Hospital and Healthcare Security

697 Pages·2009·38.88 MB·English

by  Russell L. Colling

Butterworth-Heinemann is an imprint of Elsevier
30 Corporate Drive, Suite 400, Burlington, MA 01803, USA
Linacre House, Jordan Hill, Oxford OX2 8DP, UK
© 2010 ELSEVIER Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence
or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
Library of Congress Cataloging-in-Publication Data
Application submitted
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
ISBN: 978-1-85617-613-2
Printed in the United States of America
08 09 10 11 12 13 10 9 8 7 6 5 4 3 2 1
For information on rights, translations, and bulk sales, contact Matt Pedersen,
Commercial Sales Director and Rights; email [email protected]
For information on all Butterworth–Heinemann publications
visit our Web site at www.elsevierdirect.com
Acknowledgements
The authors are extremely appreciative of all the support and encouragement received
during the preparation of this manuscript. This book would not have been possible
without the contributions of our peers, colleagues, associates, and the International
Association for Healthcare Security and Safety (IAHSS). It is difficult to keep track of all
the healthcare security professionals who we have interacted with over the years that
have challenged our thinking about the issues of safeguarding the healthcare environ-
ment and from whom we have learned so much. Healthcare Security is truly progressing
in its transition into a profession that we can all be proud due to the contributions of so
many. Our profound thanks to all of you who give so tirelessly to creating a safe environ-
ment where healing can occur.
We would also like to thank Pam Chester, acquisitions editor, and the entire Elsevier
team for their encouragement to update this classic text. Their understanding of the
changing healthcare security climate inspired Russ to tackle a fifth edition and add Tony
as a coauthor.
As with all great teams, there has to be a driving force for each of us and we owe our
deepest gratitude to the contributions and sacrifices made by our loving wives, Linda and
Cara, during this long and arduous process. In the end, we could not have completed this
manuscript without their understanding and support.
xiii
IAHSS Healthcare Basic Security
Guideline Placement
The authors have placed great emphasis on the IAHSS Guidelines in the fifth edition of
Hospital and Healthcare Security. Below is a reference guide for where they are located in
the text.
Guideline Title Chapter
01.01 Security Management Plan 4
01.02 Security Risk Assessments 3
02.01 Security Administrator 4
02.02.01 Targeted Violence 19
02.03 Forensic Patient Security 12
02.04 Security Role in Patient Management 12
02.05 Security Officer Use of Physical Force 8
02.06 Home Health Security 22
02.07 Security Officer Staffing & Deployment 6
02.08 Searching Patients and Patient Areas for Contraband 12
03.01 Security Officer Training 9
03.02 General Staff Security Orientation and Education 15
04.01 Investigations-General 16
04.02 Covert Investigations 16
05.01 Security Incident Reporting 11
06.01 Program Measurement/Improvement- General 4
07.01 Access Control-Identification System 14
08.01 Electronic Security Systems 18
08.02 Use of Closed Circuit Television (CCTV) 18
09.01 Security Sensitive Areas 20
(Continued)
xv
xvi HoSpITAl And HeAlTHcAre SecurITy
(Continued)
Guideline Title Chapter
09.02 Infant/Pediatric Security 20
09.03 Security in the Emergency Care Setting 20
09.04 Patient Elopement 12
10.01 Emergency Management-General 24

The Healthcare Environment
The only constant in today’s healthcare environment is the dynamic challenges continu-
ously facing healthcare administrators and those charged to protect the industry. Today’s
healthcare environment poses daily tests for security administrators charged with pro-
tecting these critical infrastructures. The delivery of healthcare changes rapidly and is
vastly different from what it was just a few years ago. Hospitals are no longer an isolated
group of free-standing buildings. They are critical infrastructures forming complex medi-
cal centers serving diverse patient populations with visitors traveling great distances to
seek care and receive specialized medical treatment. It is not uncommon for medical
centers and hospitals alike to find themselves as parts of a large healthcare system. These
healthcare systems often have dozens of facilities-serving communities near the main
facility, or they may be a part of system with facilities in many states removed. The com-
petitive nature of healthcare has challenged administrators and security leaders alike to
present a safe and secure environment that is coupled with an open, hospitality feel.
The current security landscape affects all types of organizations and all aspects of
the healthcare industry. Heightened safety concerns following the 9/ terrorist attacks
have compelled government agencies, the healthcare industry, and commercial estab-
lishments worldwide to employ sophisticated security services. Alarmed by the vulner-
ability of their legacy systems, many organizations are upgrading to state-of-the-art
security programs and systems, which include monitoring surveillance services and well-
trained security ambassadors. This trend is likely to continue as healthcare institutions
and various other establishments seek greater security due to growing workplace vio-
lence, changing patient populations (due to reduction of mental health reimbursement),
employee thefts, corporate espionage, and the threat of terrorism.
The need for increased security has provided an unprecedented challenge in
the methods and philosophies regarding protection of our healthcare organizations.
Their safeguarding cannot be completely dependent on the security department. Many
aspects of protecting healthcare organizations reach far beyond the control of the com-
monly accepted elements of a healthcare security department. Today, in order to achieve
a high level of security, managers, top executives, and boards of directors must be more
involved, through appropriate funding levels, with managing and supporting security
issues. These leaders must accept a greater responsibility and ownership for security in
their day-to-day management obligations.

