A Dose of Reliable Data.
Healthcare institutions throughout the United States employ a variety of security practices to provide a safe and secure environment of care for all occupants: patients, staff, and visitors. But all too often, security practitioners at these facilities lack reliable data about what their peers are doing. Recognizing that such information could become an effective comparative and decision-making tool that practitioners could use to support requests to improve security or to justify continuing effective practices, the ASIS Council on Healthcare Security conducted a study identifying primary security issues and concerns, current practices that address them, and proposed improvements to security. The study yielded data that represented national and regional profiles of security in the healthcare environment.
The benchmark process was set in motion by the council, with the support and sponsorship of Burns International Security Corporation. A New Jersey market research firm was commissioned to conduct the ASIS Healthcare Security Benchmarking Study, whose findings were recently released. The study represents considerable progress, but it is only a preliminary step toward the development of best practices in healthcare security. Much remains to be done. In the following overview, we look at the most significant findings and the council's plans for future research.
Critical concerns. Respondents were asked to rank what they considered to be critical or important concerns and issues. The highest priorities were "people safety" involving patients and employees, including concerns about crime victimization. Property crimes ranked a close second to crimes against people. Noncriminal incidents involving people and property were lower priorities.
Regarding the physical areas of the facility, the greatest concern centered around high-volume and sensitive areas such as the emergency department, the infant unit, and the pediatric unit, followed by the pharmacy and psychiatric units, parking, and public locations. Low-volume areas such as the power plant and communications center were considered a lower priority by respondents.
Four indicators were used to assess how institutions were addressing security issues and concerns in general: security staffing, technology applications, policies and procedures, and personnel training. These indicators were approached from two perspectives: What is currently applied or employed; and what increases, improvements, or additions have been requested for the next 6 to 12 months?
The survey also looked at these issues as they relate to specific care units. We look first at the findings for the care units and then at the findings for hospitals overall, broken down by the four indicators.
Special units. The questionnaire asked about security in special-care units, such as the emergency room and infant-care areas, Some of the findings may help hospitals better gauge the type of training that security staff serving in these units should receive. It may also help them determine whether security resources are being appropriately allocated among units. For instance, personnel assigned to some units may need special training in interpersonal skills and extra training in how to protect themselves and the people they come in contact with.
Psychiatric services. Fifty-nine percent of the respondent hospitals indicated that they have inpatient psychiatric services. Most of these facilities have secured units, and half have outpatient units as well.
The study showed that security staff assist psychiatric unit personnel in a variety of situations. The services most frequently requested were assistance in restraining patients, crisis intervention, and the de-escalation of potentially violent situations. Next were escorts, one-on-one observation, and transport requests. The least frequent requests for security in psychiatric units were for contraband searches and weapons recovery, though there was a high frequency of such searches in psychiatric emergency departments.
Of the respondents with psychiatric units, 95 percent provided unit-specific training, 67 percent received training from psychiatric staff, and 46 percent received training from other hospital staff, with some overlap between the latter two. One significant finding is that virtually all facilities that reported having psychiatric services not only provide special training to security personnel but also couple it with competency testing.
Technology was not applied in psychiatric units to the same degree as in general hospital areas. For example, 93 percent of general areas employed CCTV compared with only 74 percent of psychiatric units, However, 34 percent of respondents with psychiatric units indicated that they planned to increase or improve technology applications there. Why this difference exists is a topic the council may explore in future studies.
Emergency services. Eighty-seven percent of respondent hospitals have departments that provide emergency services, with 75 percent providing infant/pediatrics emergency services and 69 percent offering psychiatric emergency services.
Meanwhile, 66 percent of emergency departments provided dedicated security coverage on a 24-hour a day, 7-day a week basis, And those facilities that did not provide continuous security coverage in the emergency department increased coverage during the evening, night, and peak periods, showing a greater awareness of the need for a dedicated security presence. Twenty percent planned to increase security coverage over the subsequent 6 to 12 months.
In addition, respondents appeared to be aware of the necessity of additional training for security personnel assigned to emergency departments, similar to the unit-specific training in psychiatric units. However, psychiatric units trained almost all personnel, whereas only two-thirds of emergency departments trained assigned personnel. It should be noted that 95 percent of those receiving additional training were also subjected to competency testing.
