York CPP / MacAlister Hospital and Healthcare Security

6. Auflage 2015
ISBN: 978-0-12-420062-3
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 750 Seiten

Building on the foundation of the previous five editions, Hospital and Healthcare Security, 6th Edition includes new and updated chapters to reflect the current state of healthcare security, particularly in data security and patient privacy, patient-generated violence, and emergency preparedness and management. The recognized leading text in the healthcare security industry, Hospital and Healthcare Security, 6th Edition explains the basics as well as higher expertise concerns, such as the roles of design, emergency management, and policy. Conveying a wide spectrum of topics in an easy to comprehend format, Hospital and Healthcare Security, 6th Edition provides a fresh perspective for healthcare security professionals to better prepare for security issue before they occur. - Offers a quick-start section for hospital administrators who need an overview of security issues and best practices - Includes a sample request for proposals (RFP) for healthcare security services and incident report classifications - General principles clearly laid out so readers can apply internationally recognized industry standards most appropriate to their own environment - The new edition includes materials that address the latest issues of concern to healthcare security professionals, including security design, emergency management, off-campus programs and services, and best practices in mitigating patient-generated violence

Tony W. York, CHPA, CPP is an influential leader in the healthcare security field with over 30 years of healthcare security executive experience. He is a past president of IAHSS ('07-'08) and a long-standing leader of the Council on Guidelines. He is also a founding member and contributing author to the Security Design Guidelines for Healthcare Facilities. He has won numerous awards for his contributions to the advancement of healthcare security. He is board-certified in security management with Certified Protection Professional designation and Distinguished Certified Healthcare Protection Administrator. He holds an Executive MBA from the University of Denver, M.S. in Loss Prevention and Safety from Eastern Kentucky University, and a B.S. degree in Criminal Justice from Appalachian State University. He is currently Executive Vice President - Healthcare for the Paladin Security Group and the founder and principal consultant for FlyBox, LLC, a safeness consultancy.

Autoren/Hrsg.

York CPP, Chpa

Macalister, Don

Inhaltsverzeichnis

1;Front Cover;1
2;Hospital and Healthcare Security;4
3;Copyright;5
4;Contents;6
5;About the Authors;22
6;Foreword;24
7;Acknowledgements;26
8;Special Acknowledgement of Russell Colling;28
9;CHAPTER 1 - THE HEALTHCARE ENVIRONMENT;30
9.1;CATEGORIES OF HEALTHCARE;31
9.2;TYPES OF HOSPITALS;32
9.3;NONHOSPITAL SIDE OF HEALTHCARE;33
9.4;DIVERSE STAKEHOLDERS;34
9.5;STAFFING THE MEDICAL CARE FACILITY;34
9.6;THE HEALTHCARE SECURITY ADMINISTRATOR;36
9.7;THE JOINT COMMISSION;36
9.8;THE ENVIRONMENT OF CARE COMMITTEE;39
9.9;THE CENTERS FOR MEDICARE AND MEDICAID SERVICES;44
9.10;HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT;45
9.11;REFERENCES;47
10;CHAPTER 2 - PROTECTING A HEALING ENVIRONMENT;50
10.1;DEFINING HEALTHCARE SECURITY;50
10.2;BASIC RATIONALE OF HEALTHCARE SECURITY;51
10.3;EVOLUTION OF HEALTHCARE SECURITY;52
10.4;SECURITY, RISK MANAGEMENT, SAFETY;55
10.5;DEVELOPING THE SECURITY SYSTEM;57
10.6;PSYCHOLOGICAL DETERRENTS;58
10.7;BASIC SECURITY PROGRAM OBJECTIVES;60
10.8;EXTERNAL FORCES;62
10.9;BODY OF KNOWLEDGE;73
10.10;REFERENCES;76
11;CHAPTER 3 - HEALTHCARE SECURITY RISKS AND VULNERABILITIES;78
