November 22, 2009
JCAHO: EC.02.01.01 - Does Your Security Program Meet the Spirit of EC Standards?
We all know there is a difference in complying with the “letter of the law” and the “spirit of the law.” The same rule can be applied to Joint Commission Safety & Security Standards. You will notice that the Joint Commission standards define expected outcomes, but they do not specifically explain how to get there, nor should they.
A couple of points are worth noting: JCAHO standards implicitly recognize that security is a situational discipline, which means that what works for one hospital may not work for another. Second, JCAHO Standards as applied to the hospital security program establishes the floor, but not the ceiling. This means that one cannot assume that by merely complying with JCAHO Standards one is meeting a “reasonable standard of care.” This assertion is supported by the fact that most hospitals that have been the object of security driven litigation, have complied fully with JCAHO EC Standards on their last survey and have still been held liable.
The implicit weight of the JACHO standards is considerable. Consider the weight of this simple statement: An effective security management should include proactive surveys, remediation, and training. The clear message is: “Anticipate and Prevent!” How these standards are applied will vary greatly from one hospital to another. The variance of compliance within these standards between a rural 30 bed hospital in Montana will differ greatly from an urban hospital in Los Angeles. There is certain wisdom in these standards in that they allow for situational variances. Universal remedies do not fit hospital security programs the way universal precautions fit hospital safety programs.
Although understandable, there seems to be a disproportionate emphasis on child abduction from the JCAHO point of view. If one considers the National Center for Missing & Exploited Children data, you will find abductions from hospitals are very rare, especially since the advent of electronic tag systems. The problem is, like terrorism, the hospital cannot afford to be wrong, even once. A missing baby will always make the major networks’ six o’clock news. Our litigation experience tells us that when infants are abducted the primary common denominator is staff inattentiveness. In other words, a hospital can be fully compliant with the prescribed EC standards and still be adjudged negligent for a breach in security.
JCAHO seems to advocate the best security programs require the full participation of all employees thereby ensuring they are part of the security solution. This is one of the fundamental components of any effective security program under any circumstances. Eliciting rank and file employee input during the assessment process is also vital. Those same employees may be speaking with a JCAHO surveyor. Therefore, to understand their perceptions before the fact is vital. Additionally employees who are consulted during the assessment process are much more likely to buy in on the resulting solutions.
Meeting these standards, while at the same time, meeting a reasonable standard of care requires due diligence. The foundational basis of due diligence is a comprehensive and objective security assessment. Before one considers the application of remedies such as visitor control, infant security, emergency department chaos, and criminal acts of violence, risks and threats must be not only identified, but they must be quantified. A proper assessment will also provide the path to cost efficient decision making. The assessment process will help each hospital to define the parameters of an appropriate reasonable standard of care.
Leave a comment