 Hello, everybody, and welcome back to the ThinkTech studios. This is Security Matters Away. I'm your host, Andrew, the security guy, and I'm here today with Ed Howard. It's come in town from Castle out there on Waimanalo side, and we're going to be talking today about the healthcare environment. We're going to be talking about safety and security in a healthcare setting. And Ed, you've been in security a long time, so I always like to start my guests by asking them, what keeps you up at night lately? Well, because I'm in the healthcare field, obviously, that's a concern of mine. You know, I do oversee 20 hospitals in the Adventist Health system, so I get alerts probably every hour of some violent issue that's happening across our 20 hospitals, and sometimes I just lay awake and wonder what's the next big thing that might happen. So you actually do stay awake at night? Sometimes I do, and sometimes I get those calls in the middle of the night as well. Wow. So give our audience a little sense of, I know you've had a long history in security, give us your background if you could, kind of leading up to what you do today. Well, I've had a very distinguished and honorable career in law enforcement for 26 years. I was first 10 years with the Honorable Police Department, and I worked in narcotics, 8 out of those 10 years, and I was also on a DEA task force for several years. And then I moved over to the state narcotics, and I ran the investigative and enforcement operations for some 16 years, and I retired after 26 years. I had a great career. Wow. You fly around helicopters here looking for the crops and stuff, I remember. Did some of that. Yeah, yeah. Wow. Right on. And so when you transitioned into the public sector, how was that for you? So one retirement wasn't enough, you thought you'd go get another one? Well, I mean, we have a great retirement situation for law enforcement officers here in Hawaii, and I knew I was going to be retiring at an early age, actually was 46 when I was available to retire. So kind of being that visionary person, I knew I wanted to get into another career, so to speak, and it just so happens, I became the security director at the Castle Medical Center. Okay. So I started off a whole new career in security and in the healthcare specialty, so to speak. So I'm sure, coming out of law enforcement, which is a very difficult job, and then moving into healthcare, another difficult environment. I don't know if people understand how many, you know, it's highly regulated, there's a lot going on in that healthcare setting. What was your first, you know, your early sort of opinion like, you know, walking there because you didn't, you don't have the badge and then the gun and the sort of the control that you kind of have as a law enforcement officer, but you have a lot of the same responsibilities in that particular environment. Right. Tommy, you hit it right on the, on the head. It was a very big transition for me and it was a very conscientious decision that I had to make very early on, on whether I could actually handle the transition, a whole different mindset. I was coming in, people who did bad things in the hospital, I still viewed initially as criminals. And I didn't realize that there were so much mental health issues, true mental health issues, rather than what I would see all the time would be substance abuse and that type of thing. And just the whole environment was, was, was very different. So I really did have to make a, excuse me, a conscious, conscious decision to change my mindset and, and to look at people as, as patients and, and be able to manage situations a whole lot different than the way we're trained in law enforcement. Wow. And do you think the law enforcement trained to that and inform your ability to work there? I mean, did you have to have a training program? Was, what was it like when you first started at Castle? I mean, you know, how, how did folks deal with the situations that arose there? Well, you know, back when I, when I started some 14 years ago, you know, there's been so much change in, in the healthcare setting and the environment where security at that time, you know, was a needed, needed service that we, we had to do. But it wasn't as special, a specialty as it is today, because there's a lot more regulations surrounding it and there's a lot more issues and situations we have to deal with. And the biggest one right now is violence. And so one of the things that I always tell people when I do my lectures on workplace violence in the healthcare setting is in my 26 years of law enforcement, I've never seen the type and the amount of violence that I've seen and been exposed to in healthcare settings. Wow. It's just mind blowing. Wow. And I also compared to in law enforcement, particularly what I did in narcotics enforcement, you know, we're well equipped, we're well trained, we can anticipate and plan for violence. But in, in our healthcare settings where our security and our staff work, a lot of times it's very unexpected or very dynamic and very consistent. So it's, if you ask physicians nowadays, what's the top five issues in healthcare? Violence will always be one of the top five. Wow. So I would expect them to say something about some disease or some treatment or something, but violence is going to be on the top of that list. I know you did a talk recently at the event we did over at the Pacific Club and I was amazed at the depth. You know, you don't think unnecessarily that, you know, if I go to hospital fortunately, I don't have to go very often, maybe from my physical or whatever annually, but you don't think about violence when I go there. I think of calmness, I think of helping in caring, nurturing environment. And yet you're getting, you're seeing episodes of fairly consistent violence. Is that typical to Castle, do