11.1;BASIC HEALTHCARE SECURITY RISKS/VULNERABILITIES;79
11.2;PRIMARY SECURITY RISKS;79
11.3;FACILITY SECURITY RISK ASSESSMENT;96
11.4;REFERENCES;105
12;CHAPTER 4 - SECURITY MANAGEMENT PLANNING;108
12.1;SECURITY MANAGEMENT PLAN;108
12.2;SECURITY STRATEGIC PLAN;122
12.3;REFERENCES;129
13;CHAPTER 5 - MANAGING THE BASIC ELEMENTS OF HEALTHCARE SECURITY;130
13.1;CUSTOMER SERVICE;133
13.2;MAINTAINING AN ORDERLY ENVIRONMENT;134
13.3;PREVENTATIVE PATROL;135
13.4;INCIDENT REPORTING AND INVESTIGATION;135
13.5;RESPONSE TO REQUESTS FOR SERVICE;138
13.6;SECURITY COMMUNICATIONS;141
13.7;PARKING AND TRAFFIC CONTROL;142
13.8;ACCIDENT REPORTING AND INVESTIGATION;143
13.9;SECURITY EDUCATION AND TRAINING;143
13.10;APPLICANT BACKGROUND INVESTIGATION;144
13.11;REACTION TO INTERNAL AND EXTERNAL EMERGENCIES;144
13.12;ENFORCEMENT OF RULES AND REGULATIONS;145
13.13;ACCESS CONTROL;145
13.14;LIAISON WITH LAW ENFORCEMENT AND OTHER GOVERNMENT AGENCIES;146
13.15;INTERNAL AND EXTERNAL AUDITS;149
13.16;LOCKS AND KEYS;150
13.17;OTHER SUPPORT SERVICES;150
13.18;PUBLIC/EMPLOYEE/COMMUNITY RELATIONS;156
13.19;REFERENCES;156
14;CHAPTER 6 - SECURITY DEPARTMENT ORGANIZATION AND STAFFING;158
14.1;SECURITY FUNCTION REPORTING LEVEL AND SUPPORT;158
14.2;SYSTEMS (MULTIFACILITY) SECURITY MANAGEMENT CONTROL;162
14.3;TYPES OF SECURITY STAFF;163
14.4;REFERENCES;181
15;CHAPTER 7 - LEADERSHIP AND PROFESSIONAL DEVELOPMENT;182
15.1;DEFINING LEADERSHIP;182
15.2;LEADERSHIP COMPETENCIES;183
15.3;THE SECURITY LEADERSHIP ROLE;183
15.4;LEADERSHIP DEVELOPMENT;187
15.5;THE HEALTHCARE SECURITY SUPERVISOR;192
15.6;MOTIVATION;197
15.7;PERFORMANCE MANAGEMENT;197
15.8;REFERENCES;200
16;CHAPTER 8 - THE HEALTHCARE SECURITY OFFICER;202
16.1;THE SECURITY OFFICER;202
16.2;SELECTING SECURITY PERSONNEL;205
16.3;FULL-TIME VERSUS PART-TIME SECURITY OFFICERS;213
16.4;WAGE COMPENSATION;214
16.5;RETENTION;215
16.6;PERFORMANCE EXPECTATIONS;216
16.7;REFERENCES;221
17;CHAPTER 9 - THE SECURITY UNIFORM AND DEFENSIVE EQUIPMENT;222
17.1;UNIFORMS;222
17.2;USE OF FIREARMS;229
17.3;OTHER SECURITY AND DEFENSIVE EQUIPMENT CONSIDERATIONS;238
17.4;USE OF FORCE;249
17.5;TRAINING;251
17.6;SECURITY OPERATIONS MANUAL;251
17.7;REFERENCES;252
18;CHAPTER 10 - TRAINING AND DEVELOPMENT;254
18.1;TRAINING CONCEPTS;255
18.2;NEW SECURITY OFFICER TRAINING;258
18.3;IAHSS PROGRESSIVE CERTIFICATION PROGRAM;274
18.4;IAHSS BASIC SECURITY OFFICER TRAINING;274
18.5;IAHSS SUPERVISORY TRAINING;277
18.6;SPECIALIZED OR SUPPLEMENTAL TRAINING;278
18.7;ELECTIVE TRAINING;283
18.8;TRAINING RESOURCES AND RECORDS REQUIREMENTS;283
18.9;REFERENCES;287
19;CHAPTER 11 - DEPLOYMENT AND PATROL ACTIVITIES;290
19.1;DEPLOYMENT OBJECTIVES;291
19.2;FLEXING THE SECURITY STAFFING PLAN;293
19.3;SCHEDULING THE SECURITY STAFF;293
19.4;DEPLOYMENT PATTERNS AND CONCEPTS;294
19.5;POST ASSIGNMENTS;295
19.6;BASIC PATROL DEPLOYMENT PLANS;296
19.7;PATIENT CARE UNITS/AREAS;300
19.8;ENTRANCES AND EXITS;300
19.9;BASIC PATROL CONCEPTS;301
19.10;SECURITY OFFICER RESPONSE;315
19.11;PATROL PROBLEMS;316
19.12;REFERENCES;317
20;CHAPTER 12 - PROGRAM DOCUMENTATION AND PERFORMANCE MEASURES;318
20.1;PURPOSE OF RECORDS;319
20.2;BASIC RECORDS;324
20.3;KEY PERFORMANCE INDICATORS;337
20.4;REFERENCES;342
21;CHAPTER 13 - PATIENT CARE INVOLVEMENT AND INTERVENTION;344
21.1;PATIENTS;344
21.2;ASSISTING WITH PATIENTS;347
21.3;PATIENT RISK GROUPS;359
21.4;PATIENT PROPERTY;380
21.5;VISITORS;382
21.6;REFERENCES;385
22;CHAPTER 14 - HUMAN RESOURCES AND STAFF RESPONSIBILITIES;388
22.1;HEALTHCARE EMPLOYEE SELECTION;388
22.2;STAFF IDENTIFICATION BADGES;394
22.3;SECURITY-ORIENTED EMPLOYMENT GUIDELINES;397
22.4;REFERENCES;407
23;CHAPTER 15 - EMPLOYEE INVOLVEMENT AND SECURITY AWARENESS;408
23.1;EMPLOYEE SECURITY EDUCATION AND MOTIVATION;408
