INQUIRY INTO VIOLENCE AND SECURITY ARRANGEMENTS IN VICTORIAN HOSPITALS - SUBMISSION TO THE DRUGS AND CRIME PREVENTION COMMITTEE OF THE PARLIAMENT ...
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INQUIRY INTO VIOLENCE
AND SECURITY ARRANGEMENTS
IN VICTORIAN HOSPITALS
SUBMISSION TO
THE DRUGS AND CRIME PREVENTION COMMITTEE
OF THE PARLIAMENT OF VICTORIA
SUBMISSION BY SOUTHERN HEALTH, VICTORIA
JUNE 2011
11. The incidence, prevalence, severity and impact of violence in Victorian
Hospitals and, in particular, Emergency Departments.
Southern Health operates Emergency Departments at the Monash Medical Centre Clayton,
Casey Hospital and Dandenong Hospital. The catchment areas of these Southern Health
facilities are representative of the multi-cultural society of Victoria and see in excess of
160,000 patients on an annual basis.
Violence and aggression has always been part of Health Care operations and several studies
have been conducted worldwide in this field. The following examples from the study
findings support statements pertaining to high levels of violence and aggression in Health
Care facilities, particularly in Emergency Departments.
Research Paper – Nurses and Occupational Violence: Support in Moderating Professional
Competence – University of Ballarat, Victoria – 2003
a. Failure to address Occupational Violence in an appropriate manner may result in
lowering professional nurse’s competence levels with significant implications for
patient care.
b. A study conducted by the Australian Institute of Criminology in 1999 showed the
Health Industry to be the most violent industry in Australia. Registered Nurses
recorded the second highest number of violence related workers compensation claims
in 1995/1996, numbering higher than prison and police officers.
c. Nurses felt they had become acclimatised to aggressive behaviour and accepted it as
part of the nature of nursing.
d. Wells and Browers 2002 conducted a review and critical analysis on Occupational
Violence and reported that the best available evidence indicates more than 9.5% of
general Nurses working in general hospitals being assaulted in any given year.
e. Sources of Occupational Violence include patients, their relatives, medical staff and
co-workers – Farrell 2001.
Workplace Violence Risk Assessment Report – Langley Memorial Hospital, British Columbia
2001
a. Staff at high risk of exposure to occupational violence are employees who work in, or are
required to attend to patients within, Emergency Departments and Psychiatry.
b. Employees who respond to potential or actual incidents of violence such as participants
in Emergency Behavioural Response Teams (Code Grey) and Security are also at high
risk.
c. Nursing staff working in general areas are at a medium risk of exposure.
d. Staff not included in direct nursing care i.e. Diagnostic Imaging are deemed to be at
moderate risk.
e. Staff in money transactions should receive job specific training in dealing with irate
customers and armed robbery.
f. Other staff are at low risk.
2Hospital Security – Russell.L.Colling 1992
a. A study by the US Institute of Crisis Management indicated that Health Care is the most
crisis prone industry – responsible for 10% of all crisis conditions in 70 major industries
assessed. A third of these crisis conditions related to accidents and nearly a third were
caused by Occupational Violence and Safety issues.
b. Various studies revealed that some of the most stressful occupations are in the Health
Care field.
Although Southern Health is actively investigating suitable methods to address Occupational
Violence and Aggression within the working environment, the limited level of evidential data
available poses a significant challenge to the decision making processes. The insufficient
industry specific statistical data pertaining to incidents and the desensitised nature of nursing
staff to violence and aggression in general do not allow for effective benchmarking. The status
quo is supported in an Occupational Violence and Aggression project undertaken as a joint
venture between Southern Health and Deakin University Nursing Research Centre in 2009.
Police Crime Statistic annual reports do not distinguish crimes committed within Health Care
facilities and only allow for a general observation of reported offence data within the specific
Victorian Police Regions.
Southern Health has undertaken initiatives since 2010 to improve the reporting rate of incidents
in order to clearly define the incident rate, prevalence and severity of incidents pertaining to
Occupational Violence and Aggression within the organisation. Staff awareness of Occupational
Violence and Aggression has improved and incident reporting rates have increased.
