Architects and planners are instrumental to the security of any healthcare organization that is contemplating expansion, replacement, or renovation. Healthcare administrators primarily see security as an expense that is a necessary evil, a cost of doing business. To some degree, I can sympathize with this opinion, as it is difficult, if not impossible, to document the competitive advantage of security. That does not mean there is no advantage. Unfortunately, many healthcare organizations that have seen the light have done so reluctantly, and only after experiencing a catastrophic event; they have learned the hard way that it is better to be proactive than reactive.

This article is a glimpse at some of the big-picture items that an architect should consider to become proactive in security planning.

What Is a Security Program?

It is important to illustrate the basic strategies of a security program so that architects and planners can incorporate them in the overall design program. Any security program consists of the “Three Ds”: deterrence, delay, and detection.

Deterrence presents potential offenders with a greater perceived possibility of being caught. We all evaluate activities and weigh the potential reward against the risk. An executive for a Fortune 100 company probably would not be willing to steal $5,000 from petty cash—the risk to his job, career, family, etc., outweighs the potential reward.

Unfortunately, we cannot deter the determined criminal. But we can delay his bad acts by denying easy access to the building by interposing layers of operational, technical, and physical security, thereby interrupting progress until the last D—detection—can occur. The longer we can delay an individual from committing the criminal act, the longer we have to detect and respond to the incident. In essence, we make time our ally in minimizing the risk of a security breach. This philosophy is graphically represented in the figure.

Implementation and the Design Programming Process

Now that we know what we want from security, how do we get there? Before we delve into the world of countermeasures, let's look at a few spatial considerations encountered early in the design programming process that can affect security.

With regard to new construction, before we can implement methods to deter, delay, and detect, we need to build an infrastructure that will support the operational and technological components of the on-site security program. The reality is that security typically accounts for 1% or less of the Gross Maximum Price (GMP) of a new project. This means that security-oriented spatial planning is usually postponed while larger issues are dealt with. This postponement can lead to construction delays, as planners finally engaging security try to find space in a building that is already fully programmed.
Figure. A graphic representation of the “Three Ds” of a security program.

Although an effective security consultant will push for needed space early on in the project, there are no guarantees that a consultant will, in fact, be involved or have any leverage in the process. This is unfortunate, because many healthcare security organizations are very robust and healthcare administrators may not fully comprehend the spatial requirements of their own departments.

One consideration is the location where needed security systems will reside. In a healthcare organization, properly designed security systems will be distributed throughout the structure, and planners need to build space into the program accordingly—for example, providing for security closets and a control center. A modern space-conserving trend involves using a telecom room or an intermediate distributed frame (providing a riser for all cabling in the building) as a potential location for security equipment. Architects and planners should not assume, however, that the healthcare organization's information technology department will allow security equipment to be in the same room with the telecom equipment. If this assumption is wrong, this can lead to costly expenses down the road.

Another consideration for deploying unobtrusive security is making sure it is available for immediate use. Placement of the control center is important because, in a crisis, this area will be instrumental in dealing with the incident. Many organizations prefer to locate security control centers below grade and/or near the loading dock. The remoteness of such an area is appealing because it is outside normal pedestrian travel and congregation paths. However, placement near a dock could be disastrous in the event of a natural or man-made disaster because the control center could be destroyed. A better location would be toward the center of the building or near an exterior wall where vehicular traffic is not proximate. The point is to think about the unthinkable when planning mission-critical facilities.

Large healthcare organizations need to think about implementing security from a customer service standpoint when employees are involved. Employees who need to walk halfway across campus to replace their IDs are not going to be happy when they get there, and likely will complain about security and, through negativity, diminish the effectiveness of the security program. Why not design a remote area for getting badges and credentials, with specific days or times of operation, so that people will require less time and energy to fulfill a security function? Ideas like this, if not preplanned, will never be realized.

Other out-of-the-box thinking could be helpful. Consider, for example, developing exterior pathways and enlarged interior hallways to accommodate today's small, battery-operated personal vehicles, such as Segway Human Transporters. These vehicles can reduce the time needed for a security person to get from one place on campus to another, minimize the security personnel required, and save money.

Planners need to consider segregating the patient and visitor sides of the organization, especially in areas where labor, delivery, and pediatric areas are located. A good rule of thumb when implementing higher-security areas is to limit entrances. Limiting entrances not only provides methods for security to identify and cover escape routes, but limits the costs associated with implementing security monitoring technology.

What about increasing delay, as alluded to earlier? One approach would be to locate labor and delivery functions on upper floors rather than the first floor, and away from grade exits, thus significantly delaying potential child abductors. The same reasoning can apply to the location of psychiatric wards or other areas susceptible to patient wandering. A great deal more delay can be added if this function is placed farther away from grade exits.