23.2;HOSPITAL WATCH;421
23.3;REFERENCES;422
24;CHAPTER 16 - INVESTIGATIVE ACTIVITY;424
24.1;SECURITY VERSUS POLICE INVESTIGATION;425
24.2;TYPES OF INVESTIGATION;426
24.3;INVESTIGATOR ATTRIBUTES;432
24.4;INTERVIEWING AND INTERROGATION;433
24.5;UNDERCOVER (COVERT) INVESTIGATIONS;433
24.6;REFERENCES;435
25;CHAPTER 17 - SECURITY DESIGN CONSIDERATIONS FOR HEALTHCARE;438
25.1;SECURITY MASTER PLAN;439
25.2;IAHSS SECURITY DESIGN GUIDELINES;441
25.3;SECURITY DESIGN CONSIDERATIONS;443
25.4;CRIME PREVENTION THROUGH ENVIRONMENTAL DESIGN (CPTED);446
25.5;EMERGENCY MANAGEMENT DESIGN;461
25.6;REFERENCES;465
26;CHAPTER 18 - PHYSICAL SECURITY SAFEGUARDS;466
26.1;BASICS OF PHYSICAL SECURITY;466
26.2;BARRIERS;468
26.3;BOLLARDS;471
26.4;LIGHTING;472
26.5;TREES AND SHRUBS;474
26.6;LOCKS AND KEYS;474
26.7;SECURITY SEALS;479
26.8;GLAZING (GLASS);480
26.9;FASTENING DOWN EQUIPMENT;481
26.10;MARKING PROPERTY;481
26.11;SAFES;482
26.12;SIGNAGE;483
26.13;REFERENCES;486
27;CHAPTER 19 - ELECTRONIC SECURITY SYSTEM INTEGRATION;488
27.1;THE SECURITY OPERATIONS CENTER;491
27.2;ALARMS;493
27.3;ACCESS CONTROL;497
27.4;VIDEO SURVEILLANCE;505
27.5;OTHER SECURITY TECHNOLOGY APPLICATIONS IN HEALTHCARE;519
27.6;TESTING AND MAINTAINING SECURITY SYSTEM COMPONENTS;530
27.7;SECURITY TECHNOLOGY IMPLEMENTATION TIPS;530
27.8;REFERENCES;531
28;CHAPTER 20 - PREVENTING AND MANAGING HEALTHCARE AGGRESSION AND VIOLENCE;534
28.1;THE WHO (PERPETRATORS/VISITORS);539
28.2;THE WHAT AND THE WHY;543
28.3;THE WHEN AND THE WHERE;544
28.4;THE MANAGEMENT OF HEALTHCARE VIOLENCE;545
28.5;PREVENTING VIOLENCE IN THE WORKPLACE;548
28.6;CULTURE OF TOLERANCE;553
28.7;REFERENCES;554
29;CHAPTER 21 - AREAS OF HIGHER RISK;556
29.1;SECURITY SENSITIVE AREAS;556
29.2;INFANT ABDUCTIONS FROM HEALTHCARE FACILITIES;558
29.3;THE BASICS OF THE INFANT SECURITY PLAN;561
29.4;EMERGENCY DEPARTMENT SECURITY;578
29.5;THE HOSPITAL PHARMACY;588
29.6;REFERENCES;597
30;CHAPTER 22 - AREAS OF SPECIAL CONCERN;600
30.1;PROTECTED HEALTH INFORMATION;600
30.2;INFORMATION TECHNOLOGY;603
30.3;MATERIALS MANAGEMENT;604
30.4;THE RESEARCH LABORATORY (ANIMAL);607
30.5;CHILD DEVELOPMENT CENTERS;609
30.6;BUSINESS OFFICE/CASHIERS;609
30.7;OTHER AREAS NEEDING SPECIAL SECURITY CONSIDERATION;610
30.8;SECURITY AREAS OF CONCERN SPECIFIC TO THE ORGANIZATION;614
30.9;REFERENCES;614
31;CHAPTER 23 - PARKING AND THE EXTERNAL ENVIRONMENT;616
31.1;TYPES OF PARKING AREAS;619
31.2;PARKING SHUTTLE SERVICE;625
31.3;VALET SERVICE;626
31.4;TYPES OF PARKERS;626
31.5;AUTOMATED CONTROLS;627
31.6;TRAFFIC FLOW AND SPACE ALLOCATION;627
31.7;PAY FOR PARKING;628
31.8;PARKING SYSTEM VIOLATORS;629
31.9;REFERENCES;631
32;CHAPTER 24 - NONACUTE FACILITIES AND OFF-CAMPUS PROGRAMS AND SERVICES;632
32.1;THE NEED FOR OFF-CAMPUS FACILITIES AND SERVICES;633
32.2;HOME HEALTHCARE (COMMUNITY PROVIDER SERVICES);636
32.3;OFF-CAMPUS PATIENT TREATMENT FACILITIES;640
32.4;LONG-TERM/RESIDENTIAL CARE FACILITIES;644
32.5;NONCLINICAL OFF-CAMPUS FACILITIES;652
32.6;REFERENCES;653
33;CHAPTER 25 - EMERGENCY PREPAREDNESS: PLANNING AND MANAGEMENT;656
33.1;REGULATIONS FOR HEALTHCARE EMERGENCY PREPAREDNESS;656
33.2;EMERGENCY MANAGEMENT PLANNING;657
33.3;BOMB THREAT;664
33.4;ACTIVE SHOOTER PREVENTION AND RESPONSE;666
33.5;PATIENT DECONTAMINATION;669
33.6;EVACUATION;671
33.7;EMERGENCY PREPAREDNESS EXERCISE DESIGN AND CONDUCT;674
33.8;REFERENCES;675
34;CHAPTER 26 - A PRIMER FOR HEALTHCARE EXECUTIVES;676
34.1;WHAT BASIC OBJECTIVES SHOULD WE HAVE FOR THE SECURITY PROGRAM?;678
34.2;WHAT LEADERSHIP CHARACTERISTICS SHOULD THE HEALTHCARE SECURITY ADMINISTRATOR POSSESS?;679
34.3;WHERE SHOULD SECURITY REPORT?;680
34.4;WHAT CUSTOMER SERVICE EXPECTATIONS SHOULD BE ESTABLISHED FOR SECURITY?;680
34.5;WHY DO I NEED A SECURITY MASTER PLAN?;681
