EXECUTIVE SUMMARY
As the first people the public encounters, patient access staff need training to recognize early warning signs of violence. Employees should do the following:
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Be alert to unusual behavior.
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Know the processes for reporting and gaining assistance from security or law enforcement.
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Work with security if a visitor is potentially dangerous.
Richard Sem, CPP CSC, president of Burlington, WI-based Sem Security Management, has performed security and violence management assessments at dozens of hospitals and clinics. Thirteen of the assessments were done after “active shooter” incidents occurred.
“While much attention has been given to the high-risk areas such as ED and behavioral health, I usually find the patient access staff to be among the most exposed and most at risk,” says Sem.
He has interviewed hundreds of patient access employees. “I hear their concerns and fears,” says Sem. “They usually can relate stories of people becoming aggressive and threatening and even coming across the counter at them.”
Most importantly, “staff need training on recognizing early warning signs of violence,” he says. (See list of warning signs enclosed in this issue.) These include patients who: are irritable or agitated; make verbal threats; attack objects, such as hitting walls or banging fists on counters; pace; stare; have intimidating body language, such as clenched fists; argue with others, including family members; or have raised voice levels or change tones. “These early indicators present a higher level of concern if two or more are demonstrated,” says Sem.
Sem says the training should cover:
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de-escalation techniques;
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how and when to report concerns;
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safely managing threatening behavior;
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what to do in the face of an active threat.
“The most powerful, least costly, and most neglected of security measures is fostering a strong level of protectiveness, vigilance, awareness, ownership, and engagement by all staff, including patient access,” he says.
Sem notes that would-be terrorists tend to “scope out” a facility and test its security long before an attack. “Properly trained and vigilant patient access staff may be able to spot and report such behavior,” he says.
Thomas A. Smith, CHPA, CPP, president of Chapel Hill, NC-based Healthcare Security Consultants, has provided security services at a community hospital, an inner city medical center, and an academic medical center.
“In my 36-year career, I have always collaborated with the front-end staff to enhance the security program,” he says.
Smith has seen many adverse events averted because patient access staff members reported suspicious or criminal behavior. Some examples:
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individuals with weapons;
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individuals asking to “see the babies” without being able to provide the name of a patient;
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intoxicated persons;
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persons who appear disoriented;
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suspected patient elopement or wandering;
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violations of visiting policies;
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disturbances such as domestic violence or other inappropriate behavior.
“Sometimes, it’s just something that does not seem right,” says Smith. “Front-end staff need to know what to report and who to report unusual or suspicious circumstances to.”
Failing to report suspicions can result in dire consequences. “On a few occasions, concerning behavior went unreported — or was reported, and then was not appropriately investigated by appropriate authorities — and these inactions were contributing factors in tragic incidents,” says Smith.
Patient access provides an added level of safety by being alert to unusual behavior, Smith emphasizes. “Know the processes for reporting and gaining assistance from security and/or local police,” he says.
When someone comes to visit an admitted patient at Columbus, OH-based Nationwide Children’s Hospital, he or she provides a driver’s license and is given a photo stick-on ID badge and keycard giving access to the hospital elevators. The visitor’s information is run through a federal database of sexual offenders.
Daniel Yaross, MSM, CPP, CHPA, the hospital’s security director, says, “When the admitting person finds out the person is a match, they discreetly notify us.” Yaross is also chair of the International Association for Healthcare Security & Safety’s (IAHSS’s) Healthcare Security Council. Security staff members then verify the person’s identity, and they confirm whether the system’s match to the sexual offender database is accurate. “We check the person’s demographics with what is listed in the database, as well as the county’s criminal records system,” says Yaross. If it’s valid, security works with nursing, social workers, and the hospital’s legal department to determine if the visitor is allowed on the unit, and if so, whether he or she is escorted by a security officer. “It’s a pretty restrictive process that many children’s hospitals have in place now,” says Yaross.
Security planning should address how physically exposed the patient access staff is, Sem says. “These are frontline staff and often the first healthcare staff the public deals with,” he says.
Jeffery Young, CHPA, CPP, president of the IAHSS, says the physical environment of registration areas should have security “designed-in,” with barriers between patient access staff and the public. “There are many subtle architectural strategies that can be deployed that still look and feel welcoming,” says Young.
If registration areas are situated at an entrance, Young says access needs the ability to quickly “lock down” the area. “The organization should have emergency preparedness plans in place that consider both: being the location of the incident and for the receipt of casualties from the incident location,” he adds.