Interior design features can provide opportunities for employees to more quickly recognize persons who do not belong. For example, consider providing a transition from carpet to tile or vice versa when people move to and from higher-security areas. We can “program” employees to challenge people who do not belong in a particular environment by providing small nuances for them to recognize.

Ask any security practitioner in a city hospital what keeps him up at night, and he will tell you: a shooting. In some instances, hospitals are finding it difficult to keep staff because of their insecure emergency departments. Gangs are becoming more and more violent, and it is important to protect employees, visitors, patients, and patrons who work in close proximity to these people. Consider programming the waiting room to be located away from the emergency department and close to a security kiosk. If this isn't an option, consider the use of ballistic-resistant materials to offset risks of a security incident.

A recent design trend in healthcare organizations is providing large, open atriums. Unfortunately, these large spaces decrease the ability to provide effective camera coverage. Planners need to consider developing architectural facets such as fountains or sculptures that, while allowing for an open air venue, will still funnel people toward technologic controls such as cameras.

The installation of cameras has to be coordinated with wayfinding sign placement. Cameras are often blocked by wayfinding signs installed at a later date. The forethought involved in locating security devices properly is much like carpentry: “Measure twice, cut once.”

Exterior Countermeasure Considerations

Landscaping. Landscaping is an important aspect of a security program. It requires a lot of thought because, simply, landscaping grows. Opportunities for a security breach that may not be present when trees and shrubs are planted could arise at a later date when they mature. Planners should develop their landscaping designs not only terms of the first few years of development, but over the course of many years. Consideration should be given to the location of plants in relation to the building. Shrubbery heights should be low enough to prevent ambush opportunities, and tree heights should be positioned so that the growth of trees, bushes, and hedges will not interfere with cameras or lighting systems.

Also, select vegetation with thorns that preclude access through climbing. Similarly, to prevent climbing and hiding, lanners should avoid the use of architectural alcoves and canopies to the greatest extent possible. These architectural elements can also obscure camera views and provide opportunities for a potential ambush.

Lighting. The Illumination Engineering Society of North America (IESNA) has published a guideline which, in the author's opinion, will likely become a standard through the American National Standards Institute (ANSI) entitled Guideline on Security Lighting for People, Property, and Public Spaces (available at The guideline cites the work of Painter and Farrington who, in 1999, conducted a study on lighting and its deterrent effect on crime.

A concern that is becoming more and more important is energy conservation. Unfortunately, some of the lighting that is the most energy-conserving is the most “unfriendly” to cameras and, to some degree, employees, patrons, or visitors. From a security standpoint, the best lighting is on the whiter spectrum, the type that presents the best opportunity to reproduce images accurately from the camera during nighttime conditions.

Set-Back. The power of explosives was demonstrated by the bombing of the Oklahoma City Alfred P. Murrah Federal Building, where approximately 5,000 lbs. of ammonium nitrate/fuel oil (ANFO) caused sweeping damage not only to the Murrah Building, but to surrounding buildings, shaking some off their foundations. More recently, the USS Cole was targeted when 500 lbs. of military grade plastic explosives was placed on a small Zodiac-type of watercraft and brought in close proximity to the ship. The explosion ripped a 30′ × 40′ hole in armor plating that was approximately 0.39″ thick. The first bombing at the World Trade Center took place on February 26, 1993, when a minibus containing 200 lbs. of urea nitrate detonated in the garage beneath the complex. The blast killed six people, injured 1,000, and caused $300 million worth of damage.

Experts agree the most cost effective way to mitigate an external high yield explosive event against any facility is to increase the set-back—the distance between the building line and any potential explosive device. The laws of physics dictate that the impact of shock waves on a structure from an explosion is reduced with each foot of separation from it.

Approach paths to a facility are as important as set-backs in planning security. Approaches that are direct and allow for the greatest penetration into the building are discouraged. Parking underneath a hospital also should be discouraged, for obvious reasons. If underground or parking decks must be provided in close proximity to the building, consider reducing the clearance height of the parking deck, thereby segregating larger vehicles and providing opportunities to accurately size and predict a specific threat.


Both opportunistic and professional criminal effects can be reduced by appropriate alterations to the healthcare environment. While the above discussion should not be considered all-inclusive, it offers real-world examples of how architects can strengthen a building security program and avoid contributing unknowingly to a catastrophic event. HD

Sean A. Ahrens, CPP, is a senior security consultant with Schirmer Engineering. Ahrens has more than 16 years’ experience in the security industry and has participated on a variety of standard-setting panels, including Underwriters Laboratories (UL), Security Industry Association (SIA), and ASIS International (formerly the American Society of Industrial Security) Commission on Guidelines. He can be reached at 847.272.8340.