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Healthcare Leadership Culture Moving Forward: What I (probably) didn’t do during my summer vacation

As a frequent traveler, I tend to read a fair amount in transit (my preferred operating system for reading is the traditional “hard copy”, aka “books” most often from the coffers of the public library), and in doing so, I try to mix in fiction and non-fiction titles. Also, as a function of traveling, I hear about a lot of stuff on the radio (usually the local NPR station—there’s almost one of those everywhere I go), which is not quite as mesmerizing as chasing videos on YouTube, but I’ve found that there’s a whole world of stuff out there, some of which I only learn about because I’m in the right place at the right time. To that end, I have a few suggestions to share with you that (hopefully) will remove some of the happenstance of discovering something you might not otherwise have encountered. So here I present to you, if you will, a fall reading list.

To ease into things, first up is an article from the September 2017 issue of Occupational Health & Safety entitled “The Right Amount of Leadership Done Easy” by Robert Pater. The opening premise asks the question of how many folks have adopted a strategy because it was easy, even though it was ineffective. I liken this to the “all purpose” response to deficiencies in the environment that focuses on more education of staff, when the response should really by aimed towards why the current education process is not as effective as it needs to be, based on results. My philosophy on this is that (unless you have a woefully inadequate education process) staff have received as much education as they need to. You may need to tweak subject matter over time as risks and conditions change. At any rate, I found the article to raise some interesting / thought-provoking concerns and I think definitely worth checking out.

I just finished reading “Shooting Ghosts: A U.S. Marine, a Combat Photographer, and Their Journey Back from War” by Thomas J Brennan USMC (Ret) and Finbarr O’Reilly. I’ve heard both of the authors interviewed recently (yes, on NPR) and found their account of recent events in various war/strife zones compelling enough to take on the book. Now, you may well ask, what does this have to do with healthcare? And I can tell you there is a lot to do with healthcare—from Mr. Brennan’s travails with the management of behavioral health patients (Mr. Brennan suffered a traumatic brain injury during a deployment in Afghanistan and has been dealing with the consequences of that event) in the VA and civilian systems to some insight to how healthcare can more effectively manage care and treatment of folks by learning more about the “patient experience” (definitely a buzzword in healthcare). At any rate, Mr. Brennan and Mr. O’Reilly’s stories are harrowing, both from an experiential standpoint, but also on (and this is my “take”) the uncertainty of the treatment process—even when practitioners act with certainty.

Next up, we have the Managing Millenials for Dummies Cheat Sheet; a little while back, we covered some the more operational aspects of the impact of millennials in our workplaces (and believe me, they’re not going away), from their view of the world to the more tribal aspects of their attire and personal presentation. I think those of us older (I’m more than half way to my next colonoscopy, so I can no longer consider myself among the young ‘uns) folks can say with some degree of accuracy that things have changed a bit over the last 10-15 minutes (OK, maybe even years, but sometimes it’s overwhelming to look that far back into the past) and I think you’ll find the Cheat Sheet both amusing and perhaps somewhat illuminating. It would be nice if all these generational “buckets” were more easy to profile, but it might beg some questions with/for folks you have working for you. Just sayin…

These last two titles I have not yet read (they’re in my pile), but heard mention of them on the radio (unfortunately, I cannot recall exactly which program might have been the one that planted the seeds of interest). The first, “Games People Play: The Basic Handbook of Transactional Analysis” by Dr. Eric Berne (originally published in 1964—thankfully I was born at that point) rang some bells with me, particularly an example of how certain individuals collect slights against them to be used in the future when they have slighted someone else. The example that sprang to mind was a department director to whom I had to speak about a recalcitrant employee (I think it was a parking issue), with the director responding that “well, a couple of months ago, we found a member of your staff asleep in an exam room,” with the intent that my sleeping staff person was far worse than whatever parking issue was at hand. Of course, I did ask as to why I hadn’t been notified at the time, but the response was somewhat vague and not particularly helpful. I guess it’s kind of like saving things for a “rainy day,” but I am a firm believer in taking care of things now if there is an issue. At any rate, I think it’s kind of interesting to see the various scenarios laid out in a scholarly fashion. I think you’ll find more than a little of the information to represent familiar interactions with folks.

The last title for our little book club is of a little more recent vintage; “Mistakes Were Made (but not by me)” would be interesting if only for the title alone, but the subtitle “Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts” is probably a little more timely than at any other time in recent history. That said, as we in healthcare move ever closer to the vision of just culture (and all the accompanying acts of finger-pointing along the way), I think this is worth a read.

