Welcoming and safe children’s health facilities

Security and safety incidents are occurring in healthcare environments with increasing frequency and severity. Recent statistics show that healthcare workers in the United States are five times more likely to experience violence than non-healthcare workers. Even more concerning is the prevalence of security incidents in maternity and paediatric environments. In 2022, paediatrics ranked third among the most dangerous units for US healthcare workers, with 84% of staff experiencing violence at work, according to Children’s Hospital Association (an organisation of children’s hospitals with over 200 members in the US, Australia, Canada, Italy, Mexico, and Puerto Rico).

A more vulnerable patient population

Paediatrics represents a more vulnerable patient population that faces a range of security and safety threats — such as abductions, elopement, domestic disputes, mental health and self-harm, and active shooter incidents. In the face of disease complexity, poor clinical outcomes, or patient deaths, care providers are at higher risk of targeted aggression and anger. Hospitals are struggling to adapt to these growing threats while grappling with historic staffing shortages. The need for more inherently secure healthcare environments has never been greater.

On the other hand, patients, families, and staff, have come to expect a warm, welcoming hospital experience filled with hospitality-based features — including bright, open, and spacious lobbies; lively cafés and dining areas that may be publicly accessible; family lounges and sibling play areas; family and community resource centres, and outdoor healing gardens and wellness trails. Healthcare facilities — and particularly children’s hospitals, are increasingly seeking to expand their mission to better serve their communities through wellness and education programmes, food pantries and healthy eating options, on-site childcare, and other social services. Obvious and overt security measures like metal detectors, security fences, and heavy patrolling presence, can be intimidating and off-putting.

As physical and psychosocial barriers to health and well-being are broken down, there is a need to think more holistically and creatively to ensure safeness in a paediatric environment, without compromising the sense of warmth and welcome. Here are eight planning and design strategies to consider when enhancing safety and security on the hospital campus.

1: Specify security philosophy

Embracing a culture of safety, and maintaining heightened risk awareness throughout planning and design, lead to a more comprehensive, integrated, and effective security plan. Too often, security planning is deferred to the end stages of design, and strategies are limited to camera placement, card readers, and security desks. Engaging a multidisciplinary stakeholder team early in the planning and programming process encourages a more thorough, integrated, and layered approach to security. Ideally, these conversations involve a variety of perspectives — including those of the hospital’s Planning, design and construction team, Security team, registration and front desk personnel, frontline staff and clinicians, and even family advisory members. It’s important to develop a security philosophy early in the design process. The most effective security plan takes an integrated approach that layers design strategies, physical security measures, technology, and training and protocols.

2: Establish campus boundaries

Security measures begin well before arriving at the hospital’s front door. Best practice considers the entire hospital campus, including edges, parking structures and lots, walkways and paths, and all building entrances. Factor in the urban or suburban context of the campus, as boundaries and functional zones are defined on site.

It is necessary to determine how porous the campus will be, as well as the accessibility of campus amenities to different populations. Perhaps the community is welcome to enjoy the hospital’s gardens and walking trails, but indoor and outdoor dining areas are secure and only usable by screened visitors. When defining campus boundaries, consider leveraging topography or garden walls to create a visually appealing campus edge. Security fences may be softened by layering landscape design elements, such as privacy trees, shrubs, and other garden elements.

3: Separate vehicular flows

Clearly mapping and separating vehicular traffic so that the public is guided to visitor parking areas and public entrances will limit unauthorised access to service yards, loading docks, staff entrances, and ambulance drop-offs. A variety of subtle and more overt cues can be leveraged to reinforce the distinction between public and non-public parts of campus. These include signage, lighting, vegetation, hardscaping, narrowing of drives, and security gates.

4: Plan for after-hours

Hospital staff regularly change shifts in the middle of the night, so the path walked from the building to the parking area and vice versa is critically important. With the reduced number of security personnel on campus at night, lighting and well-maintained landscaping become critically important to maintaining staff safety. Parking facilities are among the most dangerous areas of any campus. Technological enhancements like parking deck automation, licence plate readers, and artificial intelligence threat detection, can enhance security in these high-risk areas.

5: Secure outdoor play areas

Paediatric environments often feature outdoor play areas that may be enjoyed by patients and siblings, and sometimes visitors from the community. Establish a clear perimeter, with controlled access and visibility. In more urban settings, elevating play areas to rooftops can be an excellent strategy to maximise safety, privacy, and access control, while also optimising vistas and views for patients and families.

6: Minimise building entry points

It is common for hospital campuses that have grown over time to have multiple public entrances. However, having too many opportunities for public entry creates more opportunities for unauthorised access to secure or sensitive areas. Where possible, limit the number of building entrances, separate public and back-of-house entries, strive to have eyes on all public points of building access, and provide the ability to lock down all entrances from a remote location.

7: Define the level of openness desired

In planning public spaces, it is essential to understand the healthcare facility’s philosophy on security and accessibility, particularly when the children’s hospital is located within, or shares, a campus with an adult hospital. Many children’s hospitals require guests to check in at a centralised security desk for a cursory background screening before accessing hospital patient care areas and inpatient floors. Some institutions, however, decide to fully restrict access to all lobbies and amenities, including play areas, resource centres, dining, and mediation spaces. Planning the spatial sequencing of lobby elements to support the hospital’s security philosophy sets the foundation for a safe and successful lobby design. Work with the security stakeholder team to determine which programme elements require security screening prior to access, and those that will be freely usable. Include public elevators, waiting areas, cafés and dining areas, gift shops, outdoor gardens and play areas, public toilets, conference centres and education spaces, and outpatient services in the conversation.

8: Prioritise situational awareness

Certain departments within the hospital — namely the Emergency Department and inpatient units, are considered higher risk for escalating aggression, violence, and other security concerns. Prioritise anti-abduction and anti-elopement risks by ensuring that staff can monitor and control access through all department entry/exit points. Care team stations that offer visibility into the patient room provide a layer of situational awareness so that staff are alerted to escalating situations inside. Desk designs should minimise staff isolation or entrapment, and they should be standardised from unit to unit with consistently located duress stations. Receiving bad news — especially about a child — is often a trigger for aggression and violence. Delivering difficult news in an intentionally designed consultation space can create a safer, more controlled process for providers and staff.

Acknowledgement

•  This article, titled ‘Caring for kids’, first appeared in 
the Spring 2024 issue of Canadian Healthcare Facilities, the official magazine of the Canadian Healthcare Engineering Society (CHES). HEJ thanks the author, CHES, and the magazine’s publisher, MediaEdge, for allowing its reproduction, in slightly edited form, here.