By Laura Freeny

Upon setting foot on a hospital campus or in a medical office building, staff, visitors and patients experience a range of emotions, from joy in welcoming a new baby to anxiousness over an impending diagnosis and to grief in preparing to saying goodbye to a loved one. 

Unfortunately, an added consideration for stakeholders is safety and security, especially in the aftermath of recent violent events at healthcare facilities. 

To minimize the likelihood of such incidents, healthcare facilities managers must safeguard entire campuses. First impressions are critical in easing the stress and anxiety patients and visitors experience. Mature and maintained landscaping, easy-to-understand signage, robust site lighting, and accessible and illuminated pedestrian walking paths immediately offer a welcoming experience. 

To maintain safety and security, managers need to identify risks from the time a person arrives on a property to the moment he or she leaves. Once risks are identified, managers can make mitigation efforts using physical security technologies, as well as vigilant behavior and procedures. 

Monitoring the compound 

The baseline for providing security is deploying exterior surveillance cameras to monitor and record entrances and exits. Many modern surveillance cameras use analytics to track questionable behaviors.  

Reviewing recorded video used to be time consuming because operators could only search based on the approximate time an incident occurred. Through surveillance analytics, the software in today’s cameras can use live and recorded video to classify objects and people via machine learning techniques. Operators can search by object type — for example, people, faces, cars, buses, trucks, motorcycles, bicycles — color, and traffic patterns to find an incident, as well as to understand the way a facility and campus is being used. 

This process includes detecting weapons in hopes of preventing active shooters and other violent events. Operators can use cameras for facial detection, which allows them to track a person of interest based on where his or her face was previously recorded by the system. 

Besides visual analytics, audio analytics are available to detect suspicious sounds, such as shattering glass, aggressive voices, gun shots and explosions. 

Analytics are great tools to mitigate risks, but they work best in conjunction with the entire staff diligently practicing the policies and procedures set forth by public safety and security teams. 

Analytics go beyond typical security applications and can be used for business intelligence purposes, including assessing wait and dwell times, people counting, queue monitoring and heat mapping, which is the process of assigning a color value to areas of a scene based on traffic density. 

For any camera system to perform optimally, lighting is crucial. Like the human eye, a security camera’s lens needs adequate light to clearly capture a scene. Higher camera resolutions require more light. As most healthcare facilities operate 24/7, adequate lighting must be in place campus-wide for visitors and staff to safely enter and leave the facility. Security cameras with infrared illumination are available to monitor areas with minimal to no visible light, such as parking lots and structures where unavoidable shadows occur. 

Another essential technology for any campus is an emergency phone system that is easily accessible and identifiable with signage and large lettering and is equipped with an illuminated strobe atop the unit. These systems are IP-based and can be an extension of a facility’s voice over IP (VoIP) phone system for easier deployment and management. Emergency phone units should be placed along pedestrian walking paths, at each level within parking garages and throughout surface parking lots.  They also should be illuminated by site lighting and monitored by surveillance cameras. 

Check in and registration  

The need to create a welcoming atmosphere for healthcare facilities continues indoors. Volunteers or uniformed security personnel manning reception areas should warmly greet patrons and direct them to the correct location, demonstrating the building’s safety and security. Uniformed security guards give the impression of increased security protocols, but that might not be sufficient in stopping a visitor with malicious intent from proceeding further into a building. 

In high-traffic environments, managers can establish physical barriers by securing entrance vestibules or deploying half-height optical turnstiles to deter intruders. This setup is typically seen in high-rise occupancies to restrict access to elevator lobbies, and it works well when combined with uniformed security personnel. If installing physical barriers is not an option, reception must provide visitors with legible badges that outline the purpose of the visit. 

Visitor management software is often deployed in high-rise facilities and is available to make the credentialing process more efficient by maintaining a record of each visitor that can be used to monitor an organization’s key performance indicators. These systems can be standalone or an extension of existing patient scheduling systems or access control — card reader — system. Patients and visitors can be quickly badged upon arrival with the proper authorization. 

Many visitor management systems are software as a service (SaaS), which provides additional flexibility because the application is hosted in the cloud. SaaS applications can easily be deployed among disparate departments and facilities, as well as remotely to patients and visitors. Pre-registered patients and visitors check-in on arrival using a QR code or other mobile credential distributed by the software application, further speeding up the visitor credentialing process. 

The convergence of IP-based physical security systems and new SaaS providers allows for central management and flexibility depending on the size, budget and operational needs of a facility. For some healthcare providers, traditional on-premises installed systems can be too costly. Off-premises cloud-based solutions that use a subscription model have lower startup costs and can be expanded as facility needs grow. They can be ideal for providers with limited IT infrastructure and in situations where security and public safety staff have limited bandwidth to maintain these systems. 

Separating public and private 

Beyond the reception and lobby, healthcare facility managers need to maintain separate physical access to public and private areas not only for infection control and privacy but also to maintain safety and security. This issue is crucial since departments with vastly different security needs are often located near each other, increasing the risk of unauthorized access. 

Access control systems are prevalent throughout acute care and non-acute care facilities to prevent unauthorized entry and maintain the separation between public and private areas. One worthwhile enhancement is to extend these systems to elevators or the elevators’ dispatch software. This tactic further secures elevators that are restricted to patient transport, staff access, deliveries, and visitors. 

Cameras should be installed outside access control areas to monitor ingress. Patrons can request entry by using a video intercom system to call the receiver, who can visually verify badging and confirm with the visitor or patient scheduling system. Security cameras should also be placed along public corridors to monitor typical traffic flow. Cameras in high asset storage areas such as pharmacies and pharmaceutical storage are also essential to prevent and detect suspicious behavior. 

A facility’s access control system can be extended beyond doors, and electronically controlled locking devices can be added to cabinets and closets that store controlled substances and high-value assets. If managers desire more security, wireless locksets equipped with card readers are also available to retrofit doors and other portals. 

Dual authentication methods that use biometrics are available as alternatives to personal identification numbers that can be exposed when using keypads. Biometric systems use a biologically unique identifier as the access credential that is converted to a digital format and processed by a reader designed for that digital format. Common biometric readers scrutinize fingerprints, handprints, irises and facial geometry. Biometrics can be used for hands-free access and in instances where staff cannot carry their typical access card. Mobile credentials are another proven option that managers can use in place of typical access cards. They have demonstrated success when granting access to temporary workers, students and contractors.  

Within treatment and diagnostic areas, managers should consider additional protections using real-time locating systems that can run over existing Wi-Fi. Known as asset tags, these systems are secured to people and objects to track them in real time throughout a designated area. Such devices are prevalent in labor and delivery areas where ankle monitors are placed on infants shortly after birth to ensure they remain in the units. 

Similar systems are deployed in memory care and behavioral health facilities to ensure residents remain within a secured boundary. Managers also can use this technology to track portable diagnostic equipment. Staff members also can wear or carry asset tags equipped with buttons that trigger a panic alarm when pressed. In emergencies, security personnel can view and locate issues in real time. 

While safety and security incidents might not be fully preventable, managers can adopt many strategies and technologies that will keep patients, guests and staff more secure within and around a healthcare facility.

Laura Freeny is a security consultant and technical manager at Henderson Engineers, a national building systems design firm.