Howdy, howdy, howdy.

So today we have guests from HKS Whitney K. Fuessel, the Regional Practice Director in Health and we have Rutali Joshi, Senior Design Researcher in Health joining us today Whitney has over two decades of experience in health architectural spaces, including master planning healthcare campuses.

And she's also the winner of Avery's initial citation award in 2017 and Rutali is working with the research team at HKS.

And, she's supporting the teams, I guess, in different offices across the US.

So together we're going to discuss, shielding caregivers.

And, they're going to bring some case studies and examples for you regarding innovative approaches to reducing violence and enhancing safety in health care settings.

So I'm going to hand over the lecture to you.

Thank you.

It's so wonderful.

Always being back at A&M.

I graduated in the mid 90s, and I remember taking class in this room with Mr. John only Greer.

It looks just the same except the furniture.

So, so yes, we are talking about shielding health care, you know, health givers.

But why?

Why did this topic resonate with us?

I would say, we got an email that spread like wildfire.

It has.

It was an article 30,000 weapons found at Cleveland Clinic, 30,000 weapons in one year.

When I say weapons, is everyone think guns?

It's not only guns.

It it's like guns and knives and lighters.

I question, I'm like lighters y lighters.

Wow.

It wasn't until I was with a client, and, we were doing an emergency department, and one of the staff members said, look at this picture.

I'm like, oh my gosh, that whole room, it was exploded.

Well, one of the patients fight.

I do not want to go outside and smoke a cigaret.

So I know I'm on oxygen.

Oh, I guess she didn't even realize that that was an issue.

So she, lit up her cigaret in the emergency department and the room blew up.

She had minor injuries.

Staff had minor injuries.

It was not necessarily a violent act towards staff, but it was something in which a caregiver had harm to them.

So it's nondiscriminatory.

There are issues within health care spaces that caregivers face each and every day.

So with that, we have some learning objectives for a credit that we want to make sure that we go through.

So we want to understand the trends.

We want to talk about the impact of, hazards to health care workers.

We have different exemplary projects and case studies that we'll be going through.

And we want to gain insights, to various levels of the building, the units, etc.

as we go through.

Our agenda, we're going to introduce you to our team.

It's not just for Tolley and I.

We had a great team.

We're going to understand the problem.

We're going to go through our approach literature reviews, our findings, our strategy.

And last, the conclusion.

So our team amazing brain trust routinely PhD researcher.

She has a wealth of information also insight not only from United States but elsewhere.

Same with Maria.

So it was great to also have perspective outside of the United States.

But, we all work in different offices.

We represent five different HCS offices.

But what is also unique is that Christiana and Stan worked on the client side.

Christiana has over 20 years on the client side with strategy and Stan over 30 years as, as chief strategy officer.

He worked in HR and he also worked in planning and construction.

And one story that Stan told us that was super interesting and this is his passion, is when he worked at Women's in Louisiana, he said, you know, a lady had a baby.

Wonderful.

And her boyfriend thought, I'm going to go see my new child with my girlfriend.

So he went in to the maternity, ward with his girlfriend to meet the baby.

And the two women were not very happy.

So they got into a fight.

Do you know who broke it up?

Sure wasn't the boyfriend.

It was the staff.

And guess who got hurt that were the caregiver.

So these are things that happen.

Crazy things that happen in hospitals each and every day.

So the healthcare sector in the 20, in 2024, the 18 age we are in, is at a very pivotal moment.

You probably all of you have heard about the strikes that healthcare workers go on.

There is immense amount of burnout.

There is a need to make our working conditions more safe.

We will dive a lot more into the subject and try and understand what the problem is.

But before that, if you all could pull out your phones, and scan the QR code, or type in menti.com and use the code on top and tell us what comes to mind when you think about safety.

It's, you know, a couple of words that you can enter in.

Doesn't have to be a whole definition, but what is it that comes to mind?

When you think of safety.

We have heard so many stories about safety threats in hospitals.

And I will give you a little anecdote as we, you know, see what the responses are that are coming in.

I was doing my data collection in an emergency department for my doctoral work, and happened to see two wounded men come in with a full army, both E.M.S.

security, police, and they were both handcuffed for how they wanted to do a fight.

