Healthcare Security Thoughts and Advisories

November, 2008    Literature on the subject and our own observations are noting the growing problem of aggressive behavior and violence in Emergency Departments.  These security-sensitive areas are often the focal point within the hospital for stress, frustration, anger and possible violence.  With more patients making use of ER's, and resultant waiting times often growing, there are more incidents of confrontational and frustrated patients and family members.  Add to that limited space in waiting rooms, easily accessible treatment areas, drug impaired and gang member patients and visitors, and exposed "front line" staff such as receptionists and admitting clerks, and the potential for harm can be significant. 

Contrary to what is sometimes believed, it is possible to establish a reasonably secure and safe ER without compromising the hospital's patient centric, family friendly culture, but that requires strategic and creative planning and not a series of temporary fixes.  It has been my experience that ER employees, including physicians and nurses, are happy to cooperate with new security and safety measures that will better protect them and their patients.   

October, 2008     From recent conversations with police chiefs and sheriffs, it is clear that one of the unpleasant side effects of our weakening economy is an increase in domestic violence.  Such violence sometimes has a way of spilling over into the workplace where, in many cases, an ex or current spouse or girl/boyfriend attempt to harm the person, sometimes causing harm to them and others.  The attackers can be relations of patients or family members or employees.  Healthcare operations tend to have high female populations, some of whom might be targeted for stalking, harassment, intimidation or assault.   In most cases, persons such as fellow employees who knew the victim knew that he or she was concerned over what their threatening relation might do.  If these concerns are raised to management, steps can be taken to at least better protect persons on the premises.  As with all warning signs of potential workplace violence, getting employees to recognize the warning signs and report their observations and concerns can be invaluable in planning protective and mitigating measures.

September, 2008      In recent years we have served dozens of hospitals, clinics, retirement communities and other healthcare facilities around the U.S., and some issues and concerns seem to arise again and again.  So that you know you're not alone, I thought I would share some here:

• Perhaps first and foremost, the greatest overall challenge is often achieving a workable balance between maintaining a patient centric and family friendly culture and achieving a proper and practical level of protection of people, assets and reputation.  The bottom line, in my opinion, is that these concepts are not contradictory but, with proper planning and communications, positively support each other.  In fact, especially since 9/11, I have found that patients and their families appreciate seeing a security presence and feel more comfortable in the hospital, especially after visiting hours.

• Perhaps the most common failing of healthcare security programs, in my experience, is that many employees don't feel any involvement, ownership or awareness of security.  They make the assumption that security is the responsibility of the security staff, law enforcement and administration, and not theirs.  The resultant indicators can be propped doors, allowing strangers in on card swipes (tailgating), ignored codes, failure to report, etc.   Security, like safety and patient service, must be a team effort.

• When I ask security managers and law enforcement representatives about their most significant security concerns, I often hear facility accessibility as the first or second most critical issue.  While healthcare facilities wish to present a welcoming and accessible face to their communities, there can be restrictions on accessibility that will not at all interfere with that image.  Not every treatment area or security sensitive area, for example, should be open to just anyone.  Not every exterior door should be accessible.  Perhaps the most challenging aspect of accessibility is how a hospital should be restricted to visitors after visiting hours.   

• As healthcare corporations grow, remote facilities including clinics, office buildings and retirement communities are typically added around the corporation's service area.  When I interview staff at these relatively remote facilities, they express concerns over how they fit into the organization's security program.  Too often they feel isolated and relatively forgotten.  Don't forget them in your security assessments and planning.

• During assessments I typically interview and survey employees in all departments and on all shifts and often find that their principal concern is over their perceived safety in outside areas and parking lots/structures, especially after hours. 

• I also encounter a common concern, especially among those staff who deal most directly with the public (e.g. receptionists, admitting, business office, nurses, pharmacy, etc.) and occasionally face the irate, aggressive, confrontational and even threatening person.  Many such staff don't know what to do in such situations and how to safely de-escalate and mitigate such predicaments and to communicate their concern.   Employees who work with cash should understand how to handle cash safely and how to safely respond to robberies.

• The most visible and costly, and sometimes most problematic, component of a healthcare security program are the security officers, whether contract, proprietary or hybrid.  While I usually hear from staff that the officers are appreciated, I also often encounter a perception that they are not as visible as staff would like or expect.  While hospital security officers are often burdened with many duties, some of which may not be directly related to security, there are ways to increase that perception of visibility.

• I find that while most healthcare organizations have been thorough and proactive in planning for the accidental emergency or crisis such as medical, fires, natural disasters, spills and releases, etc., they are often less comprehensive in considering purposeful, or man-made, emergencies and crises such as workplace violence (including robberies and domestic violence), bomb threats, sabotage, and terrorist or activist actions.

• Security programs sometimes emphasize the physical security measures (i.e. security officers, cameras, card readers, alarms, etc.) over the procedural (i.e., awareness, training, policies, background screening, identification, etc.).  Likewise, some security programs have evolved over time to become a mix of various measures that were added in response to incidents and particular issues.  A proper and cost effective healthcare security program should be one in which all physical and procedural elements strategically interact to synergistically deal with the true risks, threats and vulnerabilities.  It is useful to occasionally stand back and take an objective look at whether your program is actually meeting your needs.

• In many healthcare organizations there are employees, often Home Health Care staff, who work away from the facilities, often in patients' homes.  These employees don't enjoy the comfort of the presence of fellow employees and security systems that the facilities have.  They may, in fact, become victims of aggressive, threatening and even sexual or violent behavior by patients or members of their families.  It is therefore important that these employees be provided with the training and tools to reasonably protect themselves in such situations.

Please don't hesitate to call or write should you have any questions or would like to discuss a security issue or concern.   

Helping you protect your people, assets, reputation and value