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, behavioral 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 behavioral 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 organizations 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 recognized practices and standards for addressing healthcare violence. The IAHSS Foundation (IAHSSF) publishes an annual crime and incident survey analyzing 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 behavioral 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.

Violence will continue to challenge the healthcare sector in the future
Domestic violence, child abuse, behavioral 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 program 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
patterns of violence

Violence will continue to challenge the healthcare sector in the future. Domestic violence, child abuse, behavioral health, drug and alcohol abuse will all continue to challenge hospital staff in the Emergency Department, Women’s Health, and behavioral 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.

Trump Care

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.

Severe weather, violent and active shooter incidents and terrorist attacks all affect healthcare security
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 endeavor. 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 labor. 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 behavioral 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 utilization 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 utilize 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

Download PDF version

In case you missed it

Ethical Consumption: Should You Buy Security Products ‘Made In China’?
Ethical Consumption: Should You Buy Security Products ‘Made In China’?

Should ‘Made in China’ be seen as a negative in security systems and products? It’s an important and complex issue that merits a more detailed response than my recent comment in the Expert Panel Roundtable. For me, there are two sides of the answer to this question: Buying products that have certain negative attributes that are not in alignment with some part of a belief system or company mandate. Buying products that do not perform as advertised or do something that is unacceptable. For integrators and end users making the buying decisions, the drive to purchase products may not be based on either aspect and instead on the product that can do the best job for their business. But for others, a greater emphasis on the ethical implications of purchasing decisions drives decision-making. What Is Ethical Consumption? Ethical consumption is a type of consumer activism that is based on the concept of ‘positive buying’ in that ethical products are favoredEthical consumption — often called ethical consumerism — is a type of consumer activism that is based on the concept of ‘positive buying’ in that ethical products are favored, and products that are ethically questionable may be met with a ‘moral boycott’. This can be as simple as only buying organic produce or as complex as boycotting products made in a totalitarian regime that doesn't offer its citizens the same freedoms that we enjoy in the United States. Consider the goals of the Boston Tea Party or the National Consumers League (NCL), which was formed to protect and promote social and economic justice for consumers and workers in the United States and abroad. Some examples of considerations behind ethical consumption include fair trade, treatment of workers, genetic modification, locally made and processed goods, union-made products and services, humane animal treatment, and in general, labor issues and manufacturing practices that take these factors into account. Increase In Ethical Consumption The numbers show that ethical consumption is on the rise. In a 2017 study by Unilever, 33 percent of consumers reported choosing to buy and support brands that they believe are doing social or environmental good. In the same study, 53 percent of shoppers in the United Kingdom and 78 percent in the United States said they feel better when they buy products that are ‘sustainably’ produced. There’s clear evidence that products from some Chinese companies suffer from cybersecurity vulnerabilities Though the aforementioned question that sparked this conversation centers around concerns with products made in China, there are many other countries where, for example, governments/dictators are extremely repressive to all or parts of their populations, whose products, such as oil, diamonds, minerals, etc., we happily consume. There are also a number of countries that are a threat in terms of cybersecurity. It may be naive and simplistic to single out Chinese manufacturers. Impact On Physical Security Products Product buying decisions based on factors other than product functionality, quality and price are also starting to permeate the security marketplace. While this hasn't been a large focus area from the business-to-business consumption side, it's something that should be considered for commercial security products for a variety of reasons. Hardware hacks are more difficult to pull off and potentially more devastating" There’s clear evidence that products from some Chinese companies suffer from cybersecurity vulnerabilities. Last fall, 30 U.S. companies, including Apple and Amazon, were potentially compromised when it was discovered that a tiny microchip in the motherboard of servers built in China that weren't a part of the original specification. According to a Bloomberg report, “This attack was something graver than the software-based incidents the world has grown accustomed to seeing. Hardware hacks are more difficult to pull off and potentially more devastating, promising the kind of long-term, stealth access that spy agencies are willing to invest millions of dollars and many years to get.” This, along with many other incidents, are changing the considerations behind purchasing decisions even in the physical security industry. Given that physical security products in general have been lax on cybersecurity, this is a welcome change. Combating Tech-Specific Threats In early January, members of the U.S. Senate introduced bipartisan legislation to help combat tech-specific threats to national security posed by foreign actors and ensure U.S. technological supremacy by improving interagency coordination across the U.S. government. The bill creates the Office of Critical Technologies & Security at the White House, an indication that this issue is of critical importance to a number of players across the tech sector. Members of the U.S. Senate introduced bipartisan legislation to help combat tech-specific threats to national security posed by foreign actors To address a significant number of concerns around ethical production, there are certifications such as ISO 26000 which provides guidance on social responsibility by addressing accountability, transparency, ethical behavior, respect for stakeholder interests, respect for rule of law, respect for international norms of behavior and respect for human rights. While still emerging within physical security, companies that adhere to these and other standards do exist in the marketplace. Not Buying Products Vulnerable To Cyberattacks It may be counter-productive, even irresponsible, to brand all products from an entire country as unfit for purchasing. Some manufacturers’ products may be ethically questionable, or more vulnerable to cyberattacks than others; so not buying products made by those companies would make sense. The physical security industry might be playing a bit of catch up on this front, but I think we're beginning to see a shift toward this kind of responsible buying behavior.

