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Healthcare workers accounted for 73% of nonfatal workplace injuries caused by violence in 2018, an increase of 86% from just seven years prior. Given their five times increased likelihood to experience violent injury while in healthcare facilities, this data highlights the necessity of designing health facilities with safety in mind.
Hospital staff is an integral component of patient care and accounts for more than 50 percent of total expenses at hospitals. Retaining employees requires providing them with safe working environments that foster retention – something hospitals would prefer not to lose as the patient experience has evolved dramatically since 15 years ago, moving away from sterile environments towards environments which provide comfort and facilitate healing – gains they must not lose!
What must designers do in order to design environments in which staff feel safe, comfortable, and are empowered to work at their maximum abilities – without compromising patient experience?
Thankfully, behavioral health design principles and strategies offer a roadmap for safety success across a variety of service lines. The central challenge in behavioral health design lies in creating an environment which fosters healing while remaining safe; using behavioral health design strategies in combination with more conventional security measures provides a compelling approach to safeguarding both patients and staff alike.
At the entryway to healthcare facilities lies security and safety, so specifying and controlling entrypoints are of vital importance in planning behavioral health facilities. To maximize their security and safety, these entry points should also be managed. This principle can extend to non-behavioral building designs too – where everyone should use one main entrance.
One entry point near a security hub helps health systems streamline weapons screening for individuals entering, encouraging staff to become more integrated into patient communities and decreasing costs by eliminating multiple screening areas across several facility entrances while also decreasing opportunities to bypass this screening process.
Weapons screening has long been part of behavioral health settings, and now has gone mainstream. There are now multiple systems on the market which offer similar detection systems to public event venues; these low profile detection systems don’t require attendees to empty their pockets or handbags upon entry, offering additional security for patients, visitors, and staff members alike.
Consider Door Placement and Egress
A key consideration in behavioral health design is staff circulation vs patient placement in each room. This involves carefully mapping out zones so that staff members are closest to a doorway. Two forms of egress must also be provided so both staff members and patients have refuge should an incident escalate into violence.
Though behavioral health design often relies on this principle, users can also observe this principle at work in emergency department triage rooms. By providing two doors – one leading directly out onto a main corridor and another exiting to a back corridor – staff can quickly leave a space if they feel threatened, increasing safety. Furthermore, equipping one exit area with a card reader ensures that it automatically locks behind staff once they’ve exited.
Strategic door placement in registration areas should also be carefully considered. A large desk located within such an area should feature a secondary exit door to give staff members an avenue for escape or barricading themselves within an adjacent zone.
As another method to increase safety, placing staff workstations near an adjoining corridor or offstage area door is another effective strategy for increasing staff safety. Primarily used in exam rooms where two doors may not be prevalent due to onstage/offstage models, this tactic positions staff so they can exit quickly if required – providing more space between examination equipment and seating in the room, so patients and families have easier escape paths away from any potentially volatile situations that arise in exam rooms.
Maintaining Visibility to Strengthen Staff Protection
One cost-effective and straightforward strategy for strengthening staff protection is to establish the optimal door-swing direction for patient rooms in behavioral health settings. Doors must swing outward so patients cannot barricade themselves within. With thoughtful room layout in place, this strategy also limits blind spots within each space, eliminating unexpected surprises for staff members.
Designers of healthcare spaces should aim to create rooms that include furniture and equipment to cover dead corners and nest toilets in order to maximize visibility. Sliding doors may also help prevent visitors or patients from barricading themselves behind doors or weaponizing the doors when opening them, which increases safety for staff members as well as patients.
Behavioral health design principles also guide designers in optimizing visibility and creating rooms to ensure maximum safety. Doors with glazing enable staff to keep an eye on patients’ activity and well-being more easily, providing visual notifications about patient activity or well-being. In communal rooms too, door glazing allows staff members to see through doors into individual rooms while also being in view of coworkers walking outside in the halls.
Adopting behavioral health principles into workstation and panic room designs can improve safety by creating appropriate distance between staff and patients. A deep desk keeps staff out of arm’s reach from aggressive patients, decreasing the risk of aggressive attacks against staff. Although more millwork might be required for its installation, many patients remain unaware that its purpose has been achieved.
Gun violence is an unfortunate reality that healthcare designers and health systems must address. Improving patient and staff safety during an active shooter event requires being aware of potential exit routes, breach points to secure zones and staff locations during such an event.
Heatmapping a floorplan is one method of doing this, enabling designers to identify optimal locations and quantities of safe rooms on every floor and department. Once these parameters have been established, panic rooms must include reinforced door and walls with two means of egress as well as being located inside an interior room.
Healthcare Security Measures
Safety should always be top of mind in an age where over 33% of hospital nurses experience burnout, health systems across the nation face staff shortages, and incidents of workplace violence against healthcare workers continue to escalate.
Behavioral health design principles offer an effective starting point; when coupled with effective security design measures, the path toward proper protection becomes apparent.
