It’s a story healthcare professionals hear often – being near family, surrounded by familiar and caring people, can help patients heal better and faster. This is the basis behind the family-centered care philosophy at University of Michigan hospitals and health centers in Ann Arbor, Mich., but the conundrum lies at the intersection of patient service and security.

Marilyn Hollier, CHPA, CPP, is the Director of Hospitals and Health Centers Security for the University of Michigan Division of Public Safety and Security. While she manages the security programs for several hospitals, clinics and offices, visitor management levels differ throughout the facilities, ranging from after-hours badging at adult hospitals and 24/7 visitor access management and badging at the new C.S. Mott Children’s Hospital.

“The Joint Commission has set a higher standard for security at children’s hospitals,” says Hollier, who is also the 2014 President of the International Association for Healthcare Safety and Security (IAHSS). “We’re following that recommendation with visitor restrictions,” she adds. The “guest service specialists” – Public Safety and Security employees trained extensively for customer service, non-violent crisis prevention and intervention, and first aid, among other things – at the lobby desks maintain a log of patients’ visitor requests and information, and they can reinforce restraining orders or facilitate split patient visits for separated parents.

“We’ve taken on other roles within our hospitals so we can become an irreplaceable member of the team at the Children’s Hospital,” Hollier says. “We’ve even had members of the nursing staff take advantage of our services too, alerting us about domestic issues and requesting we not allow certain people up to see them – this is a large new hospital, and having gatekeepers in the lobby and at the elevator entrance to every floor helps to make our hospital staff feel more secure, especially at night.”

“Our staff knows to look for badges after-hours. Under our family-centered care philosophy, up to four family members or close relations get all-night privileges on patient floors,” Hollier says.

Similarly, in Florida, careful visitor management and badging is helping patients get the secure care they need while supplying management with more data and preventing crime. More than 8,000 people pass through the lobby of the Lee Memorial Hospital every day, and now they must check-in at a SISCO FastPass station, which checks a state-issued ID, verifies a visitor’s destination, checks for “unpublished patient” status (if a patient does not want visitors) and cross-checks sex-offender databases. After all that, visitors receive a badge with their photo, first name, destination and an expiration date.

Badges are constructed to meet HIPAA, privacy and civil rights concerns – visitors’ last names are not included on badges, and generic room numbers are used as destination markers instead of departments (for example, badges declaring a destination of the “infectious disease” department).

“This helps let us know who is in the building at any time, and it’s directly related to patient safety,” says Rafael Ortiz, System Investigator with the Lee Memorial Health System Security Department. “Having all of a patient’s visitor restrictions in a single, central system helps ensure their safety and mitigate workplace violence or domestic violence risks.  When they see and know that they will be screened in our lobbies, people are self-electing not to enter our hospitals.”

Heathcare facilities in busy urban areas face myriad problems, but the Dana-Farber Cancer Institute in Boston combines both clinical and research functions, which multiplies the risks addressed by Ralph Nerette, Manager of Security Services at Dana-Farber.

“We have a ‘bench-side to bedside’ philosophy, which means accelerated solutions from research to application. This ends up putting research and clinical departments very closely together, often with mixed occupancy or segregated floors within a building, making a unique challenge for visitor management,” Nerette says.

On the clinical side, Nerette’s key concerns include workplace violence prevention, restricting access to medication and managing patient safety. On the research side, he must manage security for both wet labs and dry labs, chemical or nuclear materials and portable device and data security. Also, as part of the Longwood Medical Area, a busy, collaborative neighborhood of medical and research facilities, Nerette does not want security to inhibit collaboration.

Instead, using three new kiosks in the lobby of the Longwood campus and visitor management software, research staff can pre-register visitors and collaborators, who will then receive a pre-registration email, telling them where to go and how to get badged. Visitors, either for clinical or research departments, can scan their driver’s license at the kiosk, and it will print a barcoded badge, which soon will enable access to certain floors via a barcode-operated elevator.

“Now, lobby security officers can just verify badges appropriately to allow access, which changes our role and posture, helping to create an open and welcoming environment,” Nerette says. “Some of our patients are coming in for the fight of their life. I don’t want security’s role to be a barrier for that.”