If any of you folks out there check any of these out, please feel free to provide feedback as to whether or not I should stay away from book recommendations.

Stay Calm and Read A Good Book!

Survey Preparation—When do you start kicking the tires?

In the “old” days, the survey preparation cycle was a fairly well-defined undertaking—you knew (pretty much) when they were coming and about six months before their estimated arrival, prep activities began in earnest. Now, you might say, that it’s pretty freaking obvious that that particular strategy is not so great for ensuring results in the current climate (even though, at least at the moment, surveys are happening on that same 36-month recurrence—there have been a few wild card survey arrivals, but not like we’ve been led to expect), but I still find a lot of folks (particularly when it comes to bringing in an extra pair of eyes to look things over) are waiting until the “survey year” to really give the place a thorough review. Now, I am two minds on that topic—while I understand that the closer you can get to survey, the (purportedly) more accurate a picture you have of what things will look like during the actual survey, I also know (from experience) that if you find vulnerabilities (particularly when it comes to documentation), you really need to have something of a track record of compliance (12 months of pristine is a good place to be, though surveyors can certainly walk you back as far as they want—a greater risk for facilities that are smaller in terms of square footage) if you are going to “survive” with minimal findings—recognizing that it is really, really tough to pull off no physical environment findings.

In other news this week, emergency management stuff continues to take center stage as Jose takes aim at the Northeast (it’s beginning to appear that any place that could experience a hurricane is going to endure just that). On the Joint Commission website ( there’s an announcement that TJC is temporarily suspending survey activities in Florida, Puerto Rico, and the Virgin Islands, as well as the Houston area for organizations that have been severely affected by recent weather events. The posting does indicate that if there are questions, organizations should reach out to their Joint Commission Account Executives, which I suspect will involve ascertaining a working definition of “severely affected.” I’m sure that TJC-accredited organizations went through the appropriate notification sequence if they had to curtail or otherwise modify their services, in accordance with the requirement to notify TJC within 30 days of any substantive changes in operations (I think we’re still within the 30-day window from the onset of Harvey, but if your organization has altered services, etc., and not yet made the call to TJC, I would put that on the to-do list for this week). I guess it would be good not to have to go through a survey during the recovery phase, but I don’t know that it wouldn’t be worth seeing how well you could do in the midst of everything else.

Let’s see what else do we have? Ah yes—the Centers for Disease Control and Prevention have updated the hurricane preparedness page on their website; definitely a cornucopia of information for health care providers, response and recovery workers, as well as affected communities in general. Nothing jumps out at me as being super special, but I think all of the available information is worthy of review. I won’t say that I’ve pored over every bit of information, but with all that’s happened (and all that might yet be on the horizon), it’s nice to have some learned source material. Speaking of which, the Association for Linen Management has also published some disaster recovery guidelines; for those of you with operational responsibilities for linen, there’s some good stuff here (and not just the warm feeling I get whenever I think about my halcyon days managing the linen department) and definitely worth checking out.


Any world that I’m welcome to…

Sometimes a confluence of happenings makes me really question the legitimacy of coincidence. For example, it can’t possibly be coincidence that our friends in Chicago use the backdrop of September to tell us how poorly we are faring relative to compliance in the management of the physical environment. Yet, like clockwork, September brings the “drop” of the most frequently cited standards (MFCS) during the first half of the year. (I did look back a few years to validate my pre-autumnal angst—they waited until October to publish the MFCSs in 2012.) And, for a really, really, really long time, the physical environment continues to maintain its hegemony in the hierarchy of findings.

In years past, we’ve analyzed and dissected the living heck out of the individual standards, looking at the EPs likely to be driving the numbers, etc. Anybody wishing to revisit any of those halcyon days, you can find the (not quite complete) collection here:

Anyhoooo… I really don’t see a lot of changes in what’s being found, though I will tell you that there has been a precipitous increase in the number of organizations that are “feeling the lash.” Last year’s most frequently cited standard, which deals with various and sundry conditions in the care environment (you might know it as EC.02.06.01, or perhaps not), was found in about 62% of organizations surveyed. This year, the percentage has increased to 68% of organizations surveyed, but that number was only good enough for 5th place—the most frequently cited standard (the one that deals with all that fire alarm and suppression system documentation*) was identified in a whopping 86% of the hospitals surveyed!

