Across North America, healthcare systems are aggressively spreading throughout their service regions by the addition of facilities smaller than the traditional hospitals and medical centers. Such facilities include clinics, MOB's, rehab, urgent care, small rural and suburban hospitals, stand-alone ER's, elder care, health centers, day surgical centers, behavioral health, pharmacies, physicians' offices, etc. These facilities could be many miles from the nearest hospital and, while they may face similar security and safety-related risks and threats, they do not enjoy the same resources, support and responders that the larger hospitals enjoy. They may have only three or four employees and often fall under a separate Medical Services group. Therefore, hospital-based security, safety and emergency processes and plans may not apply and support may be thin.
When I visit such smaller facilities and interview staff I often hear the same sorts of issues I hear at the hospitals, including concerns over confrontational, threatening and even violent persons up to the active shooter. These employees often feel like the forgotten "step-children" who don't get near the attention and support that hospital staff and patients get. When I ask to see their emergency plan I often see the hospital plan which doesn't apply in most ways.
Examples of issues I have encountered at outlying healthcare facilities include:
- Security management staff at the hospitals are often stretched and have little time to devote to these facilities. Usually, the facilities are too far away for adequate hospital security officer response.
- During a violence event at a clinic, distant hospital management attempted to manage response remotely and made a series of bad decisions
- Front-line staff like receptionists and registration relate incidents of persons threatening them and even jumping over counters and they don't know what to do
- Staff in the front had no way to safely communicate emergencies to the rear areas and vice versa
- Staff and patients at a women's health center were repeatedly threatened by current or former husbands or boyfriends
- Following a significant violence event, system administrators neglected to visit to offer support causing resentment and some turnover
- A facility took too long to achieve a lockdown during a domestic violence threat
- A hospital, following an active shooter event at the hospital, neglected to notify outlying facility staff as to what was going on, what they should do and whether they were at risk which caused resultant fear and resentment
Security and safety considerations for outlying healthcare facilities, therefore, may include:
- Policies, procedures and plans that address the true functions, culture, issues, risks, vulnerabilities, functions, size and layouts of these facilities
- Planning security and safety into the design of these facilities. For example, public areas such as waiting should be restricted from treatment and office areas for safety and privacy reasons. If at all possible, there should not be more than one public access point and all other exterior doors restricted.
- Taking protective procedural and physical steps to protect front-line staff such as receptionists and registration by training, space and counter design, escape routes, etc.
- Consideration of violence mitigation and prevention measures including identifying and equipping safe rooms/shelters, internal emergency communications, panic/duress alarms and facility or suite lockdown capabilities.
- Fostering a close working relationship with local emergency responders including fire and police.
- Conducting security, safety and violence management assessments. Some large healthcare systems commissioned me to assess a representative sampling of outlying facilities along with higher risk facilities rather than have me visit what could be more than a hundred locations. An ancillary benefit of such assessments is that they help demonstrate to facility staff that they are valued by their leaders.
- Where there are many such facilities within a system, some systems place a Manager of Safety, Security and Emergency Preparedness dedicated to the outlying facilities
- Consideration of placement of security equipment such as video, electronic access control, duress buttons, intrusion detection alarm systems, barriers, PA or intercom systems and exterior lighting. Note that, even where the facility is only open days, it gets dark early over the winter.
Related to the above, some growing healthcare systems find it justifiable to place central security monitoring centers to remotely monitor and support video, access control and alarms at all facilities. This is another way to demonstrate the administration's concern for the safety and welfare of all staff and patients.
It is essential to include these staff, especially the front line "gatekeepers," in security and safety training. They should at least understand the early warning signs of potential violence, how to de-escalate (and not escalate) and what to do when faced with threatening or violent behavior.
The trend in the healthcare industry is toward more outpatient space and less inpatient, so this is our future. These outlying "step-children" should understand that they are valued and protected members of the organization's team.
About the Author: Dick Sem, CPP CSC of Sem Security Management has over 40 years’ security and violence management experience. He serves large and small healthcare systems across North America in almost every state performing comprehensive security and violence management assessments, targeted assessments (of ED, Security Department/Program, Workplace Violence Program, Accessibility, Outlying Facilities, etc.), development of related policies and plans, expert witness service and training.
Sem served as Global Director of Security and Crisis Management for Waste Management and Vice President of Pinkerton, later Securitas, responsible for eleven states in the Northeast U.S. He can be reached at [email protected] or go to www.semsecurity.com.
