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The healthcare security dilemma

Hospitals and other healthcare facilities are, by nature, relatively porous. Compare, for example, a typical hospital against a manufacturing facility.

The manufacturing plant can be fenced, the doors can be locked, and only those with a clear and verified business purpose are allowed inside. The hospital, on the other hand, is a community asset mostly open to all who wish to enter. Any person desiring care or wishing to visit a patient typically can enter and move through the facility relatively unimpeded. Many hospitals have a variety of entry points, not all of which are properly controlled and monitored. Add to that an emergency room area into which people, patients, family and friends enter who are often stressed, frustrated and sometimes violent.

So, what options does a health care facility have? How can you provide a reasonable level of protection and control while still maintaining a welcoming and open atmosphere? The following may be worth considering:

* First of all, it is appropriate to periodically stand back and assess or survey your security programme in light of your actual risks, threats, vulnerabilities, history, culture and values. Such an assessment may be performed by an inside or consultant expert, but should be an objective and comprehensive look at the protection of people and assets.

* A security programme should be a synergistic combination of procedural, physical and staffing measures that form a strategically planned whole. Reacting to incidents by adding security measures usually results in an overly costly programme that may not address the true risks.

* A rule of thumb in security is the fewer access points the better. How can the number of access doors be reduced while not unduly inconveniencing patients, visitors and employees? How does one address hospital access after visiting hours in the evening? It can be useful to sign in all visitors entering after hours and issue them worn identification. One access concept to consider is similar to that of airports, in which there are areas that are freely accessible to the public and have a basic level of security, and other areas (labour and delivery, maternity, pediatrics, psychiatric, pharmacy, labs, etc.) that are higher security and have a tighter level of access control.

* The most powerful, cost effective and often neglected security measure of all is a sense of ownership or involvement by all staff members and departments - security awareness. Employees will often assume that security is the responsibility of others and not theirs. Every employee should be protective of their work areas and the people in their areas, should understand their duties under the security program, and should know their duty to stop or report persons or situations that are suspicious. The foundation of this awareness is a clear and communicated set of related policies and procedures and training programmes.

* Awareness can be reinforced by a worn identification system in which all employees (and visitors after hours) visibly wear photo ID cards.

* Physical controls such as closed circuit television (CCTV) can expand the range of security staff and act as a considerable deterrent. Likewise, electronic access control systems can allow controlled access through certain doors for authorised persons. Duress, or panic, alarms can be provided to persons who work alone or are particularly at risk. Contraband detectors such as metal detectors can be useful where risks are considered to be great enough, but are labour-intensive tools.

* The most costly, and often troublesome, aspect of most security programmes is staffing, usually in the form of uniformed security or police officers. Careful consideration should be given as to how such personnel are vetted/screened, hired, trained, supervised and utilised. Security staff can and should provide a proper level of protection while still acting in a welcoming and helpful manner.

* Emergency and crisis plans and procedures should include, in addition to the accidents such as fires and natural disasters, planning for man-made events such as terrorist attack, threats or violence, bomb threats, sabotage, civil unrest, labour actions (strikes), etc. All employees should understand their duties under the emergency and crisis plans. Drills and table-top exercises should be held periodically.

* While the protection of people should be of paramount concern, do not forget the protection of your assets including pharmaceuticals, linens, supplies, food, cash, equipment, patient property, private information etc.

Richard D. Sem, CPP is president of Sem Security Management ( www.SemSecurity.com) based in the Midwest US near Chicago. He has 35 years' experience in security management and served as security director of Waste Management and vice president of Securitas. He was president of the International Security Management Association (ISMA) and has been certified as a Certified Protection Professional (CPP) since 1979. He provides security consulting, planning and training services to hospitals and other facilities.

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