you think, or is it typical of the industry itself in Hawaii, nationally? Oh, it's national trends. You know, when we talk about trends, I'll give you a really good example. When you've got regulatory agencies, like for the healthcare, it's the joint commission, it's centers for Medicaid, Medicare services, CMS, and OSHA. When you have these regulatory bodies telling you that you have identified risks of violence in the healthcare setting and you need to mitigate those risks, you've got regulatory agencies not telling you have a problem. That's kind of unheard of. So it's a trend that we've seen when you've got regulatory agencies telling you have a problem and you need to deal with it, it's eyeopening. So the other thing I tell people too is, you know, there's so many associations and professional organizations out there that surround healthcare, and every one of those agencies or organizations, associations have got some kind of white paper, some kind of training program, you know, some kind of assessment program or process, all just for violence in healthcare. So you look at those kind of trends, you know, it's here to stay, I think, or at least it's very consistent. And the statistics that we gather across annually across our 20 hospitals, you know, we have seen in the last three years that workplace violence relating directly to patients and visitors and family members are all consistent and upwards in trends. Isn't that something you, it amazed me. And I remember from your talk that, you know, you get violence, violent action. Are you watching for violent action just from the family of a patient who may be concerned about the level of treatment or the type of treatment? Is this people we think lost a little respect for the industry? Or, I mean, are they just emotion carries them away or? Yeah, you know, it's it's it's really been interesting. I've dived into this this whole issue of workplace violence in the healthcare setting. And, you know, we look at a bunch of risk factors that we have absolutely no control over that come into our healthcare setting. For example, it can be gang activity. We have a hospital in Los Angeles with a huge gang presence, 51 gangs in a two mile radius hospital. And then we, you know, you've got insurance issues. You've got people that come in because they have no money and no insurance that they use the emergency rooms as their primary care because the law allows them to do it. So these are, you know, like, and I can go on and on with risk factors, but these are risk factors that we have no control over. And then we've got a bunch of internal risk factors that we do have control over. And that's where we talk about patient satisfaction. We talk about, you know, how we how we do treat our patients and do we communicate with them well? Do we offer them the pain management that they need? You know, all of these different things really do come into play and has an impact on the way people act and behave. So trying to balance all of that is kind of crucial. It's more than a one man job. Do what kind of staff training? I guess let me ask how often, you know, is your staff getting trained, you know, an awareness program? I think because it's easy to slip into being the caregiver, which is what most people, I would enter that industry for and to let your guard down, maybe. Is there a persistent awareness program about the violence thing? Yeah, absolutely. And as a matter of fact, you know, there's there's landmark legislation with California OSHA right now is the only state right now that has mandated a bunch of standards for workplace violence in health care. OK, and we believe national OSHA, as a matter of fact, I know that they've held public hearings or they've held hearings on on, you know, setting standards nationally. So we think they're going to take California's framework and pass it on. Probably the next five, seven years, it'll be a mandate across the nation for health care. As far as the training is concerned, we kind of have a two prong thing that we do. One is definitely staff awareness. That's huge. And the reason for that is a lot of the patient caregivers and clinicians that, you know, they go to school, medical school, nursing school, CNA school. They are they're not exposed to any training or education relating to violence in the workplace or in health care. So what happens is they come they come to work, they start going through their orientations and they start working on the floor and then a patient throws a tray at them and starts yelling at them. And they're they're totally caught off guard. But this is yeah, they're totally caught off guard that this is what happens in the environment. So it's up to us at each of our sites. And this happens across the nation that we expose them to all the risk factors that contribute to violence. And we talk to them about, you know, the things that we can do and the teamwork that we do with security, because there are things that we have to do to help manage. So the big phrase for us in health care is managing aggressive behavior. OK. And there's processes, there's training, there's teamwork that all have to sync together. So it's it's quite challenging. Is it while we're on that topic? Is it the the newer people that are harder to train or the old ones that are sort of set in their ways? Which employees are most responsive? That's a good point you bring up. That's a good point because, you know, during our training, what we have found is the old time physicians, the nurses that have been around for 30 years, they're accustomed to this being a part of their job. Oh, it's normal to have a trade thrown at you. Right. And we've actually we actually have heard comments and statements like, oh, you know, this is what we deal with. This is this. This is our job. This is, you know, and we have to change