Designing out violence in Emergency rooms?

Gail Taylor
Monday 23 Mar 2015

New report suggests 10-point plan

A recent statement by the UK Design Council includes an eye-opening reference to design and the important influence it can have in dramatically reducing aggressive behaviour in hospital accident and emergency (A&E) departments. 

Stressing the importance of the way the UK’s public services are delivered, it highlights this example: “Design Council’s ground-breaking design-led work in [emergency departments] helped the Department of Health reduce violent behaviour by 50 per cent.”

That ‘ground-breaking design-led work in [emergency departments]’, otherwise known as the Design Council’s ‘A&E Design Challenge’ project, is well worth exploring. The documentation tells us: “Violence and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff absence, loss of productivity and additional security. As many as 59,000 physical assaults occur in English NHS hospitals each year, a figure which continues to rise. With over 21 million patients attending A&E departments each year, increasing pressure on accident and emergency departments can lead to negative experiences for both patients and staff.”

The Design Council duly appointed PearsonLloyd, a London-based design consultancy specialising in healthcare, to lead a multidisciplinary design team briefed with finding solutions. 

Extensive ethnographic research was conducted at three NHS Trusts. Patient journeys through emergency departments were mapped alongside incidents of violence and aggression. Insights were analysed to understand why patients might become aggressive and what types of patients might be more prone to becoming aggressive.

In response to the research findings, the team developed three solutions to help improve the experience of both patients and staff, reducing anxiety and promoting a positive hospital culture. The Design Council document describes them thus: 

“The guidance solution - a comprehensive package of information about the department, waiting times and treatment processes via on-site environmental signage, patient leaflets, and digital platforms.

“The people solution – a programme of reflective practice designed to better support NHS frontline staff to manage and learn from incidents of violence and aggression.

“The A&E toolkit – A package of information and guidance for NHS managers, clinicians, designers and healthcare planners who want to develop and deliver a better service in effective and inspiring environments.”

The A&E toolkit offers a number of resources, including “Ten Lessons for Reducing Violence and Aggression in A&E”. These feature important and detailed advice to help hospital trusts produce meaningful, properly targeted briefs for designers, and to find ways of managing stakeholder expectations.

The impact of following the three solutions was evaluated by Frontier Economics and ESRO in two pilot schemes run at St George's in London and Southampton General Hospital.  They reported that 88 per cent of patients ‘felt the Guidance project clarified the A&E process’, while 75 per cent said the resulting improved signage ‘reduced their frustration at waiting times’. Overall, there was a 50 per cent reduction in threatening body language and aggressive behaviour’, and – very significantly given the extreme challenges currently facing the NHS – for every £1 spent on design solutions, £3 was generated in benefits. 

Download the Design Council's Ten Lessons for reducing violence and aggression in A&E.

The WAN Healthcare Award 2015 is now open for entries.

Gail Taylor

Features Editor

Key Facts:

United Kingdom

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