Q&A: Interview With a Hospital Locksmith

Locksmithing is a diverse industry, with sectors include residential, automotive, commercial, industrial and institutional. Locksmiths provide security/life safety as well as key/door control for exterior and interior doors.We service locks that have been manufactured and sold for just about everything that can be locked and a few that probably should never be. To make a living, we need to be knowledgeable about locks manufactured in many countries as well as those “made in the U.S.A.”

Institutional locksmiths work for educational facilities and school districts, manufacturing facilities, government and medical/hospitals. Within each of these facilities, many different lock manufacturers’ products may be installed. The locksmiths need to know how to service them and must be knowledgeable on different types of lock and related hardware as well as the rules, regulations, acts and agencies that govern facilities.
For this article, we chose to interview a hospital locksmith. Our locksmith very graciously shared his experiences and the unique aspects of working in a hospital. However, due to security reasons, we cannot be more specific about this large medical facility or the locksmiths who maintain it.

Following are Locksmith Ledger’s questions and our hospital locksmith’s answers.

Prior to this interview, I did not realize the degree to which hospitals are regulated. There are government agencies, acts, laws and regulations. Can you describe a few of them?

Not in any order, they are:
The Joint Commission – Nationwide: The Joint Commission ensures hospitals and medical related facilities follow specific regulations for safety and patient care. This includes securing pharmaceuticals, keying systems and controlling access to name a few of the tasks which locksmiths can be responsible. The Joint Commission has an affect on government funding including reimbursement.

Homeland Security – Nationwide: Homeland Security regulates controlling access to radioactive materials. Part of the regulations is that anyone who has access to radioactive materials is required to be fingerprinted and undergo a background check. All locksmiths are required to have background checks. In addition, locks securing hospital radioactive material must not be  master keyed.

Board of Pharmacy: Pharmacy regulations are an important ingredient of our daily activities. Years ago, if a medication drawer key was taken off the unit, the locksmith would be called to change the keys out and re-supply the unit with keys, no matter the day or hour. Today, we are finding electronic access using “Prox”-equipped employee identification badges work better for the nursing staff. This includes securing certain narcotics that require dual key access.

Office of Statewide Health Planning and Development – California: O.S.H.P.D. is tasked with structural, electrical and fire/safety reliability of all hospital construction in the State of California. Locksmiths are involved in access control and related hardware. Any hardwire electrical runs must be submitted for approval and permitting, prior to work starting. Another area under their purview is door replacement, which includes locking hardware.

Department of Health Services – California: DHS has codes that affect operation.
Health Insurance Portability and Accountability Act of 1996 (HIPAA): For locksmiths, HIPAA requires healthcare providers to guard the confidentiality of Protected Health Information (PHI).
Americans with Disabilities Act of 1990 (ADA)

National Fire Protection Association, Life Safety Code, known as NFPA 101
Annual and semi-annual unannounced inspections are made by the different agencies/offices to ensure compliance. If the hospital/facility is out of compliance, there are a variety of possible penalties from re-inspections to financial penalties to closure of the facility.
There can sometimes be conflict between these agencies. To be safe, our policy is to follow the most strenuous regulation, etc. This ensures the best care possible for our patients.

As with any locksmith, there is a fine balance between providing the appropriate security while maintaining life safety.
You have used the term “Hospital thinking.” Would you please explain and give a few examples?

“Hospital thinking” involves knowing and providing for the proper lock hardware and function, in a given setting. Like all locksmiths, our priority is to make the hospital as secure as possible and still meet all applicable codes. Part of that process is using hardware that will stand up to the amount of use and abuse found in the particular setting. Therefore, we have made it policy that lock hardware in the hospital is Grade one, where adjacent facilities might have Grade two depending upon traffic levels. Our goal is to use hardware that is appropriate for the application, the amount of use and to maximize the cost effectiveness.

How many square feet and doors do you maintain?
More than 5 million square feet and more than 13,000 doors.

Do you have restricted or patented keyways?
We have patented, restricted and non-restricted keyways. The keyway is determined by the application.

Do locksmiths install, service and/or maintain Closed Circuit Television systems?

No, another department handles CCTV.

What are the unique features of master keying a hospital versus an office building?
The hospital has departments in different areas that can move to expand or contract. Each area has its own master key or individual key. When we construct master key systems, we take into account departments and groups of individuals knowing how they interact with other departments/groups and what forms of access they require.
A Space Allocation Committee determines who receives permission to occupy a space and how many square feet. This committee answers only to the vice president and the president.

How do you maintain key control?
Key control is maintained by having authorized signatures for each key. Only authorized parties can sign for keys - no proper signature, no key. Department heads authorize department keys. Lower level master keys require administrator signature. GGM keys and elevator override keys for example are restricted to vice president or president authorized signatures only. When keys are issued, all recipients must sign a receipt that they have received the key indicated on the receipt, as well as the sequence number. The form also contains  their name and Identification number. When the person no longer needs the key, it is to be returned to our office and records updated to indicate its return.
Our office maintains a loaner key box, so maintenance staff, other support departments and contractors can sign out keys for buildings that they are not in on a daily basis. These “loaner” keys are to be returned when their project is completed or before the end of our business day. For projects that will continue overnight or start before we open in the morning, authorization must be given by the director of engineering for keys to be out overnight.