One of them had been stabbed, but the other, the policemen thought that they were kind of cuffed.

But there was clearly an issue with the law.

And one of the guys in the stretcher had actually pulled out a knife.

The staff members, the visitors, the patients, all of them were, you know, trying to find cover, in a safe place.

So that's the level, of, you know, stress and tension.

It goes on in the emergency department.

I love the responses that are coming in.

Mental health problems, peace, violence, comfort.

So important.

I love that somebody is pointing that out.

Prevention against harm.

Tranquility.

Nice.

Yeah, I know, I see it.

There's it's not just guns and knives.

Like Brittney said, so many other things that come in that you wouldn't even expect to become a weapon.

Peace.

Mental health.

I love everything that we're seeing.

You can all keep on shooting if you feel like.

But I switch back over to the presentation and and talk a little bit about some of the definitions that are already out there.

The CDC talks about having safe working conditions not just to maintain the well-being of staff members, but also to provide an environment where they can provide the care efficiently that's required for patients.

American Nurses Association talks about the culture of safety.

So it's not just about one incident.

We have to have collective and continuous commitment to this whole process across all different sections of the healthcare, workforce, the managers, the ownership and the frontline staff.

It is about perception.

Safety is perception.

I need to feel safe.

It's not just about the strategies that I do.

I need to have the resources or policies in place to maybe even report an incident that happens, right?

It's not always physically.

It can start out to be aware, but it's like it could be a fight that happened totally and escalated very quickly.

To a physical violence.

So there's a lot of different definitions out there.

Like, have you all that thinking, the need for peace, the need for tranquility.

Amazing.

So we will get, you know, going with that thought.

What are we seeing that's out there in the data?

Why is it so important?

A majority of the safety events that happen, happen in healthcare settings to health care workers even more than law enforcement.

You would be surprised by that.

Over 80% of nurses have experienced at least one type of safety threat in their workplace.

The number has doubled in the last few years from 2018, which was pre-COVID to 2022.

We've seen a lot of change, but a lot of incidents of has and, you know, somebody brought up the world of mental health issues.

There has been an uptick in that.

There has been an uptick in the fatigue because of that on the staff.

So all of this results in increased number of harassment or, confrontations that happen in healthcare settings.

About half of the workforce is reported feeling burnout, which is again, 32%, in 2018.

The 50% currently.

Another shocking statistic was that only 1 in 3 nurses felt like their employer actually had a policy in place to report an incident.

So imagine how many incidents go unreported and unresolved.

And then this entire scenario leads to the workforce diminishing.

Healthcare workers want to be enforced.

So that's a problem for the health system.

And we really need to tackle that at a grassroots level.

So what was the approach that we document looking at all of these staggering statistics, looking at all of these incidents that have happened in the past.

The team are small team of five but very mild team.

We got really excited about taking this up and figuring out what is it that we can do to contribute to the healthcare industry, to our folks?

So we decided to dive in.

And we combed through the literature.

We looked at the evidence synthesis right.

We looked at industry reports.

We looked at market trends.

We did case studies because it also has a wealth of different projects that we work on.

Healthcare, education, a lot of different sectors and all of that.

So we went in and did a really good deep dive into the evidence.

We also conducted many interviews with individuals in the C-suite, C-suite across the nation.

We wanted to make sure that we had a really good collection of different institutions.

So we did cancer.

We did pediatric, we did different payer mix.

We did county hospital.

You'll see that.

We did California, we did Texas, we did New York, which are some of the larger states.

We made sure that we definitely hit the Texas Medical Center, which has the largest medical center in the world.

So these are collection of those individuals that we had conversations with.

We did have only an hour, 45 minutes to an hour conversation because these individuals are extremely busy.

But one thing that we heard over and over from every single one is that eyes on from a human individual was key.

But we also heard that human mistakes also causes some of the major incidents to.

So who wants to hear some more real life stories?

No.

Okay.

All right.

So, one of the individuals, that we interviewed worked at Elmhurst in Queens, New York, and got him, and she took her and a that's why this individual was not a patient.

