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Case Study

Centre Hospitalier la Citadelle :
Securing without restricting, a successful compromise

An existing system reaching overload, new security requirements and the addition of new sites caused the Citadelle hospital to renew and revise its access control system a few years ago. The largest medical institution in the Wallonia-Brussels region placed its trust in IDtech. A site visit several months after the system was put in service.

Banning all access is one of the simplest ways of securing the premises to be protected. But in a hospital, a public place by its very nature, with repeated comings and goings, a place where people are received and where there is a certain urgency incompatible with verification procedures that slow down movement, as much freedom as possible needs to be maintained for everybody involved: staff, patients, visitors, external service providers. However, as shown recently by certain dramatic cases in the Brussels region, the risks have evolved to a point where access control in hospitals can no longer be seen as a low priority. The managers at the Citadelle hospital in Liège have understood this. Here they share their experience in an interview conducted at the hospital. We met Monique Couture, Head of the Technical Division, and Jean Olivier, Head of the Institutional Communication Division.

What is the general principle governing access control at the hospital?

Monique Couture: "The requirements we expressed to our supplier, IDtech, were basically the following: limiting the number of people entering the hospital compared with the previous situation, closing the building completely at night, giving access to authorised personnel and managing staff working hours. Additionally, various internal areas needed to be secured when people are working alone at night in sectors that are practically deserted (labs, sterilisation etc.). The staff were keen to see arrangements that would protect their safety. Certain computer and medical installations containing sensitive or essential elements or confidential data have also been secured. Finally, certain rooms or zones are now subject to access control: the cloakrooms, to combat repeated thefts, the operating rooms, the emergency rooms etc."

What do the personnel use to gain access?

M.C.: "They have bank-card-shaped proximity badges, with no need for contact with the badge readers, printed with the person's name and photo. The badge must be worn visibly, over the work clothes. Over 5000 badges have been distributed to all authorised people, whether they be internal staff or external service providers such as suppliers, back-up technicians maintaining or inspecting equipment or lifts, warders from Lantin prison, chaplains, teachers of paediatrics, members of the Red Cross etc.
We have added a colour code to the badges, which shows whether people are nurses, doctors, technical staff, visitors etc. Patients receive an explanation of the code with their welcome brochure when they are admitted. This makes things easier, particularly for patients with reading difficulties, and improves security: if someone is here for the wrong reasons, they cannot easily pretend to be something they are not."

What is the purpose of the magnetic strip on the card?

M.C.: "It will soon be used to handle payments, in the hospital restaurant for example."

What happens if a badge is lost?

M.C.: "If a card is lost or stolen, we have a dedicated telephone line with an answering machine, which staff can use to inform us. The card is immediately deactivated, and we issue a replacement."

What typically happens when a member of staff arrives, in terms of what is recorded by the badge readers?

M.C.: "People who arrive by bus come straight to one of the staff entrances, where they must present their badge. People who arrive by car have access to the staff car park using their badge. They then come to the cloakroom, which again is only accessible using the badge. From there, they go to their department, where they clock in using a different type of reader, but still with the same badge. Access to the departments is only possible via the cloakroom, so that they are obliged to arrive in uniform.
Certain areas are monitored 24 hours a day, others only at night. During the day, all members of staff have access to almost all parts of the hospital, but after closing time access will be refused unless they have special access for a night shift. This does not concern administrative staff, for example. Each type of access is linked to the person's job function. We program the system according to the information sent us by the personnel department about the person's activities.
Whenever doors are activated by the badge readers, these events are recorded, making it possible to trace people's movements within the building. But this facility is only used if an incident occurs: we do not use this information to monitor staff. There is a strict agreement about this with the trade union. A judicial authority would have to intervene before we would reveal this information. Only the clocking-in times are sent to the heads of department.
In addition to the badge readers, many other doors without readers have a magnetic contact which tells us whether they are open or closed, and at what time they were activated. Other internal doors are closed by an electromagnet, which enables staff to leave without problems, even after the hospital is closed, but cannot be opened from outside the department.
All departures after closing time can therefore be identified, whether they are legitimate or not. Certain doors which could previously be opened from inside without a badge are now secured, preventing anyone who may have let themselves be shut in voluntarily from leaving freely. They must now leave through a door which is monitored by a watchman."

