Speaker 0: This is where health care leadership comes together. Becker's sixteenth annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13 through the sixteenth. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former president George w Bush. For the agenda and event details, visit beckershospitalreview.com and click on the events tab in the upper right. We're looking forward to hosting you in Chicago.

Speaker 1: This is Scott Becker with the Beckers Health Care podcast. I I'm thrilled today to be joined to be a brilliant leader. We're joined today by Brian Urich. Brian's with Michigan Medicine, and he's gonna tell us a little bit what he does. He's got a a fascinating financing career there.

He's the senior director, the Department of Public Safety and Security, which in health care has become more and more important on so many levels. Brian, can you take a moment to introduce yourself? And and I'm gonna ask you a lot today about how you ended up in the world in the area that you're in. I'll try not to ask you too much about Michigan football, but we will talk to you about your career and your life and and FBI and everything else. Brian, take a moment and introduce yourself.

Speaker 2: Well, Scott, first of all, thank you for having me. This is, an incredible opportunity. So happy to be here. As you said, my name is Brian Uriage, and I'm a senior director of public safety and security at, U of M Health System. And it's an incredible system.

We see over 3,000,000 patients per year just at our Anarbor location. That does not include our different locations throughout the state of Michigan. And we have about 40,000 employees overall. And on our team, we have a little over, 300 team members, and they are a combination of dedicated police officers, dedicated threat assessment investigators, security officers, k nine teams, and guest services. And all of that works together.

And we like to say we have a a focus of trust, training, training, and technology to make sure that that our team members are safe.

Speaker 1: And talk a little bit about public safety in hospitals and health systems. If you went back twenty years ago, this seems like a very minor concern. You might have a security guy around, often was an older, nice gentleman, you know, and and I don't mean to stereotype, just sort of hanging around. And security at health systems has moved from that to being like a serious, serious, and very important, and and not scary, but there's lots of challenges in safety at health systems. You know, you hear often about an incident at a health system, a nurse shot, a patient knifed, so many different things.

Tell me that evolution of what health system public safety has has become over the years.

Speaker 2: Well, great point. People don't and for the most part, the the rest of the world does not understand what's happening in health care. So we know that right now, Scott, seventy two percent of all violence in any workplace occurs in a health care setting. Seventy two percent. And we know that according to Press Ganey, two nurses are assaulted every single hour, twenty four hours a day.

Yet, all of those statistics I just talked about are actually very much underreported because we know that only twenty six percent of nurses who are physically assaulted ever report the fact that they're assaulted. So the numbers are are assaulted ever report the fact that they're assaulted. So the numbers are are are very, very low compared to what is actually occurring. And I like to use the example in in 2019, there were one hundred and forty nine documented cases of people becoming angry and assaulted on airplanes. Fast forward to 2021, COVID starting to end.

We had two thousand five hundred documented cases of people assaulting people on airlines. And all that's just an example of our society has changed, and all of those people need health care. And we know that according to the joint commission, that crowded waiting rooms and long waits for care are two of the driving factors in what's causing health care violence, and we know that every health system throughout the entire United States has crowded waiting rooms and long waits for care. So that's just a quick snapshot into what we're dealing with today, and that's what you see the change.

Speaker 1: And and take a second, Brian. This concept that on airplanes, we've got triple the amount of incidents from before. In health systems, probably 10 times the amount of incidents from twenty years ago. Is that a problem with society, or what drives that? And I know that's deeper than this discussion, but but why is that?

What what has gone wrong that we have so much of that going on?

Speaker 2: Well, that's a great question. And I I don't know, like, that I can speak to the actually, what's happening in our society. I can tell you between 2011 and 2018, this is before COVID, we saw a sixty eight percent increase in violence in healthcare. And that's before the exacerbating factor of COVID. So, yes, things that are happening.

We have to realize that every hospital system is a community, and every floor is a neighborhood. Everything that you see happen out in the community and where I don't care where where you live or it's it's the same in health care. The only difference is our communities go straight up in the air. They have 10 or 15 floors. But the same principles that we use to help combat crime and violence in the community, those are the same principles that we have to apply in health care.

Speaker 1: Thank you. And talk a little bit about your career in public safety. I I know that you're at Michigan Medicine now. At some point, you spent time in Kalamazoo, one of the great cities in America, maybe underrated great city in America. But but talk a little bit about your career and how you ended up in public safety and a little bit of your background.

Speaker 2: Well, I got really lucky. So, my entire life, I wanted to be a police officer or a firefighter. So I went to college, and one day I found out there's this incredible place called Kalamazoo. That's the largest fully integrated police, fire, and medical EMS department in The United States. So I applied and I thought I will never get in.

Sure enough, I was lucky enough to get in. I spent a twenty five year career at Kalamazoo, and I retired as their assistant chief. And I remember one day, and I had about ten years in, I was at a community meeting, and a lady was talking about the crack cocaine problem. And it was it was my moment. I realized, wait a second.

