Healthcare workers accounted for 73 percent of all nonfatal workplace injuries resulting from violence in 2018, an increase of 86 percent from just seven years prior. This rising rate of violence—combined with the fact that healthcare workers are five times more likely to suffer such an injury—underscores the importance of designing health facilities with an emphasis on safety.

Hospital staff are vital to the care process, and labor costs to recruit, retain, and incentivize workers account for more than 50 percent of hospitals’ total expenses. Ensuring a safe workspace for staff is vital to retention, which will help mitigate the toll of workforce shortages and the expenses of retraining and attracting new staff. Meanwhile, the patient experience over the past 15 years has evolved tremendously, transitioning from sterile environments to spaces that provide comfort and facilitate healing—gains the industry does not want to lose.

The question becomes: How do designers create spaces in which staff feel safe, comfortable, and positioned to work at the top of their licenses—all without compromises to patient experience?

Thankfully, behavioral health design principles and strategies can provide a roadmap for safety success that can be applied to a wide range of service lines. The fundamental challenge in behavioral health design is the need for a homelike, healing, and calming environment that doesn’t compromise on safety. These design strategies, when combined with more conventional security design measures that are not exclusive to behavioral health, offer a compelling start to protecting patients and staff.

Managing healthcare facility entry points

Let’s begin at the front door. When planning a behavioral health facility, chief to facilitating security and safety is specifying the appropriate number of entry points and managing those entries. This principle can extend to non-behavioral building design, where the best practice is that everyone uses the same main entrance.

One entry point near a security hub simplifies a health system’s ability to screen individuals for weapons and encourages staff to be more enmeshed with the patient community. Additionally, a single entry sets the stage for weapons screening, reducing the cost of installing multiple screening areas across several facility entries and minimizing opportunities to bypass this process before entering into a facility.

While weapons screening has been routine for some time in behavioral health settings, the practice is now entering the mainstream. There are several systems on the marketplace that provide detection systems similar to those used at public event venues. These systems are low profile and don’t require entrants to empty their pockets or handbags, while providing an additional security measure for patients, visitors, and staff members.

Consider door placement and egress

A prime consideration in behavioral health design is staff circulation and placement versus that of the patient. This entails carefully mapping out zones in rooms so that staff are closest to a door. Two means of egress and layers of protection are paramount to enable staff and patient recourse during a potentially violent event.

While this is common in behavioral health design, users can see this principle in action elsewhere such as emergency department triage rooms. By providing two doors, one to the main corridor and another exiting to a back corridor, staff can quickly leave a space in the event they feel threatened, enhancing safety. Additionally, equipping one exit area with a card reader ensures that the door locks behind staff after they leave.

Strategic door placement is also a consideration in registration areas. A large desk within a registration area can be positioned with a backup door directly behind, giving staff a means to either escape an enclosed zone or barricade themselves within an adjoined area.

Alternately, placing staff workstations near the door to an adjoining corridor or offstage area is another means to enhance safety. Used primarily in exam rooms, where two doors are not common unless using an onstage/offstage model, this tactic positions staff to get out of an area quickly and easily. The strategic layout places examination equipment and seating further into the room, providing more space between the staff workstation and patients and families, which can ease escape if required.

Maintaining visibility to enhance staff protection

An inexpensive and straightforward strategy for enhancing staff protection is specifying the appropriate door-swing direction. In behavioral health patient rooms, doors must swing out so that patients cannot barricade themselves inside. Paired with thoughtful room layout, this guideline also minimizes blind spots in the room, mitigating any unwanted surprises for staff.

In other healthcare spaces, designers can create rooms that block dead corners with casework, furniture, or equipment and nest toilets to enhance visibility. Another option is to utilize sliding doors to prevent an agitated visitor or patient from barricading staff behind a door or weaponizing the door upon swinging open.

Behavioral health design principles also guide designers in optimizing visibility and shaping rooms for maximum safety. Doors with glazing allow staff to see into rooms, enabling a visual connection to keep them alert of patients’ activity and well-being. Communal rooms also benefit from door glazing, allowing staff to position themselves within view of coworkers walking the halls outside.

Workstation and panic room design

Adopting behavioral health principles in the design and layout of front desks, security desks, or nurse stations can also enhance safety by providing appropriate distance between staff and patients. For example, a deep desk keeps staff beyond an arm’s reach, reducing the risk posed by aggressive patients. This subtle design touch requires more millwork but is so effective that patients often do not even realize its intent.

Increasing rates of gun violence are an unfortunate reality that designers and health systems must also address. Improving the ability of patients and staff to find safety in the event of an active shooter or other violent event requires a keen awareness of possible escape routes, breach points to secure zones, and where staff might be located at that time.

Heatmapping a floorplan is one method to this end, allowing designers to determine optimal locations and quantity of safe rooms per floor and department. Once the quantity and location are determined, design considerations for panic rooms can include a reinforced door and walls, two means of egress, and locating it within an interior room.

Healthcare security measures

Designing for safety is paramount in a time where burnout is affecting 33 percent of hospital nurses, health systems nationwide contend with staff shortages, and incidents of workplace violence on healthcare workers continue to grow.

Behavioral health design principles offer a meaningful starting point—and when applied in combination with robust security design measures—a path to proper protection takes shape.

Lindsey Stang, AIA, GGP, is a planning practice leader at Array Architects (Conshohocken, Pa.) and can be reached at Elizabeth Schmitt is a healthcare planner at Array Architects (Conshohocken) and can be reached at