The world we find ourselves living in today is filled with turmoil, conflict, and disruption. Early indicators show that Y2022 is proving to be disruptive on many levels. Current global conditions have created geopolitical divisiveness coming from such countries as Russia, China, Iran, Syria, and Canada. Global security concerns present other countries facing immediate danger of civil war, protesting, civil unrest, food insecurity, critical infrastructure/energy, economic, pandemic/infectious disease outbreaks, cyber/IT, and terrorism-related challenges.
Furthermore, the current Russian-Ukraine crisis in Eastern Europe has created the possibility of economic stagflation, increased energy/oil prices, and supply chain management challenges. Russia’s waging war on Ukraine has created a humanitarian crisis not seen since World War 2. Russia’s full-court press for a land-grab situation to mine additional resources (fossil fuels and other minerals) is naturally a disaster to the Ukrainians who wish to remain an independent nation of peaceful people. Ukraine remains steadfast in its resolve to fight back against a much larger, more powerful nation-state in Russia, which is building parallels in their government and global actions reminiscent of the Soviet Union’s Cold War years of the past.
With the US mid-term elections approaching this November, there exists increased anxiety along with disruption to household incomes. Considering the global pandemic, organizations have been faced with the Great Resignation, with workers being highly selective on work-life balance while safeguarding their personal and mental health and managing their self-care. Recent events have further caused labor staffing challenges for most businesses, creating bottlenecks and supply chain interruptions with organizations and their products available to consumers as well increased wages and other associated costs. This has forced organizations to be ever mindful of their personnel and their impacts on the overall organization’s health, welfare, and vitality. This has caused disruption to the organization’s overall strategic mission, goals, and objectives. Managing risks in this situation includes organizational morale, employee empowerment, corporate budget impacts, and operational/financial risks involved in evacuating or displacing staff or employee family members.
Premier Risk Solutions has borne first-hand witness to the situation on the ground in Ukraine that is impacting locales as well as, by extension, family members who are living and working outside of the country but concerned for the well-being of their family. While the clients we have supported within Ukraine do not have full-time employees within the country, their employees have family members there, and/or the client has vendor partners in-country they work with. These situations have caused disruption to the business as the personnel are unable to focus on their work or in some cases do any work at all, further causing supply chain delays to the company. Companies are forced to decide on what level of support they can or are willing to provide to personnel who are not direct employees. Our clients who we’ve worked with directly on this issue to evacuate impacted personnel are treating them as one-off situations but have provided support for evacuation when and where appropriate based on a dynamic risk assessment of the situation. Premier Risk Solutions and our agents are also constantly evaluating opportunities through our own fluid risk assessment for avenues of egress for evacuation as it is evolving on a day-by-day basis.
The threat continuum is ever-evolving and is constantly changing based upon a multitude of security challenges. The need for organizations to create an enterprise risk security management, holistic approach to safeguarding their personnel, brand, assets, and vendor supply chain is paramount in meeting today’s challenges. Organizations are well served by conducting – at minimum – annual risk assessments while conducting normal business activities during this time of uncertainty. Should your organization require a consultation please reach out to Premier Risk Solutions for a free consultation.
How can we prevent major violent incidents from occurring? Being proactive is the best means of doing so, as we all know. With budgets constantly being challenged for resources from within the organization, corporate security department heads need to determine where their budgetary funds are best utilized in providing value to and enabling the business. Enter TipNow Pro out of Silicon Valley in California, where founder Cyril Rayan has developed a tool that acts as an extension of your existing program to deliver a proactive means of identifying threatening situations or items through anonymous reporting as well as integrated video analytics.
Cyril developed the technology after the Virginia Tech college campus active shooter incident at a time when he himself was a professor. In its current iteration of the tool, it utilizes both human capital and integrated video analytics to report on threats. It is the very definition of “see something, say something”. The human capital component through anonymous self-reporting in live streaming, SMS texting, voice tips, and mobile app tips, allows for the pre-defined administrators from the client company to receive notifications in “real-time” for assessment of appropriate action to be taken.