Vendors and contractors may have keys issued to them by using their Social Security number as their identification number. To ensure return of the keys, hospital policy states that if the key is not returned, the vendor/contractor can be brought up on fraud charges. When keys are returned, the information is destroyed.

When a major remodel or construction project occurs, the locksmith shop provides a temporary construction master key system. This master key system is not part of any existing master key system.

How many master key systems do have and what are the levels?

We have 12  active master key systems. This is because the hospital has acquired a number of buildings and several are still using their MK Systems. Our master key systems range from Grand Master Key Systems to Great-Great Grand Master Key Systems.

What is your vision for controlling access?
I see it as a two-tiered approach, macro control and micro control. Both provide audit trail capabilities.
The Macro approach typically involves high volume entries, such as outside doors to a building, parking lots, entrances to departments like surgery, clinical laboratory, emergency, etc., but can be low volume also. This type is typically the wall-mounted reader hardwired to a control panel, and uses electrified locks or electric strikes tied to the building power. This approach generally deals in access levels, so an Admin level might give access to all areas except Pharmacy; doctors would have their series of doors and parking area and nursing and general staff, theirs.
While more expensive up front than the battery powered locks, and requires permits to run the AC power and communication lines to the control panels, you do have instant control if a badge or the facility needs to go into lockdown mode immediately.
With Micro control, we are talking about individual offices or labs, where the user wants tighter control of who has access. These locks are typically battery powered and have a more limited number of users, though they can be powered by house power, with battery back up. With these locks, we program specifically who has access and when they can have access, which is an option several departments prefer. This approach can be programmed in an access level format. We have some additional flexibility to provide access specific to the needs of a single individual.
An enhancement to using these types of locks has become available in the last few years - being able to program them via wireless technology from our office. By using the wireless technology, we will be able to use badge access at our satellite clinics and offices without the major expense of the hardwire system, but does require a close working relationship with the IS and Telecom support personnel.

How long will it take to change over to this new form of access control?
While the goal is to reduce or eliminate key usage as much as possible, the cost to change over would be too much at one time. And realistically, we will not change out every keyed lock. Where we can justify the cost, we will be making the change.

How many locksmiths are on staff and what are their schedules?
We have six full time locksmiths and a technical assistant. We work a standard 40-hour week and rotate on-call responsibilities. We carry pagers for emergencies and are paid overtime.
Please discuss how locksmiths work with others including electricians, welders, etc., to provide required services.
All of the departments work together to benefit the hospital and the patients. Without joint effort, work would be more difficult for everyone.

Do you provide any personal services for employees?
As the need arises, we do just about all types of locksmith work including car lockouts, lost keys, etc.

Have you had any stories you can tell that occur as a result of being a hospital locksmith?
I believe most locksmiths have stories of having to change locks due to an employee being fired.  In a hospital setting, the locksmiths tend to get to know a good portion of the staff, and when called to make those types of changes or asked what keys a staff member has been issued, you must maintain the confidentiality of the information shared with you. Sometimes that information cannot be shared with anyone else, even after termination, at times for legal reasons, but more so in respect and consideration of the person leaving. The hospital locksmith is often involved with administration, security, and department heads, as well as doctor’s, in developing a more secure and convenient environment for staff to work in.  It may seem a contradiction in terms, but it truly isn’t. 

Are employees becoming more willing to embrace electronic access control?
Due to the increasing capability of the standalone locks and badge readers, electronic access control  is becoming more and more accepted and desired.
The advent of electronic access control for medication drawers and refrigerators has been positive. First off, the elimination of keys means staff members don’t need their keys to safely access medications.
The first move was to Personal Identification Numbers (PINs), but we found some shortcomings with it. As our facility upgraded our access control system, we have been able to extend our access system badge to medicine drawers and refrigerators. Authorized individuals simply swipe their badge to gain access.
As an added benefit, the new electronic locks provide audit trail capability. The refrigerated medications require documentation of temperature variations. The standalone electronic locks can provide electronic histories or the technicians can manually document them.

What is the most interesting thing that has happened to you as a hospital locksmith?
There are so many interesting things involved with our day-to-day activities that it’s hard to pick one.  In general, it is getting to know some of what the medical professionals need to care for patients better, and looking at our field of expertise to see if we can develop or adapt hardware to help meet their needs.  Mostly it is dealing with safety codes and privacy issues, but it can be just about anything.  It’s not just cutting keys and installing locks; it’s working with people to help other people.

What types of locks are used to secure the Locksmith Shop?
The Locksmith Shop is secured by a standalone, electromechanical lock that is programmed to unlock temporarily for access only by locksmith staff. The lock does have a mechanical override mechanism, which is only available to the locksmith staff.

Would you recommend being a hospital locksmith?

Yes, but conditionally.  The positives that I see in hospital locksmithing, beyond the benefits and job security, have more to do with the people you work with and the opportunity to get to know them and their interest and concerns. You need to learn how to work with some who initially seem impossible to satisfy.  Being diplomatic is always helpful.
For my personality, it has been the best place to be.  Keeping abreast of code changes, as well as changes in hardware, to be prepared to specify hardware that will meet our needs and still meet codes, challenges me mentally. Also recalling an article I’ve read or something used years ago could help fill a need for a particular application. 
Working with my hands and dealing with doors and hardware each day fills that part of me that enjoys repairing things.  I have the privilege of seeing staff, patients and their families and I’m not stuck in an office all day long, which provides the social element that I enjoy.         

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