We have a bias, right?

These it's patients or it's family that's in the hospital that does this.

Right.

Not all the time.

It can be you know, you're going through a bad divorce or a bad relationship, and you're going to get into that hospital and you're going to do something to your, you know, individual you're in a relationship with.

Well, this was, a couple going through divorce, and that person did not care that there was a metal detector.

He got in with a gun.

He was going to get his wife.

So he got in.

He got past security.

He shot that of her clerk, abducted his wife.

Police chased.

They saved his wife.

But they're incidents.

Crazy incidences like that.

But he also now works at a county hospital.

Human factor.

They did not secure an inmate to a bed properly.

He got out in the hospital, got through ceiling tile like this, crawled into a wall crevice.

You know, we have to really be thoughtful.

We make beautiful spaces, but we have to be thoughtful in our design to make sure that, you know, people are safe.

And these incidents are not isolated.

They represent all the broader problem that we need to address.

We recently attended a presentation by a security consulting group, and they said that the first line of defense for every hospital is to call 911.

It doesn't have to be that we can do better than that.

There's so much opportunity.

We have to prioritize safety.

There's a culture shift.

There's a mindset shift, but we need to be thinking about when we're designing spaces.

So I'm going to dive a little bit into, you know, what do we know from the literature.

These are three quick slides.

They come from the press scanning National database of Nursing quality indicators.

I highly encourage all of you to take a look at some of the statistics that have come out of that report.

It's a very compelling report.

I'm just putting out a few things that we saw in.

A majority of the assailant in healthcare settings are patients and are male.

Females are most likely to perpetrate violence in pediatric units and rehab units.

I'm not surprised are shocked by some of this, but this is what the data has been showing us.

And among staff, nurses are the most common targeted.

The report also says that two nurses were assaulted every hour in quarter two of 2020.

That really struck me.

Two nurses and hour is unimaginable.

Where do these safety fit happen?

So based on the data, section three is scanning the highest number of assaults happen in psychiatric units, in emergency departments and in pediatric units.

And the lowest numbers have been in O.B.

and neonatal intensive care units.

They are the lowest numbers, but we should be at a point where there's no assault at all.

We can all be proud of the fact that they are the lowest numbers.

One of our, interviews, one of the senior vice president and CEO of a federally known facility spoke about security guards having to be present in labor and delivery departments because significant others, you know, the mom and stuff.

And that's some of the stories that he told you about.

And why do these things happen?

There's so many reasons.

Just touching on a few of them here.

You know, waiting times are increasing.

People get frustrated.

They've translated towards shift plans.

Stop working.

Excessive hours in healthcare is very common.

That leads to exhaustion.

That leads to burnout.

It comes to a point where maybe if a staff member is not even in a position where they can react, to a safety threat, you know, a lack of security equipment.

But the saddest part about all of this is that violence or abuse is considered inevitable in the jobs of healthcare workers.

And that is unfortunate.

We have reached a point of thinking that it's going to happen.

Another, on a piece of paper from another, facility said complacency is dangerous.

If we just think we are safe, I want to let you know.

We want.

So really something for us to think about.

This is an ongoing process.

It's not a one and done thing.

You're not putting a security measures in place and feeling like you're safe.

It has to be continuous improvement for businesses.

And with that, I'm going to talk about two, theoretical frameworks that we're going to be using to frame some of the design strategies, that we'll be talking about.

So this is the social, technical, system.

And I'm assuming some of you already know about it.

But we're talking about these five different components.

So the organizational environment, technology, the people themselves.

So the individual characteristics of the people, nature of work and physical environment, all of these need to come together and work synchronously.

To be able to provide a sense of safety, if even one of the pieces of the puzzle falls through the cracks.

There is weakness in the system, and there is more chances and more opportunities for safety threats.

There have been a lot of policies in place like we've been talking about through the CDC or, the American nurses Association.

There's a lot of policies that we've been hearing about.

And, you know, to improve safety.

But there's a big gap because nobody has been able to bridge the policy to practice, read the crime prevention through mind.

The design, framework is a really wonderful framework that actually makes that leap.