I think it’s important, at this point, to keep in mind that this is the first year of a “one and done” approach to surveying, with the decommissioning of “C” or rate-based performance elements. I don’t know that I have encountered too many places with absolutely perfect documentation across all the various inspection, testing, and maintenance activities relating to fire alarm and suppression system documentation. I also don’t know that I’ve been to too many places where the odd fire extinguisher in an offsite building didn’t get missed at some point over the course of a year, particularly if the landlord is responsible for the monthly inspections. Face it, unless you have the capacity to do all this stuff yourself (and I’m pretty sure I haven’t run into anyone who has unlimited resources), the folks charged with making this happen often don’t have an appreciation for what a missed fire extinguisher, missed smoke detector, etc., means to our sanity and our peace of mind.

As I’ve been saying right along, with the exceptions being management of the surgical environment and the management of behavioral health patients, what they are finding is not anything close to what I would consider big-ticket items. I refrain from calling the findings minutiae—while in many ways that is what they are, the impact on folks’ organizations is anything but minute. If the devil is indeed in the details, then someone wicked must have passed their CORI check for a survey job…

Relative to last week’s rant regarding policies; first a shout-out of thanks to Roger Hood, who tried to post on the website (and was unable to ) regarding the CMS surveyor Emergency Preparedness survey tool as a potential source for the TJC policy requirement. (It’s an Excel spreadsheet, which you can find here, in the downloads menu near the bottom of the page: Surveyor Tool – EP Tags.) While I “see” that a lot of the sections invoke “policies and procedures,” I still believe that you can set things up with the Emergency Plan (Operations / Response / Preparedness—maybe one day everyone will use the same middle for this) as your primary organizational “policy” and then manage everything else as procedures. I suppose to one degree or another, it’s something of an exercise in semantics, but I do know that managing policies can be a royal pain in the tuchus, so limiting the documents you have to manage as a “policies” seems to make more sense to me. But that may just be me being me…

*Update (9/7/17): Quick clarification (I could play the head cold card, but I should have picked up on this); the most frequently cited standard deals with fire suppression system stuff—gray fibrous material (GFM) on sprinkler heads, 18-inch storage, missing escutcheons, etc. While I suppose there is some documentation aspect to this, my characterization was a few bricks shy of a full load. Mea maxima culpa!

Thoughts and prayers for Houston; plus, thoughts on required ‘policies’

First off, thoughts and prayers going out to the embattled folks in Texas; I do a fair amount of work in Texas, including the Houston area, and while I have absolute confidence in folks’ ability to respond to and recover from catastrophic events, I also know that this is going to be a very tough next little while for that part of the world. Hurricane Harvey will likely fade from the headlines, but the impact will linger past the news cycle, so don’t forget about these folks in the weeks to come. Thanks!

As I was casting about for a subject for this week’s missive, I happened upon a news item in Health Facilities Management This Week (HFMTW) that outlines some of the pending changes to the ambulatory care / office-based surgery medication management standards and the potential further impact of those changes on some of the EC performance elements in those environments. The changes are pretty much focused on emergency power as a function of being able to provide medication dispensing and refrigeration during emergencies.

Now, I have absolutely no issue with making provisions for the safe physical management of medications during power outages, etc.—it is a critical part of the delivery of safe and appropriate care to patients in any setting, and the more we can do to prepare for any outages, etc., the greater the likelihood of continuity of services if something does happen. What really caught my eye in the TJC blog entry cited in HFMTW (you can find the blog here) is something about half-way down the page titled “Emergency Back-Up Policies.”

At the outset of this discussion, I will tell you that, in most instances, I am no big fan of “policies.” In my mind, mostly what a policy represents is an opportunity to get into trouble for not following said policy. So, the question I wrestle with is whether we need to be mandated to have specific policies in order to appropriately manage our facilities, including preparing to respond to emergencies. For example, I am not entirely certain that a policy is going to make the difference in how well hospitals in the Houston area are responding to Hurricane Harvey (at the time of this writing, there are hospitals facing evacuation), though I would be happy to hear otherwise. I just have a hard time believing that having a policy is the answer to life’s problems; I am absolutely fine with requiring hospitals and other healthcare organizations to have a process in place to ensure appropriate management of medications during power outages, etc.—and I’m reasonably confident that those processes already exist in most, if not all, applicable environments.

