HOSPITAL SECURITY
Emergency Department Ambassador Project
reduces violence By Jeff Young iolence in the workplace has always been a very real area of concern for healthcare environments, and the issue has increasingly drawn the attention of unions, workers, regulatory bodies and the public due to its profound impact on patients, visitors and staff. While the ever-present potential for violence is an unfortunate reality in hospitals, and emergency departments in particular, it is critical that healthcare providers seek opportunities to prevent and respond to incidents of aggression. Looking for possible solutions to this issue, Integrated Protection Services (IPS) piloted the Client Services Ambassador program in partnership with Paladin Security Group Ltd. in late 2014. The program is designed to promote proactive, positive interaction with hospital visitors, by posting emergency department Ambassadors trained to recognize and deescalate potentially aggressive behaviour early; with the goal to reduce violent incidents by building trust and positive rapport between security staff, patients, visitors, and clinical staff. As Ambassadors are also fully trained as Security Officers, they are able to intervene if violent incidents do arise. The Lower Mainland IPS program is responsible for security management for four health organizations serving the Vancouver, BC area: Fraser Health, Providence Health Care, Provincial Health Services Authority and Vancouver Coastal Health. With a combined operating budget of +$7B and approximately 65,000 staff members, the health authorities serve a population of over three million people. Paladin provides a complete range of security services to all four organizations. An inner-city facility in Vancouver, St. Paul’s Hospital (SPH), was selected for the initial trial, following with two
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THE PROGRAM IS DESIGNED TO PROMOTE PROACTIVE, POSITIVE INTERACTION WITH HOSPITAL VISITORS, BY POSTING EMERGENCY DEPARTMENT AMBASSADORS TRAINED TO RECOGNIZE AND DEESCALATE POTENTIALLY AGGRESSIVE BEHAVIOUR EARLY additional locations, Royal Columbian Hospital (RCH) and Surrey Memorial Hospital (SMH) in 2015. The specific hospitals were chosen due to high levels of documented aggression and repeat clientele suffering from addiction and mental health issues. These trials introduced the specialized Ambassador position for 12 hours/day (7 days/week), focused on proactive and positive interactions with all persons utilizing the ED. The ED Ambassador is dressed in a “softer” uniform than other security staff and takes a practical approach to engaging patients who may seem agitated, and is empowered to help, for example, by bringing water, getting the patient a blanket, etc. As well, Ambassadors check on the general wellbeing
of patients in the waiting room and report any concerning observations to clinical staff. Ambassadors are provided with smartphones equipped with a specialized reporting program to document different interaction types with patients, staff and visitors falling within one of four categories: Customer Service/Hospitality; Health/Medical Support; Discharge/Social Support; and Behaviour Mitigation. The findings from the initial trials were overwhelmingly positive. The ED Ambassador works closely with the ED clinical and Social Work team and since the program’s inception, there have been fewer involvements by the regular Security team for evicting discharged patients, and fewer responses to aggression in the ED.
More specifically, the hospitals have seen up to a 40 per cent reduction in physical aggression and 31 per cent reduction in total aggression. Additionally, ED staff have reported an enhanced feeling of safety, with survey scores of staff’s perceptions of their personal safety during the trial period increasing an average of 32.3 per cent amongst the three sites. In all instances of the three pilot projects, it is noteworthy that there were no appreciable decreases in ED patient visits that might otherwise account for some of the observable reductions. Feedback from staff, patients, and visitors has also demonstrated a notable impact. One Registered Nurse observed that “The ambassador program in RCH ED has changed the quality and efficiency of de-escalation and code whites here! This is essential to increase quality of care.” Non-clinical staff have also benefitted, with one BC EHS Paramedic noting that the Ambassador position, “has been a highly clever add on; always professional, courteous, and polite. Speaking on behalf of EHS, we couldn’t do without the Ambassador and only have positive feedback to offer.” This project has garnered much attention and received multiple awards since its inception. In 2016 it received the highest award for workplace health innovation from the Health Employers Association of B.C. (HEABC) and the program was presented during the 2016 world conference for violence in the health sector in Ireland. As well, both Ambassadors at RCH and SMH received awards for quality service from the B.C. Emergency Health Services agency. All three programs are approved for funding through 2017/18, and the project has caught the attention of the Health Authorities’ senior executive team and is now expanding to other sites in BC at the request of exH ecutives and ED staff alike. ■
Jeff Young is Immediate Past-President of the International Association for Healthcare Security & Safety (IAHSS) and VP, Healthcare for PalAmerican Security. www.hospitalnews.com
OCTOBER 2017 HOSPITAL NEWS 31