Managing Today’s High-Threat Environment in Rural and Urban Healthcare Communities – A sneak preview to IAHSS 2024 Annual Conference Session

Michael Ramstack, System Senior Director of Physical Security and Emergency Management at Essentia Health; Clete Bordeaux, Director of Healthcare Business Development at HID; and Patrick E. Riley, Industry Principal Consultant for Frost & Sullivan, discuss the role of visitor management in overall security strategies.

The security of healthcare facilities isn't just another news headline; it's a narrative that has touched my life personally, and I'm compelled to share it with you. My name is Patrick Riley. I'm the industry principal consultant for Frost and Sullivan for Healthcare and Life Sciences, and joined by experts Clete Bordeaux and Michael Ramstack, we dissect the evolving terrain of hospital visitor management, from bustling urban centers to the quiet corridors of rural healthcare. Our dialogue transcends mere buzzwords, focusing on real stories and strategies that forge safer spaces for patients and staff alike.

Our conversation embarks on the challenging journey of balancing the welcoming nature of hospitals with the need for protective vigilance. We reveal how data and technology, from visitor management systems to smart cameras, play a pivotal role in crafting a secure environment without compromising the warmth of patient care. The nuances of integrating these systems are examined, alongside the role of trained security personnel who remain the heartbeat of a safe healthcare experience.

As we gear up for the International Association for Healthcare Safety and Security conference, we underscore the importance of sharing best practices and tailoring security measures to the unique pulse of each facility. The narrative of healthcare safety isn't one-size-fits-all, and our in-depth discussion lays the groundwork for what promises to be an enlightening continuation of this critical conversation in the industry. Join us as we navigate the complex yet crucial world of healthcare visitor management with a lens sharpened by experience and compassion.

Transcript

Speaker 1 Host00:06

Powering trusted identities of the world's people, places and things. Every day, millions of people in more than 100 countries use our products and services to securely access physical and digital places. Over 2 billion things that need to be identified, verified and tracked are connected through HID Global's technology. 

Speaker 2 Host00:29

Good morning everyone. My name is Patrick Riley. I'm the industry principal consultant for Frost and Sullivan for Healthcare and Life Sciences. My background is hospital administration. I've been a CEO of both a large urban academic medical center and a rural hospital, so this subject is very, very close to me. Even closer, a month ago in Concord, New Hampshire, where I was born and raised, in the State Hospital where my mother-in-law actually worked, a disgruntled patient came back in and murdered two people, totally unprepared for, in a very, very rural setting. So this is not something of a future threat, this is something we're living with every day and it's very, very, very important for me to moderate this, to learn, and it really serves as a precursor for the conference that HID and Essentially Health will be presenting at the International Association for Healthcare Safety and Security, which will be April 29th through May 1st in the Lowe's Royal Pacific Resort at Universal Orlando, and we will mention more about that at the end. 

01:43

Just let me introduce we're very, very fortunate to have two very, very qualified and prominent participants in this podcast. The first gentleman that will introduce is Clete Bordeaux. Clete is a former US Marine. Thank you for your service, Clete. Just so you know, I'm a former Airborne Ranger Army, he has over 20 years of experience as a subject matter expert in healthcare and security industry. In his current role, he serves as Healthcare Business Development Director for HID Global's Workforce Identity Management Business Unit. Clete's focus is on the healthcare industry as it relates to enhancing the security of patients, employees, contractors and visitors, as well as facilities and physical assets. So, Clete, thank you for joining us. 

02:29

Our subject matter expert today and we're very, very fortunate to have him with us is Michael Ramstack. Michael is the Senior Director of System Security for Essential Health. Michael also has 25 years of law enforcement and private sector security leadership, experiencing ratings from global, national, regional and local. He holds many degrees bachelor's and master's in criminal justice and including pharmaceutical utilities, where he's worked and manufacturing, and most recently holding the position of Senior Director, as I mentioned, of Essential Health. So, gentlemen, it's a pleasure to be with you this morning. I'd like to kick it off by you know, as we talk about visitor management and how it's evolved and how its need has never been greater, I'm wondering, Clete about is there a difference between visitor management in a large urban facility versus a community hospital? Unless, you know, we have over 5,000 community hospitals in the US. So, Clete, what's the difference? Is there a difference? And if you're in a rural hospital, should you be doing something different than you are in an urban hospital, please, sir. 