The integrated video analytics component allows for the identification of weapons, license plates, and intrusion in an automated manner. As a two-way system, it’s both people and technology working in tandem that allow further agility within the corporate security department in being proactive in augmenting their current security posture.
Premier Risk Solutions sat down with the founder of TipNow, Cyril Rayan, and had a brief discussion on his technology and how it can enable business, providing the value that so many department heads seek. He discusses some of the content written here but also shares a case study example of how the technology benefited a client in the best way possible. Have a listen! Please contact us should you have any questions.
As the world is evolving into more uncertain times in society, having a means of centered communications in a way a company can aid in proving a duty of care to their employees and contingent staff is of paramount importance. That is the reason for the existence of a GSOC. The integrated adoption of technologies with a combination of human capital to monitor and respond to alerts, developing intelligence, emergency phone calls, asset tracking, travel advisories, or other related systems notifications allow for quick response capabilities in triaging the situation. Being agile, consistent, reliable, and adopting new tasks are pivotal to support business operational needs.
In Premier Risk Solutions’ protective operations, we work with our partners at NSSG Global in Bucharest, Romania to provide remote support capabilities. With 24/7 dedicated GSOC operators, integrated network video, alarm & access control systems, telephonic response & escalation, along with protective intelligence analysts there is a holistic approach and execution to support field operations. As part of the service, we have rolled out an app that can be found in the Apple or Android stores that is called NSSG Support. We want to take an opportunity to showcase this further in this blog.
The purpose of the app is for personnel in the field – both business travelers/principals and our agents supporting them – to be able to not only provide safety check-ins but share pictures from your gallery and even snapshot one with your current location, chat with our GSOC operators with any questions or issues, as well as provide an urgent SOS signal to our GSOC operators to escalate imminently for garnering assistance to the individual.
The screenshot enclosed is directly pulled from the app, where “Send SOS” is located at the top. With “Tracking” turned on, we can get an accuracy of the individual’s location inside of 30ft and in some cases closer. You can also see in the enclosed screenshots where an individual can chat directly with the GSOC or an agent supporting the individual can also do the very same providing updates or requests for assistance. We do have our agent resources located on a map that is run in the GSOC to know who the closest assets are for deployment in an emergency. The “Send SOS” signal goes to one dedicated device with a phone number, with email notifications additionally permissible for redundant receipts.
Groupings can be set up for any number of individuals within an organization. There can be an unlimited number of groupings. Each grouping can have an email disseminated to the assigned representative from the company for any/all relevant activity desired. Should a company desire more regular reporting, the GSOC on the back end can administratively export chats, tracking info, etc collected data to share with our client.
Setting up a new user account typically takes approximately five (5) minutes time for our GSOC managers to get operational. Collaborating with your company representative, we can scale quickly to meet more volume needs as well. Knowing where your staff are and getting them expedient, qualified assistance is of the utmost importance. Should your company like a demo of the tool to learn more, we are happy to schedule a time to do so.
The main theme here is the attention to detail, quality assurance, and custom/tailored approach Premier Risk Solutions takes to ensure we reflect your brand reputation and integrity. Remaining agile to service your evolving needs, being responsive to your requests, and being consistent and reliable in our service delivery are hallmarks we strive for in each engagement. In all things we do, we provide comfort to your principals while balancing privacy and confidentiality with safety and security. We will be highly collaborative in our boutique offerings. Please contact us should you like to discuss your unique situation.
Following the protective services offerings PRS has been engaged in with our clients since the company began in early 2014, we began in late Q3 2021 exploring how we can further enhance our service offerings to our clients in the areas of:
We are proud to announce that we are operational in each of these areas! Our partnership with NSSG Global allows for our dedicated services in Protective Intelligence and Global Security Operations Center (GSOC) to support our ongoing and new prospective clients for their protective operations.
