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Webinar Looks at New OSHA Workplace Violence Directive

Workplace Violent Incidents have been on the rise in several specific organizations, including hospitals, home health organizations, social workers who do in home visit, and also late-night retail stores.

On September 8, 2011, OSHA suddenly released their internal Directive on what their OSHA investigators look for when they go to an organization to investigate a Workplace Violence incident.

Whether the incident involves a domestic violence incident, like when a husband shoots his wife at work; or whether it is patient violence against the Emergency Room nurses, it is a big problem that has been increased over the last 8 years.

We have set up a special no-cost webinar to review the new directive and see what it means for employers. Join us to look at how to protect your organization and make sure your staff, and patients stay safe.



Obesity is Being Subsidized by Federal and County Governments!

Chris Christy is a guy who looks like he is heavy enough to be pre-diabetic, must have high blood pressure, probably high cholesterol, too.

We all know what this fat-syndrome looks like.  Michelle Obama knows, with her emphasis on reducing childhood obesity.  Jamie Oliver knows with his effort to make school cafeterias healthier.

Here’s the DISCONNECT – the federal government is subsidizing unhealthy, bad food that contributes to our national health crisis.  Did you know the government INVENTED high fructose corn syrup to help farmers.  

Local city and county government subsidize bad food in their school cafeterias because it’s easier to let McDonalds make the food, then the ‘cooks’ don’t actually have to cook, just heat up the pre-packaged food.

Watch TV shows like THE BIGGEST LOSER, and see how being overweight causes emotional problems, as well as health problems and you can just go to the local mall to see how prevalent the problem.

It’s SO EASY to eat healthy and get healthy but this healthy message is drowned in government fundings for beef producers, cattle barons, pork producers, chicken farmers and even the salt lobby.

Yes, the SALT LOBBY wants the government to stop telling people they are eating too much salt and to stop setting healthy limits.

I think this country is ready for a nutrition revolution – don’t eliminate the unhealthy choices, but don’t subsidize them!  Take away their free money and food will be right-priced and the country’s energy can go to teaching people about eating healthy.

This is such a frustrating mess, energized by my own lifelong battle with weight –
that some days I want to just walk around the country, door, to door, doing personal health risk assessments – showing people how to eat and cook healthier!

The SALT LOBBY?  Give me a break…



How to Correctly Analyze 100-Year Threats for Risk Assessments

Starting a risk assessment in northern Virginia and going through the threat list they say, “You can take earthquakes out – we don’t have earthquakes here”!

Hey, Haiti didn’t have earthquakes!

Vermont didn’t have major floods!

Connecticut doesn’t have tornados!

Like Murphy’s Law, as soon as you discount a threat, and think, “it will never happen here”, it happens!   The earthquake in the mid-Atlantic in August was a wake-up call for those who that they would never have earthquake damage.

One of the reasons that security risk assessment is so highly valued as an analytical took, and why it’s required by so many governments is because it DOES take into account the 100-year flood, the 75-year drought, etc.

Natural disasters can be so overwhelming, and catastrophic, that they must be considered in any proper risk assessment.  This is why some areas are not suitable for building housing tracts, because they are in a 100-year flood plan.

Because human memories are short, just because YOU haven’t experience a flood
along a meandering creek, doesn’t mean it will never happen.  

Always check the long-term probabilities when you start a risk assessment and make the numbers work for you!



Should Hospital Staff Brings Guns to Work with Them?

Should hospital staff bring guns to work with them?

At a time when many hospital security departments have unarmed security officers, and some departments don’t even allow the use of mace, changes in state laws allow hospital staff in some states to bring their guns to work with them.

This turn-around, where the nurses may have guns – and security officers do not, has created a big, contentious debate in the security community.

In a recent paper printed in the Journal of Healthcare Safety and Security, my co-author, Jim Sawyer and I discuss the different elements of this debate and whether this is a constitutional issue, or a real threat-risk issue.

