Healthcare Facilities Struggle with Open Spaces and Security Realities

March 8, 2023
The safety and welfare of staff and healthcare workers drive more comprehensive security strategies

In May 2022, the International Association for Healthcare Security and Safety (IAHSS) announced three new guidance documents for the healthcare industry, including the Healthcare Security Glossary of Terms.  In it, security is defined as "the condition of being protected against hazards, threats, risks, or loss". 

The source of this definition is listed in several American National Standards Institute (ANSI) standards developed by ASIS International, the preeminent association for security practitioners around the world and the ASIS International Security Glossary.

Striving to Meet the Challenges

The healthcare sector presents a challenge for traditional security practices for a variety of reasons. For instance, when I was the director of security for a hospital, a surveyor from The Joint Commission asked me, "What keeps you up at night?”  My answer was simple and only two words, “access control.” Access control is the foundational principle for securing any environment and has been challenging in the healthcare environment, especially in hospitals. 

The challenge is between the desire of the administration to provide a welcoming environment of care and maintaining security. Many times, this welcoming environment was characterized by unlocked and accessible hospital entrances at any time.

COVID-19 and an increase in patient and visitor violence have placed tremendous strains on hospitals and healthcare in general. The unlocked and accessible entrances were replaced with limited access and controlled doors, limited visitation hours and areas, wellness screenings and mask protocols. People were scared and confused, often leading to the aggravation that, at times, progressed to aggression and violence. 

A survey from the American College of Emergency Physicians released in August 2022, revealed that 85% of emergency physicians believe the rate of violence experienced in emergency departments has increased over the past five years, with 45% indicating it has greatly increased. In addition, two-thirds of emergency physicians (66%) believe COVID-19 has increased the amount of violence in emergency departments and nearly seven in ten (69%) emergency physicians say that COVID-19 has decreased the level of trust between patients and physicians or emergency department staff.[1]

California broke new ground in 1994 by addressing the prevention and reporting of violence in the healthcare industry by requiring healthcare organizations to include elements in their Security Management Plans aimed at reducing the occurrence of violent incidents by enacting the Health and Safety Code 1257.7 and 1257.8.  More recently, the California Labor Code 6401.8 mandates assessment, training, and reporting requirements in the context of a distinct Workplace Violence Prevention Plan as a component of an organization’s Injury and Illness Prevention Plan. California Senate Bill 1299 was signed into law on September 29, 2014, requiring the Division of Occupational Safety and Health (DOSH, better known as Cal/OSHA) to develop standards to enforce required education and training including resources for employees to report and cope with incidents of violence.  Most recently, The Joint Commission, which oversees the accreditation of hospitals and other healthcare facilities, introduced revisions to workplace violence standards that provide guidance for developing strong workplace violence prevention systems.[2]

Technology Addresses Increased Violence

This renewed attention to the increasing acts of violence has hospitals moving toward the implementation of technology. Emergency departments are being redesigned with more attention to protecting personnel.  Hesitancies by an administration that security practitioners and consultants traditionally have encountered are trending toward the administration’s acquiescence for implementation. This includes enclosing nurse stations and intake desks in the emergency department, staffing security posts directly in emergency department waiting rooms and treatment areas, ensuring waiting room furniture cannot be easily used as weapons, and utilizing visitor management systems to track all who enter the facility.

More and more emergency departments are installing walk-through metal detectors (WTMDs), more accurately called magnetometers.  For years, WTMDs have been installed at the public entrances of emergency departments but mainly in large urban locations. Today, more hospitals are exploring their use not only at emergency department entrances but at all hospital entrances and to broader locations serving communities outside of the urban environments. Adding a law enforcement presence at or near these screening stations is becoming more frequent as well.

With COVID-19 precautions raising the level of access control in hospitals, employing turnstiles has become a growing trend. It is clear to the administration that it is necessary to control access and station staff at entrances with the responsibility for operating visitor management systems integrated tightly with turnstiles. Administration may perceive an opportunity for improvement for the next pandemic or situation requiring more monitoring and limitations to access their facilities and realize that having turnstiles in place now will help with their continuity of operation plans in the future.

In addition to WTMDs and turnstiles at emergency departments and other entrances, weapon detection systems have more commonly been explored and implemented by healthcare organizations.  Passive weapon detection systems utilizing sensor housings and more aesthetically pleasing than WTMDs are trending.  These detectors use millimeter wavelength and other technology as opposed to electromagnetic field reflection by ferrous materials found in WTMDs and can be designed less intrusively to look like flowerpots or posts. Thermal imaging and video analytics that produce alerts upon detecting items that appear to be firearms and other weapons are being explored as options more frequently than before, especially with the media’s attention to shootings.

For many years police departments have utilized body-worn cameras (BWCs) to document investigatory actions by officers and to defend against claims of excessive use of force.[3] Hospitals, and security departments in general, have explored and implemented these devices over the past few years. Hospitals will likely implement BWCs more frequently as the perceived risks against their use, such as fears relating to employee and patient privacy concerns, and, more specifically, to violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), are better understood and accepted.

Personal duress or panic devices have been a part of the security plan for most hospitals for many years.  With more attention to workplace violence and potential acts of violence, the number and locations of these types of devices have increased.  Hard-wired devices have been replaced with phone apps and software activations on computer workstations.  Whether it is due to new requirements for compliance with regulations or due to it being the right thing to do after reviewing workplace violence programs is unknown. Attention to the safety of home health workers who administer care inside patients’ residences as opposed to a medical facility has led to the development of safety plans for those workers oftentimes including the implementation of some sort of technology to aid in calling for help and reporting violent or potentially violent situations.

Regardless of the reason, the trends in hospital and healthcare security have all moved the needle on the gauge of worker safety toward “safe and secure.” Many of the technologies and strategies coming to the front of the line as commonplace are being implemented effectively in the hospital environment and are a welcome trend.


About the author: Tim Sutton, CPP, PSP, CHPA, has more than 30 years of security experience and is currently a senior security consultant with Guidepost Solutions. His expertise includes operational security management and program development, loss prevention, physical security and risk assessments, and technical security systems design and implementation. He has worked with clients in diverse sectors including healthcare, retail, government, manufacturing, and multi-use properties. Sutton is a Certified Healthcare Protection Administration (CHPA®) through the International Association for Healthcare Safety and Security (IAHSS) and is board certified in security management as a Certified Protection Professional (CPP®) and Physical Security Professional (PSP®)  by ASIS International.

[1] Marketing General Incorporated, ‘ACEP Emergency Department Violence Poll Results’, Marketing General Incorporated, August 2022,

[2] Tim Sutton, ‘The Joint Commission Has Added New Workplace Violence Prevention Requirements for the Healthcare Industry’, April 07, 2022,

[3] Miller, L., Toliver, J., & Police Executive Research Forum. (2014). Implementing a body-worn camera program. Recommendations and lessons learned. Washington, D.C: Office of Community Oriented Policing Services.