Improve Healthcare Facility Security and Reduce the Threat of Violence with a Proactive Approach to Weapons Screening

By Greg Hinds

It’s critical to keep tabs on trends within an industry, as these bellwethers determine how an industry needs to change either its mentality or its approach to a problem – even though some of those trends aren’t necessarily a reality anyone wants to face.

Here’s an unfortunate example: Violence within healthcare facilities is increasing, according to a Modern Healthcare article, which calls it a “growing problem.” The Occupational Safety and Health Administration (OSHA) found that three-quarters of all workplace assaults occur in the healthcare and social services settings. OSHA research also found workers in a healthcare setting are four times more likely to be victimized than those in the private sector, and this violence can range from someone using a fist to someone using a knife or gun; data shows an 88 percent increase in hospital shootings since 2009.

The rise in violence can be attributed to a number of factors, like the rise of drug addictions, patients with aggression issues and/or mental handicaps, and more. A 2018 study from the Joint Commission mentions a number of additional contributing causes of workplace violence in healthcare facilities, including:

• Poor lighting
• No access to emergency communications
• Unrestricted public access
• Stressful conditions
• Staff working in isolation or without a clear escape route
• Lack of training on situational awareness and de-escalation tactics
• Lack of training and organizational policies for security and staff
• Domestic disputes between patients and visitors
• The presence of dangerous weapons (knives, guns, razor blades) brought into facilities from outside
• Inadequate security and mental health personnel on site
• Understaffing

All of these figures paint an unsettling image of a workplace that can feel scary and unsafe. The Bureau of Labor Statistics found healthcare workers are more likely to take time off work after experiencing acute and chronic episodes of violence in the workplace, and that workplace violence in healthcare causes high turnover and low staff morale- and when staff are unhappy or fear for their safety, patient care in turn will suffer. These effects can be costly, both in terms of patient care and actual dollars: In 2016, U.S. hospitals and health systems spent about $2.7 billion in responding to violence.

It’s not just employees who need to worry about violence within healthcare facilities. Patients and visitors are also at risk if another patient brings in or obtains a weapon or other restricted item while in a hospital or clinic.

Yet the industry has a tendency to focus on the wrong things. An April 2016 editorial in the New England Journal of Medicine pointed out most research is centered on quantifying the problem of violence in healthcare rather than studying how to overcome it. Even those who are working actively to correct the problem struggle with an effective way to prevent violence before it happens.

To solve this issue requires a change in mindset. If an organization believes that screening means metal detectors, which many people find obtrusive and unsettling, then that means they are not looking at every angle and opportunity to make their facilities safe – and not seeing the problem and risks clearly.

Compounding the issue: Security is often the last thing considered when healthcare facilities are designed or remodeled – and yet, with the right proactive approach, there are paths to stopping violence before it even happens.

Taking a Proactive Approach

Too often healthcare facilities are in reactive mode when dealing with workplace violence – reviewing the camera footage of an incident to try to see how it occurred, for example, and possibly prevent it from happening again, instead of trying to prevent it in the first place.

A better approach is to get in front of the problem before it happens, with a proactive strategy that involves having a way to assess threats; a comprehensive staff training program; and a fully developed security operational plan with policies and procedures.

While each of these components of the proactive approach is critical – and every facility will approach this differently – we will explore one piece in particular: maintaining security and preventing violence by detecting and eliminating the entry of dangerous weapons into a facility. This is done by layering multiple tactics together, including access control, training, alert and/or active screening systems.

The access control component might comprise (but is not limited to):

• Limiting visitor access to controlled entry points
• Screening visitors for weapons
• Patrolling regularly to ensure entry points are not compromised
• Reducing the amount of available entrances to make it easier to patrol/monitor the existing ones

The training component might include:

• Training personnel to recognize signs of potential violence and how to respond to them
• Ensuring a streamlined reporting system and driving home the importance of accurate, speedy reporting. Reporting is an especially critical piece of this, as violent incidents in healthcare are notoriously underreported, and having data to quantify these incidents is helpful for the awareness component. Raising awareness can lead to actions like increases in state and federal funding or legislation to help prevent workplace violence in healthcare.
• De-escalation training

The alert and/or active screening system component is often the most challenging for facilities to grasp. The first instinct for many is to equate active screening with metal detection – but metal detectors are generally not healthcare facility-friendly, because of their appearance and connotation: large, conspicuous portals placed at entrances. This unwelcoming image can alter patients’ and visitors’ perceptions of the healthcare facility – from open and helpful to restricted and inaccessible. 

In reality, the concept of active screening has progressed far beyond metal detection, most notably in deployment options, size/form factor and performance. New technologies, such as ferromagnetic detection systems, are shifting the paradigm by providing options to continue screening at entrances if desired, but also in emergency departments, triage areas and psychiatric holding units – places where screening can be utilized in conjunction with behavioral assessments made by staff.

While metal detection is often a portal through which someone walks (though there are also hand-held metal detection wands), newer technology is characterized by minimal footprint and is aesthetically suitable to complement facility architecture and other medical equipment. Most importantly, the capability of detection is multiplied, allowing for detection of threat items that can often dupe metal detection.   

Healthcare facilities must treat security in the same way they treat clinical matters: by researching, seeking consultation and expertise, and considering the progression of new technologies to provide the right solution for care. Education is key, and the first step comes in acknowledging the advancements in technology.

These three components – a focus on training, access control and proactive technologies that keep weapons out of healthcare facilities and emergency rooms – are important parts of a layered approach, but it’s critical that facilities ensure their proactive strategy for reducing violence is tailored to their facility, their staff and even their location. Different facilities will have unique needs based on the size and acuity of the facility, the crime rate in the area, their patient and visitor attendance rate, and so forth. Facilities should assess the right tools and tactics for their individual facility.

Changing the Game

Due to increasing patient populations and complexities of care, healthcare facilities face security and safety risks, and the need for proper security technology to reduce these threats will continue to increase. With violence against healthcare staff now all too common, it’s time to look at security differently – treating it not as an expense, or something to be dealt with reactively, but instead something to take control of, and part of an investment in patient, staff and visitor safety. With so much expenditure in how healthcare facilities react to violence, instead, facilities should look to a proactive approach – which not only saves money due to fewer lawsuits and less damage to a facility’s reputation overall, but also has the potential to save lives – by increasing budgets for security.

By taking a proactive and layered approach to keeping weapons out by focusing on access control, training, and alert systems/active screening technologies, healthcare facilities can close the security gap, keeping everyone in the facility safe, and creating peace of mind for staff, patients and visitors. Proactive approaches must become the norm, not the exception, to reduce the number of assaults that go on in facilities and protect staff.

Greg Hinds leads the U.S. healthcare security business for Metrasens. Metrasens is a provider of advanced ferromagnetic detection systems, developed to change the paradigm of traditional security screening.  Hinds can be reached at ghinds@metrasens.com.