Here’s an excerpt,

Violence is not a concept that people usually associate with hospitals.  For years, hospitals have been seen as almost a sanctuary of care for the sick and wounded in our society.   However, the perception of hospitals has been changing over the last fifteen years due to a variety of factors.

or you can read the entire article (below). 

Critical Issues on Gun Violence in the Hospital Workplace

By James Sawyer and Caroline Ramsey-Hamilton

 Background

 Every reader knows that violence in hospitals is increasing at an increasing rate.  The Joint Commission has issued Sentinel Alerts, the Journal of the American Medical Association, the bastion of the American healthcare system, published an article in October, 2010, written by two doctors about the murder-suicide at Johns Hopkins Hospital in September of 20101.. 

This article started as a guest blog from a security professional at a west coast children’s hospital.  After the blog appeared, we received dozens of notes, letters and angry outbursts, as well as emails arguing for a more reasoned approach.  This article will explore those issues, and includes quotes from the emails themselves.

Why Violence in Hospitals is Increasing

Violence is not a concept that people usually associate with hospitals.  For years, hospitals have been seen as almost a sanctuary of care for the sick and wounded in our society.   However, the perception of hospitals has been changing over the last fifteen years due to a variety of factors.

  1.  Doctors are no longer thought of as “Gods”.  This means they are
          are more easily blamed when a patient’s condition deteriorates.
     
  2. Hospitals are now regarded as businesses.  This perception has been
           been aggravated by television in shows like a recent “60 Minutes”, as well as
           by the effects of the recession on jobs and the loss of health insurance.
  3. Lack of respect and resources (funding) for hospital security departments
       .  Rather than being seen as a crucial protection for the hospital staff and
          patients, many security departments are chronically underfunded and used
          for a variety of non- security functions, such as making bank deposits for
          the hospital gift shop. 

A Dirty Little Secret about Reporting
The U.S. Department of Labor tasks OSHA with workplace violence information, but there is not one sanction against it, it says right on the OSHA web site that this is solely left up to the employer.  It makes it hard for hospitals to justify spending money on workplace violence prevention, if it is not a standard, and a major compliance issue (as it should be).  And here is a dirty little secret for looking at the statistics, OSHA does not count domestic incidents (like homicides) that take place in hospitals as officially “workplace violence incidents”, instead they are counted in another system.  Similarly, many hospitals don’t count staff to patient violence incidents, or patient to patient incidents.  These practices create a false impression of the actual number of violent incidents, by reporting only a fraction of the actual events.

 Gun Violence Represents a Significant Security Challenge

The prevention of gun violence in hospitals and the hospital as workplace may well be the most challenging issue for hospital security professionals in the foreseeable future.  What are some of the reasons for this growing concern?  There are many and they include:

 1.   The sheer numbers and easy availability of guns.  There are over 270 million guns in circulation in theUnited Statesand the numbers continue to grow.  After the 2008 election,  gun ownership surged and in some areas of the country, guns sold at such a pace that retailers literally ran out of ammunition. 

2.  Approximately a 100 people a day die from gunfire in the United States and an individual is shot approximately every twenty-two seconds.

3.  One in four Americans suffer from some form of mental illness, according to the Federal government. 

 4.  The U.S. is living in an era of economic instability, following the 2008 recession and the erosion of the middle class.  The Wall Street-triggered economic meltdown has propelled what was a slow steady decline into economic apocalypse for millions of Americans.  This has resulted in an environment of record home foreclosures, record personal debt, record banktupcy, record unemployment and record numbers of homeless individuals.

5.  The reluctance on the part of many hospitals to install magnetometers and limit entrances to hospitals so that the flow of guns into hospitals can be controlled.

The U.S. gun lobby has been very successful in pushing and supporting state legislation which permits guns in the workplace, and on college campuses.

