Frank,
Just following up on my initial thought, but our local police force has a Sargent that will come in to the office and work with the staff on developing a contingency crisis plan and he will be offering his insight at our next nurse educational meeting later this month. I will keep you updated on how the experience goes for our staff.
Having worked in both physical and technology security, practices are a particularly challenging environment to secure.
As I advised a long-time board member after a break-in, a steel door with a hardened frame is the single best investment that you can make. Because confrontations typically occur in the front end of a practice, there will be a natural choke point where you can install that door. Also select a unique, but non-remarkable phrase that can be used, even under duress, that everyone understands means quietly call 911 and lock the barrier door.
In addition to a regular locking handle, an integrated frame lock will deter anything short of an entire-frame breaching charge.
The barrier door keeps everyone on the other side of the door safe, and that is best that you can hope for in that circumstance.
The other key is to talk with your front end staff about methods to de-escalate an interchange that is becoming emotional and/or confrontational. You really don't want either of those in your practice, even if the staff member is completely correct.