Adapting servers for IP video surveillance systems: choosing the right solution
Adapting servers for IP video surveillance systems: choosing the right solution

Choosing the right server for a video surveillance application comes down to one question: What does the customer expect from the system? Is it a retail location with two cameras that only needs video stored for 24 hours? Does the system need failover protection? What are the ramifications if a system goes down? Does business have to stop? How fast does the customer need to have access to video? Is it a regulated industry where immediate access is a requirement? How mission-critical is the video system to operations?  Mission Critical Video Surveillance Solutions Such questions can point video system designers to the right technology for an application, and a manufacturer and reseller with a wide product offering ensure that the perfect solution is available and can be shipped quickly. It’s important to remember that this is not a “one size fits all” marketplace. Questions need to be asked on what an appropriate server solution will provide for the customer 1) JBOD - It stands for "just a bunch of disks" and refers to a collection of hard disks that have not been configured to work together. This approach is typical of stand-alone systems such as a retailer who has one or two cameras recording locally at a remote location, and who have a tolerance for occasionally losing video footage.  2) RAID 5/6 is a redundant array of independent disks in which data is stored across all the disks. The configuration provides more redundancy and reliability, better balance of disk usage, and more throughput and performance. RAID 5/6 is a redundant array of independent disks in which data is stored across all the disks 3) SAN or storage area network is a type of centralized storage providing enhanced accessibility to disk arrays. SAN provides high performance but is not as easy to expand. It is also less expensive than NAS systems.  4) NAS or network-attached storage is another type of centralized data storage. NAS systems are networked appliances containing storage drives. Benefits include faster data access, easier administration and simple configuration. NAS systems are easier to expand than SAN but provide less performance. NAS systems fit well in situations where customers have massive storage needs (or expect to in the future.) These are applications with lots of cameras and a need to retain high-frame-rate video for 180 days or longer. Typical uses include sports arenas, large cities, universities, corporate campuses and airports. Immediate Access To Video Highly available systems, such as SAN or NAS, are needed in any regulated industry. For example, in the cannabis grower market, an end user might need immediate access to video to show a compliance regulator. Gaming is another market in which immediate access to video is critical, and, for example, if a video system goes down at a table game, the gaming has to shut down, which is an expensive prospect to the casino. Therefore, reliability is critical. Video’s benefits beyond safety and security can also help to justify the costs of more expensive system Importance Of Video In Risk Mitigation In some instances, video is used primarily to manage risk, for example in litigation (or to avoid litigation) in a slip-and-fall claim or other court action. This is referred to as Loss Prevention. The ability to save thousands of dollars (or millions) by averting an expensive legal verdict can go a long way toward justifying the costs of systems.  Video’s benefits beyond safety and security, such as for marketing and business analytics, can also help to justify the costs of more expensive systems. Identifying The Right Video Server Equipment Offering a variety of choices, and adapting those systems to specific applications, ensures customer satisfaction “A tradeoff of cost and needed functionality is at the center of decisions when buying server systems for video applications,” says Tom Larson, Chief Technology Officer, BCDVideo. “Identifying specifically what the customer needs from the system, and how important it is to meet those needs, points to the right choice in video server equipment. "Various technologies have advantages and some downsides, and it is the customer’s need for those advantages (and tolerance for the downsides) that determines which server equipment is right for the job.” Offering a variety of choices, and adapting those systems to specific applications, ensures customer satisfaction. The systems builder can help integrators analyze the site and project requirements and translate those into the right equipment and networking choices. What does the customer need and how much are they willing to pay for it? The real determination is “how important is the video?”