I don’t know, maybe some folks do need to be told what to do, but I can’t help but think that those folks are fairly limited in number. And the blog even indicates that “there is no specific direction on the content of the policy”, but publishing this blog is going to force the issue during survey. I don’t know, when you look at the Conditions of Participation, etc., there are really very few policies that are required. It seems a bit odd to think that introducing new requirements for policy will somehow address some heretofore unresolved issue (or something). This one just doesn’t feel “right” to me…

I said you’ll pay for this mischief…

In this world, or the next! Stand by for news…

In this most momentous of years / survey cycles, it appears that there may be at least one more shift in the firmament, that being a transition for a most notable AHJ. The grapevine has been singing this week. (You can reference either the Marvin Gaye or Gladys Knight version; at the moment, I’m leaning toward an invocation of Marvin as it pushes a follow of “What’s Going On”—Brother, Brother, indeed!) There seems to be a changing of the guard afoot in Mordor (or Oak Park, Illinois—take your pick) as it appears that the estimable Director of Engineering for The Joint Commission, George Mills, is transitioning out of the crucible that provides so much in the way of heartburn in the industry.

Word is that one of the engineers in the Standards Interpretation Group (SIG), John Maurer, will be taking the director’s position on an interim basis. Not by any means a comparison (my personal dealings with the departing incumbent have always been reasonable and assistive), but my past interactions with Mr. Maurer have always been thoughtful, helpful and equitable, including indication of how one might plot a course toward satisfactory compliance. In that regard, I don’t anticipate that this will engender a significant change in how business will be conducted, including the practical administration of the Life Safety portion of the accreditation survey process. While details have not yet been officially confirmed, I have no reason to think that the information in general is incorrect, so all I can say is best of luck to everyone as they (and we) embark on their new journeys and pray for a resurgence of benevolence across the board.

To round things out for this week, I would bring your attention to last week’s Joint Commission Quick Safety Issue (QSI #35 in an ongoing series—collect ‘em like baseball cards!) and the topic du jour: minimizing noise and distractions in OR and procedural units.

Now, you’ll get no argument from me that there are certain environments and situations for which noise minimization is desirable, and perhaps, essential. And, empirically, I can’t disagree with any of the characterizations indicated in QSI #35—there are quite a number of footnotes, none of which I have had the time to track down, but, again, I have no reason to think that the scholarship of the article is anything less than spot on. I guess the thought/question/concern I have relates to the practical application of this as an improvement activity (keeping in full mind that sometimes surgeons like to operate to music that ain’t exactly in the realm of quiet—think AC/DC’s “Back in Black” and you’ll be on the right track).

QSI #35 has a whole list of “safety actions to consider,” and the indication is that these are actions that “should” be considered. (But how often have you seen a “should” become very musty during survey…) I wonder if you’ll have the leeway to make the determination of whether you are appropriately managing noise in the procedural environment. I suppose it’s good that this hasn’t shown up in Perspectives

You are so beautiful, to me…

In the interest of a little summertime reading, I wanted to diverge a bit from the usual rant-a-minute coverage (rest assured, the ranting will continue next week—too much going on in the world) and cover a couple of “lighter” topics (though one does have to do with my favoritest topic—risk assessments).

First up, we have Soliant Healthcare’s list of the 20 most beautiful hospitals in the U.S. (as a music lover, I find that I am an absolute sucker for lists—go figure!); while I have not had the opportunity to do any work at the listed facilities (and have done some work at places I think measure up pretty well from a design perspective, etc.), I can say that the buildings represented on the list are pretty easy on the eye. I don’t know if anyone out there in the Mac’s Safety Space blogosphere works at any of the listed facilities, but congratulations to you if you do or did!

The other item for this week focuses on the pediatric environment; from my experiences, a lot of community hospitals have really scaled back their pediatric care facilities, mostly because demand is not quite what it used to be. Where there might once have been dedicated pediatric units, now there are a handful of rooms used for pediatric patients when they need in-hospital care, but not much in the way of dedicated spaces.

If you happen to be in a position in which your dedicated pedi spaces are not quite as dedicated as they once were, you might find it useful to perform a little risk assessment based on a toolkit provided by the University of California, San Francisco, and endorsed by a couple of professional groups. While the focus is more towards the home environment, I think it’s helpful to simply ask the questions and be able to rule out the concerns outlined in the toolkit. Any time you have to “run” with an environment that has to function for different patients, risk factors, etc., it never hurts to be able to pull a risk assessment out of your back pocket when a surveyor starts jumping ugly because they don’t agree with what they’re seeing or how you’re managing something.