Similar to psychiatric services, respondents reported that technology is used to a lesser degree in emergency departments compared with the general areas of the institution. For example, only 76 percent of emergency departments employed CCTV for surveillance, according to the survey, compared with 93 percent of general areas.
One noted exception was metal detectors. Twenty-seven percent of respondents reported the use of metal detectors overall, with 22 percent of this use in emergency departments and 14 percent in psychiatric units. With respect to metal detectors, respondents also reported regional and demographic differences in their application. For example, 33 percent of urban hospitals indicated that they used metal detectors, compared with 25 percent of rural facilities and 16 percent of suburban institutions. These differences may be useful to a security director attempting to justify a resource request in a particular geographic area or location. According to the survey, thirty-five percent of emergency departments planned to improve or increase their use of technology.
One specific issue addressed by the survey was search protocol. Seventy-nine percent of psychiatric emergency departments searched patients for weapons or contraband, while 49 percent of acute care emergency departments searched categories of patients they saw.
Many respondents complained about the lack of a standard search protocol or a common best practice employed across the country. The council may explore this topic further in future studies.
Women, children, infants. This part of the survey elicited specific information related to security concerns in womens health, pediatrics, and infantcare units, services provided by approximately three-quarters of respondent hospitals. The three service areas received similar degrees of dedicated security coverage; about one-third of each had dedicated security officers present hours a day, 7 days a week. And approximately 10 percent of respondents planned to increase security staffing in these units over the subsequent 6 to 12 months.
However, these three service areas received half as much security coverage on a round-the-clock basis as the emergency department (an average of percent compared with 66 percent), with half as many planning to increase security coverage (10 percent versus 20 percent). It appears that these units were considered less of a priority than other hospital areas.
Fifty percent of respondents reported the use of technology in these three service areas, meaning that technology is applied to a lesser degree here than in general areas of the hospital (93 percent) and in both emergency and psychiatric units (76 percent and 74 percent, respectively).
Looking at these findings, the council concludes that some hospitals may need to review their security presence requirements in these areas, as they are not given the priority most likely due. For instance, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has requirements specific to infant units addressing areas such as abduction risks. It is reasonable to deduce that areas involving the protection of infants and children would or should be considered a higher priority for security services. This is another area that the council will consider for further study.
Freestanding facilities. More than So percent of respondent hospitals had freestanding facilities, such as those providing outpatient care and laboratory services. Approximately one-fifth of outpatient facilities received security coverage on a round-the-clock basis, whereas one-tenth of laboratories received similar coverage.
Though 8 percent of these facilities planned to increase security coverage in the subsequent 6 to 12 months, the data suggested that, of the specialized areas addressed in the study, freestanding facilities received the least security personnel resources.
Also, among the areas studied, freestanding facilities used security technology the least. For example, CCTV systems were used in 29 percent of outpatient facilities, compared with percent of general hospital areas, 76 percent of emergency departments, 74 percent of psychiatric units, and 50 percent of women's health areas.
In addition, fewer freestanding facilities were planning to upgrade the use of technology than in any other specialized area: 25 percent compared with 39 percent of women's health departments, percent of emergency departments, and 34 percent of psychiatric units.
The study results indicate that freestanding healthcare facilities should he closely evaluated to ensure that they have an adequate security presence and that they are adequately and appropriately applying technology. It should he noted that variables not captured in this study may be having an effect on freestanding facilities' use of technology. This issue may be explored more closely by the council in the future.
Four indicators. As noted earlier, four indicators were used to assess how institutions were addressing security issues and concerns in general: security staffing, technology applications, policies and procedures, and personnel training.
Staffing. In regard to staffing, percent of respondents reported using a proprietary security force, 12 percent reported using contracted services, and 10 percent indicated that they used a combination of the two. However, rates varied significantly by region. For example, in New England, 88 percent of respondents used proprietary security and 12 percent contracted their security officers, while in the Western region the split was more even: 59 percent reported using proprietary security and 41 percent said that they used contracted security.
The council speculates that one reason for the geographical difference is that in the Northeast hospitals historically and traditionally use their own police or proprietary security forces; to some degree, this may be due to the strong union in- fluence in that area of the country. Whatever the cause, the regional differences matter because security directors looking to justify resources would argue the case differently depending on their geographic location and what the norm is there. The council hopes to look more closely at the reasons behind these regional variations in future studies.
The study also found that decreases in security staffing were often offset by other measures. These included increases in security personnel training and greater use of technology.