that thinking. I think so. So basically what happens is, you know, people who work in the health care industry that are patient caregivers and clinicians, you know, they go in with really good ideas that we're going to help people. And this is what I've chosen to do. And and they just don't see it coming sometimes. So we really need to we really do educate them. We get them to understand. And as a matter of fact, just to add this in, which is really interesting is with the whole Obamacare, you know, everything now is patient satisfaction is how we get paid. Our reimbursements are based off of patient satisfaction. So the better patient satisfaction scores we get, the more we'll get we'll get the reimbursements. But we've also realized that if you if you do satisfy that patient satisfaction situation, you're also going to also address violence at the same time. So there's a lot of strategies out there. There's a lot of consulting companies out there that have all these strategies to boost patient satisfaction. But then at the same time, we're also realizing that it's also it can help with our management of violence as well. Wow. We're going to be back in just a minute. We're talking about safety and security in the health care setting. Thanks. Hi, I'm Bill Sharp, host of Asian Review here on Think Tech Hawaii. Join me every Monday afternoon from five to five thirty Hawaii Standard Time for an insightful discussion of contemporary Asian affairs. There's so much to discuss. And the guests that we have are very, very well informed. Just think we have the upcoming negotiation between President Trump and Kim Jong-un. The possibility of Xi Jinping, the leader of China remaining in power forever. We'll see you then. Hello, I'm Dave Stevens, host of the Cyber Underground. This is where we discuss everything that relates to computers that just kind of scare you out of your mind. So come join us every week here on ThinkTechHawaii.com. One PM on Friday afternoons. And then you can go see all our episodes on YouTube. Just look up the cyber underground on YouTube. All our shows will show up and please follow us. We're always giving you current, relevant information to protect you. Keeping you safe. Aloha. Hey, welcome back to the ThinkTech Studios. We're here on Security Matters with Ed Howard today. And we're talking about safety and security in a health care setting. And we were talking just a little bit about you brought up the JCO scores and the patient satisfaction scores and how hospitals get reimbursed. And that's a self-reported by the patient sort of thing. But you're seeing that one of the byproducts of that is if you drive up patient satisfaction, there's maybe less violence, you know, at least from the patients. Maybe I don't know about their families and things like that. That amazed me when I learned that they're getting violently angry, you know, in a hospital. But no, it's absolutely true. We've seen it in studies and I've seen it with my own experience. So when that patient satisfaction is driven at a high level and it's basic stuff a lot of times, too. It's proper communication and explanations, even introducing yourself, you know, doing things like that to keep patients informed, not over-promising and under-delivering. It keeps people calm. Family members are unique because they want the best service for their family member, right? I don't think that's, you know, anything different than you or I and our son or daughter or husband and wife in the hospital. So it's kind of human nature stuff. So it's simple concepts and principles, but sometimes not always be able to carry out. The last thing a family member realizes or cares, so to speak, is this nurse has got five other patients, right? So it's challenging to kind of keep that balance, right? Wow, do you have it often where they, because medical terminology, you know, things aren't familiar to people who may be in the hospital for the first time, for example, with either for themselves. Do people have a hard time comprehending, even though you've told them, do you watch their face just not absorb the information and then they just get frustrated? Yeah, sometimes that happens, but, you know, we've got a lot of really good nurses and physicians out there that do take the time to explain. And that's the key, if they have the time, they can make the time to explain. Another interesting thing really is, you know, a lot of people hold physicians as almost godlike. Sure, especially when you're the one hurting. And, you know, when they have that interaction with them and there's specific training and stuff on this. But when they have that interaction with a physician and it's negative or it's uncaring, you know, that can spite reactions from family members and patients. So I think physicians have come a long way when it comes to interacting with patients. So that's that's big. And that has driven up, you know, at least for Adventist health and Adventist Castle, it has driven up our patient satisfaction scores with the way our physicians are interacting with patients. And do you they have to get close, I guess, maybe as well as the nursing staff. You mentioned, you know, mental illness and you mentioned the behaviors associated with those things. I'm sure you see folks that are having problems with drugs maybe that come in. How do you how do they give care and also take care of themselves? What's the do you give some hands on training for that? Or I mean, how, you know, because they've got to get really close. And, you know, once you're close enough to grab a hold of, that's a that's a no. So good point. So, yeah, we do we do provide certification relating to management of aggressive behavior training. So that's not only recognizing the behaviors, but it's also hands on defensive tactics and movements that you can do. I mean, that's