Although the availability of supportive data has improved, statistical information still does not
reflect a high level of accuracy pertaining to incidents. The Incident reporting system in
operation at Health Care organisations within Victoria is still impacted by issues such as:
a. The perception that the time commitment required to register an incident is too long and
impacts negatively on operational requirements.
b. The improved incident report rate is not reflective of the total Southern Health operation
but limited to specific operational groups within the organisation.
c. Longer serving staff members are still desensitised and more unlikely to report incidents.
d. Staff entering the Health Care industry are more likely to report incidents pertaining to
Occupational Violence and Aggression.
e. Differing levels of perception amongst staff members of what constituties an act of
Violence and Aggression.
Southern Health is aware of the existence of Violence and Aggression within the organisation
but is challenged in its initiatives to establish a clear profile outlining; the number of incidents
that occur, the source of incidents, the severity of such incidents and the prevalence of such
incidents. Incidents are currently addressed as they occur although it is recognised that a more
robust program is required to address the root causes of the issue, monitor the effectiveness of
initiatives and ensure a reduction in the incident rate.
32. The effectiveness of current Security arrangements to protect against
violence in Victorian hospitals and, in particular, Emergency
Departments.
Security officers employed at Southern Health are required to be licensed as per the Private
Security Act:2004 and in possession of Certificate III Unarmed Guard. Officers will be required
to upgrade to the new training requirement, PRS20103 Certificate II in Security Operations.
The Security staffing model at Southern Health is based on an in-house model. The majority of
personnel in the employment of the organisation range between 6 and 20 years.
Although the Certificate III in Security Operations provides a good foundation and skill level to
Security officers within the Security Industry, this training is aimed at personnel employed
within the Industrial and Retail sectors within Victoria. The challenges faced by Security
personnel entering the Health Care industry are highlighted at the time of their employment
reflecting the limitations of these staff to come to terms with the fact that all people presenting
for treatment are deemed to be patients/clients of Southern Health.
Incidents pertaining to Violence and Aggression within the Emergency Departments caused by
people presenting for treatment or by existing patients need to be clinically led. Southern Health
identified limitations in existing processes and procedures and implemented initiatives to address
these limitations including the establishment of a program to educate staff, including Security
personnel, to manage incidents of violence and aggression in a more effective manner. The
training program rolled out in early 2010. Once a critical mass in trainee numbers has been
reached the positive impact of this training program should become noticeable.
Southern Health deploys dedicated Security personnel to Emergency Departments at times when
the highest level of incidents pertaining to Violence and Aggression occur. Emergency
Departments are also serviced by Security personnel deployed on site on a 24 x 7 basis, with
priority of service delivery to areas when and where incidents occur. The existing security
response to incidents is deemed to be reasonably effective, although it can be tested li when
multiple incidents occur simultaneously and where a Security response is required at all of these.
3. An examination of current and proposed Security arrangements in
Australia and internationally to prevent violence in hospitals and, in
particular, Emergency Departments, including the appropriateness of
Victoria Police Protective Service Officers in Victorian hospital
emergency departments.
A comparison of Security staffing numbers at the majority of Melbourne metropolitan health
care organisations during the last quarter of 2010 revealed a high level of consistency in the
number of officers deployed per individual site. The ratio of staff and patients at these facilities
differ significantly.
There is no standard benchmark for the number of Security personnel employed within the
Health Care Industry. Each organisation needs to determine the appropriate staffing level in
relation to the type of facility, number of incidents experienced, risk profile of the organisation,
4etc. Consideration also needs to be given also to the ratio between patients and visitors to a
facility is on average 7 to 1. That is seven visitors to every patient within the system.
International
In the United States of America procedures differ from state to state however it is common
practise for Police Departments to have office facilities at hospitals which are staffed on a
permanent or semi-permanent basis by Police officers, or when the need arises. The specific
skills required by Security personnel employed within the Health Care Industry are recognised
and training requirements are managed via a dedicated body, the International Association for
Healthcare Security and Safety.
A Security benchmark study was conducted by the Health Care Security Committee of the
American Security for Industrial Security (ASIS) in 2000.
