The challenges of securing employees, assets, clients and facilities can be difficult to meet in any environment; however, few organizations must contend with the level of daily turbulence and pressure that hospitals do. Changes due to federal health reform, compliance with data protection laws and employee safety directives, shifts in demographics and service philosophy, and increasing crime must all be addressed without inhibiting public access, reducing the speed of service, or enhancing patient discomfort and stress.
The practice of security in hospitals has rapidly evolved over the past five years and continues to adapt to new challenges as it improves its response.
Increasing Workplace Violence Attracting Attention
The idea of a formal security program is fairly new in many hospitals, says David Gibbs, a managing director at Guidepost Solutions, a low-voltage consulting and design firm with 30 years of experience in the healthcare market. Gibbs is a regional chairperson for the International Association for Healthcare Security and Safety (IAHSS) and is heavily involved in ASHE, the American Society for Healthcare Engineering.
Traditionally, hospital facilities directors and building engineers have taken on security and safety responsibilities, says Gibbs, but many hospitals he’s worked with — particularly smaller or more rural facilities — had no security to speak of. “That’s all dramatically changed in the last five years as the overall frequency of physical violence and verbal abuse has spiked. This has had a dramatic impact at the C level,” Gibbs says.
A 2010 survey by IAHSS reported that in four categories — sexual assault, robbery, aggravated assault, and simple assault — violent crime in hospitals increased by 200 percent from 2004-2009. Other studies bear out similar findings. The Joint Commission’s Sentinel Event Database, which tracks unexpected events resulting in death or serious injury, shows that 2011 had the second-highest reported rate of criminal events since the database’s inception in 1995, and that data only covered events reported through the third quarter of the year. The Emergency Department Violence Surveillance Study released by the Emergency Nurses Association in Nov. 2011 found that of more than 6,500 emergency department nurses surveyed, 54.5 percent had experienced physical violence and/or verbal abuse at work at some point in the previous seven days.
“The high-tension atmosphere of a hospital is unequalled in any other industry,” says Bonnie Michelman, Director of Police, Security and Outside Services at Massachusetts General Hospital, a member of the Security Executive Council. “People are at their worst, in fear and pain. People equate being in a hospital with a loss of freedom and dignity. Visitors are upset, and there are a lot of vulnerable people who are not ambulatory or mentally competent or rational,” she says.
These tensions have always been a part of the hospital risk landscape, but Michelman and others are seeing more drug addicted, suicidal and mentally unstable patients coming into the emergency department. In effect, this combines the most high-pressure, busiest and most publicly accessible area in the hospital with some of the most unpredictable, potentially violent patients. The IAHSS further reports that increased gang activity and increased unemployment play a role in the crime spike.
In the face of the dramatic increase in violence — most of which is violence against nurses by patients in emergency and psychiatric departments — hospitals are seeing an increase in healthcare-specific regulatory oversight of workplace violence, according to Bryan Warren, Senior Manager of Corporate Security at Carolinas Healthcare System and president of IAHSS. Guidance and recommendations for workplace violence prevention in hospitals have existed for years in the form of OSHA 3148, whose latest version was released in 2004; but, OSHA published a new directive in Sept. 2011 specifically targeting healthcare as one of several high-risk environments that warrant special attention. “The new directive addresses the need for much more workplace violence prevention training, using specific healthcare examples,” Warren says.