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, someone 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. Those 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 7 in 10 (69%) emergency physicians say COVID-19 has decreased the level of trust between patients and physicians or emergency department staff.
New Workplace Violence Requirements for Healthcare
According to The Joint Commission (TJC), which oversees accreditation of hospitals and other healthcare facilities, about 73% of nonfatal workplace injuries and illnesses leading to missed workdays in healthcare are connected to workplace violence. This figure does not consider the number of unreported incidents, so the actual percentage is likely higher.
In January 2022, TJC introduced revisions to workplace violence standards that provide guidance for developing strong workplace violence prevention systems. While there is no new standard related to workplace violence, there are modifications to existing standards with new or modified elements of
Central to these new elements is a requirement that a hospital conducts an annual worksite analysis related to its workplace violence prevention program. A proactive worksite analysis includes an investigation of the hospital’s workplace violence incidents, and an assessment of how the program’s policies and procedures, training, education, and environmental design reflect best practices and conform to applicable laws and regulations.
An independent third-party consultant can bring an objective viewpoint to the process. The hospital then takes actions to mitigate or resolve the workplace violence safety and security risks based on findings from this analysis.
A new EP has also been added that mandates staff participates in ongoing education and training. The hospital determines what aspects of training are appropriate for individuals based on their roles and responsibilities. Read more about these new EPs at https://guidepostsolutions.com/the-joint-commission-has-added-new-workplace-violence-prevention-requirements-for-the-healthcare-industry.
Technology Addresses Increased Violence
This renewed attention to the increasing acts of violence has hospitals moving toward the implementation of more technology. Emergency departments are being redesigned with more attention to protecting personnel.
Hesitancies by an administration that security practitioners, consultants and integrators 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.
Metal Detectors: More and more emergency departments are installing walk-through metal detectors, and 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.
Turnstiles: 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.
Passive Weapons Detection: In addition to walk-through metal detectors and turnstiles at emergency departments and other entrances, weapon detection systems have more commonly been explored and implemented by healthcare organizations. More aesthetically pleasing passive weapon detection systems utilizing sensor housings are trending. These detectors use millimeter wavelength and other technology and can be designed less intrusively to look like flowerpots or posts.
Video Surveillance: 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.
Hospitals, and security departments in general, have explored and implemented body-worn cameras over the past few years. Hospitals will likely implement them 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.
Panic Devices: 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.
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.