In Protective Intelligence, a high-level snapshot of capabilities include:
Flexible and Agile to Scale to your needs
24/7 Dedicated Analysts
Custom, tailored research, analysis, and reporting of threats to staff and properties
Guide executive protection team members and client personnel in planning, protecting and responding to operations
In Global Security Operations Center (GSOC) support services, a high-level snapshot of capabilities include:
Flexible and Agile to Scale to your needs
24/7 Dedicated, Highly Trained Operators
Command, Control & Communication Flow
GPS Tracking Capabilities
Integrated Network Video, Access Control & Alarm System Monitoring
The Protective Intelligence Analysts and Global Security Operations Center (GSOC) personnel are all co-located out of Bucharest, Romania in a secure location with the latest available high-speed broadband and network abilities. Being co-located allows for as near “real-time” information flow to PRS support operations and our clients. The personnel at the center are adaptable to tools preferred or required by our clients, which depending on the tool may require additional license fees beyond our standard package offerings.
Our Medic personnel is resourced from our local healthcare partners in the market of need throughout the U.S. They can either be full-time, dedicated staff members to a client or temporary needs for specific events or activities like board meetings or larger special events like a sales kickoff or tradeshow. The medic training packages offered include:
Short 1-4 hour refresher/tac-med skills driven
One Day, up to 12 students with 2 instructors, skills & scenario based training outside (class is POST, DHS & EMSA approved)
Two Day, up to 12 students with 2 instructors, Tactical Medical Operator (TMO) training (class is POST, DHS & EMSA approved)
Five Day, up to 20 students with 2 instructors and 4 skill/proctor instructors, Tactical Medical Technician (TMT) training (some medical training pre-requisites; class is NAEMT, POST and EMSA approved), with TECC certification included
Program Development Consulting: Advising on best practices for medical preparedness, preventions, early interventions, gear selection, travel medicine programs, and emergency medical response.
The medic training can be delivered to our client in-house and/or contingent staff (vendors), along with providing to our own team members.
Drug Diversion Interviews in Healthcare: Gateway to the Truth
The Emotional Connection Interview
By: Kevin Vanover and Rich Cinfio
The intent of this article is not to provide an in-depth review of drug diversion in healthcare; rather, it is to shift the primary focus to what we believe is the most critical component of the investigation process: The Interview. The interview is all too often overlooked, misunderstood and mishandled by well-intentioned leaders who may not be fully prepared to perform this responsibility at the level needed. There are inherent obstacles when trying to determine the truth under very stressful circumstances. Drug diversion interviews are by their very nature high-stress with much at stake. To overcome these challenges, the interviewer needs to possess a significant level of training and experience. The latter poses its own set of challenges when the interviewer is unaccustomed to utilizing conversation on a daily basis to determine the truth. To help better understand the importance of a sound interview approach, it is helpful to possess a general awareness of drug diversion nuances in healthcare.
Drug Diversion in Healthcare
Internal diversion of controlled medications by hospital employees erodes the care plan and safety of patients, hurts the service image of the care provider and supports the employee’s unhealthy and unlawful lifestyle. Further compounding this is the possibility of state-imposed fines, Joint Commission sanctions and patient initiated civil litigation. Typically, clinical care providers, such as physicians, nurses and pharmacists, have the most access to controlled medications. Despite existing systems to deter such activity, some caregivers possess the motivation and opportunity to circumvent safeguarding protocols to use medications for their own purposes. One motivation is drug addiction. The American Association of College for Nursing estimates there are 3.8 million registered nurses in the United States. Various studies place drug addiction rates among nurses at 8 to 15%. This is not to assume, however, that all drug addicted nurses divert medication. The frequency of diversion is also a factor to consider. John Burke, President of the International Health Facility Diversion Association, using extrapolated data from medical facilities in Ohio, estimates that 37,000 drug diversions occur nationwide annually at an estimated loss approaching $200 million.
What is clear, is the consequences of drug diversion are significant and harms everyone involved. In many instances the patient is denied pain relief and the risk of exposure to blood-borne pathogens from the cross contamination of supplies can elevate. Other concerns include inaccurate billing for medications never received and criminal and state regulatory board investigations resulting in sanctions.
