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Designers reveal new ways to reduce violence and aggression in Accident and Emergency

Healthcare and security workers have welcomed the prototypes unveiled today, which aim to reduce the incidence of violence and aggression against staff, as part of a project to discover the common triggers of frustration and anxiety in A&E departments.

In the year-long project, commissioned by the Department of Health and run by the Design Council, designers extensively observed patients and staff in A&E departments to identify the influences which lead to ‘flare-ups’ of anxiety or frustration in normally calm patients and those accompanying them. It is estimated such cases account for half of all aggression (or in some cases, violence) against staff, which costs the NHS in excess of £69 million a year.


By studying patient behaviour and interactions with staff, including incidents of aggression, the team of designers, psychologists and healthcare experts discovered the key to the problem lies in providing patients with a better understanding of the system they are in, and to display the relevant information at specific moments in the patient journey through A&E where frustration and misunderstanding is likely to be exacerbated.


The solutions were specifically designed to be simple to implement across both older and newer hospitals, be low-cost to implement and avoid creating physical ‘barriers’ between patients and staff, which could create a sense of alienation and lead to an escalation of the problem.


The prototypes unveiled include:

- A new approach to greeting patients on arrival, answering their questions and ensuring they start the A&E experience positively

- A system of environmental signage, which designers have called information ‘Slices’: clear, intuitive, location-specific information. These give patients guidance about their physical location and where they are within the A&E process

- A personal ‘Process Map’ explaining what to expect from the treatment process and when to expect it, in order to manage users expectations of waiting times.

- Screens which provide live, dynamic information about how many cases are being handled and the current status of the A&E department.


The project also looked at how violence and aggression can be tackled more effectively by staff reporting of incidents and sharing information on how to spot the early signs and take steps to ‘de-escalate’ potential problems. Designers developed a suite of tools to facilitate staff-centred reporting, and an eight-week programme to help them work with managers to address incidents at a local level.


The third aspect of the programme was to provide an extensive toolkit of research and best practice for hospital senior managers, allowing them to factor in the new insights when making decisions about major refurbishments or alterations. The toolkit includes advice and guidance on the best ways to reduce the incidents of violence and aggression through better department layouts, sight-lines, lighting, décor, seating, and systems and procedures.


Health Minister Simon Burns said: “NHS staff work hard to save lives every day and they should be able to carry out their work without fear of assault, be it verbal or physical. We want to safeguard staff and patients and that is why we asked the Design Council to look at helping A&E departments become calmer and safer environments.


“Any violence and aggression towards staff is totally unacceptable. Despite an increase in the sanctions taken against people who assault NHS staff, more needs to be done - and we are taking action.


“These are practical solutions to help support and reduce the pressure on busy staff - ways in which hospitals can easily redesign the environment according to their budget and how difficult situations can be diffused by simply giving patients more information.”


Design Council’s CEO, David Kester said: “This is design at its best – finding an effective low-cost solution to a long-standing, high-cost problem through creativity, simplicity and collaboration. For not much more than £60,000 hospitals can now quickly and easily install this system which could significantly reduce the burden of aggression from patients. It’s this sort of win-win which we need more of, by using good design to tackle some of our most pressing economic and social challenges.”