There's five different factors that they talked about.

These design principles of access control, surveillance, territorial reinforcement, maintenance, and social management of the five key principles.

And really quick, that's often these.

But keep that in mind when we talk about, the design strategies.

So what is access control.

Trying to limit entry points into a facility.

So how do you do that.

There's color.

There's wayfinding strategies.

Several of those that we will be talking about.

We need to be able to segregate and separate flows and access into facilities.

When we're talking about surveillance, that's more about maximizing visibility, the ability for staff to be able to monitor, multiple different ways we can do that again and build up about those.

What is territorial reinforcement?

Being able to draw very clear boundaries.

Right.

Separate staff areas, separate patient areas, making sure that the flows don't mix up.

Again, you can use wayfinding strategies, color, camera systems, fencing, gates, a lot of different things.

But again, I want to point out something that really said knife safety doesn't have to be in your face.

We are architects.

We need to make sure we try to balance safety with esthetics.

Maintenance.

Super important, but often overlooked.

If a place is unkept, if it is in a dilapidated state, that's the place where violence is potentially going to happen the most.

And we hear this a lot from a lot of pipelines.

So maintaining a place, keeping it up all the time important again.

And then social management, trying to figure it out and make these spaces for communities to come together to be art installations, you know, common green spaces, where people know the intent of the space and can come together will minimize, chances of any kind of noise, because they do things.

So with that, I will hand it over to Whitney again to talk about some findings and strategies.

Absolutely.

And so now we're going to talk about the balance between beauty and safety.

And so we're going to go from macro to micro.

And then key considerations from the campus level all the way to the root level.

And looking at the way to us physically create safe environments.

For.

So on the campus level we look at the campus.

There is never a one size fits all, but there are ways in which we can do things in a repetitive way, like separating staff from visitor and making sure that there are no separate entry points and one way flow.

Know that ends one entry point into areas.

Landscaping that is low, no hiding places with landscaping or buildings, hardened entryways, lighting, etc.

we're going to go through some of the some different case studies.

All of these are from each campus projects.

And this is banner Andy Anderson.

And so looking at this one, you can see that at night the parking area is well-lit.

Staff can get to the hospital in a very safe way.

The landscaping is either very low or minimal or the trees are cut very high, so there's no place to hide and, you know, it's very clean and it doesn't look like I believe it's a nice building and safe as well.

This is another way.

The public entry.

There are multiple entries that the front of the building, but that is, visitor.

So there's one way you enter and the staff areas are in the back.

But if there was an incident, it's easy to shut that, Daniel, as opposed to multiple places among campus to shut down.

You can shut it down or get people in and out in a very easy manner.

We also like to take examples from other things that we do.

Another practices education.

So I feel you guys live it every single day.

This campus in Florida, what they have done is they actually elevated the building off of the ground that allows for one entry point as opposed to multiple entry points into a building, ample lighting.

You have passage way above the street level from building to building, as opposed to on the ground.

And you know, the cars can pass through and they remove the parking from the actual building itself.

Then we go to the building itself, kind of moving in.

So we also, you know, whenever you get into codes, it's going to want you.

The larger the building, the more you know small compartments is going to require, the more egress you're going to need.

Lock the doors do not have those as entry points.

Limit those entry points into the building and only use entry points that you need.

Entry.

Main entry entry to the entry for staff.

If you are required to have secure entry for potentially inmates, have that entry.

Have a sally port.

Lock it down.

Let them enter.

That way you'll have your ambulance entry secure, right.

If you're in you know, like Houston, you have to know that, if you're a trauma level one, you're going to be bringing an ambulance and you're going to have a police car with it to there are things that you're going to have to think about where you are in the environment, but you also want to limit the way people get into the building.

Penetration resistant.

In Houston, that's where I'm from or where I live.

You may say, oh, we have hurricane loss.

Well, yes, it's great, but it's not bullet resistant.

There five levels of bullet resistant glass, so if it's required, make sure you use the ride resistant for penetration into that building if it's required.

If you need bollards to prevent vehicles from going into your building or impact fencing, but just make sure that you put everything in.

It can be beautifully built, but in to resist anything going into the bucket.