It is a serious mistake for security professionals to deride,  make light of, or dismiss this surge of pro-gun-at-work-and-school legislation.  These laws are getting passed (see Texas, Indiana, and Tennessee), and the likely result is that we will see an ever greater numbers of guns at work, and if our work is in the hospital, then the guns will be coming to work here, too. 

Guns aren’t just increasing in numbers, but they are getting more lethal and currently 30- shot clips and armor piercing bullets are readily available for the civilian population.  Citizens can now buy weapons that rival what is found in military armories.   These lethal weapons again present a sentinel challenge to security professionals.

 Most security directors remember life when Space Invaders was the only video game around.  Now children are exposed to violent images from a very early age.  Children and teenagers sit entranced watching endless hours of violent programming where gun violence is choreographed in slow motion action scenes where the scripted hero’s miraculously avoid injury even while they are dispatching the prime time  villains while showcasing their amazing gun prowess.  

By the time they show up at your hospital, the average child over 18 years of age will have viewed over 45,000 murders and 200,000 acts of violence just on television! This grim tally does not account for the high octane bloodshed and slaughter that make up the majority of the most popular video games.  

All of these factors suggest that the prevention of gun violence in our hospitals will become our premier challenge.  Many hospitals are already hosting ‘active shooter’ seminars to teach hospital staff how to deal with  “shooters in the workplace”.  This subject promises to become a cottage industry for consultants and violence prevention professionals.

As hospital security professionals, there are some strong, prevention-based practices that we can implement and develop that drastically reduce the chances of gun violence in the workplace.  Some of these best practices include:

 1. Acknowledge the reality and the persuasiveness of the U.S. gun culture.

 2.  Develop a strong, multi-department workplace/domestic violence response team at your facility, and make sure that both Human Resources, and Security are part of this team.

 3.  Develop a written workplace violence plan that is reviewed annually.

 4.  Do an annual  baseline workplace violence assessment that you can build on.

 5.  Have your workplace/domestic violence response team respond and meet within 4 hours of any  reported incident.  Have a response plan/action plan in place within 24 hours.

 6.  Encourage reporting of all workplace/domestic violence incidents to the police – without exception.

 7.  Run background checks of individuals of concern.  Information is light and a background check may provide you with crucial information. Obtain orders of protection – anti-harassment orders against individuals of concern.  Security should take the lead here.

 8.  Flag problem patients – problem families – have a “red alert” or a “red flag” program that alerts – tips off – advises both the care team and security that a potential problem exists.  This is especially important if the patient/family member has a history of violence.

 9.  Build a workplace culture where verbal threats are reported.  Have Security immediately investigate all verbal threats.  Make sure that Human Resources is fully informed of any situation involving threats.

 10.  Post  large, prominent“No-Weapons” signs at your facility – especially in parking lots, perimeter areas and all main entrances.

 11.  Officially prohibit staff from bringing firearms to work.

 12.   Offer annual violence prevention and threat awareness training to all staff.

 13.   Require workplace violence training – either on line or via classroom training for all new staff and annual retraining.

 14.   Have security involved and part of the planning for all “problem” terminations.   Note – Advise Human Resources to never terminate a disgruntled staff without strong pre-planning.

 15.  Screen all hospital patients and visitors.  Develop a major entrance screening program for your institution.  Knowing who is inside your facility is a critical part of any good prevention program.

 These pro-active solutions  will support and enhance a hospital gun violence prevention program.  Let me state again, it is critically important to have a hospital gun violence prevention program in place.

 AND IN RESPONSE

 Here are some of the comments that were received by other hospital security professionals around the country, after the original blog post.

 “Please remove me from your mailing list immediately.  Apparently the letter below blames the firearm and not the person holding it and putting 5-7 lbs of pressure on the trigger with their index finger.  I find it difficult to separate the “Spirit of the Security Community and our commitment to safety and protection” from this attack on my Second Amendment rights.”               

