, with staff from Hospitals including Westmead Hospital, Royal North Shore, Randwick Hospital, Blacktown Hospital and Nepean Hospital participating. Security staff, allied health, catering, administration staff and paramedics alike took part to raise awareness of the growing Hospital security crisis.
Between 2010 and 2018 the number of Hospital Security staff has risen from 974 to 1243, representing a 27% increase over 8 years. Considering this, the HSU is calling for at least 250 more security guards across the state. There are also demands for these guards to be given extra constable powers. Additionally, while the Government has spent around $19 million on security works in NSW Hospitals so far, Hayes is calling for a further $50 million injection to address the crisis. This investment would go towards developing proactive security teams at Hospitals, including special training for guards in areas of mental health and substance abuse, equipping them with appropriate resources, introducing de-escalation methods and minimising aggravation.
Despite Hayes’ vow to maintain industrial action until something changes, the Union has warned that no action will be taken until the final review from Peter Anderson is released later this year.
Understanding the Sources of Violence
There is a melting pot of reasons why staff face such unprecedented levels of violence within Hospitals, each wrought with complexity and social influence. It ranges from patients with drug-induced psychosis, intoxication, mentally ill patients, cognitive impairments, dementia and delirium, drug seekers and more. It even relates to poorly designed waiting areas, as certain patients aren’t able to be separated in order to prevent injury to staff or other patients.
Interestingly, in some cases the issue isn’t where the patients end up, but rather where they’ve come from. Senior Security Advisor for Metro South Health, Nigel Armstrong, explains that Police Stations have become stricter on who they will detain, preferring to bring certain people to a Hospital if they present with at-risk indicators. This means essentially that “Hospitals have become the end of the line for some badly behaved or aggressive people previously dealt with in a police watchhouse”, Armstrong states.
Other experts have pointed out that patients appear to have a unique understanding of their rights and Hospital protocol and are not afraid to use this knowledge in order to intimidate clinical and security staff. From this, aggressors tend to gain confidence when staff hesitate to address their violence, knowing they prefer to avoid reporting incidents through the Incident Information Management System (IIMS).
The President of the Australian Medical Association, Tony Bartone has stated that the violence within Hospitals is an “extremely worrying development”, linking it to an increase in the number of drug and alcohol affected people arriving at Hospitals. Add to this the lack of effective mental health and drug and alcohol community services availability, and you have Emergency Departments flooded with violent, confused patients with nowhere else to go.
Other common sources of occupational violence within the health setting include frustrated, agitated, uncomfortable patients and family members who are forced to bear long wait times in tense environments, with little information being relayed to them. Dr Simon Judkins, the President of the Australasian College of Emergency Medicine, explains that there is a distinct link between the length of time patients are waiting in Emergency Departments and the escalation in their behaviour.
Understanding the Response to Violence
Unfortunately, this perpetual violence has permeated the organisational culture within many Hospitals, leading to an attitude of tolerance – a notion that violence is simply part of the job. In a recent security review of the NSW Health Emergency Department, it was found that staff had often become “inured, if not immune” to verbal aggression, anti-social behaviour and generally poor patient and public conduct. Indeed, Armstrong finds that often clinicians will try to justify a patients violence, choosing to focus on the intent of the aggressor rather than the outcome.
These “business as usual” types, as security expert Troy Park explains, simply accept violence as a part of the job and will rarely report it, particularly because it is time consuming and often pointless to do so. Indeed, a recent Taskforce Report from WorkSafe Victoria honed in on this lack of reporting, attributing it to a number of factors including culture, lack of feedback and follow up and the ineffectiveness of existing reporting mechanisms.
Another issue is the lack of appreciation and understanding for the roles and responsibilities of Security Officers. Security Consultant Scott Brown emphasises that Hospitals often fail to empower their security teams, emasculating them and making them feel unsupported in their use of reasonable and necessary force. There is a significant divide between clinicians and security staff, perpetuated by a distinct lack of integration and understanding between the two. In particular, many clinicians are unsure of the security team’s responsibilities, legislative mandates and methods and therefore can sometimes become unsupportive and critical.
What Can Be Done?
Acknowledge and Evolve
The first step towards addressing this systemic issue is to acknowledge and accept it. Government, staff and the public alike must accept that clinicians and guards are facing unacceptable and ever-growing levels of violence in their day to day jobs. Part of this acknowledgment involves understanding why Security Officers are important and why they need to be supported, well equipped and respected in their roles.
In acknowledging the violence, you must then equip your staff against it. While many experts will agree that handcuffs are necessary, having been proven to assist in the management of acute behaviour, there is little consistency when it comes to other tools such as body cams, stab resistant vests, soft shields and soft restraints, batons and pepper spray.
Interestingly, Armstrong emphasises the fact that what Security Officers need today is vastly different from 5 years ago and will be vastly different again in the next 5 years. He understands that eventually there may even be the potential need for tasers or armed guards, considering the heightened threat from fixated persons, terrorism and more.
Enhance Understanding, Training and Education Between All Staff
It is vital that clinicians, the public and Security Officers alike understand the rights, responsibilities and powers a Security Officer has within Hospitals. Arguably, security staff are given sufficient legislative powers to effectively carry out their role, yet they are often prevented from enforcing these laws in one way or another, and are poorly supported in their duties.
To prevent misunderstandings and tensions between staff in violent situations, there needs to be enhanced education and advocacy of the security team’s role within a Hospital. Part of this will involve addressing the disparity between hospital policy (wanting non-violent approaches to violent situations) and the law. Another method of achieving this integration is to help clinical staff to feel more involved in the process of security, for example by seeking their insight during the recruitment, training and development of security teams.
