Photo Credit: Martha Dominguez de Gouveia
Many ambulatory practice leaders don’t think much about the physical security of their site until something bad happens, until there’s a near-miss, or when they hear about a tragic incident in the news that hits home. At that point, it may be too late- staff now feels unsafe, they have lost trust in their leadership to be proactive about security, and knee-jerk security changes may seem like placating measures only.
So why wait until there’s a problem? Well, for many ambulatory sites, violence doesn’t occur at the same rate as it does on hospital campuses. When it does happen, it’s often verbal abuse, intimidation, and other, non-physical forms of violence, unlike in hospitals where escalation to physical violence is more common. But the psychological harm of verbal abuse, threats, and intimidation from patients, their family members, and co-workers should not be underestimated. I have seen the damage that this can inflict on staff as both a security director and as a consultant.
Clinical staff cannot render excellent patient care when they are in fear for their safety in their own office and your front office staff can’t provide great customer service when they’re afraid of who is going to come through the front door next. This erosion of the feeling of safety and security in the workplace can be detrimental to the practice as a whole- impacting patient care, staff morale, and turnover.
So what are three signs that you’re getting security wrong at your practice? Let’s take a look:
Your staff have little to no training in security and de-escalation. Empowering your staff through a de-escalation program tailored to the ambulatory/outpatient setting is one of the best, most cost effective ways to help staff feel safe at their workplace. Think about it- most ambulatory sites don’t have the luxury of security staff who can be called and quickly arrive to assist in escalating situations and the police are usually several minutes away. Staff are responsible for their own safety and they know it. Leaving them without the training and the skills to recognize when a situation requires de-escalation, avoid dangerous situations and when and how to get help is a recipe for disaster. A lack of time for training is no excuse. Practice administrators inevitably will find time for training when an incident has already occurred, but by then the psychological (and sometimes physical) damage from the incident has already been inflicted.
There’s no access control between the waiting area and the treatment area. I can’t tell you how many times I’ve seen the door from the waiting area to the treatment area left unlocked or propped open in ambulatory practices. It’s a common mistake that virtually eliminates the control that your staff have over who enters the treatment area of your practice. If Mr. Jones, your medication seeking patient comes in and wants to see his doctor right now, how are you going to stop him from finding her? And if Mrs. Smith wants to give your nurse a piece of her mind for the conversation they just had over the phone, how do you stop her from entering? The answer is that you can’t! Simply locking the door between your waiting room and the treatment area is an important step. However, you need to be sure that the locking method is easy to use and that staff are on board with it. If you require your staff to fumble with keys to get in the door every time or there’s no door closer to ensure it shuts after each entry, you’ll quickly end up with an open or unsecured door.
You don’t plan in advance for difficult patients. Every practice has difficult patients regardless of the quality of the care team and practice. Some patients are demanding, some are threatening or verbally abusive, others are unhappy with their treatment. In many cases, you’ll know when a difficult patient is coming, when you need to give some bad news to someone who might react poorly, or when you need to set limits with a patient. It’s important to trust your gut instincts and the instincts of your staff when it comes to these patients and plan ahead for their visit. Develop a plan A, plan B, and maybe even a plan C for various scenarios that may unfold with the patient. Designate who will do what and when. Don’t forget to inform all staff in the practice about the plan. For example, if your nurse standing outside the exam room of the difficult patient hears yelling and tells the front desk receptionist to call the police, the receptionist should know what the situation is and why they need to call already. Don’t wait for the you-know-what to hit the fan before making a plan on the fly. And don’t talk yourself out of what your gut is telling you about the potential risk that the patient poses.
There you have it- three signs you’re getting security wrong at your ambulatory practice and how to mitigate these issues. None of these issues are costly to implement- they just require a small financial and time investment and some ongoing planning and assessment. So, why wait?