Speaker 3 Host03:48

Thank you. Thank you, pat. There is absolutely something to be done in every healthcare facility. That's my standpoint. Something should be done to forward healthcare security, primarily for the protection of staff and then, of course, patients at every healthcare facility in America, beginning there. 

04:07

But as to the actual differences, that's one of the reasons why we have a good friend, mike, here. So I'm aware that things happen differently from the vendor side. Mike's actually boots on the ground. So one of the reasons I chose Mike is because Mike has the urban experience, not just urban but urban trauma level one trauma center. That's a whole different ball game, whole different ball game as far as violence, the patient population, the payer mix, like all that stuff is different. But then now Mike also has rural experience. And another reason I grabbed Mike is now that he has rural experience. It was kind of rural and then now it's going super-duper like almost Canada rural, and then Mike still found the need to do something more with healthcare security. So I'm anxious to hear what did you find, you know, when you're getting way out there, what did you see that still made you peek up and say I should do something, especially coming from urban level one trauma, and if we don't have them with us today but we'll have them with us in April. 

05:20

Another friend is Craig. Craig came from urban Craig Crosby, I'm sorry. He came from a urban environment, southwestern. He did it for decades and then now he is urban slash rural Texas. So I'm going to be very interested in April, like you said at IAHSS, to hear what Craig has to say, like what is he seeing now? And he's going to actually see them within the same healthcare system. He's going to have to administer certain visitation policies right in the heart of Dallas and then way out there somewhere in Texas. So very, very interesting. That's why I chose Mike. So you know I got two cents, but I'm sure Mike has four cents as to what he sees coming out of level one trauma versus moving around a little bit to a little bit more rural area. Go ahead. 

Speaker 4 Host06:13

Mike. Yeah, thanks Clete and Pat for having me here today. I think you know the biggest thing I see as a difference. I'm coming from. You know the urban environment and now you know majority of our facilities are 13 hospitals, are critical care, urban or, excuse me, rural areas, and you know there's a lot of challenges we face. You know small towns care we still have, you know this perception of things are safe and we don't have problems. 

06:47

I think you know one of the educations we've been doing as an organization is around. You know, no matter where the facility is located, an ED is still going to get the same type of patients coming in, right, and it's not going to be the same volume. We all understand that, but you're still going to have the same type of patients and the challenges and things that we currently face is lack of, you know, behavioral health resources for people, so it's the mental health of you know the environments that were, that were challenged with them. That's everywhere currently, right now. I think the other thing you know. So it's you know, as I mentioned, it's the culture part of it. It's also the facility design part, right, I mean, in these environments we design these facilities differently. We have a little bit more of that open, you know, type feeling as healthcare historically has. 

07:38

But we still see that challenge when we're working with different groups. So how do we bring that all together from a visitor management perspective has been the challenge. And you know, our biggest challenge we have in these areas is really resources. Even, let's say we have a smaller hospital, we want to have security there. Doing visitor management, it's hard, it's a struggle for us to find those qualified people just to staff that Take that away. Let's say the facility is not doing that. You got, you know, either a registration or some type of customer service person that would be in place. Again, challenge on resources how do we get, get the right people and put you know with the right skills to put into those particular roles and positions? 

08:20

So I really think you know just kind of something. I mean I think it's it's resources, culture and part of culture's facility design are really our biggest challenges that I've seen as we try to, you know, move this forward. I think it's a little easier when you're in a urban environment or a bigger hospital setting. I think it's a little bit more people have a better understanding. But you know, let's we have to be realistic about things and conversations I have. If you look at events that have happened across this country, they don't happen, you know. I mean they happen, but they're not happening just in the big cities, and that's people's yes, and that's people's thought process. It's really, you know. And why are we seeing it more in smaller rural areas? Right, well, there's less resources there to support. 

Speaker 3Host09:07

So I mean, if I'm going to do something, that's okay. Mike, you said something that I had actually never considered. But I'm thinking, I'm going to say Chicago. I'm going to think, I'm going to assume that there's more behavioral health resources via outlets, funding etc. There's just more available help. I'm going to think in Chicago, then there is in downstate Centralia, illinois, in the middle of nowhere. So that doesn't mean those problems aren't down there. That doesn't mean there's people that need that kind of care down there. I'm just going to assume and I think you said it, mike the resources are not the same. You know, somebody in Minneapolis does not have the same resources for behavioral health as somebody in smack in the middle of Wyoming, but that person still has to go somewhere for care. He still has to. He or she still is going to wind up in someone's healthcare facility. 