Importantly, clinical staff should feel confident in the skills and competencies of their security staff. Therefore, another vital step in improving the security of Hospitals in the long term is to recognise the skills required to work in Hospital security and then offer appropriate, specialised and ongoing training in de-escalation, self-defence, WHS and Security Risk Management and more.
Importantly, the training, licensing and education of Security Officers must have a strong focus on the unique threats, risk and hazards that are present in a healthcare environment. As part of this, Armstrong suggests that mentoring or apprentice schemes be developed to recognise that Hospital Security is a specialised area and should be treated as such.
Enable Security Officers
Similarly, it is important to give Security Officers a voice, to utilise their valuable input and empower them to fulfil their duties. Brown emphasises the importance of developing a recruitment strategy that embeds a “proactive, informed and professional security management structure within every Hospital, which encourages the security team to be proactive, to train on their own time and to maintain a high level of operational fitness and skills to address the job requirements”.
This concept permeates all levels and elements of security; from implementing policies and procedures that have direct security input, to wearing uniforms that lend a sense of authority and inspire respect from patients and clinicians. Going further, some experts suggest including a Security Manager in the NSW Ministry of Health, while others point to the re-introduction of Special Constables amongst security teams, ensuring that officers could act solely under the law and are answerable to it for their actions. Significantly boosting the number and training of security staff within Hospitals is another well supported idea.
Regardless of how it is achieved, the aim of this strategy is to introduce a concentrated platform of security within Hospitals, to abolish the idea that security is merely an after-thought, and to empower the security teams to perform to the best of their abilities and responsibilities in a supportive and integrated environment. The benefits of this would be numerous and would trickle down into many areas, from recruitment to public perception and further.
Enhancing the levels of reporting is vital in changing organisational culture and the public attitude towards violence. Currently, reporting systems are inefficient, time-intensive and too internalised. To change this, reporting any level of assault and obtaining an incident number from the NSW Police should be mandatory. Additionally, new incident reporting and recording systems should be introduced that use a central database that is able to identify high risk areas and typology. This type of reporting will improve the way the health sector “prevents, responds to and learns from incidents of violence”.
Find a Standard, Cater to it and Enforce it
Hospital management needs to take the time to define different levels of violence, set their levels of tolerance, outline their triggers and then design clear responses at every level. This is a way of creating measured responses that can be easily followed and understood by all staff.
Additionally, this vital process can be made simpler by taking best practice examples from across Australia. This would involve analysing why certain security teams work well, what their policies and procedures are, how they go about advocating for security, then developing best practice policies based on this and recruiting accordingly. Adding to this process could be a concerted effort from the Government to set up an independent Hospital Security Board or Panel, then developing an Expert Security Panel from this. Using this Panel, the Government could then roll out education, training and implementation of best practice security teams within NSW Health.
Legislative and Regulatory Changes
Experts argue that differing levels of legislative and regulatory changes are required in order to enhance the security within NSW Hospitals. Many would agree that a new specialised licensing system should be introduced for Hospital Security specifically that focuses on mental health, customer care, de-escalation and practical training. Another less controversial reform that has been suggested is to focus on more efficiently prosecuting occupational violence offenders.
Other changes are more complex and contentious. While some experts have suggested that Hospital Security Officers should be able to arrest on suspicion, others focus on allowing the security staff to have slightly enhanced powers of arrest. For some time, there has been significant discussion around introducing ‘Special Constable’ powers through a specialised Security Health Act, although the idea has been explicitly rejected by Peter Anderson in his Interim Report.
Interestingly, another expert suggests that security staff should have a legal indemnity from prosecution in matters such as detaining persons not under the Mental Health Act 2007, as long as they are acting under the direction of a Doctor and in good faith.
The growing levels of violence faced by staff within Hospitals around Australia is a frightening trend that has disrupted the ability of these professionals to care for and protect their patients and has even limited the access patients have to this care.
It is important to recognise how Hospital security differs from other types of security. Essentially, no other public law enforcement agency or private security operators deal with the level of hands-on control and restraint of members of the public as Hospital security staff do. For example, statistics show that Hospitals across NSW can average between seven to eleven hands-on restraints per day.
On top of these numbers, clinical and security staff are handling people with a variety of health issues, from brain injuries, mental health, drug overdoses, intense emotional responses and more, inherently making the management these kinds of situations incredibly difficult and complex. Despite these unique challenges, it is vital that the issue is acknowledged and understood sooner rather than later. Effective and workable strategies must be introduced that tackle the issue at every level.
Agilient provides security services to the Health Sector in the following areas:
- Dealing with Aggressive and Violent Clients;
- Health Protective Security;
- Health IT Systems Penetration Testing;
- Health Related Business Continuity Planning;
- Health Cyber Security; and
- Health IT Governance.
Agilient places a strong emphasis on understanding and addressing our clients’ security needs, by contextualising their risks, evaluating their needs and options and ultimately producing effective security policies and strategies. Specifically, Agilient offers a variety of security services to the Hospital and Health industry, including:
- Comprehensive Health Service Security Review.
- Hospital Security Review.
- Formal Health Security Assurance Review.
- Hospital Security Risk Assessments and/or Review.
- Hospital Threat and Risk Assessments.
- Hospital and Health Service Threat and Risk Methodology.
- Health Service Security Risk Assessment.
- Hospital Protective Security Risk Review.
- Security Risk, and Associated Hospital Risk Controls Assessment.
- Hospital Business Impact Analysis.
These security services are designed to help Agilient to understand our client; their risk profile, and current security approach and the specific challenges they face, all so we can help to develop a strong and effective security policy and minimise or eliminate risk. Contact Agilient today to request an assessment and see how Agilient can help.
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