Security as a Design Driver

Designing clinics where safety supports care

Beth Nordstrom

CID, LEED AP ID+C

Project Executive, Partner

Healthcare Practice

On a busy morning, a clinic’s floor plan decides how much warning its staff get: whether they notice a concern the moment it walks through the door, or only once it reaches the counter. That warning is designed in or out long before anyone is standing at the desk. We pay attention to that vantage point on every project, whether we are walking through an existing clinic or reviewing a floor plan where nothing is built yet. The view from the check-in desk is where the flow of a clinic starts: who walks in, where they pause, what the person at the desk can see, and what they cannot. A desk a few feet too far from the entry, or angled away from the door, changes how much warning staff have. On paper, the difference looks small. In practice, it decides whether staff see a concern at the door or meet it at the counter.

Every clinic has a security posture: the way it’s laid out either helps staff stay safe or quietly works against them, whether anyone planned it or not. The building’s layout is always making choices for the clinic, determining who can go where, what staff can see, and how much warning they have when a situation develops. Those decisions happen with or without a design team. The real question is whether they were made intentionally.

Why the conversation has changed

Security comes up in nearly every clinic project we touch. That was not always true. Safety used to live with the security department, addressed only after the design was complete. What changed, in part, is the scale of the problem. Across the healthcare sector, workers are five times more likely to be injured by workplace violence than the average worker, and outpatient clinics run about one and a half times the all-industries rate (U.S. Bureau of Labor Statistics, 2018). That is still above average. Today security is on the minds of facility executives, operations leaders, and clinical directors, who weigh it alongside workflow and staff retention. Their question is straightforward: will the building help staff do their jobs safely on an ordinary day.

Security may be top of mind, but that does not put it at the top of the agenda. Some clients raise it on day one, but plenty do not. A project carries a hundred competing priorities, and security is easy to defer. Part of our job is to bring it into the conversation early, without waiting to be asked. What has changed is that when we do, clients are increasingly ready for that conversation.

The principle and the standard

Two ideas ground everything that follows. One defines what design can realistically do. The other holds the line on how a clinic must feel for every patient.

Why timing matters

For a long time, security was treated as something that happened after the design process was finished. Doors were locked, cameras mounted, badge access programmed. Those investments have value, but they operate inside a physical environment that was not designed with them in mind. When security is not part of the original design, the problems compound. Vital sight lines were never drawn, doors that should exist are missing, and staff flow does not support what the building now asks of it. Fixes after the design is complete can mean demolition, rework, or a solution that no longer fits the space.

The consequences are not measured solely in dollars. When security is missing from the design process, staff end up compensating for vulnerabilities in a building that should support and protect them. The most important reason to have the conversation early is to hear what staff and patients need while the design can still respond to it.

The design professional’s role: guiding and translating

One thing should be clear: as design professionals, we do not set security thresholds, evaluate risk, or decide what protocols a healthcare organization should adopt. Those decisions belong to leadership, their security consultants, and the clinical and operational teams who know the patients and care environments best. They are the experts who need to be in the room during the design process.

Our expertise is in guiding the conversation and translating those decisions into physical space. When a clinic decides it needs controlled entry into the clinical zone, we design this threshold so it supports the workflow, gives patients clear nonverbal cues, and fits the budget. The best version of this work has the security consultant at the table from the start, informing the design rather than correcting it afterward.

The clinic in zones

Reading the plan

Public zone (waiting, reception) Clinical zone (exam, treatment) Back of house (staff only) Building core (restrooms, elevators) Controlled access point

The floor plan as a series of control points

We approach the floor plan as a series of control points, each one adding a little time and giving staff a chance to decide what happens next. Each step is an opportunity to recognize a situation, assess it, and respond before it reaches the next stage.

Workflow and security are connected considerations, not separate ones. The people who work in these settings face real risk, from verbal to physical, and the degree of that risk varies with the care environment. Decisions about circulation, visibility, controlled access, staff support spaces, and patient flow all shape both the quality of care and the security of the environment. That is why we design the clinic’s workflow and its security as one, each strengthening the other.

One principle governs how we sequence this work. Security does not create the flow of a clinic. The flow is shaped by how care is delivered and how patients and staff move through the day. What security does is influence that flow, in proportion to what a given clinic actually needs. That is why we work to learn the required level of security early. Once we know it, we can design the circulation to support it rather than fight it. We find out first, then shape the flow around the answer.