10:03

Mike, was it you or it may have been someone else? But Mike mentioned culture. It's not going to happen in downtown Chicago. I'm in the suburbs of Chicago, so I use it as a continuous example. But because of where they are, like Mike said culture and I don't remember if this was Mike's story but because of where some of these places are located, it's nothing pat for you to come in there with, like you know, like a two foot machete, because that's where you work, it's what you do for work. It's it has to do with your lifestyle. That's the culture of that place. That's still a place of care with this incredible weapon Should you choose to not want to do the right thing. So I don't remember if that was my story, if it was somebody else, but that's a real story of her, from a security director that you know because of where they are. It's nothing for people to come in the door with huge weapons. 

Speaker 2Host10:52

Absolutely Well for my experience as a rural hospital CEO. Daily census nine. Okay, klee, in that rural setting we would have meetings where we would be alerted by our security, but not of a mega threat. But Bob Johnson came in the other day because the school reported that his daughter appeared to have been abused. She had bruises on her back. Well, bob knows who the nurses are and the ER and the doctors are, so he has a personal vendetta because he's been reported to be a potential domestic violence perpetrator. So it gets very personal on the rules. So we would be asking questions. Okay, watch out for Bob. If he shows up, be very careful. So, if I were to invite you to speak to my board, Michael, and you mentioned resources, what kid steps could I see you on our board immediately doing a rule setting to better position ourselves to the threat that Klee described? Please? 

Speaker 4 Host12:02

Yeah, really great question, Pat. I mean, I think you know that's a unique question. I'm certainly based on environment and those kinds of things, but one thing I'm always a proponent of is we always have to be careful of perception. And then what are the facts? And what does our data, you know, demonstrate to us and represent to us? And I think traded data is what we use. You know our use, I mean, you know, to drive changes and what we need to put in place to keep people safe. Right, Because sometimes we may have a incident, you know, and maybe it's minor, but others, because they don't have much, it seems to be a big thing, right? And I think, when we talk about these things, a big key component in regard to managing our facilities and what do we need to put in place and what that reality is is, I think, this greatly integrates with, you know, threat management, right, Do you? 

12:55

have a program to analyze and look at what's happening to be able to, you know, be educated enough to come back and talk to your employees about the why behind. What strategies are we putting in place and what strategies are we not? You know it's tough, I mean it's. You know, as you mentioned, you know about the census right being nine, I mean we have. You know, eds and locations where you know, after hours we have two people in the hospital. 

Speaker 3 Host13:26

And it may not be security. 

Speaker 4 Host13:28

And then when we talk about resources, if they have a problem, they're so rural, maybe law enforcement is an hour away and we know the shortage of law enforcement in this country is, you know, becoming even more of a concern. 

13:40

So what we have to be conscious of as organizations is how are we still providing that safe environment, right? So the question to you know, if I were to come to your board and have that conversation, that's where you know I would lead the conversation how are we, which we are required to do as organizations, providing safe environments for our employees? Now, that's not going to be the same at every facility. I mean we got to be realistic, right. I mean, there's things that you know we all have to do as a business, and cost is certainly one of them. 

14:10

But one of my big things, and where I really like visitor management, especially a system that has the capabilities to, you know, be spread across the system, not just localized to a desk is we can share information right Across the enterprise. 

14:28

Because, let's be it was the other thing we have to really think about, right, we're a mobile environment, people can go anywhere and people do go anywhere, and you know so. To have that ability, to have that type of control and that type of communication is key, right? It's like using, if you have an electronic record system and you're using flags or those different types of things for potential issues and concerns with you know, certain patients. It's that same type of communication but from the visitor management standpoint, you know of having that. You know right at that entry point, right, let's understand that before they're introduced into the environment and now potentially causing a problem. So I think that's where I would kind of lead and go with the conversation about you know, those different types of topics. We're trying to understand what do we do in these environments and I believe in we're working on a lot of initiatives right now in leveraging technology because we understand we got to make a shift right. 

15:27

We we personnel isn't going to be the answer everywhere, but we can support and we can provide a safe place through technology as well, and so those are some of the things that we're looking at because really it makes more sense for us, and so these are all key. You know a little components of that, right. I mean visitor management, a technology solution, as well as other things that we're doing. So that's, I guess you know, pat, I'd respond to that. 

