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Access policies: A hard or soft approach?
Assessing your hospital's threats should help you address what type of police or security presence you should have. And just as crimes vary by community, security presence differs by institution.
"I'm an advocate for a strong access control policy to be able to identify those areas where folks cannot get in unless they have the proper electronic badge access to get into these areas," says Michael R. Parks, director of security at Mercy Medical Center in Baltimore.
"For example, if there's an incident of potential workplace violence where one employee may work behind a closed area, a sensitive area, you certainly wouldn't want somebody to be able to walk into that area to carry out an act of violence." That area, he says, should be protected so that only workers with a specific level of access can enter.
The facility also require visitors to have passes and to identify upon entering the facility which patient they are coming to see so the hospital can verify that patient is in-house. "A security officer is also there at the elevators to make sure that those who are accessing patient care floors have gone through step one and had identified the fact that there is a patient here," he says.
"Some of the other things that we do, specifically as it relates to the mother/baby delivery area, we've required folks to give their photo ID before they're given access to go to those floors."
The hospital happens to be going through the process of crendentialing vendors with direct patient contact. "It's very easy to have these companies out there do all that homework for the hospital," by checking that the individuals who come to the facility fit "all the requirements that need to be in place before they're allowed to visit patient care areas," he says. "You have to have a robust visitor access plan in place, specifically as it relates to clinical contractors or vendors as it relates to patient care. So you just don't have everyone willy-nilly going to patient care floors because they want to sell a product or they're trying to get the ear or attention of a particular physician or what have you," he says.
"Mercy has something unique that the majority of hospitals do not have. And that's a canine unit. We actually have authorized five teams of handlers and dogs, and these dogs are trained in explosive detection, crowd control, obedience, handler protection, etc.," he says. They commonly round in the ED. "The mere presence of that dog seems to have a very calming affect on people who are acting out. We don't make it a point to call attention to that patient with this dog. We just happen to walk through. It has reduced criminal activity and incidences of assault. I'm confident of that," Parks says.
"Personally, I like a uniformed security officer," says Joe Bellino, CHPA, HEM, president of the International Association for Healthcare Security & Safety and system executive, security at Memorial Hermann in Houston, TX. "I think they present a high level of visibility and professionalism. They're what we call 'squared away,' and you keep them moving. Then what happens is you develop a perception, whether real or not, that there's a heavy security presence and you can do that by keeping your people moving."
Flexing security staff in the future is going to be a big focus, he says. "I keep my shifts pretty well rounded because they're all very busy. What helps at night is to have a better screening system. I know most hospitals are open during the day, but at night you start to concentrically close down so that you have one point of entry at night and you can screen people and keep the bad element out," he says. "Don't leave your doors wide open at night. At night, a hospital is like a hotel with sick people, and we can't lock patient rooms, so we have to do a better job at the front room."
Kristen Kenst, JD, MBA, manager of risk services at Community Mercy Health Partners in Springfield, OH, says her facility limits access by having only two access points the main entrance and the ED. For employee-only areas, one must have a key. At the critical access hospital in the system, doors are locked at night.
"Right now we don't have metal detectors or wands. We do have security guards who are present 24/7, more than one on a shift, who do frequent rounds in the emergency department, but I wouldn't say that we necessarily block access. We don't have visiting hours so family are free to come anytime of the day or night, but we do maintain a security presence all the time as well," she says.
"We try to have kind of a mix of both [a hard and soft presence]. On our perimeters we like to have our officers dressed in more of a hard uniform; they usually use the LAPD blue uniform," says Don Charley, executive director of security and parking at UPMC Presbyterian Shadyside and Magee-Womens Hospital of UPMC. In the hospitals' ED, officers are in a "harder-style uniform."
"And then officers on the patient units are dressed more in a soft uniform with a blazer and tie," he says, adding that it's important to "strike that balance of a warm and welcoming presence for our visitors, but at the same time having a security presence."
At its flagship hospital, UPMC Presbyterian, there is a metal detector at the ED entrance, and "that's one of the areas we have a hard presence in terms of our uniform and style. On the weekends we do employ off-duty armed police officers to supplement our security force."
He characterizes the access control system as "extensive." "Our philosophy is trying to divide our facility into public space and private space. The public space is where people can come and go. As we get more in certain areas of the facility, we start tightening it down. Like our trauma units are access-controlled for the most part." For that unit, each patient is given two passes a day, which he or she or the primary care physician can give to family members. There's also a camera on the buzz-released door so if people try to enter without an access card, staff can talk with them and make the decision whether to allow them to enter. "We have some restrictions like that in our OB areas as well and our postpartum and labor and delivery," he says.