And so you have to be very, very thoughtful whenever you have a sequence actually going into a building.

I'm only going to hit on the main entrance.

But whenever you step into the entry, it should be transparent.

You should be able to see a reception, you should be able to see the elevator lobby, but you should not be able to get there until you've gone through a sequence of first security's.

In the entry vestibule.

There's going to be, some type of metal detector, not just for guns, but for more, because there could be other things that are weapons.

Right?

And you could have an amnesty box outside.

People could be coming in in a hurry, maybe at the emergency department, and they could have other weapon strikes, no questions asked.

Don't those items there so you're not walking in.

And then if there's a problem there's a holding or a questioning room in that, a civil once you pass security and we hope that this is only one way and you have a discharge lens elsewhere, so you don't have traffic coming and going in different directions, then you go into queuing to get credentialed to get your card.

The card gets you to the elevator, and then you go through a turnstile.

You have eyes on the restroom, you guys in the elevator, and you always have eyes on the people because you want to make sure you know that your stuff is safe.

This can be done in a beautiful way, but you just want to make sure you follow those.

And then we talk about staff and staff safety.

I was in a focus group yesterday, and we got this very interesting story from a nurse, who works in and, she said, I start my shift at 3:15 a.m., so she found at 3:00.

And so I wanted to get to the parking lot of the units.

She had two bedroom, 11 times where she was like, okay, there has to be a limit to this.

So we need to try and balance this.

Is there any other type of technology that's out there?

The support?

Is facial recognition an option?

Potentially.

So we need to be thinking about that as well.

And that's going to be June 11th times of three.

I'm just like I was sending out in the garage trying to find my badge.

You know, I was feeling unsafe in the garage.

Once you're in, it's fine, but there's several steps that we need to be thinking about as well.

So there's the built environment aspect with the influence of technology and policies that we need to be thinking about.

I like that you said feeling unsafe in the garage.

We've heard that so many times.

So let's open those garages.

Let's put the light in.

I mean, even men that we interviewed said, I feel unsafe in a closed garage, so open it air.

Let people see you or even in the building.

Let's put I mean, put those, those stairs in glass.

So even on the exterior there, cuz where you're exiting is.

This is a behavioral health center.

We we learn a lot.

We go back and forth between, you can see that they have this turnstile here, and before that, they had the metal detectors.

But look at the colors.

There's a lot that we can do with color that also is calming.

So whenever you go in, you're like, oh, I already feel it piece, you know?

So you don't want to paint our rates red.

Let's, let's, let's think about what we do with our colors as well.

Before you go in.

And then, you know, infection, disease laboratories, these are, you know, high security spaces.

Most of this is a block.

We this is a place that, we have built that we want very few people going in.

We want very few people going out.

But we have layers of materials that creates a nice architecture but allows light and people, places.

So we can also be creative in our architecture that way as well.

You were talking about 11 badges hotels.

When you go to a hotel for the parking garage, you have the badge on right?

With a you don't have your car chain in it.

So that should have the badge in a smart.

And why not have a metal detector we heard about though you know sometimes it's not always patients that are after stuff.

Let them go over a bridge.

Imagine metal detector, a detector, security, make sure that people are appropriate.

They're also going in on the staff side as well.

And then we are going we're getting smaller.

We're going you know we're more on the unit.

So you are up the elevator.

You have your badge.

It took you to level seven.

Now you're in a waiting room and there's someone receiving you, and then there is a locked door you cannot go past go unless you are now not a nurse at the desk, but a full time employee that screens you again.

That checks.

Oh, you need to go to room 712.

Let me check.

Then you can go pass and get in.

So we want to make sure that there are those barriers and you are still continuing to go.

You didn't follow someone in the elevator.

You're just going to a random floor check.

And while you're talking about having eyes on the unit all the time, having people interactions all the time, technology can be such a powerful tool.

Are we using security video cameras for surveillance?

To ensure that you have both covered security units that, are we talking about high security systems, especially in units like PDF, because we've heard so many stories there.

And then ongoing stuff, safety and security training that is almost.

We also, I mean, staff sometimes you may have 15 minutes.