                                                           — Hospital Security Director in the Northwest

“I believe we should focus our attention, and when I say attention I actually mean money, on mental health resources (or the lack there of) and domestic violence issues, which quite often lead to fatal shootings.  Our emergency rooms have become a revolving door for patients with drug abuse, depression and other psychological issues and there appears to be very little our legislators and community/government leaders are doing about it.  To me, that is the real injustice and crime related to the firearm issue!                                              
                                                                   — Hospital Security Director in the Midwest

 “I would agree with the individual that I don’t believe there is a place in hospitals, government buildings and places of worship for guns; however if there had been guns on some of the college campuses, maybe there wouldn’t of been the blood baths they turned into.                                                       
                                                                –  Security Analyst – Washington DC

“As for firearms being banned from the workplace, I agree.  Policies and procedure should dictate along with a severe disciplinary, then handle accordingly.  Just that simple.”
Let’s clean it up, let’s clean up America!  Let’s lessen the need for firearms to be in the hands of thugs as well as those who just want to feel safe.    The FIRST STEP would be to BAN and make it ILLEGAL for businesses to sell paraphernalia, pornographic anything, strip clubs, places that promote alcohol and drug use, etc. 

Let’s Clean That Up!  …something that is tangible and promotes drug and alcohol use as well as many other criminal actions just to run these types of businesses.  Let’s make that illegal.  Let’s get Americans involved in the real issues of illegal firearms and drugs coming into this Country.    All law enforcement know that it takes big money to keep drugs coming into this Country.      Disarming America. RIDICULOUS.    Keeping firearms away from the workplace, understandable.

                                                    — Ex Army, Ex-Police, Hospital Security Officer

 

 Conclusion
While the issue of “gun control” is both a “hot button” and simultaneously,  a topic that is seemingly a forbidden or taboo matter for hospital security professionals.  It should not be this way.  Questioning the wisdom of allowing citizens to buy 30-round clips for semi-automatic handguns and keeping assault rifles at home is not a crazy liberal rant, it is a reasonable, non-political position.

Challenging the wisdom, if not the sanity, of the current flood of legislation that both allows and actually encourages guns in the workplace is neither “liberal” or “radical” – but pragmatic and grounded.   Hospital security professionals are the vanguard for progressive crime prevention education and development in the United States.  This is a mandate and responsibility that we all share.  How we respond and learn to protect our staff, our hospitals and our patients from this senseless violence may prove to be our greatest and most important challenge.

 www.riskwatch.com               www.caroline-hamilton.com



Risk Assessment: How about Giving Guns Back to Former Mental Patients

A recent New York Times article explained that a provision tucked in a bill to make it harder for people diagnosed with mental illness to possess firearms, actually restores the rights of mental health patients to get their firearms back. The legislation was passed after the massacre at Virginia Tech in 2007.

One of the main elements of risk assessment is a quantitative (meaning = real numbers) on what has happened in the past. Looking at 2 or 3 years of incident reports, for example, show how many times there has been an incident involving gun violence in a particular neighborhood, city or organization.

Another element is the history of a particular individual to see whether individuals with a diagnosed history of mental illness are MORE OR LESS likely to trigger (forgive the pun) – a violent incident.

If we run that scenario, we will find that individuals who previously had a violent incident with a firearm are MORE LIKELY than the standard population to have another incident.
And that especially holds true if other threat indicators are present, for example:

Termination from a Job
Romantic Difficulties
Foreclosure
Difficult Economy

There is a ‘risk multiplier’ effect that takes place that makes the risk higher. By combining different sets of threat categories with areas of weakness, we are create general predictions on the likelihood of repeated violent incidents.

Do the math – it doesn’t make sense for people with a history of mental illness to
get their guns back!



Lessons I Learned from little Caylee Anthony

Caylee Anthony and Lessons Learned

Everyone who has watched this case found it compelling and fascinating – like watching a cobra ready to strike.

This case caught my attention right in the beginning, and what a great job #Nancy Grace and HLN did in keeping the pressure on, assisting with the search in the beginning, and actually finding photos, etc.