34.6;HOW DO WE IDENTIFY OUR SECURITY RISKS AND VULNERABILITIES?;682
34.7;DOES THE COMMUNITY STANDARD HAVE A ROLE?;682
34.8;THE SECURITY STAFFING MODEL: HOW LARGE A STAFF IS NEEDED?;683
34.9;SECURITY TRAINING: WHAT SHOULD I EXPECT?;684
34.10;HOW DO I KNOW MY SECURITY STAFF ARE COMPETENT?;685
34.11;HOW MUCH INVOLVEMENT SHOULD SECURITY HAVE WITH PATIENTS?;686
34.12;WHAT TYPE OF UNIFORM SHOULD SECURITY OFFICERS WEAR?;687
34.13;WHAT USE OF FORCE OPTIONS SHOULD BE MADE AVAILABLE TO OUR SECURITY STAFF?;688
34.14;HOW SHOULD SECURITY BE DESIGNED INTO THE HEALTHCARE FACILITY?;690
34.15;HOW IMPORTANT IS ACCESS CONTROL?;691
34.16;WHERE ARE ALARMS NEEDED?;691
34.17;WHY INVEST IN VIDEO SURVEILLANCE?;692
34.18;WHAT OTHER SECURITY TECHNOLOGY APPLICATIONS SHOULD BE CONSIDERED?;693
34.19;THE INVESTMENT IN SECURITY TECHNOLOGY HAS BEEN MADE, BUT HOW DO WE KNOW IT WORKS?;695
34.20;HOW CONCERNED SHOULD WE BE ABOUT VIOLENCE IN HEALTHCARE?;695
34.21;ARE WE DOING ENOUGH TO PROTECT OUR INFANT AND PEDIATRIC PATIENTS?;697
34.22;WHAT SHOULD WE DO DIFFERENTLY TO MANAGE FORENSIC/PRISONER PATIENTS?;698
34.23;ARE WE DOING ENOUGH TO PROTECT THE PRIVACY OF OUR DATA?;699
34.24;HOW DO WE GET EMPLOYEE INVOLVEMENT IN THE PROTECTION EFFORT?;700
34.25;WHAT SECURITY-RELATED POLICY AND PROCEDURES DO I NEED?;701
34.26;WHAT PERFORMANCE METRICS SHOULD I BE USING FOR BENCHMARKING MY SECURITY PROGRAM?;701
34.27;REFERENCES;703
35;Mental Health Physical Security Review Checklist;704
36;Sample Healthcare Security Request for Proposal;714
36.1;1 INTRODUCTION;714
36.2;2 INSTRUCTIONS FOR SUBMITTING PROPOSALS;715
36.3;3 SCOPE OF WORK;716
36.4;4 REQUIREMENTS;717
36.5;APPENDIX A;724
36.6;APPENDIX B;724
37;Glossary;726
38;Index;736

Leseproben

Chapter 1 The Healthcare Environment
Abstract
This chapter emphasizes the macro environment challenges and accreditation and regulatory agency expectations of healthcare security, and provides an overview of the higher purpose of healthcare that influences the security practitioner. Hospitals are no longer an isolated group of free-standing buildings. They are critical infrastructures, forming complex medical centers, serving diverse patient populations, and having visitors who travel great distances to seek care and receive specialized medical treatment. It is not uncommon for medical centers and hospitals alike to find themselves as parts of a large healthcare system, or delivering care in the community in a model reflecting the full continuum of care. This chapter addresses the basic objectives of the security program whether protecting hospitals or the nonhospital side of the healthcare environment. It discusses the need for security, managers, top executives, and boards of directors to accept a greater responsibility and ownership for security and risk mitigation in the protection effort. Keywords
critical infrastructure; healing environment; The Joint Commission; HIPAA; Centers for Medicaid and Medicare The only constants in today’s healthcare environment are the dynamic challenges continuously facing healthcare administrators and posing daily tests for security leaders charged with protecting these healing environments. The delivery of healthcare changes rapidly and is vastly different from what it was just a few years ago. Hospitals are no longer an isolated group of freestanding buildings. They are critical infrastructures forming complex medical centers, serving diverse patient populations, with visitors travelling great distances to seek care and receive specialized medical treatment. It is not uncommon for medical centers and hospitals alike to find themselves as parts of a large healthcare system, or delivering care in the community in a model reflecting the full continuum