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CPTED offers simple solutions to influence criminal behavior


CPTED principles provide a simple and effective way to improve security, reduce the risk of violence, and increase awareness

CPTED offers simple solutions to influence criminal behavior

CPTED principles provide a simple and effective way to improve security, reduce the risk of violence, and increase awareness

Effective healthcare security revolves around control. The most effective security departments control how patients and visitors get into the facility, where they go once they enter the building, and at least attempt to control their behavior once they arrive. Although those elements of control are relatively straightforward, effectively influencing those behavior modifications can be tricky.

The design of your building may play a significant role in behavior modification. Crime prevention through environmental design (CPTED) was first coined in the 1970s by criminologist C. Ray Jeffery, although it wasn't until the 1990s that the principles of CPTED gained widespread acceptance. And although CPTED was originally applied to large scale communities, it wasn't until recently that CPTED design gained traction in the healthcare industry.

Although some hospitals have adopted some of the primary principles of CPTED, many facilities could be using this ideology more effectively to provide a more secure environment, says William H. Nesbitt, CPP, president of Security Management Services InternationalTM in Newbury Park, California.

"I think the answer is that hospitals are using it implicitly, but I don't know that they are using it explicitly," he says. "They might be doing things without putting that label on it, but I think it's something they could be doing more of."

The theoretical principles of CPTED are simple, Nesbitt adds. Elements like "way-finding"?how visitors make their way around the hospital?and line of sight are basic security concepts, but the practical execution of fixing those problems can be complicated.

The benefit of CPTED in the hospital is that it asks the questions that will identify the most pressing security concerns, rather than jumping directly into problem solving that can often lead to the misuse of resources in the hospital environment, says Randall Atlas, PhD, AIA, CPP, president of Atlas Safety & Security Design, Inc., in Fort Lauderdale, Florida, and author of 21st Century Security and CPTED: Designing for Critical Infrastructure Protection and Crime Prevention, Second Edition.

"CPTED asks, 'Where is the front door? Where do you want people to park? Where are the doctors supposed to go in? How are supplies delivered? What is the experience you want in the emergency room?'" he says. "Those are the top four or five questions as compared to just putting cameras here, gating here, and having access cards. It's about problem seeking versus problem solving. That's the starting point and that sets the tone."


Discouraging crime

CPTED revolves around three main principles:

  • Natural surveillance: Appropriate lighting, adequate lines of sight, and elimination of hiding places all contribute to natural surveillance
  • Territoriality: Discouraging criminal activity by clearly communicating the intended purpose of each area, whether it's public or private
  • Access control: Preventing accessibility through signage, locked doors, and fencing


The ultimate purpose of these principles is to discourage crime by making alterations to the physical environment.

"It's how you generally guide someone through the building with suggestive means," Nesbitt says. "Most people will walk where they can walk."

Sometimes those design changes are subtle, and sometimes they are overt. In one hospital Nesbitt consulted with, the reception area was located in the back of the entrance way. A bank of elevators was on one side of the desk, but on the other side was a hallway that visitors had no reason to be in. After some discussion, the hospital elected to install a theatre rope to discourage people from walking down that hallway.

"That was a sort of classic CPTED methodology," Nesbitt says.

Too many hospitals rely on damage control while "shamelessly throwing money" at the problems they encounter, Atlas says. Although they also are useful, cameras alone cannot prevent criminal activity. Instead, by utilizing the principles of CPTED the hospital can effectively control circulation patterns, while promoting a design that is user-friendly and functional.

During any renovations, expansions, or hospital construction, hospitals should apply these principles and think about security's role in that space. Using these design elements will make a security officer's job easier, and effectively control the flow of visitors, patients, and employees.

"That's where CPTED shines best," Atlas says. "It's not doing damage control, but thinking about how do we improve circulation patterns, make these spaces functional, and make it user-friendly."

Hospitals can also discourage criminal activity simply by maintaining an orderly environment. A clean, clutter-free campus sends the message that the hospital is well cared for, which detracts criminal activity, Nesbitt says. For example, graffiti often seen on a bathroom stall gives the wrong impression and even promotes gang activity.

"Take a photograph of it because it may be something that gang members can read, but then get rid of it," he says.

Pay attention to your landscape

Although CPTED is best utilized during the building and construction process, the lighting and landscaping around the hospital campus may be one area that can benefit from ongoing changes utilizing CPTED principles. Shrubbery and trees are visually appealing, but overgrown foliage obstructs lines of sight and reduces the effectiveness of outdoor lighting.

Toeing that line between aesthetics and function is crucial and it's a common problem among hospitals, Nesbitt says. Trees that are planted too close to windows or underneath outdoor lighting structures may unintentionally conceal criminal activity.

"[Foliage] doesn't have any degree of reflectivity," Nesbitt says. "If you look at the lighting in parking structures, most are very well lit because of the higher reflectivity of the concrete, but where you have foliage and trees, that's all absorbing light."

Preventing overgrowth falls under the natural surveillance principle of CPTED, Atlas adds, and it plays a role in the larger concept of forcing visitors, patients, and employees to use the property appropriately.

"When you boil all the fat away, what is left at the end of the day is this: Are people using the property for what its intended use was?" Atlas says. "Whether that's parking a car, dropping off someone at the emergency room, visiting someone at the hospital, a doctor coming in to do surgery or an exam, nurses coming into work, or maintenance showing up and doing their job. How do they get onto the property, do they know where to go and where to park, and does the hospital actually know they have arrived?"

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