Common Methods Used to Divert Medications
Some common methods for diverting medication include “wasting product”, which occurs after a patient refuses the medication or the dose pulled is inconsistent with the amount ordered, and the remaining dose is then used for the healthcare workers (HCW) own purpose. “Substitution” of medication occurs when the HCW diverts the intended medication and administers a common uncontrolled medication in its place. Another way to divert medication is the concept of “One for you and one for me”. This occurs when the HCW pulls two doses of medication – often two pills – scans the dose in the system and gives one dose to the patient while keeping one for their own use.
There are many systems commonly used to support prevention and detection of diversion activities. In addition to having a sound early recognition system to detect anomalies and other patterns of possible diversion, common defense strategies include strict transportation and storage guidelines, the tracking of retrieved or “pulled” medication from storage systems, such as “Pyxis machines”, and documenting when and to whom the medication is provided.
Suspected Diversion: Initial Response Options
Despite existing systems and protocols to prevent and detect diversion, it does occur on an all too frequent basis. Responses can vary and typically consist of:
Monitoring the behavior to determine if additional steps need to be taken.
Remedial education and training if established protocols are not being followed.
A review of practices and behavior exhibited by critical stakeholders involved in the dispersion of medication processes.
Convening an internal review group consisting of experts representing various medication touchpoints to examine and assess existing facts.
Reporting to state regulatory agencies. Typically, each state has a regulatory oversite board that falls under various branches of the state government.
While there are numerous response strategies available when diversion is suspected, it is our belief that all must strike the proper balance between protecting the patient, provider and employee. Fairness, balance, compassion and sensitivity is highly important when ensuring the determination of truth and the inherent accuracy of facts. Taking an aggressive posture that wrongly accuses the employee will leave them feeling abandoned by the organization with trust irrevocably broken. At the same time, determining the truth is a significant safety and risk- management concern for all involved parties.
Despite the existence of numerous response strategies, interviewing the employee is often the only available course of action that yields the greatest results and determines the truth. The question then becomes how to fairly balance everyone’s interest while protecting the needs and safety of the patient? It is our belief the interview and statements provided by the employee most often sheds direct light on what occurred and in a fair manner; thus, eliminating the need for speculation and an unsettled outcome. A truthful admission has many benefits including:
A legitimate explanation that clears up a misunderstanding.
Identifying training gaps that need to be rectified; very helpful when the employee is new.
Providing clarification on next-steps to help guide the recovery process.
Preventing future diversion attempts in a timely manner.
Shedding light on protocol adjustments in the event the interview does not yield a clear direction.
Gathers facts that can be used to prevent future activity by strengthening oversight.
Serves as a mitigation strategy for patient safety, risk management and liability exposure.
A fair process done in a compassionate way messages to the organization and patients that the organization has a strong, yet balanced approach while focusing on a zero-tolerance standard.
It has been our experience, however, that this most valuable tool, in our professional opinion second only to direct observation of theft (which rarely occurs), is often mishandled resulting in a cloud of confusion, frustration and mistrust. Common interview pitfalls include:
Rushing to conclusions.
Supervisor and others dismissing or downplaying the facts: rationalization and denial.
Inherent bias when leaders make decisions based on personal relationships with staff.
Interviewing before all available facts are known.
Poor or non-existent documentation.
Using harsh language and tone of voice.
Conducting a “police interrogation” first.
Attempts to outsmart and outwit the healthcare worker or bluffing with false information: “The Colombo approach”. The mistaken belief that a factual “gotcha” moment will result in an admission.
