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The growing role of door hardware in healthcare facilities design

By Sandy Matheny / Special to Healthcare Facilities Today
September 7, 2017

A welcome trend is transforming the appearance of long-term care facilities, hospitals and most other healthcare-related buildings. Structures that traditionally sported a bland and sterile look have now taken on an air of elegance. In fact, the average person walking into a newly constructed healthcare facility could be forgiven for thinking they entered a luxury hotel. 

This shift in the healthcare industry can be credited to the principles of evidenced-based healthcare design and the availability of building components, including doors and hardware that combine superior product performance with sophisticated aesthetics.

Healing environments and the patient experience

There are currently more than 6,000 hospitals in the U.S. Many are modifying their physical facilities, taking cues from the hospitality industry to create patient-centered, “healing environments” that improve patient experiences and outcomes, and provide unsurpassed environments for physicians and nurses who deliver care.

Evidence-based design, a process that bases design decisions on credible research, suggests that physical environments can be designed to achieve best comes. It’s now understood that in hospitals, the physical environment can influence a patient’s sense of well-being, promote healing, relieve stress and pain, and reduce infection, falls, and medical errors. For example, research suggests that single-patient rooms can actually reduce the risk of infection, and maximize patient safety, dignity, privacy and satisfaction. Once thought to be a luxury, single-patient rooms are now becoming commonplace.

Positive patient experiences are directly linked to positive patient outcomes. Positive patient outcomes position hospitals to successfully recruit top physicians and nurses, and to better compete for market share. But positive patient outcomes and experiences are also important to hospitals that depend on reimbursement for payment. The Patient Protection and Affordable Care Act (PPACA) ties a portion of a hospital’s reimbursement to its patient experience scores. Medicare uses the scores, as well, to measure the progress of its accountable organizations. 

Consequently, hotel-like surroundings with fine art galleries, and amenity programs that include gourmet dining, valet parking and luxe linens, are becoming integral to successful patient-centered, healthcare provider business models. A Chief Experience Officer (CXO), whose job it is to ensure that every patient’s experience is a positive one, now populates the C-suite of most major hospitals.

Evidence-based design seeks to create a therapeutic environment by eliminating visual stressors and emphasizing pleasant décor right down to the smallest details, including door hardware. This design principle does not override patient safety or lessen the strict security requirements of a hospital. But it does encourage facilities to seek out security and life-safety solutions that blend in with the rest of the décor.

Design oriented door hardware can contribute to this desired setting. A brute looking lock could stand out as a visual cue that a need exists for heightened security within the facility — a subconscious and unsettling reminder that danger lurks. Decorative locks, on the other hand, blend in with the building design motif and create the appearance of a free and more relaxed atmosphere. 

So if a proximity card, for example, is required to gain entrance to a ward, the healthcare facility can eliminate obtrusive security devices by using a proximity card reader built into the hardware trim. The strict security requirements are still in place, but they are now hidden from sight or replaced with decorative trim.

Loss prevention

Locking hardware innovations have made it possible for hospitals to extend electronic access control to nontraditional openings. Pharmaceutical distribution, storage cabinets, employee lockers, and server cabinets containing sensitive data are prone to theft. 

These small “doorways,” typically on cabinets, can be protected with a new generation of cabinet locks that connect wirelessly with the building security control system. The locks communicate with a nearby hub that relays signals back and forth with the central system. Therefore, these often-overlooked openings, even when found on a portable cart, are now incorporated as another layer of security that can be monitored and tracked.

Sustainability considerations

Sustainable building practices are becoming the new norm in the healthcare construction industry. Doors, frames, and hardware can help facilities address specific sections of these building standards without straying from evidenced-based design principles.

Doorways can boost energy efficiency by improving building envelope thermal performance. This can be accomplished with doors and hardware designed to block heat/cold transfer.

Interior doorways also offer opportunities to lower energy consumption. Just as LED technology is revolutionizing lighting, Power over Ethernet (PoE) locks are drastically reducing the energy consumption of electronic access control systems. PoE locks are particularly energy efficient compared to other electronic access control locking solutions, offering the lowest power consumption at only 2.85 watts per lock, which is 50 percent less than typical EAC devices.

Sound transmission control

Doors with high sound transmission control (STC) ratings go hand-in-hand with sound control measures expected in many building applications where sound containment is a must, particularly in healthcare facilities. While STC-rated doors have always been available, traditional higher-rated versions have been constructed with massive materials resulting in a finished product that tips the scales around 300 pounds — a very heavy door to operate. It is also a significant load for the overall opening, requiring heavy-duty hinges as well as a more laborious installation process.

Experimentation with different construction materials and processes has led to lighter-weight doors that can carry the same STC ratings of their heavier counterparts. These are typically 30 percent lighter and can be hung with standard weight hinges with no more installation effort than that of a regular door. Better, they have operable STC ratings ranging from the low- to mid-50s.

Design continuum

Now that durable, commercial-grade doors and hardware are becoming increasingly available with stylish accents, architects can easily incorporate door openings into the overall design element of a building.  This makes it possible to have a design continuum throughout the entire structure. 

So if an executive office or pharmacy suite needs tight access control, the architect can go ahead and use a mortise lock with a credential reader and not have to worry that the hardware used on those particular doors will stand out or look different from those on other openings. 

Healthcare facilities have come a long way in functionality and looks. So too has commercial grade hardware. Technological advances have given locks the capability to meet the most diverse security and life-safety needs of a facility. Greater attention to aesthetics has given architects more design options.

All of the features mentioned above make it possible to design a facility that is safe, secure and aesthetically pleasing. 

Sandra Matheny is ASSA ABLOY’s Director of Decorative Opening Solutions and editor of The Good Design Studio blog. Sandy can be contacted at and her work can be seen at and at


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