This is not a philosophy we invented. The recognized standards for healthcare design agree with it. They call for security to be assessed early in planning and point to the same spatial ideas we work with every day: separation of public and clinical space, buffer zones between them, and clear points of control. What we bring is the judgment to apply those standards on a specific project, for a specific client, early enough that it can shape the plan.

The first point of control is the entrance. The question there is whether staff can see a patient approaching, and control access before that person enters. In most clinics we design, the entrance is the earliest point of control. When staff can watch who is coming and secure access before a door opens, they can influence a situation before it is inside. The earlier staff can identify a concern, the more options they have. No place in the clinic offers a better vantage point for recognizing and assessing a situation than the entrance itself.

The second point of control is the reception desk. Once someone reaches reception, the next question is whether they can move beyond it. The boundary between public reception and the clinical space beyond it is a real threshold. Its design determines whether staff can manage access to the patient care space. These measures cannot guarantee that a determined individual will be stopped. What they provide is another step, and more time: time to pause, engage the visitor, assess the situation, and respond before it escalates. When reception and clinical circulation are not separated, that second point of control disappears. Once someone moves past reception, they are effectively inside the clinical environment, with no threshold left to cross. Clear boundaries between public and clinical space are relatively straightforward to design in at the start, but far more difficult to add once the walls are in place.

The check-in desk as a threshold

Reading the view

Public entrance (patients arrive) Staff-only entrance (back of house) Desk as controlled barrier

The third point of control is the clinical space itself. The most challenging situations often develop after someone has moved beyond the public areas. No floor plan can prevent every incident, but thoughtful design can give staff options when a situation unfolds: a corridor that lets a provider move away from a problem, sight lines that keep staff visible and supported, or access to a secure room where people can gather while help is called. None of these measures eliminate risk, but each creates time and a chance to respond.

Designing the patient care space

The exam room, consult room, and any other patient care area must be designed for comfort and safety as a stand-alone space. These are the places where patients and providers are together, often only a few feet apart with the door closed. The design should protect both parties while feeling like a place where care is delivered.

Designing these spaces starts with the care team. We need to understand what each room must support within the larger clinic. That direction should come from the clinic’s safety risk assessment, not guesswork. The level of concern may vary by patient population, the type of care, and at times the clinic’s setting. Our role is to frame the conversation so the client can decide what the space needs to accomplish for their safety and security. These answers should shape each room.

The exam room: safety through arrangement. In a standard exam room, safety depends less on added hardware and more on the room’s layout. A newer safety practice is to position the provider with a clear path to the door, rather than placing the patient between the provider and the exit. Because most exam rooms have only one door, thoughtful planning is what makes that exit usable. The room can still feel calm and welcoming with natural light, warm materials, and an environment that feels supportive rather than restrictive. A calmer, more supportive setting can help ease tension before it builds, making the room part of the broader safety strategy.

Higher-risk settings. In clinics with higher-risk patient populations or care environments, the room design should reflect the security measures identified in the client’s risk assessment. That may mean providing a clear path away from a threat, or a room where a provider can shelter in place and call for help. For patients, the space should still feel less clinical and more like a comfortable place to talk. Protective measures can remain subtle, such as a clear route out or a discreet way to signal for help, allowing the room to support care while helping keep both providers and patients safe.

What design can and cannot do

Let’s be clear about the limits of design. A well-planned room can help a situation settle rather than escalate and give staff critical seconds to respond. It does not replace training, staffing, or clinical protocols. The room can support safer conditions, but the response depends on the people and processes in place. The time a room needs to buy also depends on the setting. A clinic with security nearby faces a different design challenge than a standalone clinic waiting for a police response. The room and overall clinical design should account for that difference. As designers, our role is to make the clinic as supportive as possible, helping staff and patients stay safer while preserving the space’s purpose: to provide care with dignity.

From the full clinic floor plan to a single room, the scale may change, but the principle remains the same: design shapes how safe staff and patients are within the space. As designers, we have a responsibility to make that safety intentional, not accidental.

Sources: U.S. Bureau of Labor Statistics, Workplace Violence in Healthcare (2018) and Workplace Violence (2021–2022). Facility Guidelines Institute safety risk assessment guidance. CPTED principles for healthcare environments.