Technology Most respondents indicated that they employed technology such as CCTV, access control systems, security alarms, and occupant-identification systems. Radio communications were the most frequently used application, with 94 percent of respondents availing themselves of this equipment. CCTV came in a close second at 93 percent. Metal detectors were least employed, with 27 percent of respondents using them.
In addition, survey responses indicated a move toward significantly increased use of security technology. The most prevalent planned increase in technology regarded the wider use of CCTV and access control systems.
Policies and procedures. Virtually all of the respondents reported that they have a set of formalized policies and procedures with which to manage, administer, and operate their security programs. Ninety-six percent of those surveyed are accredited by JCAHO and are required to have a security management plan in accordance with JCAHO standards and guidelines. Ninety-five percent of these respondents reported that they have a published security management plan. In essence, there appears to be almost 100 percent compliance of the two with the JCAHO requirements.
Eighty-six percent of respondents reported that they have a workplace violence program in accordance with the Occupational Safety and Health Administration (OSHA) and other related guidelines. Approximately one-third of respondents reported that they planned to improve their security management plans, workplace violence programs, and related policies and procedures over the 6 to 12 months following the survey.
Training. Training was another focus of the survey. Questions were linked to the JCAHO standards, which require that security departments provide training for their security personnel. This training should encompass general security topics as well as those specific to the healthcare environment and the facility. Eighty-four percent of respondents reported that they conduct general as well as healthcare and facility-specific training for their security personnel.
While that is a high percentage, the council notes that it means that 16 percent are not conducting training. Because of the importance of training for all facilities, this is an issue on which the council is considering further study.
Twenty-two percent of respondents indicated that they planned to increase or improve general security training, while 30 percent said that they planned to improve or increase healthcare and facility-specific training.
The survey questions on training were very general, but in the future the council hopes to concentrate on the specific programs and courses people are using. One interesting issue revealed in a "comments" section of the survey was the importance of health and safety training, such as courses on bloodbrone pathogens and airborne agents, which may be a response to requirements from JCAHO and OSHA regarding personal protection and workplace violence initiatives.
The future. The council is currently developing an initiative to review the survey results and determine which issues should be more closely studied. For example, the security profession has formulas that are used to determine security staffing levels in both proprietary and contracted settings. These formulas should be examined to determine whether they represent the best approach for a healthcare environment. Salaries and benefits in healthcare security should also be considered, as should the pros and cons of using contracted security compared with proprietary forces.
The council also plans to address the move toward integrated security programs in healthcare security. Existing models might be effectively applied or new ones might be needed. For example, in the context of training and development, research might look at what levels of security need the most attention. Should the focus be on front-line officers and supervisors or on higher-level managers?
As additional research-based information emerges, healthcare security practitioners' decision making will improve. Further research is a positive tool to be applied to improve healthcare security practices as well as a means to reinforce continued use of successful practices. The bottom line is to ensure a safe and secure environment of care for all occupants of a healthcare facility.
Joseph J. Gulinello is the healthcare security executive for Burns International Security Corporation. He is currently vice chair of the ASIS Healthcare Security Council.
Digging Up the Data
THE QUESTIONNAIRE WAS DESIGNED TO elicit healthcare security information from two perspectives. One is a general security profile that encompasses the overall facility, including its size, location, types of incidents, and solutions being implemented. The other includes profiles that provide more in-depth views of selected areas, including psychiatric services, emergency services, women's health, pediatric and infant care, and freestanding facilities.
Factored into the development of the survey questions were the "Environment of Care" standards from the Joint Commission on Accreditation of Healthcare Organizations, which require that healthcare institutions have a well-developed security management plan in place. Although not specifically used in the survey, the standards provided an avenue for asking respondents about their security program, issues and concerns, and how they are currently addressing them.
Researchers selected a representative sample of 1,200 healthcare security practitioners from across the United States, organized into eight geographical regions. Questionnaires were mailed to 1,000 potential respondents, and telephone interviews were scheduled for the other 200. Later, researchers completed a second mailing of questionnaires to individuals who did not respond the first time, and follow-up interviews were scheduled with individuals not available for the initial interview. Response rates were better for the phone interviews than for the mailing: 38 percent compared with 25 percent. The overall response rate was 27 percent.
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|Author:||GULINELLO, JOSEPH J.|
|Date:||May 1, 2001|
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