We recently sat down with Ryan King, Corporate Manager of Security, Safety and Emergency Management to discuss how hospital security leaders are addressing major industry challenges and what forward thinkers in the industry are doing. 

An Expert's Approach

Can you tell us a little about yourself and your background?

I have been in the healthcare security industry for 20 years, all of which has been spent in different healthcare systems around Florida. I’ve been a member and held positions of leadership in IAHSS (International Association of Healthcare Security and Safety) since 2009. In college, I attained my Masters in Criminal Justice and Security Administration, and a Bachelors in Information Technology. I currently oversee Security, Safety and Emergency Management in a large healthcare system.

How would you describe your approach to security?

I approach Security as more of a business entity than many. We are in the business of loss prevention, however the definition is expanded from traditional roles. We center our mission around preventing loss of not only goods, but services, staff safety, patient safety, reputation, and community risk related to the patients and communities we serve.

How has it changed in recent years?

I have watched over the past 15 years and seen two major shifts in the Healthcare Security Industry. We are becoming closer to the model of campus police like you would find at universities or larger campuses. At the same time, our approach has to be balanced with business management as well. Risk Avoidance, Project Management, ROI calculations, Business Analytics. Also, you must have experience in Safety and Emergency Management as these are often overseen by the security Department as well. I remember a statement another Security leader once said that we have moved beyond Guns, Gates and Guards and that is definitely true.

Can you give us a brief overview of your security strategy and its elements? What kind of technologies do you use? How about training and certifications? 

A: We work with overlapping zone methodology. We currently have 38 FTE’s in the Department and gives us 4 zones per shift per hospital. We also staff 1 officer around the clock at our Freestanding EDs. We leverage technologies that include CCTV, Access Control, Panic devices, and officers carry the Axon TASER X2 device. Officers receive over 80 hours of policy and theory training specific to healthcare security work, then generally shadow another officer for 40-80hours depending on the zone complexity. All officers are annually certified on handcuff, BLS and TASER.

Leading in a Challenging Environment

What are some common challenges you face running security within a healthcare environment?

The major challenge I’ve come across is the convergence and lack of resources for mental health. As more public health infrastructure surrounding mental health is closing due to financial, staffing, or other constraints, this load is being pushed onto hospitals. Those of us in the field have known this for some time. The violence we see as security personnel are involving mentally ill or those with some kind of behavior abnormality not necessarily premeditated criminal behavior.  This also goes against what most people think where security is an extension or type of law enforcement action.

Any specific examples you can share that illustrate those challenges? 

Over 20 years, I can easily say >80% of all my use of force actions have been in dealing with those of some type of behavior modification. That can be mental illness, substance abuse, alcoholism etc.  Now in the past two years with covid and increase geopolitical tensions we are seeing more escalation from people with long wait times in the ED, restricted visitation of loved ones and other issues. These are also related to diminished coping mechanisms, maybe not people dealing with clinical mental illness, but definitely not dealing with people having their best day. We often say, “nobody wakes up and says I think I’ll go the hospital for the day”. 

So the reason this is a challenge is because in hospitals we have cardiac specialist, and a respiratory therapist, and an orthopedic specialist, but only those with internal mental health units have a behavioral or psychiatric specialist. A lack of staff equipped to deal with mental issues is what leads to these issues escalating into criminal events. Few come in with the intention of causing harm but when tense situations are not met with the right response, things often escalate.

How did COVID challenge your security team?

Touching on what I said earlier, things did get more escalated. For a while we got a little bored. You know units were closed down, visitor access was greatly reduced to minimize exposure so there was a reduction by as much as 60% of the people on our campus.  We went into a more traditional asset protection role.  But after 2020, and about midway through 2021, when masking was becoming a contentious issue, we saw people’s patience wane and tense situations turn into violent situations more often. Even staff members, burned out by the past year, were becoming part of the escalations and just didn’t have the bandwidth to deal with some of these issues. We changed our posture again for high visibility, frequent rounds through all units, more customer service to get people where they need to go quickly and with little confusion that can be a trigger of anxiety or emotions. I call it being emotionally proactive to reduce the likelihood of scenarios escalating into violence.

What are the next big challenges you see on the horizon? How do you plan to adjust your strategy to meet these challenges?

I think if Covid has shown us anything, it’s that the world is volatile right now and the healthcare security industry is changing quickly. That doesn’t mean we shouldn’t plan, but I feel the answer isn’t the next gadget or business book strategy. It’s how you interact with people. Rebuilding relationships lost, working together, not as security roles, business roles and patient care roles, but working as a team will have the greatest impact. And I’ll give this example. If you have 1,000 employees on your campus and they are moving around, that is equivalent to 1,000 mobile cameras roving your halls. If you train them properly in how to de-escalate and avoid confrontations, you’ll avoid incidences of assault and violence more effectively than with any other tactic. That’s why the government took the “see something say something” approach. It takes a village, and we must think holistically about how the community can prevent assault and violence.

