Hospital design experts Christina Grimes and Sarah Markovitz explain how caregiver environments can balance the need to maintain a welcoming environment while protecting staff and patients from the recent uptick of violence at healthcare facilities.
Safety in healthcare settings has always been a top priority, whether to protect against infection, occupational injury, or attacks against staff. Unfortunately, it is this last item—violence against healthcare workers—that requires renewed emphasis.
That is because violence against healthcare employees has markedly increased since the onset of the pandemic. The American Hospital Association (AHA) reports that healthcare workers suffer more workplace injuries because of violence than any other profession. The industry group also says that 44% of nurses report an increase in physical violence since the pandemic and 68% report an increase in verbal abuse.
While safety and security are of utmost importance, healthcare environments must also create a welcoming and restorative environment for patients and caregivers. Here, we discuss design solutions that balance both requirements.
Keep Facilities Welcoming By Making Security Invisible
The ground floor is the first bastion of safety, with security that can range from more obvious (metal detectors) to less so (guards who serve as “ambassadors”). Because an overly aggressive security presence can be off-putting to patients and visitors, aim instead for measures that are “invisible.”
For example, upon entry, a welcoming yet secure check-in area provides an additional layer of safety. At Loma Linda University Medical Center in California, a unique entry experience featuring a series of dramatic outdoor archways leads to a shallow lobby and reception, creating a single controlled access point while creating a warm, beautiful first impression. Taking this idea one step further, a design that requires all visitors to flow through the ground floor with a security presence without allowing direct access from parking levels to patient care floors, or reducing the number of entry and egress points, also helps limit the flow of people into the building—though this is more difficult to execute in larger hospitals or on a sprawling campus.
Taking cues from behavioral health, where safety infrastructure is embedded in the environment in subtle ways, is another way to design safer healthcare settings. Elements like double action door hinges which are barely noticeable but ensure rooms are barricade proof, and panic buttons or on-person technology—in addition to or instead of wall-mounted technology—can be inconspicuously incorporated into the design while giving staff peace of mind that they can always call for help.
Finally, technologies such as Real-Time Location System passes or badges deployed upon entry benefit patients and families by providing information like when a loved one has come out of surgery, while also enabling organizations to track every occupant of the hospital at any given time. Similar tracking devices worn by staff can be tied to patients’ Smart TV’s, notifying them of who has entered their room while also being able to quickly locate staff who need assistance. Lastly, leveraging predictive analytics to better track behavior and predict instances of violence is another under-the-radar way to keep employees safe.
Maintain Security By Utilizing Separate, Flexible Spaces
As mentioned above, emergency departments (EDs) are often best equipped to handle unexpected circumstances such as an aggressive individual or someone under the influence of drugs or alcohol. However, additional measures can be taken to ensure the safety of providers—and the patients waiting to be seen.
Multiple, separated waiting rooms can keep escalated patients apart in situations involving gang violence or similar scenarios, while larger ED bays that can scale up or down in acuity offer flexibility to accommodate a variety of circumstances. For example, Loma Linda features two separate emergency departments—one for adults and one for children—that can share suites and imaging to adapt to scenarios from a mass casualty event to an environmental disaster such as an earthquake, and its ambulance bays are screened so that people outside on the street or in the nearby parking garage cannot see them.
Focus on Staff Protection For Patient Floors
As opposed to ambulatory clinics, inpatient settings often benefit from security at the ground floor upon entry. Therefore, safety in these settings should focus on measures to protect staff if an unauthorized or agitated individual accesses the patient floors.
A reception or control desk at the entry to the unit with both the ability to visualize those arriving on the floor and to lock down entry into the floor’s patient care areas can serve as a first line of defense. Medication rooms fitted with bulletproof glass and two exit doors can function as a safe room for staff, as can staff lounges or locker rooms. And incorporating technology for remote visits and reducing visitor hours limits the number of people on the floor and in rooms, creating a safer environment—though virtual visits do not replace the valuable role that in-person interaction plays in a patient’s recovery.
Make It Easy To Leave The Facility
Outpatient settings such as ambulatory clinics typically have fewer security features than hospitals or emergency departments. Yet as outpatient care continues to grow, the safety of ambulatory care facilities is increasingly called into question. For safer ambulatory care settings, focus on design interventions that enable providers—and patients—to escape from dangerous situations quickly.
Traditional exam rooms can position providers in the back corner, with limited entry and exit points and the patient located between the door and the workstation. Newer models that place providers close to the door, or double-sided exam rooms with a work core in the center—allowing patients and caregivers to exit the room more quickly—can be considered as an alternative. The design of the room and the location of the caregiver and patient zones is also important; for example, placing the computer at the head of the bed makes it difficult to maneuver quickly in the case of an emergency.
Finally, having a “back of house” or staff offstage area that can be secured offers another alternative for team members to escape, and hallways and corridors designed with no dead ends or loops ensure that once someone has exited the exam room, they are able to leave the building entirely.
Safety for caregivers is a difficult, yet crucial, topic to address. While the Covid-19 pandemic highlighted the immense stressors that caregivers face, staff safety deserves increased attention beyond pandemic measures, and it is important to highlight their well-being—a crucial element of which is feeling safe in the workplace. Designs that prioritize staff security while also creating comfortable, healing spaces contribute to an inherently healthier environment for all.
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