My daughter-in-law wasn’t pregnant when this trial started, but now she and my son have 18-month old twins, and we are all watching this trial together.    I started out disliking the Anthony parents, but now that I’ve seen Cindy and George break down on the stand and now that I understand the critical role of grandparents, I have sympathy for them.

Here’s what my lessons learned include:

1.  If you are a grandparent and thinking something is wrong – don’t wait.  Who 
     cares if your child thinks you’re nuts, you are an advocate for a child too young to
     protect themselves.   Grandparents can save the lives of their grandchildren when
     young parents are overwhelmed.

2.  Lock up the swimming pool.   Whether it’s an in ground or above-ground pool – it’s
     too dangerous for children who can’t swim.  Take extraordinary steps to keep that pool
     out of reach of any children.

3.  Don’t tolerate lying from your children when they are young.  This must be a
     lesson that is taught when children are young.  Lying is not right, and not acceptable. 
     When you in your twenties, or even in high school, it’s too late.  This tragedy was
     compounded by the constant lies of Casey Anthony.

4.  Love and enjoy your children every day because life is uncertain and you may
     never get another chance to say how much you love them, and how much they add
     to your life!



Unsnarling political differences based on Type preferences

A key component of decision making is laying out all the options to make an informed decision.

Watching the angst of the political parties trying to solve the debt problem shows that they are both charging around saying their favorite rallying cries, which does not promote dialogue, but just inflames the other party.

Think of these two parties, Dems and Repubs, as made up of two TYPES of individuals.  The MBTI (Myers Briggs Type Indicator) personality test is made up of 16 distinct types of people and you can summarize and put them into two main groups – the Traditionalists and the Innovators.

See if this sounds familiar – Traditionalists like for things to stay the same, they always support the status quo.  They dislike change for change’s sake, so they don’t want to raise taxes.  They like to keep a strong sense of order so they
are often military, law enforcement, corporate titans, etc.
  They are often presidents of associations and organizations and they are great at keeping things running efficiently.

Innovators want to explore and try new things – in life AND in politics. They want to get out of Afghanistan and put in a new tax structure, and reinvent old institutions, instead of cherishing them, as the Traditionals do.

Both these groups have great contributions that they make to society – Traditionals keep things organized and running and Innovators find new, better ways of doing things.

Innovators are always searching for the next new thing so it’s so coincidence that
California has more than it’s statistical share of Innovators – they keep kept going west, and kept looking until stopped by the Pacific ocean.

Type preferences are set before you are 5 years old and indicate preferences for your entire life.  I am already seeing types emerge from watching toddlers under the age of 2.

When you understand the values of the other party, according to type preferences, you can have a more civil dialogue because you can now understand where the other side is coming from, so to speak. 

You can find out which type you are,  or just find out more about the MBTI at www.myersbriggs.org.



The REAL VALUE of a Hospital Security Program

Violence in hospitals and against healthcare staff has been steadily increasing since 2004. A recent article in the Journal of the American Medical Association (JAMA), cited the National Institute for Occupational Safety and Health, NIOSH publication 2002-101, which indicated that healthcare workers face four times the violence potential as other occupations.

If you add in the many domestic violence cases that play out in our hospitals, you can double or triple that figure. For reporting purposes, OSHA does not count domestic incidents (like murders) that take place in hospitals as officially “workplace violence incidents”.

Anecdotal incidents such as the shooting of a physician at Johns Hopkins Hospital in Baltimore, Maryland in September, 2010, and the January 1st, 2011 stabbing murder of an engineer at Suburban Hospital in Maryland by an employee angry because he didn’t get a good performance evaluation, keep the issue on the front pages, and cause hospital staff to worry about their personal safety.

The Joint Commission issued a Sentinel Event Alert in June 2010, on violence in hospitals and how it can affect both staff and the patients themselves. Nurses are on the front lines, and they are the most likely to be attacked, a fact which has not been lost on the nurse’s associations who are actively lobbying for safer working conditions.

