A new information and communication system costing as little as £60,000, and small changes to décor, lighting and seating, could help hospitals across the country to stamp out aggression and violence towards A&E staff.
As part of a year-long initiative commissioned by the Department of Health and run by the Design Council, project teams have observed patients and staff in casualty departments to identify the influences that can lead to anxiety and frustration and, in turn, the threat of violence.
As a result the teams, made up of designers, psychologists and healthcare experts, discovered the key problem lies in providing patients with a better understanding of the system they are in and displaying relevant information at specific points in the journey through A&E where frustration and misunderstanding is likely to be exacerbated.
Low-cost solutions have now been put together that are designed to be implemented across both old and new hospitals while avoiding creating physical barriers between patients and staff.
Any violence and aggression towards staff is totally unacceptable and, despite an increase in the sanctions taken against people who assault NHS staff, more needs to be done - and we are taking action
The prototypes 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 that 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. As a result designers have 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.
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
The third aspect of the project was to provide an extensive toolkit of research and best practice for senior hospital 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, sightlines, lighting, décor, seating, and systems and procedures.
Commenting on the unveiling of the prototypes earlier this week, 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.
This is design at its best; finding an effective low-cost solution to a long-standing, high-cost problem through creativity, simplicity and collaboration
“Any violence and aggression towards staff is totally unacceptable and, 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.”
David Kester, chief executive of the Design Council, added: “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 is 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.”
Figures from NHS Protect show that in 2009/10 there were more than 150 assaults per day on healthcare staff in England – more than 54,000 a year – at a cost to the NHS of around £70m.
Now the prototypes have been developed, a number of showcase NHS trusts will adopt the solutions so their impact can be properly evaluated, demonstrating the extent of the return on investment, both in terms of finance and incidents of violence and aggression. It is hoped they will then be adopted across the wider health service.
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
Kester said: “Once the results of the evaluation are available, the Design Council and Department of Health aim to share them with key stakeholders, including those who work in A&E and commission change in NHS trusts. This will form a considerable evidence base which will directly assist in the dissemination and adoption of the designs across the NHS.
“The online resource will also act as a quick reference guide for those who work in, commission, design, or are simply interested in learning more about the design of A&E departments. This toolkit will continue to be a dynamic, living resource which can be updated as the development, implementation and evaluation of the design solutions and recommendations progress.”