Private security firms go undercover in your hospital

A patient with a drug problem slouches in an armchair in the emergency department waiting room. He has $500 in his pocket and needs serious attention. When the nurse finally calls his name, he empties his pockets and changes into a hospital gown. The employee logs in his possessions on a personal belongings sheet: tennis shoes, jeans, sweatshirt, but only $165. The other $335 went right into the hospital clerk’s pocket.

Little did she know, her patient wasn’t a patient. He was an investigator from Pinkerton Consulting & Investigations, performing a security performance evaluation. That type of undercover operation is performed at many hospitals, says Catherine Curtis, supervisor of investigations at Pinkerton.

"This was an ongoing, 2½-year problem for this hospital," she says. "It only took us 2½ hours to resolve."

Modeled after the mystery shopper used by many retailers, this program is used to improve staff performance and customer service. It also can serve as a practice test to prepare health care institutions for their triennial surveys by the Joint Commission on Accreditation of Healthcare Organizations, says Walter J. Pry, CPP, senior consultant for Chicago-based Pinkerton.

"Our program is tailored to meet the needs of each specific health care facility," Pry says. "State-licensed Pinkerton investigators go into a facility and evaluate the effectiveness of their security procedures, customer service and personnel performances. Their findings give the management a clear picture of the facility from a visitor’s viewpoint."

Pinkerton is not the only private security firm providing these services; other companies provide similar undercover work. Many security companies provide security performance evaluations, and some, like Pinkerton, also work with hospitals on specific projects such as baby abduction drills. Pinkerton assists with baby abduction drills through a four-phase system, which include attempting to enter the secured area, entering the secured area, entering the secured area and causing diversionary action, and finally participating in the drill. After each phase, reports are submitted to security and nursing directors.

Criminal acts are only one focus

Undercover investigations are excellent for discovering the source of criminal activity in the health care organization, Pry says, but most of Pinkerton’s health care work involves testing security procedures and staff’s compliance with policy and procedures. Many hospitals hire a security firm to test access points, for instance.

"Can you enter the emergency department easily?" he asks. "We’ll see what happens when a person walks in and tries to go places he shouldn’t. And it’s more than just whether the attempt was successful. We want to see how the staff treated this person when they approached him. What did the officer say? What was the security officer doing when you approached?"

The same kind of questions applies during the first phase of a baby abduction test. It’s good if security officers or other staff challenge visitors, but undercover officers also focus on customer service. In other words, can the staff say no and be nice about it?

"Customer service is key because health care is so competitive these days," Pry says.

Pry and Ron Long, managing director of Pinkerton, initiated the program in 2000 when Pry was director of security at Sinai Hospital of Baltimore. Pry says he became concerned when staff members commented on the security performance of his department.

"I didn’t feel that random visits to the department by myself were productive. I was searching for an additional tool that could be used as a performance improvement program with the Joint Commission," Pry says. "The risk manager and the director of security are there for 40 hours a week, and when they’re gone, everything changes. For the most part, our investigators go in on weekends and at night when employees don’t think they’re being watched as closely."

Long says access vulnerability is more of a concern since the terrorist attacks of 2001, and security firms can be hired to investigate any kind of compliance with hospital policy. Most investigations, however, combine patient safety and customer service concerns.

"One example is an investigator will go out in a parking lot and call security to say he or she can’t find their car," Pry says. "Everything is noted: how long it takes security to get out there, what they do, what they don’t do."

At one hospital, undercover investigators reported that a guard in the emergency department was lax, so his superiors warned him to improve his performance. Soon after, the guard noticed a suspicious person who said he was waiting for a shooting victim. The guard thought the man was another undercover investigator and didn’t want to be reprimanded again.

"So he asked the man more questions until he figured out that the man actually was the shooter and came to finish off the patient," Pry says. "The guard’s questioning caused the man to flee, and he was able to help identify him for the police. The first experience had put the guard on his toes."

Long points out that the undercover investigations are not used strictly to punish poor performers. Pinkerton encourages clients to reward those employees who are found doing admirable jobs. All the positive findings show in the final report by the company, just like the problems.

"If you have a security guard who acts responsibly and says, Wait a minute. We don’t have a Dr. Smith. Who are you really looking for?" then that we write that up as a very proactive intervention," Long says. "The employer might praise the guard for his good work and give him a night out at the movies as a reward."

The investigators usually do not reveal themselves to staff, even if they find misconduct. That way, the same investigators can be used again, with the benefit that they are familiar with the facility and employees. But in some cases, such as criminal conduct, the investigators may have to act immediately to apprehend the offender and preserve evidence. In the case involving the thieving emergency department clerk, the investigator summoned security and identified himself so the evidence could be collected.

Drills can spot problems, test improvements

Pinkerton recommends doing an undercover investigation quarterly, though some facilities will do them as often as monthly. The investigations can target any area or problem known to the risk manager, or the company can randomly test various access points and similar areas known to be at risk for problems.

Normally, only the risk manager and director of security know of the undercover investigation at first. But after the first time, the staff usually knows that the technique is being used because the findings are presented as a teaching tool. And Pry says that can be good for the staff to know that undercover investigators might be present somewhere, some time.

"They know that the next patient might be an investigator and it keeps people aware of the need to act properly at all times," Pry says. "It’s always in the back of their heads."

One hospital leader in charge of security says undercover work can make a big difference in how staff perceives it job. Security guards, in particular, change their attitude when they know they might encounter an undercover investigator at any time, says Lionel Weeks, vice president for facilities at Lifebridge Health in Baltimore, which operates three hospitals and other facilities in the area. Lifebridge has used undercover investigators for several years.

"The first time we had them come in, we got reports that some of the guards were not customer-friendly, no eye contact, and sometimes the investigators should have been challenged more and they weren’t," he says. "We sat down with the guards and supervisors and showed them exactly what we had found when they thought no one was looking. Next time the investigators came in, what a difference."

Weeks says his organization continues to use the undercover investigators at least twice a year. The first time, Weeks took no disciplinary action based on the findings. But after that, staff were on notice that they could be punished for poor performance uncovered by the agents. And Weeks points out that many of the reports highlight exemplary performance by security guards and others, which always results in the employee being praised.

The cost of an investigation depends on the size of the campus and exactly what is being investigated, but Pinkerton charges an hourly rate of $100 to $200 that covers all the necessary personnel and other expenses. A single visit might take about eight hours, so Pry says $1,000 is a typical fee for an investigation. For quarterly investigations, a hospital might spend a total of $5,000 a year.

Clients often have the company come back and investigate the same issue after improvements have been made.

"It can even be used as a quality improvement project for the Joint Commission," Pry says. "They will ask what you’ve done to improve security and ensure the safety of patients and visitors. You can show that you were at this level the first time we came in, then you improved this much each time the investigators came back."

Undercover security programs have been implemented in 10 Baltimore metropolitan hospitals with a high degree of success, Pry reports.