Workplace violence issues were traditionally something handled in the Department of Human Resources, but security departments are increasingly involved in violent incidents and are critical to safeguarding hospitals.

Why Violence in Hospitals is Increasing

Violence is not a concept that people usually associate with hospitals. For years, hospitals have been seen as almost a sanctuary of care for the sick and wounded in our society. However, the perception of hospitals has been changing over the last fifteen years due to a variety of factors.

1. Doctors are no longer thought of as “Gods”. This means they are
are more easily blamed when a patient’s condition deteriorates.

2. Hospitals are now regarded as businesses. This perception has been
been aggravated by television in shows like a recent “60 Minutes”, as well as
by the effects of the recession on jobs and the loss of health insurance.

3. Lack of respect and resources (funding) for hospital security departments
. Rather than being seen as a crucial protection for the hospital staff and
patients, many security departments are chronically underfunded and used
for a variety of non- security functions, such as making bank deposits for
the hospital gift shop.

4. Resistance to Visitor Management programs in many hospitals. Again,
because of the unsettling effect of the recession, violent solutions are
becoming more common in the United States in general, for example, the
recent Tucson tragedy.

The federal government issued a guidance document for dealing with violence issues in healthcare,
OSHA 3148.01R, 2004, Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers

The Evolution of the Hospital Security Program

Even as recently as five years ago, many hospitals didn’t have a Security Director, instead they used the Safety Officer to double up and handle security. However, the Joint Commission and many professional hospital organizations recommend the formation of the Security Director position.

Now every almost every hospital has a Security Director who oversees the various security functions at the hospital. These cover a wide range of duties including managing either a contract security force, or developing and managing a proprietary security force; managing violent patients in the Emergency Department; managing incidents regarding kidnapping, infant abduction, cash handling, helicopter coordination, handling admission of prisoners, monitoring visitors, managing hundreds of cars and garages, dealing with harassment, sexual assaults and domestic violence issues which end up at the hospital.

As the Security Director has assumed responsibility for an expanded list of duties, the security budget has not always kept pace with the expansion of the security function.

Assessing the Value of Security to the Functioning of the Hospital

When we start to assess the value of the security program to a hospital, we have to start with the total value of the hospital.

One of the greatest surprises we find in conducting risk assessments on hospitals, is that they possess tremendous value but because they are so large, and perform so many different functions, individuals can’t always see the hospital as a whole.

To make it easy to understand, we can breakdown the value of a hospital into its component parts:

1. The value of the Facility – this is the current replacement value of the building, usually over 50 million dollars.

2. The value of the hospital Staff, including both administrative and medical staff members (use the value of their salaries for a year).

3. The value of specialized medical equipment, including all
the IT systems, X-rays, Cat scans, MRIs, and medical lasers, photon knives, etc.

4. The value of the actual revenue from the patients.

5. The value of the patient’s safety and their health information.

You can see that when we add up these asset values, and add another 10-12 categories, the hospital usually ends up with a value of $100 million to $500 million, or often higher. That is the total of the assets that are potentially ‘at risk’.

That is the value that the security function protects. Each of these asset categories can potentially experience a loss that would interrupt their operations, either for a limited time (like a gang fight in the lobby; or a theft of pharmaceuticals), or permanently (for example, a catastrophic fire).

The next step in the analysis is the see what kinds of controls are already in place to protect all these assets. Controls are mandated by a variety of federal, state and local laws, as well as best practices from insurance companies, and standards created by industry associations such as the Joint Commission, the Center for Missing and Endangered Children, the International Association of Hospital Security and Safety.



TSA – Why pat-downs are ridiculous and after 9 years – they still can’t spell R*I*S*K management. Follow the money.

TSA – Why pat-downs are ridiculous and after 9 years – they still can’t spell R*I*S*K management. Follow the money.




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