of care. These healthcare systems often have dozens of facilities serving communities near the main facility, or they may be part of a system with facilities many states removed. The competitive nature of healthcare has challenged administrators and security professionals alike to present a safe and secure environment that is coupled with a warm and open feel. The current security landscape affects all types of organizations and all aspects of the healthcare industry. Heightened safety concerns following the 9/11 terrorist attacks have compelled government agencies, the healthcare industry, and commercial establishments worldwide to employ sophisticated security services. Alarmed by the vulnerability of their legacy systems, many organizations are upgrading to state-of-the-art security programs and systems, which include monitoring surveillance services and well-trained security ambassadors. This trend is likely to continue as healthcare institutions, and various other establishments, seek greater security due to growing workplace and patient-generated violence and changing patient populations (due to reduction of mental health reimbursement). As well, looming challenges of staff (physician and nurses) shortages, employee thefts, continuing downward pressure on Medicare reimbursements and the changing structure of the medical care model are all contributing to the increased focus on security. The growth of electronic health records, and associated data security breaches and patient privacy concerns, medical insurance fraud, the threat of terrorism, and the need for better preparation and response to man-made and natural disasters must also be viewed as cogent factors. The need for increased security has provided an unprecedented challenge in the methods and philosophies regarding protection of our healthcare organizations. Their safeguarding cannot be completely dependent on the security department. Many aspects of protecting healthcare organizations reach far beyond the control of the commonly accepted elements of a healthcare security department. Today, in order to achieve a high level of security, managers, top executives, and boards of directors must be more involved, through appropriate funding levels, with managing and supporting security and other risk management issues. These leaders must accept a greater responsibility and ownership for security and risk mitigation, in their day-to-day management obligations. Practically everyone uses healthcare, or has a close connection to someone who uses healthcare, in any given year. In 2012, the U.S.’s healthcare bill climbed to about $3 trillion.1 On the average, healthcare consumes over $8,500 per person per year—approximately one-sixth of the average American income and growing much faster than the rest of the economy, with healthcare spending projected to nearly double in the next decade.2 It’s not all private spending; U.S. taxpayer funding provides close to 50% of this amount. The Canadian Institute for Health Information data supports the U.S. trend in rapidly rising healthcare costs in Canada, projecting healthcare spending to grow to $211 billion in 2013, consuming 11.2% of Canada’s gross domestic product (GDP).3 The delivery of healthcare is primarily a provincial responsibility in Canada, with healthcare now consuming 40%, or more, of provincial budgets.4 UK and New Zealand spending on healthcare is also in the vicinity of 10% of GDP, while Australia is slightly lower at 8.7%. These countries spend about half of the U.S. amount on a cost-per-person basis, somewhere between $3000 and $4000 per person, with all of these countries dwarfing the $4 per person expenditure committed to healthcare in Myanmar (Burma).5 