An Innovative Future

How do you stay current on security trends and innovations?

I attend the IAHSS meetings and conferences on a regular basis, and keep up on industry newsletters and publications. Unfortunately, a lot of the publications again keep to this violence piece almost exclusively and active shooters even more so. I think that is because it is the end effect (the criminal action) so they find it easier to define. I am excited by coverage that gets into how situations were prevented from escalating.

I do think camera AI is going to be big. Most hospitals have over 300 cameras. There is no way for an officer in a command center to watch that with any efficiency. The video walls are no longer going to work. They need to be triggered by set AI then pop up on screens that are then answered by intervention. The issue again with that is to be proactive you must have the right programming.

 Could you talk about any recent trends or innovations that have caught your attention? 

One is use of force options. I have carried a TASER for a long time. My opinions differ from many colleagues, but not all State Security Officers have to go through a psych evaluation, and I believe it is important for how security responds with lethal force. There is also no training or legal mandate in regard to how security should engage a shooter like there is for law enforcement. So, if I can’t test your mental soundness, train you on tactical response, and legally require to you to engage an active shooter then how do we know how to respond with lethal force?

The TASER allows us to keep people and ourselves safe without resorting to a lethal option. It may not help in an active shooter situation, but I’ll prep for the 95% likelihood of physical violence over the small likelihood of an active shooter in the hospital.

What are the key topics healthcare security leaders are talking about right now?

Active shooters and workplace violence. I could talk about either of these topics for a while, but I will just say that although they both relate to violence, we must separate these in discussion. Active shooter is almost always pre-meditated and you know you have one when the first shots are fired. Other than building hardening and corridor lockdown design, I don’t believe there is much you can do. These are criminally driven, and the first one shot is the Officer at the metal detector.  Hospitals also have unique risk is that much of our patients are not ambulatory so they can’t Run, Hide or Fight.

Workplace violence against nurses is the #1 rally cry for Security, and it should be. But for WPV, the preventative measure is the mental health specialist.  Every day we have chaplains reading through patient files and looking for indicators of an active shooter. Mental health should be at least that important. Most of the violence in hospitals stems from mental health, emotional explosions and a need not met. Security is just one part of the equation needed to prevent workplace violence.  

Are there any challenges you face when creating change within a large healthcare organization?

The largest of course is competing priorities. The bills are paid with clinical interventions, we simply protect the business. So funding and prioritization of projects are always difficult. And video/access control is very expensive. You have to be good at business proposals, showing the ROI and strategic planning.

Another is the turnover. Hospitals tend to have high turnover both of actual people and roles. The person you worked with in accounting may move to payroll, or IT, or the ED director may move to Surgical. The use of travelers also make training of nursing staff difficult. Many come with their training or security views from another state. Both of these labor issues make training and professional relationships difficult. I feel every couple years it’s like we have to start over.

What do event healthcare leaders need to focus on to succeed over the next few years?

Learn healthcare business and risk. It’s not a retirement job nor is it just criminal protection. It has its own unique flavor, but healthcare security leaders must understand finances, strategy, prevention and risk just like any other leader. Our business is dealing with people that are not at their best. Whether that’s pain, mental health, or fear. It’s fight or flight with many of our patients and we have to recognize this to respond appropriately.  

What will healthcare security look like in 5 or 10 years?

Recapping what I said prior, I think proactive AI, body cams, mobile panic devices are probably the greatest needs. We aren’t getting any more staff, so streamlining processing to make them more efficient will be necessary. I think the line between security and policing models that look more like college campus police will be the norm. However, I don’t want to see the other values we bring such as safety and empathy suffer as a result. The protective division of the hospital just needs to have multiple verticals. I’ll compare it to Public Safety – you have Police, Fire, EMS and Communications as part of this collective. That’s how I envision healthcare security in the future - Security, Emergency Management, Safety, Education and Technology.

Any interesting stories or experiences to share as a parting thought? 

A story I have on this is when we had a really sharp ED Director that came from Chicago. Now I mentioned I live in Florida so she started asking why I don’t have metal detection and armed police at every entrance and K9 units. So I asked for a meeting and I brought our crime index for the area, 3 years of ED violence data, and the local law enforcement liaison to discuss trends and give a united front and was able to show that Florida, (and especially my area of it), just doesn’t have that level of gangs or violence. She used this to reassure her own staff that were often more worked up by media and news stories than they needed to be. You have to know your area, and sector.