In addition to failing to establish an emotional bond with the employee, one of the more common mistakes is having too many people involved in the interview process. There is the mistaken belief that some bit of information will be missed, or an employee’s right will be violated so every entity who touches the diversion process needs to be in the room. With so many group representatives involved, the interview takes on the appearance of an inquisition. This all but guarantees an unsuccessful outcome because the interview focuses on what occurred thus failing to answer the more important question – why it occurred. It is the “why” that provides the gateway to determining the truth. Simply stated, having too many people in the room more often than not severely limits the interview and prevents a connection. This was one of many reasons why criminal investigators, who perform sensitive and stressful interviews, transitioned away from this model decades ago
A Different Approach: The Emotional Connection Interview & Determining the Why
Unrealized by many, interviews are highly complicated, involve many facets and require the interviewer to make an instant emotional connection with the interviewee. A connection that fosters trust, reduces fear and provides the best opportunity for establishing the truth. The interviewer needs to actively listen for a small kernel of information that requires a seamless and instant pivot towards a new direction; the ability to ease the employee’s concerns, fear and eliminate untruthful defenses while genuinely investing in their future recovery. There are five primary facets to the emotional connection interview: Preparation, Environment, Opening, Narrative and Closing. The following is a brief summary for each:
Preparing for the Interview
Preparations in advance of the interview include:
Reviewing and understanding all facts associated with the incident.
Examining the employee’s work history.
Determining what is known that could drive the employee to engage in this behavior.
Preparing the interviewer’s mindset – determining how best to approach the interview.
A proper interview environment is critical. In general:
Conduct the interview at a neutral and confidential location that is free of distractions.
Silence cell phones.
There should be no more than two factfinders in the room.
Only one person should ask questions.
Initially, only take written notes when necessary. Note taking is a distraction and prompts defensiveness.
Prepare a few questions in advance and avoid a script.
Explain to the HCW that the interviewer is here to understand why this happened. Explain that we know what happened, but we don’t know why. The why is important for many reasons including setting the context for what occurred – the salient driving issues – which help set the foundation for discussion.
Summarize that you are representing everyone involved including them. Recognize and discuss the pressures the employee must be feeling.
Explain that the organization has a robust analytical system that provides the pharmacy team with anomalies associated with the distribution of medication and these cases are investigated daily just looking for answers.
Allow the HCW to explain the processes they use when performing their medication responsibilities for narcotics and non-narcotic medications.
Assure the HCW that this process has the ultimate goal of making sure that the HCW is healthy and to have better work-life balance.
Practice active listening by letting them talk.
Listen for defensive themes designed to mislead the interviewer. Themes many times include statements that attempt to imply the theft did not occur or they are not responsible. Examples include, “I know you won’t believe this but…”; “To tell you the truth…” or “I swear on…”
Explore opportunities to reaffirm that “good people make mistakes”.
Compare many life events to the interviewee with the ultimate goal of minimizing what has occurred.
Speak to the root-causes for the behavior not the behavior itself.
Empathize with them as they explain the why. You are asking them to open up and to be vulnerable. Be prepared to be vulnerable yourself.
Vary tone of voice to encourage conversation and to display compassion.
Once there has been sufficient conversation to adequately address all facts and concerns, then the interview can enter into the closing phase.
Explain to the HCW that this investigation has to be reported to the state regulatory board and local law enforcement for separate investigations. Emphasize that their cooperation with the additional investigations is optimum to reaching the end goal of a healthy lifestyle.
Actively share in their relief by telling the truth; be encouraging and non-judgmental.
Let the HCW know that they will be supported through the Employee Assistance Program to include the drug screen process prior to leaving the site on the day of the interview. Think of it this way: The ultimate goal is to determine the truth and to bring closure for all involved. Done right, the employee may reach out and thank you in the future for impacting their life in a positive way, sharing with you the recovery process.
The investigation of suspected diversion can be a complicated, emotionally charged and stressful endeavor. A properly trained interviewer has the ability to obtain the truth, streamline the process, lessen stress for everyone involved and enhance future safety.
Kevin has served law enforcement and healthcare security for over 20 years. He is a recognized security expert who specializes in complex investigations with a special focus on drug diversion. Previous experiences include serving as a law enforcement officer in the State of Ohio, including a special assignment to a drug task-force, and was subsequently promoted to Lieutenant in-charge of felony investigations. Kevin is currently employed by a large healthcare system in the Greater Cincinnati Area where he serves as a Protective Services Investigator, supporting drug diversion investigations for multiple locations within the system. Kevin is well educated and highly experienced in best practices related to diversion within a healthcare setting. His work has gained the professional respect of local, state and federal authorities as well as regulatory board personnel due to his case work in addition to his presentation of case work within the board setting.