Health care facilities face escalating security challenges in the 21st century. However good facility management/design and today’s state-of-the-art access control technology can significantly reduce incidents.
Recently gathered statistics should illustrate the need for health care security improvements. For example, it’s estimated that approximately 10 percent of U.S. health care workers are assaulted each year. This estimate is based on the National Health Service (NHS), the United Kingdom’s publicly-funded health care system, which recently documented 55,000 assaults on its health care workforce in 2007. The NHS figures that an additional 55,000 assaults were committed and most likely not reported, raising the estimated total to 110,000 assaults—approximately 10 percent of its 1.3-million health care worker system. While the U.S. has no reporting system, the similarities between the two health care systems and societies would point to the fact these trends are mirrored in the United States.
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Emergency department incidents
Based on statistics collected at Colorado hospitals by Hospital Shared Services (HSS), Denver—which supplies security as well as other health care services to 85 percent of Colorado’s hospitals—70 to 80 percent of hospital incidents are generated out of the emergency department (ED). This is primarily due to the openness and customer-friendly nature of EDs. Additionally, ED patients and the people accompanying them are typically in a higher than normal emotional state that is many times aggravated by extended wait times for service.
In addition, the trend of reduced behavioral health care funding in the U.S., as illustrated by Denver’s recent closings of five primary mental health care facilities, is flooding emergency rooms with a growing number of mental patients.
However, assaults aren’t clearly defined in the U.K. study. An assault could range anywhere from verbal to physical abuse to even confrontations with weapons such as knives and guns. A four-year study conducted by the Henry Ford Medical Center, Detroit, reported that 4 percent of people arriving at the Ford Medical Center ED carried weapons to some points in the hospital.
Separation and access control
While the statistics point to a rather dire state of society, the hope for better health care workers’ protection can begin with facility management/design and access control equipment upgrades. The first step to better protection is increased separation of the walk-in and reception area from triage, treatment areas and patient quiet/safe rooms, without displaying a predominance of unfriendly barriers or obstructions. Today’s older designs are overly open and allow too much accessibility to walk-in guests without any sort of record or accountability.
Current technological advancements in access control enable higher degrees of security in ED areas without compromising aesthetics, customer service, user-friendliness or overall hospitality.
Hospital security is a combination of good facility management, information technology and the latest security best practices. All three aspects of hospital management must recognize their part to the overall security and asset protection of the institution. Facility management plays the role of maintaining access control and closed circuit television (CCTV) hardware as well as others. Information technology has a role to implement and upgrade security software. It is the central role of security management to blend the two for a cohesive security package.
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| (small) Matrix MX-Series Card Reader CU at TAMU | (large) Matrix MX-Series Card Reader at Cleveland clinic |
Security technology
Access control—arguably the most critical aspect of hospital security—puts the combination of all three functions to the test. It starts with critical thought to the design. The goal is to allow patients and visitors to move freely without feeling oppressed while still protecting both guests and staff. Access control can keep critical areas safe such as pharmacies, surgery rooms, infant treatment rooms, technology closets and rooms, information storage rooms and areas that separate staff from the public.
Contemporary security technology enables staff to enter and exit specific rooms or buildings without fear of confrontation from the general public. Not only does this protect staff but it safeguards assets as well. The general public enjoys a greater degree of protection knowing parking facilities are monitored and the flow of guest traffic is limited, observed and monitored.
Contemporary access control measures do more than just open a door. They allow or deny access to individuals based on the hospital’s needs. Software programs allow administrators to determine who gains access, at what time and when. Security staff utilizes user-friendly software (all password protected) for audible alarms of intrusion, and develops reports for all access control activity. Such activity may include identifying individuals that attempt to gain access to off-limit locations, as well as identifying doors that are left ajar or need mechanical attention. Contemporary access control programs can protect “itself from itself” by requiring double or triple authentication for access. Lost identification cards are not to be feared when biometrics or personal identification codes must accompany the card to gain access. (See sidebar.)
Policy signage
From a facility management/design viewpoint, there are non-access control steps that can be taken as well. Signage, for example, is important in directing visitors to the waiting room. Policy signage explaining issues such as wait times, which patients have priority status, etc. can help quell anger toward hospital staff. Policy signage to delineate the legal responsibilities and rights of patients, visitors and employees ensures cooperation and protects the hospital from litigation. For example, many licensed hand gun holders are not aware that carrying their hand gun into a hospital with a “no gun” policy is a violation. Posted policy can prevent potential problems. It is equally important to advise visitors and patients that security staff use CCTV for patrol through signage. However, institutions should never provide signage indicating CCTV is operating when it is not, and never install “dummy” cameras without the recording capability.
Other safety measures
Waiting rooms should have a public phone, restroom, television, vending machines, water and other necessities so visitors don’t have to seek these conveniences elsewhere within the hospital. Television programming should avoid confrontational shows.
An off-duty police or security officer stationed in the waiting room will offer a psychological deterrence to inappropriate behavior, present a calming mood among visitors and enable quicker hospital security response to an incident. Uninhibited access to a facility is the greatest risk facing health care today.
In a new design phase situation, including the radiology group, the ED will reduce infiltration of patients that aren’t officially in-patients of the hospital itself. It also affords additional protection to those staff members who often work alone or in isolation with a patient.