How Biometrics, Integration And Cloud Tops The List Of Access Control Trends In 2019
How Biometrics, Integration And Cloud Tops The List Of Access Control Trends In 2019

The access control industry tends to be more conservative when it comes to the adoption of new technology and services for end users, but that doesn't mean that 2019 won't provide a significant amount of progress through emerging trends taking shape in the industry. In addition to the increased adoption and acceptance of the cloud, mobile credentials and biometrics are becoming more mainstream, and integrations between manufacturers will take centre stage. Here, we take a look at these and other trends helping to shape the coming year. Cloud-Based Products We're continuing to see a demand by end-user customers for customized responses to certain actions within an access control system For many access control manufacturers, the core of the business is in more traditional products, with a high percentage of installs continuing to be these kinds of projects. However, over the last couple of years, cloud-based products have emerged as a viable option for customers. We've seen more of a willingness for end-user customers to inquire whether this is an option for them, citing ease of use, remote management, cybersecurity and more as part of their foray into this branch of access control. The cloud has established its reputation as being quicker to install, more flexible for customers to access and manage both their access points as well as the video associated with these doors, and placing less pressure on internal (or in some cases, non-existent) IT teams to help set up and manage an access control system. Mobile Credentials Applications We're continuing to see a demand by end-user customers for customized responses to certain actions within an access control system. For example, if there's an alarm set off during the day along a perimeter, the ability to automatically execute a lockdown and simultaneous email or message to everyone within the building alerting them to the issue is critical. The desire for this kind of flexibility within a system is prompting manufacturers to build new simple to use graphical tools into their systems that allow customized action responses that are proportional to the level of alarm. There's a strong desire by many of today's companies to be able to use mobile phones for access control and as such, manufacturers are either developing their own mobile credentials applications or integrating their systems with these kinds of products. Over the last couple of years, cloud-based products have emerged as a viable option for customers Future Of Biometrics As companies start to ask about whether their facilities are safe enough, they're often more willing to consider access control that takes security to a new level, such as the implementation of biometric readers. Biometrics is getting more usage in professional security applications and many customers want to move away from using physical cards for access control. Manufacturers that don't currently have biometric hardware in place are starting to integrate with readers designed to offer this functionality in an effort to meet the demands of customers. The dramatic rise in facial recognition biometrics is something that will likely shape the future of biometrics as costs start to decrease. While the access control industry is highly fragmented, we're seeing a trend toward increased partnerships and open-platform technology that helps end users achieve the kind of comprehensive security that they desire. Video Management Platforms We're seeing a trend toward increased partnerships and open-platform technology that helps end users achieve the kind of comprehensive security that they desire For example, there are a number of access control providers that are providing paths toward full integration with lock manufacturers and vice versa in an effort to meet the needs of clients who may have purchased locks but a high powered access control system to properly manage them. There's also a large shift toward full integration with video management platforms and access control systems to fully integrate the two into a single, user-friendly experience and give end users more control over both. Additionally, manufacturers are looking to provide customers with a single system that meets the needs they have with regards to video, intrusion and access control. Right now, I don't think there's a system that can fully deliver on the promise of being exceptional at all three, so integrations and partnerships remain important to achieve that end goal. Access Control World An increasing number of end users are realising the holes in the current Wiegand protocols that have been in place since the 1980s, along with the large number of ‘off the shelf’ equipment that's now available to allow outsiders access through readers that operate under these protocols. As a result, in the last decade or so, OSDP has come onto the scene and is growing in popularity. One of the most important steps for access control manufacturers in 2019 will be to listen to customers who are concerned with this vulnerability and work toward fully supporting OSDP in an effort to protect these access control systems. It's an exciting time to be a part of the access control world, as we finally see results from all of the hype centred around the cloud, biometrics, mobile credentials, hacking protection and strong partnerships come to fruition. As 2019 begins, look for these trends to grow in popularity and for manufacturers to really listen to the end-user customer they serve and respond in kind.