I she knows that we are not gonna be able to stop crack cocaine. But what she wants to know is that, can she have a relationship and trust us to know that we're on the same team and that we're working together to try to solve problems. So when I retired from Kalamazoo and I got into health care, I realized, wait a second. This that those same principles of trust and training technology, all of those apply in health care.

Speaker 1: And talk for a second, Brian. What's the most interesting thing that you see currently in health care and public safety when when you look at the overlap of those two areas?

Speaker 2: Well, probably the biggest thing is first of all, you have to understand the the key principle is we've gotta make sure that our patients, staff, and visitors are safe. But just as importantly, we need to make sure that they feel safe. And if they don't feel safe, we've not accomplished our mission. And for those of the that that will listen to this, that are old enough to remember the movie Gladiator, there's a portion of Gladiator with Russell Crowe where the head gladiator is talking about, you know, I wasn't the best gladiator because I was the best swordsman. I was the best gladiator because the crowd loved me.

If you wanna be the best, win the crowd. And I show that video to my staff, and I always talk about win the crowd. So the biggest issue facing facing health care security is understanding that we have to use nontraditional public safety outreach. We have to focus on relationships. We have to focus on building that trust so that we can make sure people feel safe because emotion will always trump data.

People will see something on the news, and even though it's a rare event, that's the only reason it's on the news, they will equate that, well, that's gonna happen in my hospital. So we have to understand that focusing on that relationship based public safety outreach is the number one key to keeping people safe.

Speaker 1: Thank you. No. I I I love that perspective. And how does that work in process in trying to defend and keep safe a large health system? How does that work in process in in in in in in in in how many people work in public safety at a system like Michigan Medicine?

Speaker 2: Well, we know the vast majority of hospitals in the nation are critical access hospitals. They don't have those resources. So the most I always tell people the most effective tool that you have is what's between your ears. It's your it's your mind. And so having a trained and engaged staff that has training in situational awareness, understands personal safety, that is engaged and works with their security teams.

That's the most important thing, that that we can do, to help keep peep people safe right now.

Speaker 1: Thank you. And and when you look at the future of public safety and health systems, what are things that people should be thinking about? What what are what changes do you see? What is there more and more use of technology? But the technology only goes so far on monitoring everything.

You still need people on the ground to see things and develop relationships. Right? What's what's this mix of where technology fits into public safety?

Speaker 2: What you absolutely do, and you you know, I didn't really do a good job of answering that first question when you talked about process. So let's you're absolutely right. Technology is key. Right now, we have cameras with analytics. They can they can capture exposed firearms.

They can capture people who are loitering. They can capture physical fights. But nothing will ever be able to replace that human touch. So So what do we do about about process? So let's talk about that.

We we know that what we do is we ask our staff every day, do two simple things. Number one, go meet a staff member that you've never met and engage them in a two minute conversation about nothing. Talk about where they're from. Talk about what the weather's like there. Talk about their background.

And then two, go meet a patient or a visitor that you've never met and simply engage them in a conversation about where they're from. Reduce their anxiety. If you've ever read the book, If Disney Ran Your Hospital Nine and a Half, Think You Do Differently, incredible book. And it talks about the number one patient need is assurance. We've gotta get our staff out and understand that we've gotta reduce that level of anxiety.

So let's focus on one of the biggest things in health care now is behavioral threat assessment and management. We all know about the tragedy that happened to the UnitedHealthcare CEO. Well, that person who committed that atrocity, that person was on what was on what's called a pathway to intended violence. So now what I always recommend is you need to have a multidisciplinary behavioral threat assessment team who focuses on people who could be on a pathway to intended violence. People who are giving pre incident indicators or they're exhibiting behaviors of concern Because we know, and this is a horrible statistic, that fifty four percent of all active shooters start with what?

They start with domestic violence. And we know when we look at the other parts, it's an adverse employment action. And we know that the vast majority of times, they will exhibit pre incident indicators. And I'll never forget, I was talking about this in front of about 40 nurses. I was explaining behaviors of concern.

And Scott, there was a nurse in the back and she was crying. And her manager was rubbing her back, and I I walked up at the end of the presentation. And I said, you know, was the presentation that bad? And her manager said no. The problem is that her husband, her soon to be ex husband, is exhibiting everything you're talking about, every one of those pre incident indicators, and she's scared to death.

Now let's think about that for a minute. That's a horrible tragedy. And is that nurse able to deliver good patient care? Absolutely not. She is not.

So our job is to identify those behaviors of concern, but that would not start unless we build relationships with our staff so they can trust us. And it starts with that non traditional public safety, which goes to that process you talked about, which then goes to those pre incident indicators, which lets us disrupt that pathway to intended violence. It's all interrelated.

Speaker 1: Thank you so much. And and talk about this. Like, from your perspective, having that intelligence, whether it's on a patient who's got trouble or an employee who's got trouble or anybody who comes in the hospital that has trouble, how challenging is it to access some of that information that must be so out there in an AI world, but there must be privacy issues in how you access it? Because, like, you talked about the shooter of the United CEO, and people knew he was on the pathway to violence. He as much said he was on a pathway to violence, but trying to connect dots is so hard.