Speaker 3 Host15:59

I'm sorry, Pat, I was gonna key in on that one. When he says, you know, when he says visitor management is one side of it and, to be clear, it is absolutely a multi pronged approach. Yes, what Mike has done and what I've seen I mean I tour the facility just a couple weeks ago and it was the same setup I've seen it over and over again that people that are choosing to put visitor management in their ED a lot of times it comes after weapons detection. These are also facilities that are going to put a premium on having some form of uniformed officer. These are also facilities that are either doing or giving a hard look at having some form of staff arrest, like it's and of course there's smart cameras, mass notification, like it really takes a multi pronged approach. 

16:45

There is not a silver bullet for this. It's a multi pronged approach and I see it go hand in hand. So, like Mike said, it's technology, but um, technology and it has to be partnered with people. Somebody has to run that visitor management system. Somebody has to respond to the duress when I hit that button. Absolutely a multi-pronged approach. And then he did it, but he didn't say it. But when you say what, would he talk to the board about. I think what the board would love to hear is something that Mike has actually done before, and that is show H-CAP right, h-cap scores, isn't it Mike? 

17:24

Show the increase in H-CAP scores, I think based on pilot programs, sometimes based on actual deploy programs, and I think that's what somebody like you, pat, in your former position, you'd like to hear, not just the emotional Mike saying, hey, we should use this, but actual data to move the needle, before and after pilot surveys, h-cap scores, et cetera. 

Speaker 2 Host17:45

Well, exactly, the H-CAP scores is, as you know, michael, our patient experience right Very, very important in how payers review you and how the incentives you can gain. So I look at this as a CEO and I say, okay, I've got security right, I've got patient experience people In a rural hospital. Michael, are you recommending that I should create a position for director of visitor management who would be in the, would coordinate, as Cleek just correctly articulated security, patient experience and visitor management. Is that something that appeals to you intellectually, or how would you organize those three elements of hospital to be in? 

Speaker 4 Host18:28

Yeah, pat, I think that's you know. Again, another good question, and that's, I think, the challenge that we continually face. I'm not suggesting, because to me, you know, it would not be practical when we talk about resources, to say, hey, you know, we're gonna put a specific person responsible at a dedicated location. 

18:48

Exactly exactly To me. That's that system approach to security, right? That's that system security operations center and that physical security person that's helping support that. Now, what my recommendation is how do we look at those responsibilities about something that we're going to implement and who's the appropriate right People that we currently have to manage that particular part of it, right? And so that's how we kind of been going about it and we'll talk more in person at the conference about this, but it's you know what are some of the you know Key solutions are different things we're looking at and it we're certainly, you know, I I never sit here and say I have all the answers, because I don't, and I really love reaching out and talking to counterparts and seeing what everybody's really doing because and learning and understanding about these Different challenges that we all have, because they're all the same, everybody talked to his face in the same thing. 

19:48

But how do we, you know, collectively, right, I mean a lot of smart people. I mean, how do we collectively talk about this stuff as an industry and really come up with? You know, here's some things we tried. Maybe didn't work so great. Here's some things that we tried. 

20:01

That worked well and so, yeah, to answer your question, pat, I wouldn't suggest you know you have it as a dedicated. It would be a responsibility of someone that we currently have. And how do we Integrate that in? Because the last thing we want to do also is put a person who has no experience in, let's say, de-escalation training In the forefront and now deal with somebody who's upset that they have to go through the process right. So we have to identify those key things that we would need to either a bring somebody up to part two or B Put the right person with that already has those skills and abilities available. No, you get it out. 

Speaker 3 Host20:40

I was. I was gonna wrap this up with with Keenan on one of the things that Mike just said about talking to his colleagues. But go ahead, pat. 

Speaker 2 Host20:46

Yeah, I would ask both of you and you touched on it, michael. Both of you have seen so much. Is there a best practices that you think of? Oh, I know this one hospital that did this and it just it's working phenomenally well. I see that as a best practice, michael. Do, have you experienced someone who's really figured this out in a rural setting, and what is that best practice? Let's just click with you what's your best practice, that that you think it will come? 

Speaker 3 Host21:18

Hmm, I don't think that it is one size fits all. Like I said, there's not a magic. 

21:24

No, if I say if there's a best practice, I would probably say, to begin with, a very knowledgeable consultant or a knowledgeable driver in that seat you know a mic as an example bringing to your organization someone that realizes it's going to take several things to get done and also that realizes no two hospitals are the same, even within a healthcare system. So I wouldn't tell you there's a best practice. Even with visitor management, which you know, I know well I wouldn't tell you there's a best practice. What works in the downtown Chicago does not work in Peoria Illinois. I saw it first hand. You can't ask any questions during COVID. We couldn't ask that stuff in Peoria Illinois. It's asked all day in downtown Chicago. So the understanding of how flexible you must be in healthcare and the knowledge that it's a multifaceted approach, that's probably the best practice, before I would mention any technology or anything like that to have someone very knowledgeable about it. 