But one shoe doesn’t fit all when it comes to hospital visitor management, says Dennis Hemphill, VP and Chief Security, Safety and Emergency Preparedness Officer at Dignity Health, a massive California-based healthcare system with 40 hospitals and several hundred ancillary office buildings across 17 states. In order to determine which facilities require visitor management programs, Hemphill coordinates hospital security assessments, identifying vulnerabilities, interviewing employees, looking at area crime statistics and making overall recommendations.

“As a not-for-profit system, it is harder to get proactive funding for security,” Hemphill says. “You have to understand the dollars in healthcare – if it comes down to funding for a new MRI machine or an additional security officer, the MRI will get the dollars, because it’s directly part of the service. So there’s some more creativity required. For example, concerning productivity and staff size, even if the number of patients shrinks, the hospital size doesn’t. So we pull officers from less critical areas and remove ‘fixed post’ positions in favor of more patrols.”

While each hospital maintains its own security budget and in-house security director, Hemphill knows that having a certain standard of training for officers, whether in-house or contract AlliedBarton security officers, is key to maintaining a safe, welcoming environment for patients and visitors, from the lobby on up.

Security officers serve a customer service function here as well, similar to the guest service specialists in the University of Michigan Health System. All Dignity Health officers are cross-trained for various posts, so one officer could shift from behavioral health to the emergency department to a greeting post at the front desk to a patrol or a shift at the control center. “Training officers to multitask creates a pool of security officers to pick up slack in an emergency or to help manage different staffing levels,” says Hemphill.

“What’s unique to healthcare across the country is that many mental health facilities are closing down, leading to more mental health patients being seen in emergency departments. Staff is not trained for this, so we’re having to learn from experience,” he says. “Local law enforcement response times vary so much – our longest tested response time was nearly five minutes – so all of our employees in high-risk areas and our security officers are trained in workplace violence (CPI training), to know what to look for in terms of escalation, and to know when to call for assistance and get out of harm’s way. Our goal is to diffuse the situation.

“Having a security officer in the lobby is a deterrent, whether they’re in uniform or in a soft look (blazer and tie – a ‘security ambassador’ image). This makes people ‘see security first, think twice,’ I believe.

“Hospital security is always a work in progress; there’s always something to change or tweak, and it requires continuous adaptation to keep pace with the changing times,” Hemphill says. “But you only fail when you don’t try.”

The Fundamentals of Hospital Lobby Security

Hospitals need to retain a delicate balance between providing an open and welcoming environment for its patients and visitors but still have security measures in place to protect the people and assets in the facility. There’s a constant flow of people in a hospital lobby for many different reasons –a doctor’s appointment, a visit to the clinic or lab, visiting a friend or relative, sales call for medical devices, pharmaceuticals or other products, deliveries, and employees moving from area to area. Most are probably entering or exiting from numerous entrances with no central reception point. It’s nearly impossible to effectively manage all of this activity without taking away some of the friendliness, but here are some measures that can create a more secure environment:

• Lockdown preparedness to contain violence – keep people safe where they are, control the movement of the perpetrator to a less populated area.
• Secure areas when needed such as offices, departmental entrances, back-of-house operations areas, chapels, gift shop, cafeteria and other rooms with standalone or networked electronic locks and/or credential readers including time zones, audit trails and other basic access control attributes.
• Use access control to restrict elevator access to patient and other floors that require privacy. Use the readers in elevators to require a credential to get to certain floors.
• Clear and safe egress must be furnished as the lobby will be a main exit point in the case of an emergency. Thus, make sure exits are marked and the proper door hardware is in place.
• Ensure that openings operate and close properly. Security is no good if the door doesn’t close.
• Train staff so they don’t prop open doors, which reduces the security of the entire facility.

Other things that will keep the hospital and its lobby more secure include: 

1. Make sure the sliding doors (used primarily on perimeter openings) are working properly and can be secured if needed.
2. Consider a visitor management system that gives visitors an ID and lists the purpose of their visit. This also lets the hospital know who is in the hospital in case of an emergency (Did everyone get out?).
3. Provide a video camera that gives security personnel a real-time view of what is happening. It will also provide valuable info in the case of an investigation and protect the hospital if there is an incident/litigation. For instance, did the person really slip due to the hospital’s negligence, or is this fraudulent behavior?
4. Provide good and easy directions. If people know where they are going, they are less likely to poke around trying to find their way and end up in areas they shouldn’t be in.  -Ann Timme, Hospital Marketing Manager, Allegion