Do we get to spot where it's easier to utilize different types of data to get a better sense of where we could have problems?

Speaker 2: Well, very good points because, obviously, we run it we run into all sorts of barriers because there's obviously law enforcement sensitive data that may not be easily easily accessible by people who were not actually in law enforcement. That's a key component right there, and that's why I always recommend to the critical access hospitals, build that relationship with your local police department, have them in when times are good, have them sit down for coffee so that in the event there's a critical incident, I can call police officer Scott up and say, Scott, I have a problem. I I have a person who's exhibiting behaviors of concern. Can you come over and help me? And that is key.

And then the second key is understanding, and this is really, taking making headway now in The United States. It's a trauma informed care approach. Meaning, I need to understand what is Scott's background? What trauma has he been exposed to? Because the last thing I wanna do is retraumatize Scott.

So if I can respectfully understand what is your background? What is it what have you experienced, and how can I relate to that, and how can I adjust my care to more respectfully support you and your family and understand what differences we may have? That way, I can make sure I don't retraumatize you and perhaps not cause you to escalate into some type of violence.

Speaker 1: Thank you. When you look at this year coming up, what's the biggest priority this year in 2026?

Speaker 2: Our big our biggest focus at Michigan Medicine is is really threefold. Number one, building our behavioral threat assessment and management teams at all of our hospitals using that multidisciplinary approach to help support people who may be on a pathway to an intended violence. That's number one. Number two is developing training in collaboration with our nurse educators that reduces both risk and anxiety of our staff. And I always tell people, you can build it in house.

All you need is two things. You need people who care and people who are creative. And I guarantee you, I don't care what hospital you go to in The US, there's somebody out there that is very caring and very creative. Otherwise, they would not be in healthcare. And then finally, using technology that actually reduces risk.

And that people talk about weapons detection or metal detectors. Yep. They they do have benefit, but there's other technology like we talked about before. Cameras with analytics that can focus on identifying that threat level, making sure that we have access control so that there's an on stage and an off stage presence, meaning your waiting room where it's on stage, but there's access control to get back to your clinical areas because that's your offstage area. So those are really our three areas that we're focused on.

Speaker 1: Fantastic. And and just one more question for you, Brian. You've had this great leadership career. We'll ask you first, I'll ask you the the tough question. The tough question is this.

Have you become a University of Michigan fan? Were you always a University of Michigan fan, or do you avoid that like like the plague?

Speaker 2: Well, I will tell you this. So my wife's from Michigan State University, graduated from there, so I can't even talk about it. I can just tell you this. I was never, nor would I ever be smart enough to get into the University of Michigan. In fact, my claim to fame is every meeting that I go to at the University of Michigan Health System, they are some of the smartest people I have ever met in my life.

And I can honestly say that I am always the dumbest guy in the room, and I'm just honored to be there.

Speaker 1: Well, you're you're you're a good man and no no better put than saying it somewhat like that, especially with the wife who's a Spartan and you're a Western Michigan guy. We get it. Well stated. Last question. You've had this great leadership career regardless of that tremendous humility even though you're really bright and just fantastic.

Talk for a second about any advice you would give to emerging leaders generally on the public safety field.

Speaker 2: Yes. Absolutely. And I'm gonna give you a quick story. My first day as a sergeant in Kalamazoo Public Safety, my first time ever being alone, my first call was a garage that was on fire attached to a house. I was the first one there, Scott.

I was scared to death. There were flames everywhere. It was starting to burn the house and the garage was fully involved and the fire truck pulled up and I was in charge of the person on the fire truck, but he knew more. He'd been there longer. He was more experienced.

And I looked at him, and his name was Dave Toth. I said, Dave. I said, we need to connect to the fire hydrant to get more water. He said, Brian, that is the wrong decision. We need to put on our gear.

We need to climb in the living room to stop the fire from getting into the into the house. So I said, you know what? That's a lot better idea. So we did it, and we saved the house. And I walked away.

I was mortified. I was like, my first day, my first decision, my first call, and it was wrong. But, Scott, what I learned from that is three things. Number one, create a culture where your staff feel free to disagree. Number two, always ask for help.

Always ask for advice. And number three, always remember the next person on scene of any situation, any critical incident always has a better idea because they don't have tunnel vision. And that's my leadership advice.

Speaker 1: That is literally brilliant. Brian, I love that. Again, we're fortunate today to to get to visit with Brian Urich, department of public safety at the University of Michigan. Brian, remind me of the exact title for our audience, if you don't mind.

Speaker 2: I'm the senior director for public safety and security for University of Michigan health system.

Speaker 1: Fantastic. It is really a pleasure to visit with you. You've also got several educational degrees and certificates. You're a lifelong learner, constant improvement person. Brian, fantastic to visit with you today on the Becker's Healthcare podcast.

Thank you so much for joining us.

Speaker 2: Thank you.