 HospITAl And HeAlTHcAre securITy
practically everyone uses healthcare, or has a close connection to someone who
uses healthcare, in any given year. In 006, the us’s healthcare bill climbed above
$ trillion. on average, healthcare consumes over $7,000 per person per year—over
one-sixth of the average American income. private funding provides 54% of this dollar
amount, while public programs pick up the remaining 46%.
For more than two decades, the cost of healthcare has exceeded the general rate of
inflation (or the rate of growth of the economy) and is rising faster than wages. Much of
these costs are incurred by the sickest patients. It is estimated that about 0% of the popu-
lation accounts for more than 60% of healthcare costs.3 despite private, free-standing
ambulatory care centers, declining patient days, long-term care facilities, wellness pro-
grams, and advances in outpatient and home care, hospitals remain the primary source
of healthcare in terms of dollars expended.
The increased costs of providing healthcare is at least partly the result of the success of
our healthcare delivery system—it is the result of larger number of people living to an older
age and needing increasing amounts of care. There continues to be an explosive growth
in the number of individuals with chronic conditions, a seemingly insatiable demand for
emergency care services and intensive care, progressive expansion of applications for mini-
mally invasive surgery and other procedures, and heightened concerns about inefficiency,
access to care, and medical errors across the healthcare delivery system. A 008 analysis by
pricewaterhousecoopers concluded that more than half of the dollars in the us $. trillion
healthcare system are wasted. Medical errors, inefficient use of information technology,
and poorly managed chronic diseases were all cited as factors. dwarfing these reasons is a
phenomenon in which doctors order tests to avoid the threat of a malpractice lawsuit—
otherwise known as “defensive medicine.” At $0 billion annually, defensive medicine
is one of the largest contributors to waste. A 005 survey in the Journal of the Medical
Association found that 93% of doctors reported practicing defensive medicine.4
Categories of Healthcare
direct clinical care of patients is being delivered in all kinds of organizations and in
all types of facilities. This diversity is generally the result of a particular entity wanting
greater patient market share and is creating environments with low overhead to main-
tain cost control. A basic concept is to bring the delivery of care geographically closer to
the patient. lower unit costs are also intended to provide greater patient accessibility to
quality care. This geographical spread of organizational facilities is based on the great
amount of outpatient procedures once done only in the hospital. Healthcare can be
viewed on a continuum from assisted living (low acuity) to acute care (high acuity). This
progression follows these basic steps:
l Assisted Living—provides some help with day-to-day living activities, often
including transportation services to healthcare delivery sites, some limited medical
care presence in the living facility, and general staff watchfulness.
Chapter 1 l The Healthcare environment 3
l Home Care—healthcare staff generally visit and provide care in the home with a
coordinated plan of treatment and services.
l Outpatient Services—include surgery, clinic visits, physical therapy, psychological
counseling, speech therapy, and dental care.
l Intermediate Care—provides 4-hour oversight and is often tied closely to geriatric
care.
l Skilled Care—requires intervention skills by caregivers as opposed to caretakers.
l Short-Term Acute Care—is generally medically complex and includes post-surgical
intensive rehabilitation, respirator care, and intensive oversight.
l Acute Care—occurs when a patient is medically unstable and includes extensive use of
invasive procedures, high level of staff skills, close monitoring, and complex care plans.
Types of Hospitals
Hospitals in the united states are owned by a wide variety of groups and even occasion-
ally owned by individuals. Most hospitals are community hospitals, providing general
acute care for a wide variety of diseases. In terms of ownership, three major types of facil-
ities exist:
l Government hospitals are owned by federal, state, or local governments. Federal and
state institutions tend to have special purposes such as the care of special groups
(military, mentally ill) or education (hospitals attached to state universities). local
government includes not only cities and counties but also in several states, hospitals
are authorities that have been created from smaller political units. local government
hospitals in large cities are principally for the care of the poor (also referred to as
safety-net facilities) but many in smaller cities and towns are indistinguishable
from not-for-profit institutions. unfortunately, there are 300 fewer public hospitals
today than 5 years ago, with safety-net hospitals having closed in los Angeles,
Washington, d.c., st. louis, and Milwaukee.5
l Not-for-profit hospitals are owned by corporations established by private
(nongovernmental) groups for the common good rather than individual gain. As
a result, they are granted broad federal, state, and local tax exemptions. Although
they are frequently operated by organizations that have religious ties, secular
(or nonreligious) not-for-profit hospitals constitute the largest single group of
community hospitals both in number and in total volume of care, exceeding
religious not-for-profit, government, and for-profit hospitals by a wide margin.
l For-profit hospitals are owned by private corporations, which are allowed to declare
dividends or otherwise distribute profits to individuals. They pay taxes like private
corporations. These hospitals are also called investor owned. They are usually
community hospitals, although there has been rapid growth in private psychiatric and
other specialty hospitals. Historically, the owners were doctors and other individuals,
but large-scale publicly held corporations now own most for-profit hospitals. These
4 HospITAl And HeAlTHcAre securITy