The National Center for Missing & Exploited Children used to provide some risk assessment guidance for healthcare professionals, but in looking at their website, it appears to me that they are confining guidance to law enforcement, media, and families. (Some of the stuff for families is interesting and worth sharing in general.) Since they’re an at-risk patient population, you never know when your efforts to provide an appropriate environment for infants, children, and teens will come under survey scrutiny—and it never hurts to periodically review your efforts to ensure that your plan is current.

Reefing a sail at the edge of the world…

What to do, what to do, what to do…

A couple of CMS-related items for your consideration this week, both of which appear to be rather user-friendly toward accredited organizations. (Why do I have this nagging feeling that this is going to result in some sort of ugly backlash for hospitals?)

Back in May, we discussed the plans CMS had for requiring accreditation organizations (AOs) to make survey results public, and it appears that, upon what I can only imagine was intense review and consideration, the CMS-ers have elected to pull back from that strategy. The decision, according to news sources, is based on the sum and substance of a portion of Section 1865 of the Social Security Act, which states:

(b) The Secretary may not disclose any accreditation survey (other than a survey with respect to a home health agency) made and released to the Secretary by the American Osteopathic Association or any other national accreditation body, of an entity accredited by such body, except that the Secretary may disclose such a survey and information related to such a survey to the extent such survey and information relate to an enforcement action taken by the Secretary.

So, that pretty much brings that whole thing to a screeching halt—nice work of whoever tracked that one down. Every once in a while, law and statute work in favor of the little folk. So, we Lilliputians salute whomever tracked that one down—woohoo!

In other CMS news, the Feds issued a clarification relative to the annual inspection of smoke barrier doors (turns out the LSC does not specifically require this for smoke doors in healthcare occupancies) as well as delaying the drop-dead date for initial compliance with the requirements relating to the annual inspection of fire doors. January 1, 2018 is the new date. If you haven’t gotten around to completing the fire door inspection, I would heartily recommend you do so as soon as you can—more on that in a moment. So, good news on two fed fronts—it’s almost like Christmas in August! But I do have a couple of caveats…

I am aware of 2017 surveys since July in which findings were issued because the inspection process had not been completed, and, based on past knowledge, etc., it is unlikely that those findings would be “removable” based on the extended initial compliance date. (CMS strongly indicates that once a survey finding is issued in a report, the finding should stay, even if there was compliance at the time of survey.) So hopefully this will not cause too much heartburn for folks.

The other piece of this is performance element #2 under the first standard in the Life Safety chapter. (This performance element is not based on anything specifically required by the LSC or the Conditions of Participation—yet another instance of our Chicagoan friends increasing the degree of difficulty for ensuring compliance without having a whole mess of statutory support, but I digress.) The requirement therein is for organizations to perform a building assessment to determine compliance with the Life Safety chapter—and this is very, very important—in time frames defined by the hospital. I will freely admit that this one didn’t really jump out at me until recently, and my best advice is to get going with defining the time frame for doing those building assessments; it kind of “smells” like a combination of a Building Maintenance Program (BMP) and Focused Standards Assessment (FSA), so this might not be that big a deal, though I think I would encourage you to make very sure that you clearly indicate the completion of this process, even if you are using the FSA process as the framework for doing so. In fact, that might be one way to go about it—the building assessment to determine compliance with the Life Safety chapter will be completed as a function of the annual FSA process. I can’t imagine that TJC would “buy” anything less than a triennial frequency, but the performance element does not specify, so maybe, just maybe…

But I got the crystal ball, he said!

And he held it to the light…

In their (seemingly) never-ending quest to remain something (I’m not quite sure what that something might be, but I suspect it has to do with continuing bouts of hot water and CMS), our friends in Chicago are working towards modifying the process/documentation for providing post-survey Evidence of Standards Compliance (for the remainder of this piece, I will refer to the acronymically inclined ESC). The aim of the changes is to “help organizations focus on detailing the critical aspects of corrective actions take to resolve” deficiencies identified during survey. Previously, the queries included for appropriate ESC submittals revolved around the following: identifying who was ultimately responsible for the corrective action(s); what actions were completed to correct the finding(s); when the corrective actions were completed; and, how will you sustain compliance (that is, as they say, the sticky wicket, to be sure).