What happens if a door is opened illegitimately?

M.C.: "We have our own internal security staff. Outside normal opening hours, a guard is posted at a screen which tells him of any doors opened illegitimately anywhere in the controlled area. He can then inform his colleagues by radio or pager and send them to the location of the incident."

And in case of fire?

M.C.: "We can deactivate the whole system to enable a quick evacuation of the building."

Apart from the badges, are there any other control systems?

M.C.: "We are considering installing cameras, but this is still being studied."

Are there any other projects in this area?

M.C.: "Yes, we are equipping the Château Rouge site with timeclocks, badge readers and about a dozen magnetic contacts. At the Citadelle, extra badge readers are planned. We will soon also have a system making it possible to display on the watchman's control screen a part of the plan of the hospital, showing the location where an incident has been detected. We have made contact with IDtech with a view to beginning this project. We would also like to link the camera system to the access control screen, which would make it possible to check that the badge-holder is physically present, by comparing the image with a personnel file with a photo. This will be particularly useful for preventing car theft.
We are also thinking about a system of cheap, disposable cardboard badges, which would give access at any time but for a limited duration to certain legitimate visitors, such as young dads visiting the maternity ward, for example!"

How long has the new system been operational?

M.C.: "Since the beginning of 1999. We implemented it initially at Sainte Rosalie, and then at the Citadelle. We were able to preserve much of the existing cabling from the previous system. This saved us a lot of time and made the equipment purchase much more economical. The following new equipment was supplied by IDtech: the cabling for the extra readers, all the badge readers and the software, which is normal in a field where development is rapid and significant.
All the information is centralised at the Citadelle via computer link, even the data from Sainte Rosalie and Château Rouge."

What improvements and consequences have you noticed since the system was put in service?

M.C.: "The presence of a photo on the badge is an important bonus from the point of view of security and identifying the badge-holder. The production of the badge, including the photo, is instantaneous, which was not the case before. This frees us from the cumbersome system of temporary badges. Apart from this visible aspect, it is clear that a whole series of attempted intrusions has been avoided, but we will never know about them. Finally, thefts from the cloakroom have fallen sharply."

Jean Olivier: "Another bonus is that the badge and the photo are a unifying element, facilitating communication between staff members, who are so numerous that they can never all know each other by name. Apart from any security concerns, this sign of belonging is a positive contribution to our daily professional life."

(Interview by Patrick Bartholomé)

Monique Couture, engineer, Head of the Technical Division, responsible in particular for supervising the internal security service and wider security issues.

Jean Olivier, Head of the Institutional Communication Division.

The Citadelle: a little town in the heart of the city

The Citadelle regional hospital is a shared facility serving 16 municipalities and bringing together a certain number of financial and medical institutions. The Citadelle, built on a plateau overlooking the Meuse valley, owes its name to the abandoned military fortification which was its predecessor on this magnificent spot. The Liège hospital institution, the largest in the Wallonia-Brussels region, currently includes four sites: the Citadelle itself and the Château Rouge, Val d'Or and Sainte Rosalie sites located in the town.
Altogether, the hospital offers 1,043 beds, admits 39,000 patients a year, is the scene every year of 2,000 births, treats on average over 200 emergencies a day, and is the workplace of 3,000 people. To this is added a flow of about 6,500 visitors a day and large numbers of supplier visits.

3,500 IDtech badges are used in the hospital, activating 10 timeclocks and 60 badge readers. Over a hundred magnetic door contacts operate in the hospital.