Findings of this study are as follows:
a. Health care industries struggle to adopt organisational methods incorporating better cost
control, improved operational efficiency and reflect regional market trends.
b. Staffing performance standards and criteria requires an in depth understanding of how the
industry and providers have changed, requiring benchmarking tools to utilise for
competitive values and purposes.
c. Continued requirement for healthcare organisations to perform at the highest levels with
reduced funding (per capita).
d. Health Care organisations are required to ensure security technology systems provide
greater efficiency with improved outcomes.
e. Training of Security staff is significant at the time of employment but the importance
then reduces.
f. There are indications that staffing and technology are not implemented in an effective
and cohesive manner.
g. Expectations that as staffing and technology increases this results in safer environments,
needs to be qualified.
h. Technology installations should deliver reasonable, quantifiable improvement in
efficiency and favourable financial outcomes.
i. Large cultural diversity requires ethnicity specific training.
j. Compliance to existing security standards and guidelines is fragmented. There is a
tendency to focus on Industry accreditation requirements which do not sufficiently reflect
legislative and best practice requirements.
Police officers in New Zealand were stationed at hospitals on a Monday to Friday basis during
office hours until around 1994 when the Community Police function was introduced. The
exception was Wellington hospital where the Police presence was maintained. The main focus of
these Police officers was not security per se but the support of policing processes such as
capturing and managing evidence, obtaining statements and documentation pertaining to Coroner
Inquests, etc.
Victorian Police Protective Service Officers
There appears to be high level of uncertainty amongst Health Care staff in relation to the specific
roles and responsibilities of the Protective Service Officers should they be deployed at Hospital
Emergency Departments. There are staff members who believe that the deployment of armed
5Police personnel will potentially cause some patients to react in a negative manner which would
potentially affect patient care and increase the risk to staff.
Once the roles and responsibilities of the Protective Service Officers to be deployed at
Emergency Departments has been clarified, relationships between these officers and Health Care
staff defined, and goals and expected outcomes communicated the benefits of such deployment
should become apparent. Health Care staff will however be looking for appropriate safeguards
and clearly defined operational processes to ease their concerns.
4. A recommendation of initiatives to enhance the overall Security
arrangements and safety in Victorian hospitals, particularly Emergency
Departments, to ensure appropriate levels of safety for Health
professionals and the general Public without compromising patient
care.
Recommendations include but are not limited to:
a. A review to be conducted to provide a comparison and insight into the current and
future Security risk trends within the Health Care Industry reflecting on existing
Security Australian Standards and international best practices.
b. Review of Australian Standard AS 4485:1997 – Security for Health Care Facilities.
This standard is deemed to be outdated and does not support Security requirements
aligned to 21st century needs.
c. Health Care organisations to conduct organisation wide Security Risk assessments
aligned to AS/NZS ISO 31000:2009 – Risk Management and HB 167:2006 – Security
Risk Management to define their Security Risk profiles. Evidential data will support
long term strategic Security planning and financially viable solutions to effectively
address Occupational Violence and aggression.
d. Review of the training requirements for Security personnel employed within the
Health Care industry.
e. Review of Security compliance requirements for Health Care organisations.
f. Develop suitable ethnicity training programs. Evidence indicates that linguistic,
cultural differences and insufficient knowledge are a potential cause of Occupational
Violence and Aggression.
g. Establish a standing working group incorporating members of the Victorian Police,
Protective Service Officers and Health Care organisations. A high level of interaction
will address; real and perceived concerns, build trust, provide a method to address
differences, enhance consultation, improve the quality of expected outcomes and
create opportunities to find solutions to emerging issues.
References
Research Paper – Nurses and Occupational Violence: Support in Moderating Professional
Competence – University of Ballarat, Victoria – 2003
6Workplace Violence Risk Assessment Report – Langley Memorial Hospital, British Columbia
2001
Hospital Security – Russell.L.Colling 1992
Health Care Security Committee of the American Security for Industrial Security (ASIS) in
2000.
Private Security Act:2004
AS/NZS ISO 31000:2009 – Risk Management
HB 167:2006 – Security Risk Management
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