Plug Building Security Risks

Security and control of access is a safety and quality concern for hospitals and other provider facilities. A literature review of the reported security incidents and undesirable events published in health journals during the past 15 years yields a long list of security related problems – theft of newborn babies, rape, assaults on patients and staff, internal and external vandalism, wide-scale pilferages of hospital goods, fire risks, staff abuse of access codes on doors, improper use of emergency fire doors, losing patients who subsequently become harmed or even die of exposure, media intrusions and harmful reporting, and theft from staff and patients. Clearly it is not possible to eliminate all security risks in a health care facility, but it is possible to develop a strategy for identifying and minimizing them. The Joint Commission’s hospital standards address security in several chapters. For example, the patient’s rights standards state that the hospital is expected to demonstrate respect for patient security. The standards regarding storage of medications indicate the importance of a secure environment. There are several references to security in the environment of care standards. There is a clear directive from the Joint Commission to provide a safe and secure environment. It is essential that the link between patient care and facility security be fully understood by all staff, including physicians.

Managers can informally identify and assess security risks by asking staff members what security risks they perceive, and then assessing with staff members how best to minimize these risks. It is ideal to have a more formalized approach to identifying what constitutes security. By considering the four factors listed below health care organizations can gain a better understanding of the issues affecting facility security.

Perception of risk. Different groups of people are likely to perceive and report different risk concerns based on the jobs they perform and the environment in which they work. For example, nurses who feel exposed to personal harm or physical attack are very conscious of the open building design environments in which they work. Nurses who care for elderly patients may be concerned with losing patients labeled as “wanderers.” Nurses working in maternity units are acutely concerned about infant abductions. Pharmacists may be primarily concerned with drug theft. Essentially, the identification of risk must take everyone’s concerns into consideration.

Exposure to risk. The level of risk exposure varies between facilities and is dependent on local factors. Individual facilities need to develop and tailor their own risk management strategies around their exposure to risk. The process should begin by confirming common everyday risks reported by staff and then identifying any additional risks that may represent less frequent exposures. For example, some hospitals are occasionally exposed to bomb threats, while this happens infrequently it is a high-risk incident.

Prevailing culture. The organization’s culture may indirectly and covertly oppose attempts by management to impose security regulations and equipment that restricts staff autonomy and free access. Such problems may be compounded by the location of parking lots and staff residences. Some facilities particularly suffer from the abuse of fire exist doors that are used as normal access points by staff members and physicians. Access control, fire doors and fire regulations may directly conflict with the organization’s culture and undermine management attempts to secure the facility. In such a situation, management should involve staff and physicians in developing strategies to address access control and other security-related risks. The link between good building security and quality patient care should be constantly reinforced.

Functional design of buildings. The larger and more open the internal building design the more difficult it is to restrict access, particularly if many of the emergency fire doors are used as normal access points. Abuse of fire doors increases the facility’s exposure to risks such as walk-in thefts. Thieves select hospitals as easy targets if there is no control of access, particularly on weekends when staffing levels fall. The number of internal facility areas where visitors are allowed to enter should be reduced as far as is reasonably practical. Offices and other high-risk areas of the facility become less vulnerable when the general public do not have access or reason to walk past them at all hours of the day and night.

At the center of any risk management strategy should be an attempt to correctly identify the security risks to be managed and minimized. This also means diligently recording all incidences of loss, theft, and personal harm. Measuring the scale of security risks is the first step in identifying how best they can be managed.

To Learn More: Patrice L. Spath is available for in-house presentations on this and other health care performance improvement topics. For further details, visit Brown-Spath & Associates on the web at: http://www.brownspath.com or write to: Brown-Spath & Associates, PO Box 721, Forest Grove, OR 97116.

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