Risk managers should work closely with hospital security directors to coordinate efforts to address workplace violence and other threats.

  • Hospitals must balance security with welcoming the public and providing a pleasant atmosphere.

  • A property checklist can help avoid claims of lost patient belongings.

  • Body-worn cameras on clinicians can help defend against claims of abuse.

A well-run security program is important for ensuring safety in any hospital or health system, whether security staff are employed by the facility or provided by an outside contractor. Close coordination with risk management is essential.

Workplace violence is more common in healthcare settings than most people would imagine. Hospitals often have a hard time balancing the need for security with a desire to be open and welcoming, says Paul Baratta, segment development manager for healthcare with Axis Communications, a Boston-based company that provides security technology to healthcare institutions. He spent 26 years in law enforcement, including service as chief of police for Beth Israel Deaconess Medical Center overseeing police, security, and emergency management.

During his tenure at Beth Israel, he transitioned the hospital’s security program from an outside vendor to a fully employed staff of 120 people and 15 armed police officers.

“You can’t have your hospital be like a prison, but because of the incidents that happen in hospitals, you have to have a high level of security,” Baratta says. “It has to be nonintrusive, but there at a level that protects both patients and staff without interfering with their quality of care. It’s an everyday balancing act for a security director in a hospital.”

Hospital security departments typically are quite busy with calls for service, which range from escorts to patient watches and responding to violent incidents, Baratta says. Nearly everything hospital security officers do involves some potential for injury to someone, or allegations that harm should have been prevented. That means risk management should coordinate closely with the security department.

“Whoever is in charge of safety and security at the hospital should have a really good working relationship with the risk manager. You need to have a good partnership,” Baratta explains. “I used to have near-daily meetings with the risk manager at our hospital.”

Baratta and the risk manager would discuss daily events at the hospitals, including costly slip-and-fall incidents and the loss of patient property. A hospital can spend thousands of dollars per year on lost dentures and eyeglasses.

Baratta, who also is an EMT, realized many patients claiming lost dentures had arrived at the hospital intubated, their dentures removed in the ambulance. Similarly, eyeglasses were removed in the ambulance, and both items were easily lost when the ambulance was cleaned.

“One of the things I put in place with risk management was an easy checklist so that when a patient came in, the staff could indicate what property the patient came in with. One of the things on the list was to check for dentures and eyeglasses,” he says. “By working together with risk management, we were able to save a lot of money for the hospital and address concerns from patients.”

Baratta also suggests risk managers and hospital security directors work together to educate hospital leadership about the prevalence of workplace violence and the costs to the hospital. It also is important to remember that improving security is about more than just staffing officers in the building, or technology like cameras and key cards.

“You have to have people, process, and technology. All three,” he says. “You can’t put in a technology solution without ensuring that you have good policies, procedures, and guidelines around it, and people trained to use it. A risk manager needs to look at any security solution in terms of all three.”

Cameras are becoming more prominent in hospital security programs, including body-worn cameras for security officers and those inside ambulances, Baratta notes. They are particularly important when transporting behavioral health patients. For instance, in Florida, a “Baker transport” refers to the law that allows an individual to be committed for an involuntary 72-hour mental health examination if they display certain violent or suicidal signs of mental illness. Liability exposure can be reduced by using cameras in those situations.

Some hospitals are beginning to adopt body cameras for doctors and nurses in the emergency department. Similar to how body cameras are used by police departments, the cameras worn by clinicians most at risk for workplace violence can be important evidence in prosecuting violent patients or defending staff members against claims of abuse, Baratta says.

Body cameras also can be a deterrent to violence. When a doctor points out the patient encounter is recorded, some patients are discouraged from acting out in a violent way.

Widespread use of security cameras in hallways and other common areas also is good practice, he says. They can be particularly helpful with slip-and-fall claims.

“Every trip is worth a thousand dollars. There are people who do that for a living, just going to different hospitals and trying to collect,” Baratta says. “Have that video to document the incident and see if what the person says happened really happened. Risk managers should work with their security teams to make sure they have those common areas covered well with cameras.”

Management of aggressive behavior, known as MOAB in security, is a growing issue for healthcare organizations, Baratta says. Hospitals should create a MOAB program that teaches security officers and clinicians who are most at risk how to de-escalate potentially violent situations and how to minimize harm when they occur.

After Baratta implemented a MOAB program at Beth Israel, incidents of assault decreased significantly.

“It trains them not only how to restrain a patient if they have to, but also issues of self-defense like making sure you have a door behind you, how to place yourself in the right position in the room,” he says. “Every risk manager should make sure their hospital is using a MOAB program.”


  • Paul Baratta, Segment Development Manager for Healthcare, Axis Communications, Boston. Email: healthcare@axis.com.