Every CFO I have worked with in healthcare eventually asks how much a hospital should spend on physical security, and every one of them is hoping for a benchmark. A percentage of operating budget, a number per bed, something that can be compared to a peer and defended to a finance committee. I understand the wish, and I am not going to give you a figure, because any figure I gave you would be wrong for your hospital. A community hospital with a quiet emergency department and a single building is not exposed the way an urban medical center with an open campus and a busy behavioral health service is exposed, and the spend that protects one would either waste money at the other or leave it dangerously thin.
What I can give you, from a career in law enforcement, fire service, private security, and federal government, is a way to think about the number so that the budget you set is tied to the risk you actually carry. Most hospitals arrive at their security spend by inheriting last year’s guard contract and adjusting it by a percentage. That is a spending habit rather than a decision. The right number comes from working through a short set of questions about your own campus, and the answers usually change the conversation more than any benchmark would.
Start With the Risk Profile, Not the Contract
The first question is what the hospital is exposed to, and the honest answer requires looking past the guard schedule. Pull a year of incident reports from every place they live: the ED, HR, the guard vendor’s log, pharmacy, the maternity unit, and the parking operator. Read them together. Where do the assaults happen, on which shifts, and in which areas? How often do visitors reach units where they have no business? How many times has a behavioral health patient become violent in a corridor rather than in a secured space? Has drug diversion been detected, and if it has not, has anyone looked? A hospital that does this exercise usually discovers that its exposure is concentrated in a few places and times, and that its spending is spread evenly across the campus as if it were not.
How Much Should a Hospital Spend on Physical Security Given Its Campus
The second question is how open the campus is. Count the entrances, all of them, including the clinic doors, the loading dock, the connecting corridors from the parking structure, and the ones propped open by staff for convenience. Ask which are locked, which are staffed, and which are simply open at each hour of the day. An open campus with dozens of unlocked entrances cannot be secured by putting officers at two of them, and money spent on the two while the rest stay open is money spent on the appearance of security. Sometimes the right answer is not more officers at all. It is closing or controlling entrances so that the officers you already have are standing where people actually come in.
Emergency department volume is the third question, and it may be the most important. The ED is the highest-risk point in nearly every hospital, because it accepts anyone at any hour, because the people who arrive are often in crisis, and because the nurses and registration staff at the front are within arm’s reach of all of them. A high-volume ED with a large behavioral health or intoxicated population needs a different level of coverage, a different triage design, and different officer training than a low-volume one. If your ED volume has grown over the past several years and your security coverage there has not changed, your spend has fallen behind your risk without anyone deciding it should.
Price the Workplace Violence Exposure Accurately
Hospitals carry a workplace violence exposure that most industries would treat as an emergency, and it falls hardest on nurses and frontline staff. When you think about the security budget, think about what that exposure already costs you in ways that do not appear on the security line. It shows up in nursing turnover, in recruiting costs, in workers’ compensation, in overtime to cover staff who are out after an assault, in the difficulty of staffing night shifts in the ED, and in the survey findings that follow when accreditation and regulatory bodies ask about your workplace violence prevention program and find that no one owns it. Those costs are real, and they are being paid now. A security budget that reduces them is not an expense competing with clinical priorities. It supports them.
What Leadership Costs Against What an Incident Costs
Here is the comparison I ask CFOs to make. On one side, put the cost of leadership: an experienced security executive, full time or fractional, who owns the program, assesses the risk, holds the guard vendor to a contract that reflects it, sets the standards for the ED, behavioral health, the maternity unit, pharmacy, and parking, and tests whether any of it works. On the other side, put the cost of a serious incident that the program would have prevented or contained. Include the injured staff member, the litigation, the regulatory response, the reputational damage in a community that chooses where to receive care, the leadership time consumed for months, and the security spending that always follows a bad incident, which is spent quickly, emotionally, and usually on the wrong things.
I have watched hospitals spend more in the six months after an incident than a decade of leadership would have cost, and spend it on cameras and officers without anyone deciding what the program was supposed to accomplish. The point of putting leadership in the budget first is that every other security dollar gets spent by someone who knows where the risk is. Without that person, the guard contract is a bill you pay. With that person, it is a tool someone is using.
Spend on Testing Before You Spend on Equipment
The doctrine I built Until Tested: Security Is Only Assumed around has a direct budget implication. A great deal of what hospitals already pay for is assumed to work and has never been tried. The infant security system is assumed to lock the doors. The ED panic buttons are assumed to reach someone. The access control system is assumed to have a current list. The officer at the entrance is assumed to check credentials. Before you approve a single new camera or officer post, spend a small amount of time testing what you already own. Trip the infant alarm at night without notice. Walk in through an unstaffed entrance during shift change. Audit the pharmacy’s after-hours access list against the current staff roster. In my experience these tests reveal that some of the budget is already buying nothing, and that the money to fix the real gaps is often sitting in the spend you already have.
How to Build the Number
Assign one accountable owner for security who reports above facilities, and have that person produce a written risk assessment of the campus that ranks your exposure by area and shift. Have them compare the current guard contract and post orders against that assessment and identify where coverage is misplaced. Have them run the tests described above and report the results to the executive team unedited. Then build the budget from the assessment rather than from last year’s contract: fund the leadership first, fix the failures the tests found, close or control the entrances that should not be open, and put officer hours where the incidents actually happen. Present the result to the finance committee as a risk decision with the incident costs on the other side of the ledger. That number will be defensible in a way that no benchmark ever is, because it will be yours.
Go Deeper
For hospitals that want the leadership in the budget and cannot yet fund a full-time executive, the fractional model is the practical answer, and I explain it in What Is a Fractional Security Director? The Complete Guide. My book Fractional Security Director makes the full case for putting a part-time executive over the program so that every other security dollar is spent by someone who knows where the risk is.
Commissioner William Epps is a former elected Fire Commissioner, federal law-enforcement supervisor, and firefighter since 2006, with instructor credentials in Hazardous Materials response, Active Shooter preparedness, and Stop the Bleed®. He spent seven years in federal law enforcement in physical security, executive protection, and incident command, and now serves organizations as a Fractional Security Director. He is the author of The Spirit of Saul, The Spirit of Pharaoh, and other practical books on security, leadership, and faith, built around one idea: knowledge should be practical enough to use when it matters.
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