We don't want them having to go downstairs.

Level one mixing in the general population.

They do want to get fresh air.

They do want to get, you know, a snack.

But this provides spaces for them upstairs for rest.

But outside on the unit.

Waiting room.

You know, you're going to feel like you have a private space.

Staff can still see you in these areas.

Or even, if you are meeting with a staff member, you're not in the room with the staff member where no one can see you.

You're not having a conversation in the hallway where everyone can hear, but you can have, you know, semi-private eyes can still be on you in that area.

So that is a nice design in that aspect.

But at the same time, family may need to get away from the room.

Away from where family or away from where the patient is.

We don't put them in a closed room either.

So you can also sign nice spaces.

That gives them a place to get away, but you can still have eyes on them as well.

And this is that aspect of social management that we were talking about today, having these different spaces, not just patients, even staff is providing just a break room enough, or do we need to do more than that?

Right.

We we've been talking a lot about, you know, patients and staff, wanting to but staff and staff audience is also common.

It's not unheard of.

So we need to be thinking about those aspects as well.

When we go to the patient room, I don't know if you've had a lot on in for toilet, outworked toilet.

You want my opinion?

A toilet is the way to go and the reason is you have a square room.

You have very few spaces to hide in this room.

If you had an indoor toilet, you can hide behind that toilet and you are at risk of having an encounter with staff.

In this situation, you have two ways that you can easily monitor a patient.

You have a foot wall where you could get up to 80ft.

Monitor at the end, where you can still segment part of it for your TV or screening.

The other could be part of your toilet sitting, etc.

but you also have the ability for line of sight into the patient room, line of sight down the corridor, and then you're able to see the patient even more.

This example, is a Fort Worth.

It's actually looks like a hotel is pretty nice room, but you can see that there is no restroom obstructing that nice square room and the restroom.

While this it costs a little bit more, you don't have the shower curtain in the room the way that they treated this restroom with the glazing there also gives more line of sight in that restroom.

So you are able to have more eyes and no hiding places.

We've spoken to little bit about some of the policies and people centric strategies, but I want to go through some of them, once more.

So ongoing training.

Definitely.

We need to initiate ongoing training, around safety and security for our staff members, ongoing feedback, you know, hosting some sort of listening sessions to understand staff's, experiences and their perspective, perceptions about safety in this space and what can be done better for them to feel safe.

Extremely important, community partnerships, trying to establish these partnerships with your, police in the area, the sheriff's, your first responders, that's where you're going to get the most help from one interesting story, because we've been doing this other study on noise for now and analyzing tons of comments from nurses on what makes them feel good.

So, one thing that we heard, and we also have this in our interviews for this, this study is badges that nurses or staff members with.

What if we started eliminating the last name of people, from the badges, because there have been times when patients and families have tried to track down their care team members based in the hospital.

So, what can we do to prevent the identities, and confidentiality for staff?

You know, being very careful when you're trying to hire, considering hiring security personnel who might be, you know, former policemen, trying to have staff in uniforms to make sure that there's a sense of safety.

And that is a important for safety and security.

Within the hospitals, is very important.

We recently heard that there are some states, like, I think Indiana, Ohio and Georgia, but they're now allowed to have their own police forces on campus so they can, you know, create their own force with their own uniforms and have them, set up in the campus.

So just a few things to think about outside of the built environment.

That will also affect, the amount.

Some high level takeaways from our study.

There is definitely a need for us to create and sustain a positive work environment.

We are 100% struggling in that data right now.

And we need to do something about it for sure.

Investing in measurement assessment is very important.

Like I said earlier, it is.

But it's not that you put on a camera and you're safe and secure that has to be a constant evaluation of what's happening.

If to understand the context of a major health care system, the situation your hospital is located that is going to impact the demographic that you see, and that's going to impact a lot of the safety and security measures that you put in place.

Mental health is an issue, as we all know right now, and we need to support it.

And we need to reduce the stigma that's around that.

A lot of bad policies need to be in place, compliance with policies, and trying to make sure that there are systems in place for people to report any sort of incidents that are happening.

