Even as hospitals scrutinize sales reps, they allow visitors to flow through their facilities unchecked, putting patients and staff at risk
By Bruce Stanley
With last year’s shooting at a Reno, Nev., hospital and many similar incidents, the question of safety arises at U.S. hospital facilities. We’re not talking about data security covered under HIPAA, but actual patient physical and clinical safety. Who monitors the visitors, and how should monitoring be addressed? There is no easy answer, no simple solution; but we in the healthcare industry need to elevate this dialogue.
Visitors number in the millions
In any given year, millions of visitors enter hospitals. It is difficult to find any metrics on visitor identification and frequency. Where are the process controls to minimize the chances of visitors bringing disease, or worse, weapons, into hospitals and clinics? One can travel around the world not in months or days, but in 24 hours. Diseases travel faster and without regard to borders. As such, new practices need to be developed and implemented.
Many of us believe that a patient recovers better and faster when surrounded by family and friends. Some patients may benefit, but at what risk to others? Often facilities leave monitoring of visitors to the floor supervisor’s discretion. Other times, patients appear to decide what’s appropriate and what’s not. Recently, in a major U.S. hospital, one of the patients in a shared room entertained a party of family members who brought in outside food, drinks and music. When the family member of the second patient in the shared room complained to the floor supervisor, he was told that he should call security to remove 14 people from a very small hospital room. This single example leads to the question, “Who monitors the monitors?”
Our industry has been struggling with the implementation of credentialing sales representatives. They undergo extensive background checks, submit immunization records, provide proof of full liability insurance, show testing competencies and prove they do not have certain diseases. Comparing the number of sales rep visits per facility per year to the number of visitors per facility, one might question who brings the greater risk. Some clinicians believe that hospitals are becoming more like hotels, because of loose implementation or lack of regulations. This should be a blinking red light and a critical clinical concern.
To be fair, credentialing of sales reps, while noble, hasn’t improved patients’ healthcare or reduced healthcare costs. Rigorous practices for visitors, on the other hand, can have a direct and significant impact on patients in facilities and overall cost to delivered healthcare. There are practical ways to control sales reps’ access while focusing attention on higher-risk visitors. The struggle is whether credentialing is driven by economics or by concern for the patient.
Current mindset
The biggest obstacle to implementing a visitation control program is the current mindset. Visitors feel they have a right to do what they believe is best – whether it’s bringing in dozens of family members for a Friday night “hospital get-together” or providing the patient with “forbidden” comfort foods. The general population must be convinced that the risk, if not managed, is high, not only for other patients in the area, but for their loved ones as well.
Policies currently in place need to be enforced, monitored and analyzed. Stricter guidelines on the number of visitors per patient, hand washing, and types of food allowed into a hospital must be better managed. Many visitors come to the hospital without thinking about hygiene or the nasty cough they just can’t seem to shake. The first step is to manage at the door, as we do at some international airports, where the risk to the population is great.
Documenting hospital visitors could be tracked by scanning any legal ID and using existing third-party technology. Some would say this is overkill. I argue it’s imperative in order to maintain privacy, security and control of our facilities. We can’t buy certain OTC medications without proof of ID; why not apply similar rules for controlling the recovery environment of those patients most at risk? Left unattended, this is our largest unmitigated risk today.
Liability premiums could be partially based on visitor policies and provable metrics. This requirement should be enforced by the credentialing agencies. This could be the final chapter in access and credentialing, and most likely the most important and impactful for the care of our potentially compromised patients.
Bruce Stanley is a supply chain and contracting operations consultant with more than 30 years in the healthcare industry, and an adjunct professor at Endicott College’s MBA program, teaching global supply chain, contracting and healthcare informatics and regulations. He served as senior director, contracting operations, for Becton Dickinson. He is a former chairman of the AdvaMed working group focused on vendor access-credentialing, and has collaborated with MassMedic and AdvaMed on legislative initiatives related to this topic. In 2011, he co-founded The Stanley East Consulting Group, in Ipswich, Mass., a global consulting practice specializing in supply chain, contracting, order fulfillment and project management for small and medium-sized companies, startups, and companies in transition or divestiture.
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