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The Conflicting Roles of Hospital Security

The Conflicting Roles of Hospital Security
Next to teaching fifth or sixth grade, I think hospital security might be one of the most difficult jobs out there. I find it truly fascinating how differently hospitals define who and what the purpose of their security team is.

Some hospitals define the role, responsibility, or purpose of their security teams as “enforcement”—security staff are viewed as enforcers of the rules, policies, and procedures of the hospital. Others see their security staff as partners in the patient care process. Finally, there is a group of you reading this saying, “What security?”

More and more, I find myself leading the discussion on training within hospitals with “In your facility, what is the role and responsibility of the security staff?”

The competing identities surface right away and it’s not unusual to get two or three different responses depending on who you’re asking.

Throughout my entire tenure at CPI, this has been a sticky spot for hospitals. From one extreme— “We just call security and they handle it” to the other—“We don’t want security to respond; they don’t have a patient care focus,” it’s been a lively and interesting struggle to be a part of. To add to the mix, ask the security staff and you hear, “They refuse to handle anything and then yell at us when we arrive” or “We want to get there earlier so we can try to de-escalate the situation but the nurse just yells ‘Take them down’ when we’re trying to calm them down.”

Of course this is not the case in all hospitals, but the tension and the silos exist. Here are a few tips for breaking down the walls between the groups in the hospital and creating a culture where safety is paramount and everyone’s responsibility.
 
  1. Define the Role and Hire, Train, and Develop to the Role.
    What is the vision you have for your security—whoever they are? The security personnel I speak with take their roles very seriously, however they are defined. Take time and evaluate not only your hospital’s mission and vision, but how that all fits together with the need to balance individuals’ care and welfare with safety and security.

    Most security teams also see themselves as extensions of the patient care team. Many hospitals hire security professionals that are part-time or retired law enforcement, military, or corrections officers. Of course this makes sense, but how are you educating them on the difference between addressing criminal behavior and addressing behaviors driven by mental health diseases, medical complications, or declining cognition?

  2. Create Intentional Partnerships.
    One place you can start to create a more united response is by having your training team be a multidisciplinary team. So having the trainer from your behavioral health unit training alongside your security staff for the staff in the emergency department develops a wider range of application of the core concepts to a variety of situations and perspectives.

    At the end of the day, behavior is behavior whether it’s taking place in the parking lot, the emergency department, the maternity ward, the ICU, or the behavioral health unit. If we work collaboratively to recognize the early warning signs and respond from a like approach, we stand a much greater chance at successfully de-escalating situations as they occur.

    You can create an intentional partnership with a review team as well. All incidents should be reviewed as learning opportunities. Having a multidisciplinary team conduct the debriefing and review of situations can also foster teamwork among departments.

  3. Set Realistic Expectations.
    Because security personnel have other responsibilities at the hospital that are not related to the patient care aspect of de-escalating or managing crisis situations, we need to be realistic about our expectations for them to serve as primary responders.

    I have been in many a hospital with multiple floors and units that have two to three officers on at a time responsible for the entire building and the outside perimeter. If they are the only ones in the hospital that are expected to handle an escalating patient or visitor, I can assure that there will come a day when there are too many situations happening at once for them to cover everything.

    Everyone can be a part of a crisis response team, and everyone should be expected to work at preventing workplace violence in healthcare. The other option is to increase staffing or to create a layer of responders whose primary responsibilities become milieu management.

  4. Tie It All to a Common Goal.
    If we expect direct care or service providers to work cooperatively and collaboratively on this task of preventing workplace violence and improving the patient experience and outcomes, then we have to start by modeling that in our leadership teams.

    Tie all decisions back to that nonviolence statement your hospital has (or I hope you have). Establish a goal for each department related back to the corporate goal of preventing workplace violence and safely managing assaultive and disruptive behavior. Make sure you have a great solid corporate policy on preventing violence in your workplace. (Need a template? Get our Workplace Violence Prevention and Response Policies and Procedures Template.)

I’m sure my bias for seeing security as part of the patient care process is evident. This comes largely from my belief that a culture of collaboration and cooperation is ultimately more productive at improving outcomes than an environment built around the use of force and coercive displays of authority. I am not in any way saying those approaches aren’t ever successful or even beneficial, but I think ultimately balancing Care, Welfare, Safety, and SecuritySM is more easily achieved when we empower others to be in control of their own behaviors. 

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