The future state will be (more or less) an expansion of those concerns, as well as including extra-special consideration for those findings identified as higher-risk Requirements For Improvement (RFIs) based on their “position” in the matrix thingy in your final report (findings that show up in the dark orange and red areas of the matrix). The changes are roughly characterized as delving “deeper into the specifics” of the original gang of four elements, so now we have the following: assigning accountability by indicating who is ultimately responsible for corrective action and sustained compliance (not a big change for that one); assigning accountability for leadership involvement (only for the high-risk findings—whew!) by indicating which member(s) of leadership support future compliance; corrective actions for the findings of noncompliance—this will combine the “what you did” with the “when you finished it”; for high-risk findings, you will also have to provide information on the corrective actions as a function of preventative analysis (this sounds like a big ol’ pain in the rumpus room, don’t it?); and , finally, an accounting of how you will ensure sustained compliance, which will have to include monitoring activities (including frequency), the type of data to be collected from the monitoring activities, and how, and to whom, the data will be reported.

In the past, there was always the lurking (almost ghoulish) presence of what’s going to happen if you have repeat findings from survey to survey, and this new process sounds like it might be paving the way for more obstreperous future survey outcomes. But I’d like to know a little bit more about what might be considered a repeat finding—does it have to be the same condition in the same place or is it enough to get cited for the same standard/performance element combo. If the former is the case, then I “get” them being a little more fussy about the process (in full recognition that every organization has some repeat-offender tendencies), but if it’s the latter, then (insert deity of choice) help us all, ‘cause it’s probably going to get more ugly before we see improvement. Or maybe it will just be repeats in the high-risk zone of the matrix—I think that’s also pretty reasonable, though I do think they (the Chicagoans) could do a little better in ensuring consistent approaches/interpretations, particularly when it comes to ligature risks.

All that said, I stand on my thought (and let me tell you, that’s not an easy task) that there are no perfect buildings, no perfect physical environments, etc., and that’s pretty much supported by what I’ve seen being cited during surveys—the rough edges are where the greatest number of findings can be generated. And since they only have to find one instance of any condition in order to generate an RFI, the numbers are not in favor of the folks who have to maintain the physical environment. If you’re interested in the official notice, the links below will take you the announcement article, as well as a delightful graphic presentation—oh boy!

Show up or shut up

Every once in a while (and I don’t think I abuse this privilege, but please feel free to disabuse me of that notion), I like to vent a little regarding those annoyances that can impact how the folks in the safety world carry out their duties. In this particular instance, I’d like to rant a bit about those members of the “safety committee” that seem only to attend meetings when there is an opportunity to stonewall/derail/obstruct, etc., the ongoing work of the committee.

Lately it seems a lot of folks are struggling to bring their active shooter response plans past the initial stages and move into the implementation phase. That struggle inevitably seems to revolve around those transient members that always seem to know when you’re committee is just about to “birth” a new policy or process and they glide into the action with reservations/objections/all manner of constipations to set things back, without having participated in the work leading up to that point.

In my heart of hearts, I know that this is not very collegial behavior, but the question I have for the community is: How are you managing these occasions? My philosophy (which can be sorely tested from time to time) is that you have to birth the policy before you can tell for sure how well it will (or won’t) work when you operationalize it. I guess the analog to that is that it is better to have a flawed policy that you can work to improve than it is to have no policy at all, particularly to manage critical functions or risks. It is very, very difficult (certainly bordering on impossible) to come up with perfection without doing some trialing in the real world (maybe it’s possible, but I can honestly say I’ve never encountered it). I suspect this has happened to many (if not most, and probably all) safety professionals. Anybody have any inventive solutions for organizational blockages? Please sing out—let the world in on your secret!

Mirror, mirror on the wall … is that me?

One of the curious things I encounter on an increasingly regular basis is the Dorian Gray-like (but in reverse) effect of the ID badges of folks who’ve worked at an organization for a rather long time. So long, in fact, that they really don’t look like their ID pictures any more. I know you’ve seen it too.

Now, I’ve always considered the hassle of having folks wear ID badges as being an important component of our security management strategies. As a general consideration, we do have an obligation to ensure that we’re not giving any interlopers a chance of breaching our security (and don’t get me started on those folks who are not nearly as careful about their ID badges as they should be. I know it makes me sound petulant, but we really ask so little of folks in this regard).

So, I ask those of you responsible for the ID process, have you established criteria for an update of photo IDs? Weight loss or gain, hair color changes, the aging process (all potentially contentious topics for discussion)? Or, like the motor vehicle registry folks, do you re-take pictures after a certain amount of time, maybe contingent on how much a person has changed in the ensuing period. Any feedback or discussion would be most appreciated.