Violent incidents in healthcare facilities are rapidly increasing. That’s why including security elements into the design of healthcare facilities is top of mind for Brendan Riley, MS, CHPA, the director of security, parking, and transportation at Lahey Hospital & Medical Center in Burlington, Massachusetts, a part of the Beth Israel Lahey Health system.

Facilities managers and security professionals must build safeguards into the design of healthcare buildings to thwart threats and violence within facilities. Whether it be hospitals, behavioral and mental health facilities, medical-surgical units, emergency rooms, or other types of healthcare facilities, facilities managers must incorporate security elements in new construction and when renovating existing buildings.

“What we’re seeing [is a] record volume and severity of violent events towards caregivers,” Riley said.

In fact, healthcare workers “are five times more likely to be a victim of an aggravated assault,” and 70% of aggravated assaults in the workplace are happening in the healthcare industry, wrote Paul Sarnese, MSE, MAS, CHPA, CAPM, owner of Secured & Prepared Consulting, and former assistant VP of Safety, Security, and Emergency Preparedness for Virtua Health, in a previous Facilities Management Advisor article.

“[T]he overwhelming majority of those acts are patient- or visitor-generated, so that needs to be front of our mind when it comes to how we implement engineering and administrative controls,” Riley said.

Facilities Management Advisor talked with Riley who suggested ways facilities managers can secure healthcare buildings, especially as they are working on renovating or building new facilities.

Riley has also served as a security and workplace violence prevention manager at Lowell General Hospital, in Lowell, Massachusetts, and is a workplace violence prevention subject matter expert for the International Association for Healthcare Security and Safety (IAHSS).

Security Design Prevents Threats

Riley explained that in the past facilities managers used to develop building plans without security features front of mind.

“I remember in my early career where very often these plans would already be developed; the budget had been finalized and approved without any of the security features being included and no representation from security leadership in that process.”

“Fortunately, we’ve evolved quite a bit over the years, and public safety and security at most organizations is an important member of that team early on with the opportunity to bake in the security features right up front before you get too deep into your project,” Riley said.

He continued, “I think a lot of facilities leaders are well-educated now on crime prevention through environmental design, including those features where applicable.”

Environmental design for security considers environmental factors when developing plans for buildings and using that design for crime prevention, according to the International Crime Prevention Through Environmental Design Association (ICA).

“I think it’s even more important than ever to have the public safety and security people and your clinical leadership weighing in when a patient care area is renovated or designed to ensure that everyone’s being thoughtful … how the rooms are designed,” Riley said.

A Deeper Dive into Security Design

When planning security design, the biggest area of concern in hospital organizations is access. Where and what should visitors have access to? Riley has several recommendations about the issue of access to help decrease incidents:

Access Control

Healthcare organizations need to decide whether they want spaces to be accessible during the daytime and only secure access in the evenings and overnight or have 24/7 secure access so that security will have to vet and approve access to all visitors.

“Historically, you might have layers of protection on your front end, but once you’re in the hospital, one could typically roam freely and walk in a different unit.”

“But having access control through security systems in place, it strikes an appropriate balance,” Riley said.

While this security is usually part of the plan for new facilities, he said that “for a lot of aging buildings, there’s been a lot of investment of money, time, and equipment to make sure that … inpatient units have effective access control systems.”

For example, Riley said when Lahey added access control systems to all inpatient units, there was a significant improvement noted in employee engagement surveys about increased safety, specifically with registered nurses, as opposed to survey results before the security increase.

“We never really had a high volume of unwanted visitors coming in and doing harm, but it was more that risk being ever present, and I think the psychological impact that it had on caregivers was substantial,” Riley said.

He added that these units previously did not have secure doors and “were very easily accessible to anyone who entered the facility.”

Today, he explained that staff feel more empowered and that they have more control over who’s coming and going from their units in their facility.

“I think it not only created a better perception of safety, but it’s making these units safer,” said Riley.

For healthcare facilities in high-crime areas, it is especially important to prohibit visitors who have a history of risky behaviors or threats and provide a layer of secure doors to prevent them from accessing inpatient units.

When asked what kind of security Riley has seen at healthcare facilities in high crime areas and those located in cities versus rural healthcare, he explained it includes “multiple layers of physical security, people at the front end, often weapons detection systems in place at entry points and usually robust visitor management systems.”

To learn more about implementing a visitor management system, read “How a Visitor Management System Can Solve Facility Problems,” on Facilities Management Advisor.

Access to Objects

It is not only important to limit access to visitors to protect caregivers from violent assaults, but also to control what objects visitors can access. For example, healthcare equipment can be turned into weapons.

“We’re looking to prevent items that could easily be weaponized for blunt force drama or thrown objects, and I think that needs to be how we continue to evolve with our focus nowadays,” Riley said.

This includes limiting visitor access to heavy items like oxygen tanks.

“I think when it comes to protecting caregivers, [and] creating barriers, particularly when they’re vulnerable—if someone’s documenting, and they’re focused on their computer— we want to eliminate the opportunity that anybody might be able to come up unexpectedly from behind,” Riley said.

Riley also recommends that facilities managers ensure that caregivers always have access to an exit so they cannot be cornered in a room, “making sure we’re thoughtful” about designed space.

Additionally, facilities and security professionals should check out “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers” on the Occupational Safety and Health Administration (OSHA) website.

Consistency Is Key

Riley said it is also important to provide adequate security precautions in ambulatory settings, such as doctor’s offices, clinics, and other facilities where there are no physical security personnel.

Especially in those situations, he recommends facilities professionals follow the latest IAHSS security design guidelines when renovating and building new healthcare facilities.

He said that the guidelines are particularly focused on inpatient and emergency department environments, as well as behavioral health environments, pharmacy areas, infant and child units, and areas where money is exchanged in a healthcare facility.

Riley said one thing that could be improved in the guidelines is a blueprint.

“I think the biggest opportunity right now is for consistency. The more we can be consistent of how we design … is a big opportunity area. I think systems are independently coming up with their own standardization. I’m interested in seeing when we bring together the top thought leaders in this space, and they come up with a guideline—I’m interested to see how we compare what we’ve been doing.”

He added, “There’s a lot of work to catch up on because there’s so much variation when you go from office to clinic settings across the footprint of a large health system. So, there’s going to continue to be that opportunity to standardize.”

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