HSS recommended that five hospitals in Colorado, with higher than normal degrees of trauma incidences, employ very discreet metal detection systems at entryways for patients, ambulatory workers and ED staff members to deter any weapon infiltration. The metal detection systems, which are wall-recessed and barely noticeable, can prevent weapon infiltration in hospitals that reside in high crime, heavily-populated urban areas.
Benefits
Aside from a security attendant on duty at the station, it’s also highly recommended that the system is integrated into the access control system. All technology with open architecture can be integrated to complement each other. In fact, CCTV with digital DVR capability can integrate with access control when an unauthorized individual attempts to gain access at a door or access point. Access control software can signal the closest CCTV camera to pan, tilt or zoom to the door and observe the action—thus providing authorities with more than a computer printout of an illegal attempt, but actual identification of the perpetrator.
Keep in mind that today’s CCTV technology can be an institution’s best ally or worst enemy. During the design phase, security staff must determine the CCTV’s single main objective: Is it to identify persons and record the event, or to just monitor/record an event? The answer is in the quality of the system and the software to accompany it. How many times has a real event been caught by CCTV and broadcast over network television with viewers scratching their heads stating, “Is this person male or female, what ethnic race could this person be and is the person wearing a coat or a sweatshirt?” This type of system was not developed for identification but rather for event recording. A more complex system would have the technology to identify the perpetrator of the crime.
There are other benefits to the latest access control technology software. Alarms do not have to be criminal in nature. There is software available to monitor elevator operation, heating/cooling operation, lighting control, emergency call boxes in parking lots, and panic alarm stations or alarm monitors on infants or the infirmed at risk of elopement.
These software systems can be monitored by security staff in a safe room, recorded for posterity and reports, or can be sent as an alarm to a patrol officer for he or she to respond at the time of the occurrence.
Lockdown protection
Every medical institution is only as good as what has been rehearsed. It is imperative that hospitals and medical facilities practice their security measures through demonstration as well as an annual drill. Preparedness is paramount. It is the fervent recommendation of many security professionals that medical facilities work in tandem with local authorities to address these issues, test the program and make necessary improvements where needed. For instance, the use of the word “lockdown” is tossed around vicariously, but this means that the institution must take serious measures in the event of a crisis. A lockdown translates into doors locked, lights dimmed, no traffic in or out of the building and indicates all staff must stay at their present location. Many locations may heighten their security and restrict access because of an event within or near the institution but regular activity continues.
Preparedness is key
Contemporary access control software permits the system administrator to lock all controlled doors for both entrance and egress from interior doors. Exterior doors can be locked from an outside entrance. With locking hardware and/or magnetic locks, a building could be secured from the control room within minutes and conventional keys would be to no avail.
Most importantly, today’s access control and other security technology breakthroughs allow for more people to be protected, more space secured and a more profound security management program with less chances of error. Today’s advancements enable security staff to focus further on prevention of crime and incidents rather than waiting on an incident to happen.
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| Magnetic lock |
Ohio Hospital Uses Access Control to Full Cutting-Edge Capabilities
Flower Hospital’s surgery room is just one example of perpetuating state-of-the-art technology updates that give Promedica Health System (PHS), Toledo, Ohio, one of the most cutting-edge health care access control/security systems today.
In an effort to eliminate the challenge of surgeons, nurses and support staff from fumbling with identification badges through clothing or forgetting them, PHS’s Sylvania, Ohio-based hospital’s surgery room grants door entry access through hypoallergenic- /antimicrobial-coated biometric hand readers. The access control system increases entry speed in critical situations and creates a highly secure entry beyond card swipe technology, allowing PHS central security personnel to monitor and record activity.
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| Toledo Command Center |
Registration is a two-minute process in Flower Hospital’s security center. Surgery room personnel enroll by making a biometric hand scan template, which is processed and attached to the employee’s security ID profile in the access control software. Once enrolled, the employees enter the surgery room via the keypad code followed by a biometric hand scan in a process that spans five seconds or less.
“There are a lot of great new security products on the market, but you must have access control software with interfacing capabilities so that different brands of new readers function just like any of the other hundreds of existing readers in the overall access control system,” said James Hofbauer, security director, PHS’ Central Region.
PHS is an eight-hospital, not-for-profit health care organization that services 27 counties in northwest and west central Ohio and southeast Michigan. 
Bruce A. Canal, CPP, is director of field operations for Matrix Systems, Dayton, Ohio, an access control manufacturer and security technology integrator that takes projects from the consulting stage through system engineering/design and installation to user support. Canal is a 31-year security industry veteran. Canal retired from the Indiana State Police and is a Certified Protection Professional through ASIS International. He may be contacted at bruce.canal@matrixsys.com.
Tony York, CHPA, CPP, is senior vice president—security for Hospital Shared Services, Denver, which provides security as well as other health care services for approximately 85 percent of Colorado hospitals. York will soon release the co-authored, fifth edition of Hospital and Healthcare Security, which is used widely by hospital security professionals nationwide. He is the immediate past-president of the International Association for Healthcare Security and Safety (IAHSS). York may be reached at tyork@hss-us.com.