Speaker 2 Host22:26

Yes, michael your thoughts, please. 

Speaker 4 Host22:29

Yeah, no, I think. Have I found the perfect or seen the perfect solution? I would say no, I think, in the reason behind that is this is the tricky part that we're dealing with, right as an industry right now is how do we provide this in these rural environments? And unfortunately, you know, we're still a little bit behind, right as healthcare, in thinking that we have, you know, issue, despite all the things we see happening and all these things out there. I mean, the security world understands and knows right, but I'm talking about how do we, how do we get that message? You know, all the way up to the past of the world? 

Speaker 3 Host23:07

How do we get the facts of? 

Speaker 4 Host23:09

the world To understand what's the need, right? I mean, let's be honest, we can't sit here and guarantee that we can prevent everything from happening. Right? All these strategies and solutions are to reduce the likelihood of something bad happening, and the more that we put in place, the more we reduce that likelihood. And now, when I say put things in place, they don't. 

23:32

You know there's a lot of places, especially these small environments, and you know I've had some really good conversations with some counterparts over the last year. 

23:40

You know, kind of around this topic and those that are, you know, having the same challenges is, you know, it doesn't have to be necessarily a big, elaborate thing either to to to have an impact. It's. It's starting small. And you know Clete mentioned it and what I've done where I previously came from, at Freighter and now here where I'm at Ascension, as I really believe in piloting, piloting things, creating data and having information that we can go back to the paths of the world and have those conversations intelligently. Too many times in our world around security, where we have emotional reaction, that's people who experience things, but then that's also the people that you know are driving some decisions and we. That's the last thing we want to do, because emotional decisions aren't really getting us to the root cause of what we need to address and what is the proper solution for us to put in place, albeit smaller, big right, I mean anything we do makes a difference. 

24:42

So that's really kind of how I think about those those types of things. 

Speaker 2 Host24:45

Well, thank you for that, because I was thinking you know, Clete, you hit on it. You need to hire a consultant. You can't buy a software package off the shelf that's going to fix everything and visit a manager for your hospital. That's not going to happen. You're right, it's a unique hospital. Everyone is different from the other ones and you have to understand the personnel, the people, the community that you're in, the security that you're in and put all that together. So I know it's going to be talked much, much more about that in Orlando and that's a great thing. But the takeaway for me that I would tell my C-suite colleagues and hospital illustrations you need to get somebody on the ground in your hospital that's going to walk the ramps at two o'clock in the morning on your med surge wards in the ER. Understand egress of your facility. Look at your security system what the weaknesses, strengths are. Look at your community and then put it all together with your electronic medical record. You need somebody who really knows what they're doing to do that. 

Speaker 4 Host25:47

Yeah, I'd add on to that, pat. I think what's really important is is we in the security industry I mentioned it earlier about culture. We really got to understand that culture. We have to understand the things that we do have an impact on our operations and some of the way we're set up as an operation is a strategic model right to be competitive, and the last thing we want to do is how do we come in and provide that benefit of reducing those likelihoods while still maintaining what that strategy of the organization is? 

26:22

And that's not the easiest thing all the time, but it's possible. It's possible and, to your point somewhat, you have to get in there, you have to understand it. You're not going to be able to come up with a solution unless somebody really is looking at the totality of everything that's happening at a location or a site to understand what is the perfect or appropriate solution for that place. Because, again, it's not going to be cookie cutter, because even internally in our own organizations we have very different facilities, you know, set up differently based on region and area and state, you know type stuff. 

Speaker 3 Host26:54

So this has me. This has me pumped for IHSS. So we are. In conclusion, it'll be more of myself moderating for Mike, but I think it'll be interesting, like for us to be able to bounce your Midwest experience off Craigs West Southwest experience. He may have totally different concerns, so I look forward to talking to you guys in Orlando. We will be down there April 29 to May 1 in 2024. Of course, thank you again, Mike; always a pleasure to talk to you, and Pat, thanks for setting this up for us. 

Speaker 2 Host27:34

My pleasure. Gentlemen, I wish you all the best, good holidays and simplify to you Cleveland. Thank you, sir. 

Speaker 4 Host27:40

Yes, thank you, gentlemen.