a must. We have to train everybody to do that. Sure. So, you know, we get what we call high risk patients and high risk patients are basically your emergency department, your behavior, health patients. These are patients that, you know, have the most potential to be violent. So we look at them differently. And as far as safety and security is concerned, we treat them differently. There's processes in place to ensure that we're as safe as possible. So there's a lot of things that go into this. I'll try to do all that without them knowing that you're doing all this around them, right? Trying to create that that a caring environment, nonetheless, but a safe environment, very difficult stuff. So you're you're big in IHSS is a strong group out here. I think you've got 40, 50, maybe more members than that. I don't know. So I've been to some of the meeting. That's a large group. What's the focus? Does the folks go there to get training as well? It's the what kind of what sort of, I guess, services do the members, you know, get by being being part of IHSS in Hawaii. So IHSS stands for International Association for Health Care, Security and Safety. It's a national international organization. And it's specifically for health care, security, safety, emergency preparedness professionals. And we have a chapter here in Hawaii, which I'm the chapter chairman of. And we have about 40 plus members all from the various hospitals and other health care providers. And, you know, we get together for meetings and we do provide training. A lot of networking and sharing because a policy that works at Queen's Medical Center can very well work at, you know, polymomy. And so we have that tight networking where we where we can communicate with one another and then then just a lot of blasts of information out there that I happen to get quite a bit of nationally as well. So kind of keeps us all in the know. So it's a it's a great organization. And again, it's very, very specific to to what we do in health care. Is are there like like the FAA has like a no fly list. Do you have are there people that everyone knows? But if they show up in your ER, they're a problem. Is there that sort of this is a small enough community in Hawaii? I would think. Yeah. No, to be honest with you, we don't share that type of information specifically because there are some federal privacy rules surrounding that. So yeah, we don't really have a database or anything that we that we share on stuff like that. But we do we do know what the risks are. And we talk about that quite a bit. And it's always interesting to know how like triple triple or medical center deals with their physical environment and and how others do. So we do talk about those kind of things. We share about those things. And and I will say that one of the important things that we use to help mitigate our risks are security systems. Security systems are big for us. So, you know, your access control and your CCTV cameras, video surveillance, our infant protect protection systems, our duress alarms, our emergency communications and phones, mass communication. So we use all of these things technology as well as again, can't overemphasize the processes that we have to put in place to to to manage certain situations and patients. Wow. And as so as HSS also beneficial, I'm sure that some of that's evolving. You know, as you talk about, we didn't used to get graded by the Fed to get reimbursement. Now you're graded for patient care. Have you seen that impact? Has it changed or is there a more frequent training or better training? What's your what's your take on the industry? And it's, you know, where it's going in the future? No, it's it's there's definitely more awareness for sure and training. And when you have the regulatory agencies now really looking at if you if you want to call it an isolated topic, looking at workplace violence a lot more closely than they did five, six, seven years ago. I mean, there's expectations now that you need to have active shooter plans. You need to have workplace violence plans when like seven, eight, nine, ten years ago when a surveyor would show up from the Joint Commission or CMS Department of Health, they didn't automatically ask for those things. I see. You know, so now they're really scrutinizing your security management plan and they're looking at things that you're doing to help mitigate these identified risks, which is a standard in the health care setting. So the environment's improving a lot. That's it's amazing. It sort of took that long, you might say. I guess it was swept violence in the violence at any place. I guess it's kind of kept under the carpet. It's hard to recruit people to work if they think they're going to be working in a violent place. And I'm still amazed it's not part of maybe the curriculum for the doctors. In their medical training, you think they have at least near the end, maybe not too early to scare them off, but we need doctors. But it seems like some of this training might be good to have along the way. Yeah, they definitely need to have some classes so they can see what they're getting involved in in that health care setting for sure. Amazing. Well, we have, I think, gotten a great picture on the health care setting and what safety and security is about. So if you're out there and you're visiting a hospital, try to be a part of the solution when you're there. Ask for types of communication if you're not getting it. Make sure you're talking and getting the kind of service that you want. And remember that those folks have a lot going on. You're not the only patient, you're Ken folk are not the only folks there. And try to be helpful and try to be aware in a health care setting if you have to be engaged in that. All right. Thank you so much. We'll see you next week on Security Matters. Hawaii, aloha.