Technology is a very powerful tool that I don't think we have used to its fullest potential, but we certainly need to, you know, effectively use technology.

And there's other things that we've not spoken about cyber threats.

Cyber security is a big thing of late.

We've not even touched on that, but is definitely something for us to start considering.

So we do have next steps and we're going to be validating our findings.

We're going to be doing some brainstorming and, sharing more of what we have learned with our firm in the industry at large.

But before we leave, I just want to leave you with one last, story in, October 2021, in Dallas Methodist in a maternity ward, there was an individual that came in and actually shot two individuals.

And, since then, I don't know if you have gone into the hospital, but individuals are wearing red and black ribbons or they're starting to wear red or black scrubs, which we've seen loud, but it is a silent way of telling everyone, this is an epidemic.

This has got to stop.

Nurses, our caregivers are not a punching bag, and collectively we have skin in the game too.

And we can help design better and safer places for those that care for all of us.

Thank you.

Thank you so much.

It's such an, critical to such a critical topic.

And your presentation was very, very informative.

The stories that you shared was also very impactful.

Well, thank you so much.

Now, we're going to have some time, a few minutes for, some, questions that you guys may have.

And of course, I'm going to check out the chat box for out of some participants to see if we have, we have to have ten participants online.

So if you guys have any questions, please include them in the, Chat.

And of course I see some notes.

But first of all, let's see.

Andrew.

Yes.

There you go.

Okay.

So when you're talking about psychiatric care, I know ligature related elements are integral for the patient to reduce crime cells, but is there additional measures to prevent harm to the caregivers looking over psychiatric patients?

We've seen I don't want, I don't want to call them, but the the cages that goes down and you can lock up, you know, some of the televisions and things like that.

You're not just for the patient presents for both of them.

So for the staff and for the patients, it's something interesting that yesterday was we're talking about, came up.

Was there any patient who is in a hospital and is being psychiatric or not having a family member with them, as their advocate?

Just because I mean something, you really aren't very empathetic to the other people that you gave you that's not your family.

Same with even with the psychiatric patients, but having that one person, by your side to your advocate, I think would go.

Exactly.

And that's what we talked about yesterday.

The degree to that, to.

You.

Thank you.

Okay.

We have a question in the back.

You mentioned you mentioned the, penetration of, health care facilities and, so what is, do they have the standard for the safety?

You know, for example, the hospital and local or the state level of the hospital, they have a certain level of the safety type of the hospital.

So safety what type of system?

Yeah.

So are we talking about the bed operation and the level 12345.

That bulletproof.

Yeah.

Yes.

Yeah.

No.

At this point it's more of a choice that are required and and ask.

But I do think that the policy and recommendation that is one thing for our next step that we are going to roll out as a recommendation.

I mean, there you go.

Here.

Yeah, yeah.

So my question is, I've heard about the debate between centralized nursing station and decentralized one.

And you mentioned with your case studies, like centralized works best.

Oh yeah.

So I absolutely should have gone.

So if I design a facility so should I some intervene.

Should I or incorporate one centralized and is decentralized.

So the staff would be safe.

I guess you should have both decentralized and centralized nursing that at the end of the day and through the debates.

And you may have some from your literature and your research.

Yes.

I would say there's a lot of factors that go into it.

And how big is your unit?

Okay.

Let's move back to the last thing.

If you have an eight bed okay, you go to if you have a larger unit, 24 rooms.

Yeah.

Maybe you do.

It depends on the patient population that you your, the unit is used for it, right?

If it's a very low acuity, maybe not.

There's there's a lot of factors.

I don't think there's a definitive answer to say, you need to go with a centralized versus a decentralized.

And safety is just one aspect of it, right?

There's so many other outcomes that you need to be thinking of as well.

Yeah.

So I don't think that is a 100% answer for this versus that.

But there's definitely benefits to having a centralized and a decentralized board.

Yeah, it is kind of you kind of answered my next question as well.

So it is the example of just the crisis stabilization unit is in the pediatric, you know, settings.

If the kid is highly agitated, it is a thing on the staff person.

So like the open observation lodge.

So just to know, staff, if you are doing open, open observation, this has been observation lodge.

