Typically, access management control begins at the perimeter, but it doesn’t need to end at the perimeter. In fact, it should not end at the perimeter. Most public and semipublic enterprises have public areas, as well as areas that are, to varying degrees, somewhat restricted. This is especially true for hospitals.
With access control in mind, hardly a week goes by without out the headline of the day pertaining to some form of workplace violence. Common to the majority on these incidences are those facilities that provide some degree of public access. Yet It is not infrequent that the level of public access is often called into question by the Monday morning Quarterbacks. Monday morning is usually a little too late.
Most of the time, these incursions go unnoticed, and certainly these intrusions are not reflected in headlines in public media. However, on those occasions that the interloper is an Active Shooter, or commits a sexual assault, the media will show up in force. These attacks occur on a regular basis at 24-hour convenience stores and gas stations. These cases may dominate local media, but rarely national media. However, when the target is a school, a mall or a hospital, the media coverage is wall to wall. Of these three examples, hospitals offer the greatest challenge.
Clearly an act of violence committed in any hospital is antithetical to the mission of care and healing. Those who are committed to the healing arts, are often not prepared to deal with individuals, consumed by rage, bent on doing serious harm, and doing so in a very public way. Individuals bent on committing acts of extreme violence, and or sexual assaults, generally do not rely on stealth. Often the assailant has some sort of connection to the facility under attack. Frequently the incipient behavioral clues are missed.
The differentiation for protecting schools, malls or hospitals, begins at the perimeter, and/or sometimes the property line. Since the number of school shootings that occurred in the wake of Columbine, and certainly after Sandy Hook, the emphasis for school security was applied to the perimeter. Because, malls have open perimeter, mitigating methodologies include heightened vigilance and added security forces. The challenges for hospitals are more daunting, in part because the primary mission is healing.
For purposes of emphasis the remainder of this discussion, we will focus on hospitals.
It is a generally accepted reality that hospitals are held to a very high standard of care when it comes to the efficacy of security programs, especially as related to the control of access to the facility, as well as within the facility. As with most security programs, hospital security programs begin at the perimeter. However, hospitals security programs do not end at the perimeter. Hospitals must also endeavor to secure inner space. This means that emergency departments, mother-baby units, behavioral health unites and all other patient care units require situational, internal access control. Not only do patients need to be kept reasonably safe, but so do the healthcare workers. Despite the reality that hospitals are often exposed to episodes of domestic discord and domestic violence. For some, the mere experience of hospitalization can be stressful to those indirectly affected, which in-turn, may precipitate aggressive behavior.
Therefore, from a security perspective, attention must be focused on inner space, in addition to the perimeters. In order to achieve effective securing of inner space, employee involvement is a must, including the ability to reasonably recognize the potential for aggressive behavior, preferably during the incipient stage. However, access management of inner space is often overlooked, and/or given insufficient attention within the context of many security plans.
Consider that Incidents of workplace violence in hospitals can also be sparked by hospital employment related disagreements, psychiatric disorders and/or domestic disputes that migrate into the hospital affecting patents and/or employee conflict. It is therefore essential that designated, and relevant employees should be trained to recognize hostile and aggressive behavior at the incipient stage. This includes human resource professionals, who are involved with discharging employees for cause.
Designated employees and all security personnel must also acquire the skills to deescalate, and subsequently reasonably control aggressive and hostile behavior (Management of Aggressive Behavior). De-escalation is generally effective during Stage 1 aggression, and may not require a take-down. Understanding of the escalation hierarchy is a must. Clearly law enforcement should be notified as early in the process as is practical (a tougher objective in large metropolitan areas where police departments are stretched thin).
As part of the prevention of workplace violence is the application of computer based incident management systems that have the analytical capability to recognize discreet and emerging trends that may be a portent of future vulnerabilities. These systems support the notion of preventative actions, as opposed to corrective action after-the-fact.
Clearly a qualified security assessment, is not only a good first step, it is offer a cost effective first step. The cost of inaction, both direct and indirect, is generally far costlier than being relevantly proactive.
Schools, Malls and Hospitals need to develop relevant workplace violence prevention strategies that are site specific to the ambient threat milieu. Of the three, hospitals are the most granular requiring situational, site-specific mitigation methodolgies, including effective team leaders.