There have been many changes in the healthcare environment over the past decade. The Affordable Care Act has been established, severe weather events are on the rise, violence along with active shootings continue to increase, behavioural health patients present treatment challenges and hospitals continue to consolidate to increase purchasing and service capabilities. Over the next decade, healthcare will continue to transform. Emphasis will be on financial reform, violence response, emergency preparedness, the proper care and handling of behavioural health patients and service efficiencies.
Current issues affecting healthcare security
Violence in healthcare continues to pose the greatest risk to hospital staff. Several key healthcare organisations have published information to assist security directors in the reduction of violent incidents.
The International Association for Healthcare Security and Safety (IAHSS) publishes security and design guidelines specific for healthcare facilities. These resources provide valuable and internationally recognised practices and standards for addressing healthcare violence. The IAHSS Foundation (IAHSSF) publishes an annual crime and incident survey analysing violence in healthcare.
The American Hospital Association (AHA) recently published a webpage specifically to assist in the mitigation of violence. ASIS International has published several whitepapers addressing healthcare security; specifically violence related to behavioural health patients and disruptive and violent behaviors in healthcare. The Occupational Safety and Health Administration (OSHA) website offers numerous tools and resources pertaining to workplace violence and safety with a section devoted specifically to the healthcare industry.
Possibility of healthcare workplace violence prevention
At the time of writing, the Republican Party had not figured out how to change the Affordable Care Act (ACA) while still making healthcare more affordable. Most likely changes in health care will occur within the expanded purchasing options, Health Savings Accounts (HAS’s), Medicare reimbursement and the use of government exchanges. The indoctrination of the ACA included increased investigation to Medicare fraud and audits to hospitals for billing errors. In 2016, the Federal government collected over three billion dollars in fraud and reconciled billings to Medicare.
|Domestic violence, child abuse, behavioural health, drug and alcohol abuse will all continue to challenge hospital staff|
The Joint Commission issued Sentinel Alert 57. This alert focuses on the role of leadership in developing a safe culture. The Occupational Health and Safety Administration (OHSA) contemplated issuing a healthcare workplace violence prevention standard. This standard required healthcare institutions to have a clearly defined prevention programme in place.
This year, a total of 25 states have legalised marijuana. This legislation will dramatically change how we care for patients and deal with patients, employees and visitors who are using the substance and may be impaired at work and within the hospital, and who may request continued use while being an in-patient within a facility that is smoke free.
The future for healthcare security
In the future, healthcare security professionals will have to deal with a variety of events from severe weather, violent and active shooter incidents, terrorist attacks, and continued changes to healthcare reimbursement. Severe weather has the potential to impact all healthcare systems across the globe. Specific attention must be directed at knowing the weather threats common to specific geographical locations. A Comprehensive Emergency Management Plan (CEMP) must be current and thorough for disaster response. Performing exercises is a valuable tool in staff education and opportunity to reinforced skills for those assigned to incident command positions.
The Hazard Vulnerability Assessments helps in defining risk severity and identifying historical
Violence will continue to challenge the healthcare sector in the future. Domestic violence, child abuse, behavioural health, drug and alcohol abuse will all continue to challenge hospital staff in the Emergency Department, Women’s Health, and behavioural health areas. The Hazard Vulnerability Assessments (HVA) along with facility wide risk assessments helps in defining risk severity and identifying historical patterns of violence.
Active shooting incidents
According to the FBI, an analysis of 2014 and 2015 active shooter incidents identified 20 incidents in each of these years. This annual tally is an increase from 17 in the year 2013. In a John Hopkins study entitled, “Hospital-based Shootings in the United States: 2000 to 2011,” Hopkins identified 154 hospital related shooting events (26.6 events per 1,000 hospitals) in 148 hospitals, affecting 235 victims (0.79 per 1,000,000 population). The risk of experiencing an active shooter incident is increasing. Hospitals must be prepared to not only deal with their own active shooter incident, but any that could occur in their service community.
Changes in terrorist tactics now present a new challenge for the healthcare security. According to Homeland Security, hospitals play a major role in the response for terrorist-related incidents and terrorist activities within the United States. Today, incidents are comprised of local combatants whose goal is to kill civilians in crowded areas like restaurants, concerts, and other mass gatherings. Attacks in the past have focused on first responders and their ability to treat victims. Healthcare institutions need to be ready to again accept victims of terrorist events and prepare for the potential for becoming victims of an event as well.
At the writing of this article, “Trump Care” is still being debated. However, certain things seem clear. In the future, Medicare reimbursement will probably be reduced leaving hospitals with less money within their payor mix. Trump Care may also see increased State control over the reimbursement process, allowing each State to decide its own fate when it comes to Medicare and Medicaid payment rates. This could provide hospitals with less revenue, leaving hospital security departments with budgets struggles for both staffing and technology.
|Today, incidents are comprised of local combatants whose goal is to kill civilians in crowded areas like restaurants, concerts, and other mass gatherings|
Staff recruitment will remain amongst the most challenging endeavour. The need for qualified and skilled security staff will challenge the best of talent recruiters. Competitive wages and benefits will require continual focus for attracting skilled labour. Recruiting practices and personal skill screening tools will be of benefit. Some systems find outsourcing their security department the best option. Hybrid models are options as well as contracting with local law enforcement for additional presence.
Training for healthcare security staff
A key factor of success for security in healthcare is training. Providing staff with the necessary tools and skills will afford significant return on investment with quality and satisfaction outcomes. Healthcare security staff should receive training focusing on patient safety, patient experience, customer experience and quality of service. Awareness and understanding of behavioural health, aggression management and de-escalation talents, crime prevention and customer service abilities and aptitudes are a must. The International Association for Healthcare Security and Safety (IAHSS) offers several educational certification levels designed specifically for healthcare security officers.
Importance of robust security department
Utilising concepts and dynamics of lean tools, technology options, clinical throughput, and Standard Work all influence security services. The concept of Standard Work is popular in the business world. Utilising this concept is beneficial to security. Standard Work can identify staffing needs, work flow process, consistency in service levels, and maximum utilisation of technology resources and equipment. Striving for the right person doing the right work with the right skill set is the desired outcome. Often the same concept will hold true for identifying the right department providing the right service for the right reason.
Data will be of extreme importance in the distribution of those resources. Security departments need to collect relevant data on all aspects of security services from reported crime data, security calls for service, annual risk assessments and benchmarking data. Hospital security departments must create a data-driven environment that can help to demonstrate service needs and improve processes over time. The real success of using data is the analysis of data to determine patterns and trends that can demonstrate the need for and successes in security services.
Methods for managing healthcare security are driving factors. A robust security department will implement and utilise security technology to support and influence safety, security and quality outcome measures. Return on investment (ROI) and the ability to show quality metrics and positive influence in life-safety, security and patient satisfaction scores will be core in driving positive capital decisions. Challenges of healthcare security in the future will require continued education and knowledge of current trends, guidelines, and standards within the healthcare security industry.
By Ben Scaglione and David LaRose