facilities have had different periods of growth but have never accounted for more than
5% of all hospitals.6 except for having the obvious right to distribute dividends and the
obligation to pay taxes, for-profit owners function similarly as not-for-profit owners.
Most of the us hospitals are small but larger hospitals provide the majority of the
services.7 The merger of hospitals has reduced the space requirements on a per-bed basis.
This reduction in space is most noticeable in facility support services and patient/visitor
intake and processing space. This reduced need for inpatient space is often lost, however,
on the expanding need for outpatient facilities. The cost to convert inpatient bed space is
often too costly to convert to outpatient services, and thus the space is often left vacant
depending on the age and condition of the structure.
In addition to the ownership of hospitals, the type of medical specialty is another
way to differentiate facilities. Basic medical specialties include pediatric, medical/surgical,
rehabilitative, long-term care, and psychiatric facilities. The teaching hospital generally
has elements of these specialties in addition to research, education, and clinic activi-
ties. each of these specialty-care facilities presents unique security and safety challenges,
which will be explored throughout this text.
The critical access hospital program, created by federal law in 997, was designed to
slow the closing of small rural hospitals. To be awarded the designation as a critical access
hospital, the organization must have no more than 5 beds and must be the sole health-
care facility within a 35-mile drive. critical access hospitals enjoy a financial advantage
over other hospitals in that they are reimbursed by Medicare on a cost-plus basis instead
of at a flat fee by procedure. This financial advantage has allowed many small rural hospi-
tals to remain open and viable.
Nonhospital Side of Healthcare
The traditional healthcare campus has expanded its service boundaries. physician offices,
outpatient surgical centers, home healthcare, and outpatient mental health clinics
expand the horizon of healthcare and the role of the security department, on and off cam-
pus. These include public clinics, nursing homes, pharmacies, dental clinics, specialty-
care facilities, home care programs, hearing centers, hospices, and durable medical
equipment suppliers. Many of these are affiliated with general hospitals and clinics but
may also operate as independent entities.
These care organizations have become important industries themselves, while
remaining a relatively small part of the total expenditure for healthcare.
A reason for the recent expansion and success of these programs can be attributed
to the changes in the delivery of healthcare services and patient care patterns, which
have stemmed from managed care organizations. With managed care, there is increasing
need for case management, which can result in the earlier discharge of patients. Today, it
is common for an emergency department to assess and triage a patient and determine
that the patient is not “sick enough” for hospital admittance and refer him/her to a home
Chapter 1 l The Healthcare environment 5
health agency. ever increasingly, healthcare professionals are traveling into the commu-
nity to provide services to their customers in the home environment.
Diverse Stakeholders
The stakeholders in the healthcare environment are numerous and display a vast vari-
ety of characteristics. The patient can be a newborn infant, a teenager, a middle ager, or
of advanced age—each with unique security concerns and needs. The patient’s medical
condition and treatment regimen often render the patient less able to take responsibility
for his/her own safety and security. The healthcare provider organizations must under-
stand that they have a moral and legal duty to provide a safe and secure healing envi-
ronment for all patients. This duty is heightened when the patient is less able to provide
basic elements of self-protection due to age, dementia and other mental health issues,
mobility, and administered medicines.
The healthcare staff range from the highly educated physician and technical care-
giver to the food service and grounds staff. A high percentage of caregivers are female,
which presents certain protection concerns relative to working late night shifts and often
in remote locations.
Staffing the Medical Care Facility
The delivery of medical care is very labor-intensive, and utilizes a wide range of profes-
sional and service staff. The staff-to-patient ratio is extremely high in the pediatric facil-
ity and is quite low in nursing homes. The diversity of technical positions continues to
increase as new equipment and care procedures develop, yet the need for nurses con-
tinues to increase, driving an extraordinary labor demand. Job growth is expected to
continue for the healthcare sector well into the future. As a result, the search for quali-
fied workers is becoming increasingly competitive with the shortage of registered nurses,
physical and respiratory therapists, radiology technicians, and other positions. The need
to replace workers due to retirements and high job turnover are also factors creating the
increased labor demand.
The technical specialization of patient care is expected to create a nurse shortage of
epidemic proportions as nursing schools cannot keep up with demand. The median age
of registered nurses is anticipated to be 50 by 00 (increasing at a rate of more than twice
of all other workforces in the united states), and there are not enough younger workers
to replace them. coupled with the issue that nursing schools are not attracting enough
qualified instructors to meet enrollment demand, an imbalance has resulted between the
supply of and the demand for qualified workers.
The shortage of registered nurses is already having ill effects on the us healthcare
delivery system: 90% of long-term care organizations lack sufficient nurse staffing to pro-
vide even the most basic of care; home healthcare agencies are being forced to refuse new
admissions; and there are 6,000 nursing positions currently unfilled in hospitals across