Designing secure facilities for the health care field

The Smith File

CV

• President and lead consultant at Healthcare Security Consultants Inc., Chapel Hill, N.C.
• Former director of hospital police and transportation at University of North Carolina Healthcare System, Chapel Hill, N.C.
• Former director of public safety and assistant director of public safety at Hurley Medical Center, Flint, Mich.
• Former director of security at Saginaw (Mich.) Osteopathic Hospital.

Professional activities

• Current International Association for Healthcare Security and Safety (IAHSS) council on guidelines member.
• Chair of IAHSS health care security design guidelines task force (first and third editions).
• Current IAHSS Foundation member.
• Current ASIS International health care security council member.
• Past member of Facility Guidelines Institute Health Guidelines Revision Committee.
• Past president and board member of IAHSS.
• Past president and current member of Southeastern Safety Security Healthcare Council board.

Education

• IAHSS Certified Healthcare Protection Administrator.
• ASIS International Certified Protection Professional.
• Bachelor of science degree in security administration and law enforcement from Northern Michigan University, Marquette.

Thomas A. Smith, CHPA, CPP, spearheaded the latest edition of the International Association for Healthcare Security and Safety (IAHSS) Security Design Guidelines for Healthcare Facilities, produced in collaboration with the American Society for Health Care Engineering (ASHE). This month, he talks about the publication.

How did the IAHSS Security Design Guidelines for Healthcare Facilities (SDGHF) first come about? 

I have worked in a variety of health care facility types, including a small urban hospital, large inner-city trauma center and a multi-hospital university health care system. Additionally, I started working for Healthcare Security Consultants Inc. in 2001 and purchased the company in 2014. These experiences provided me with a unique opportunity to experience large and small-scale construction and renovation projects and my share of security design failures. 

While working at UNC Health, the planning and design office asked for security-specific input for a hospital project that was in design. To prepare, I scoured references but found few health care-specific security design documents. Beyond that, I felt unprepared to navigate the design process and was, therefore, less able to advocate for the recommended security elements. This became particularly clear when the value-engineering efforts of the project began. 

This experience helped me develop an understanding of the wide gap of knowledge in available information on health care security design elements. Most security leaders did not have an in-depth understanding of the design process, while architects and design professionals did not fully understand crime prevention through environmental design (CPTED) and other leading security principles. 

At that time, I was serving on the IAHSS council on guidelines (CoG). With this experience top of mind, the innovative idea of creating security design guidelines for health care facilities was presented to the CoG. The rest is history. The project was funded by the IAHSS Foundation, and a new taskforce was created to develop the SDGHF. 

What is the process for the Security Design Guidelines for Healthcare Facilities? 

The first edition of the SDGHF was developed in 2012 by the IAHSS CoG and funded by the International Healthcare Security and Safety Foundation. These two groups approved and supported the work of a health care security design task force composed of experts with experience in various aspects of design and development of health care facility security programs. The task force membership included protection professionals with extensive expertise in planning, design and construction; health care security management; physical and electronic security; CPTED; regulatory compliance; emergency management; and health care physical plant management. 

The group included international representation to help make the guidelines applicable outside the United States. This original version was used to provide content to the 2014 Facilities Guidelines Institute (FGI) Guidelines for Design and Construction of Healthcare Facilities, the Center for Health Design, and other accrediting bodies and governmental entities interested in smart and effective health care designs that improve safety and security through the built environment.

The second edition of SDGHF was updated in 2016 and was again used to develop content related to security design in the 2018 FGI Guidelines. The 2016 document included updates on the design of interview and exam rooms, decontamination spaces, both emergency department (ED) and behavioral/mental health treatment areas, and included a review of relevant sections by the Emergency Nurses Association. Consistency between the documents was addressed by virtue of having two members of the IAHSS design guidelines task force also serving as members of the FGI Health Guidelines Revision Committee.

How is the new edition different from previous editions? 

This third edition of the SDGHF was developed in 2020 using the original methodology established for the first edition that included the expertise of a multidisciplinary team of subject matter experts to update the existing document and develop new guidance for emerging areas within the health care environment. 

The new edition places considerable attention in its updated guidance to help prevent violence in health care using the built environment. Specific emphasis was placed on the design of high-risk patient and observation rooms that may be used for disruptive or aggressive patients, those at risk for elopement and forensic (prisoner) patient treatment. 

New guidance was created for the locked emergency psychiatric section of the ED, also referred to as the “crisis intake center.” Additionally, new guidance was developed for off-campus areas within the health care environment, including standalone EDs and behavioral health patient care settings as well as urgent care and surgical care facilities. The glossary of terms was also expanded. 

What issues are addressed in the new section on long-term care (LTC)?

A new chapter was created for residential LTC facilities that addresses securing the various settings that may be used in providing residential care. Design features for residential LTC facilities can be particularly challenging due to the risk of resident wandering, elopement, and resident-on-resident and resident-on-staff violence. Resident mental acuity can be variable because of several factors. 

Maintaining residents’ privacy and dignity while addressing the potential risks is the challenge. The residential LTC design guideline identifies features that can reduce the likelihood of these events. As with all design projects, identifying designs that promote appropriate security features begins with a security vulnerability assessment led by a qualified health care security professional. 

What are some of the issues discussed in the section on outpatient care?

Specific design features for outpatient care areas are dispersed throughout the guidelines. These elements are found in the chapters on buildings and the internal environment, pharmacies, cashiers and cash-collection areas and, of course, EDs. 

What role has ASHE played in the development of the new edition?

We were fortunate to have Chad Beebe, ASHE’s deputy executive director, join the task force. Chad brought a great depth of knowledge to the team with his experience with regulatory agencies, and standards and guidelines development. He also helped us leverage the ASHE network for specific questions such as door hardware descriptions and ligature risks, to name just a couple. The publication is cobranded by the IAHSS and ASHE and is for sale on the websites of both organizations. The link to the ASHE page is ashe.org/security-design-guidelines.