However, the trend is clear—countries are spending more and more on healthcare, and the rising trend continues. For more than two decades, the cost of healthcare has exceeded the general rate of inflation (or the rate of growth of the economy),6 and is rising faster than wages. Many of these costs are incurred by the sickest patients. It is estimated half of the U.S. population accounts for only 3% of all healthcare expenditures, while about 10% of the population accounts for more than 60% of healthcare costs. The top 5% of the population accounts for nearly half of U.S. healthcare spending, while the top 1% accounts for 20%.7 Despite private, freestanding ambulatory care centers, declining patient days, long-term care facilities, wellness programs, and advances in outpatient and home care, the hospital remains the primary source of healthcare in terms of dollars expended. The increased costs of providing healthcare are at least partly the result of the success of our healthcare delivery system—with larger numbers of people living to an older age, and needing increasing amounts of care. There continues to be an explosive growth in the numbers of individuals with chronic conditions, a seemingly insatiable demand for emergency care services and intensive care, progressive expansion of applications for minimally invasive surgery and other procedures, and heightened concerns about inefficiency, access to care, and medical errors across the healthcare delivery system. A 2008 analysis by PricewaterhouseCoopers concluded that more than $1.2 trillion dollars in the U.S. healthcare system are wasted. Medical errors, inefficient use of information technology and poorly managed chronic diseases, related to obesity and being overweight, were all cited as factors. Dwarfing these reasons is a phenomenon in which doctors order tests to avoid the threat of a malpractice lawsuit—otherwise known as “defensive medicine.” At $210 billion annually, defensive medicine is one of the largest contributors to waste. A 2005 survey in the Journal of the American Medical Association found that 93% of doctors reported practicing defensive medicine8 and there is no indication this trend has changed. Categories of Healthcare
Direct clinical care of patients is being delivered in all kinds of organizations and in all types of settings. In the U.S., this diversity is generally the result of a particular entity wanting greater patient market share, and creating environments with low overhead to maintain cost control. A basic concept is to bring the delivery of care geographically closer to the patient. Lower unit costs are also intended to provide greater patient accessibility to quality care. This geographical spread of organizational facilities is based on the great number of outpatient procedures, once done only in the hospital. Healthcare can be viewed on a continuum from assisted living (low acuity) to acute care (high acuity). This progression follows these basic steps: • Assisted Living – provides some help with day-to-day living activities, often including transportation services to healthcare delivery sites, some limited medical care presence in the living facility, and general staff watchfulness. • Home Care – healthcare staff generally visit and provide care in the home with a coordinated plan of treatment and services. • Outpatient Services – include surgery, clinic visits, physical therapy, psychological counseling, speech therapy, and dental care. • Intermediate Care – provides 24-hour oversight, and is often tied closely to geriatric care. • Skilled Care – requires intervention skills by caregivers as opposed to caretakers. • Short-Term Acute Care – is generally medically complex...