So what is the best safety barrier?

Should we add some partitions?

I don't think that is one safety solution to anything.

It has to be a mix of what works for the facilities, but operations vary drastically.

Facility to facility, right?

We don't know how many staff members are going to be present.

That's just one staff member for eight rooms.

Yeah.

Well, then we need to think about additional safety measures to bolster, you know, to support that nurse.

If we have four, if we have a higher patient ratio, like I said.

Okay, okay.

Go back.

Is there somebody else that I can depend on?

Maybe some of the language teachers don't need to be there.

So it's, it's that flavored.

I mean, what's the operations?

What is the staff patient ratio?

What are the different, you know, what's the room type like?

Right.

Whether you have an input output nested toilet and all of these factors are going to impact.

So you cannot have your design done in isolation.

You need to understand the context of where this is going to be laid out.

Yeah, that's the last door so far in that question that you have, honey.

So, based on the factors that normally, are considered for, you know, safety measures or the design of different, types of nursing stations within two minutes usually.

How do you think facilities prioritize guys, it anything I know it's, not this question.

Like, if anything come up in the interview separately, like, how would be when like, safety, for our caregivers when it comes to, you know, the design decision making, you know, that patient monitoring, you know, patient safety is always a big issue.

So where does that fall for caregivers?

One thing was we want line of sight.

So our line of sight from nurse Station.

And to be able to always see, you know, the caregiver.

So that was the priority.

And and I think there's a few different examples that we love about harassment in the patient population and the community that turn on that also impacts how much you want to invest in something.

For safety measures, if you have something, I can give you an example of a, study we did in chicago.com.

Right.

We had, an emergency department we were working on.

They had system that centers like a whole bunch of things in the, in, they had a patient who walked in with a donkey or donkey.

I'm not even talking a patient.

The bottom of the donkey through all of the security system.

And this is a real story from a client that I'm thinking.

So they know exactly what they're up for.

And you may want to learn something from that associated with you.

Yeah.

In the EDI is where we see a lot more, and then it gets less and less and disseminates from there.

But, we're going from a trauma level three to a trauma level one capable.

And so it's really important that we are able to take one of the parts that is, for more behavioral health and design it in such a way that we can contain it very quickly, whether it's for the behavioral piece or even for a safe environment for staff.

So it can go one way or the other.

Okay, Kayla has a question.

And a question more more on the administration side where so you you come up with like maybe like every month or every couple months about issues and things that come up with safety concerns.

And so what is it look like when everyone who's in charge of coming up with solutions and bringing up issues, like, what does that meeting look like?

Like kind of like how does the discussion go?

Like how often do the discussions happen?

And then like, is it like, this is all the things that are happening and these are future solutions or this is like, what's going to happen now?

This is gonna happen in like two months or, you know, whatever.

What does that mean?

Like it's, it happens all the time because especially from a technological standpoint, things are changing.

And when we have bills, it can be five years before it's built.

And so we want to make sure that we have things built in that will adapt.

Because what are we building behind the wall that we can plug in later from that standpoint?

But we have meetings with the local police department.

For instance, whenever someone, checks in and say an inmate, it's one on one there with a police person.

But if you are a pregnant woman, you cannot be handcuffed.

So it's two individuals.

And so, and the amount of staff it takes just from the police force to be there at the hospital is incredible.

And then you have to also have a discussion.

Do you have them with the general population or do you segregate them?

I think, you know, so there is a lot that goes into and this is General Hospital.

And do you have a separate behavioral health aide or you bring them in, you know, and everyone who has a system should have a system.

You must report incidents.

I have to be there's a lot that you can learn from that data to do.

We can.

What's happening?

Where does it happen?

Maybe this time of the day that you see that and then you, you know, want to strengthen your security at that time.

So there's a lot of different factors, including, and there's continuous improvement, I think said it's not a one and done thing.

Need to constantly go back and do that.

We strive to do is really to be a future forward thinking fund.

Let's get a project to you did last for you.

So, and then you changing the funds we used ten years ago.

I don't think they exist anymore.

So we really need to think about think about what technology is going to help you, because