How site planning fortifies healthcare security
By: John Iffrig and Jordan Wilkinson
Landscape architecture plays a critical and often underappreciated role in enhancing site security for urban healthcare environments. Unlike overt security measures, landscape strategies can provide subtle, non-intrusive protection while maintaining a healing, welcoming atmosphere.
Building program drives security design measures
A healthcare building’s program is the main driver for what type of landscape security design measures are necessary. For example, a large hospital with multiple entrances, emergency department and inpatient facilities will require more consideration for crime prevention through environmental design. On the other hand, a smaller medical office building that only offers outpatient services will require fewer techniques to provide safety.
Urban healthcare facilities have a higher volume of patients and visitors, which can ultimately increase the risk of crime. In these dense environments, there is always a greater need to control access across a site. Visitors may arrive at an urban hospital by foot, public transportation or car — and often from several different arrival points. Suburban and rural sites offer a little more flexibility for site plan layouts and how outdoor spaces are designed, since visitors and patients arrive in a more predictable way.
Early design participation facilitates positive site planning
There’s a lot that goes into landscape architecture in a healthcare setting. For every project, landscape designers should aim to participate early in the design process to facilitate a positive impact on site planning.
For instance, thoughtful planning of vehicular and pedestrian circulation during early site planning for a new facility is critical in the landscape design process, and key to safely guiding traffic to designated areas of the hospital. If the team is involved in the overall layout of where the building goes, where parking goes, where circulation goes, then they’ll have a better chance of determining where people are going in a meaningful way.
Intentional security measures improve overall safety
Ensuring sidewalks and entrances are developed in an intentional way that keeps walking patterns simple and predictable helps to improve overall security. Low fences, barriers, berms and even paving patterns can help to direct traffic. Using properly sized plant materials, such as dense massings of shrubs or perennials along the border of a route, reinforce the intended circulation.
At a new 500,000-square-foot pediatric hospital in St. Louis, Missouri, Lawrence Group landscape architects designed busy intersections and crosswalks with added security measures for visibility. Anywhere there were intersections or crosswalks on the site, the team elevated the grade to create a “table” so that pedestrians are more visible crossing the street and security guards have a better, elevated view of traffic. As cars are approaching, the “table” acts as a speed bump, so cars have to go slower. This also allows license plate readers and security cameras to focus on the cars when they are slowing down at intersections or turning into the hospital’s parking lot.
Know security team’s priority areas
Another key element of healthcare landscape design is coordination with the property’s security team. Ensuring security is aware of what landscaping will be installed, and more importantly, where it will be installed, is crucial. Security teams want their cameras and emergency call boxes to be visible, so planning for plant material that has enough clearance and the right mature height to avoid blocking any camera views is important to promoting a safer environment.
Knowing where a security team’s priority areas will be located helps designers develop a site plan that supports their needs. Access points, parking lots and main walkways must always be visible. Site lighting also plays a critical role in ensuring the facility is visible to security at all hours of the day.
Stick to hospital’s budget, maintenance perimeters
Landscape architects should be thoughtful not to “overdesign” for a client who may not have the budget or workforce to maintain the intended appearance. Utilizing plants and shrubs native to the region along with careful selection of foliage size will make vegetation easier to maintain over the long run.
Selecting plants that will not mature to sizes that will block views or circulation in the future is important. A clear and relatively simple design also helps to reduce maintenance overall. At the same time, a landscape that appears well-maintained is helpful to deter criminal activity.
Plants and fencing can deter visitors and vehicles from entering restricted, dangerous areas of a hospital campus, such as a utility plant or building where chemicals and gases for hospital use may be stored.
Utilize landscape design in areas prone to hazardous weather
In locations where hazardous weather or flooding occurs on a regular basis, landscape design can be utilized to protect the building and its occupants. For example, our team raised the ground on which to build Health First’s Cape Canaveral Replacement Hospital by 13 feet above sea level in Merritt Island, Florida to protect it from flooding. Outdoor benches, tables, chairs and bike racks are securely anchored on the site to prevent them from becoming hazardous projectiles during a tropical storm or hurricane.
In certain instances where site constraints limit visibility of a certain space, geofencing features can be utilized with security cameras. By using this technology, a virtual boundary, or geofence, can be used to notify staff that someone has been detected within the prescribed zone. At St. Louis City’s new pediatric hospital, our team made sure to select landscape elements that would not interfere with the campus’ geofencing and would discourage hiding spots not visible by the security cameras.
Crime prevention through environmental design
Lawrence Group utilized Crime Prevention Through Environmental Design — a proactive design philosophy that integrates security into the built environment, particularly in landscape architecture and site planning — to design landscaping at the urban pediatric hospital. The following are several key 2025 CPTED standards and site considerations relevant to landscape architecture:
Natural surveillance
- Design open sightlines by avoiding dense shrubbery or tall fences that block views
- Use lighting strategically along paths, entrances and gathering areas to enhance visibility at night
- Position seating and gathering areas where they are visible from nearby buildings or streets
Territorial reinforcement
- Use landscaping elements (e.g., low hedges, decorative fencing, paving patterns) to define public, semi-public and private spaces
- Incorporate signage and art to foster a sense of ownership and pride in the space
Natural access control
- Guide movement with pathways, plantings and changes in elevation or texture
- Use gates, bollards or natural barriers like berms and water features to control entry points
Maintenance
- Ensure regular upkeep of vegetation, lighting and infrastructure to signal the area is cared for and monitored
- Prune trees and shrubs to maintain clear sightlines and prevent concealment
Design tools and strategies
- Lighting: Install pedestrian-scale lighting to enhance safety and usability after dark
- Wayfinding: Use clear signage, tactile markers and visual cues like colored paths to help users navigate safely
- Seating and programming: Encourage legitimate use of space through seating, community events and active programming to increase “eyes on the street”
- Artwork and identity: Public art can reinforce community identity and deter vandalism by fostering pride
Landscape design for urban hospital security is a multi-faceted approach that incorporates early collaboration with security personnel, layered design strategies, a consideration of social dynamics and a plan for long-term maintenance and adaptability. From plantings to pathways, subtle design strategies in site planning can help protect both patients and staff, while keeping facilities welcoming.
John Iffrig, PLA, ASLA, is Lawrence Group landscape architecture group leader.
Jordan Wilkinson, PLA, ASLA, is Lawrence Group landscape architect.
Photos + PDF courtesy Lawrence Group
