The Design Council has been commissioned by the Department of Health to run a year-long project that will examine how changes to traditional casualty units can help to stamp out the problem of violence towards staff.
The initiative, entitled Reducing Violence and Aggression in A&E By Design, comes as research from the Care Quality Commission reveals that 11% of NHS staff experience physical violence from patients or their families. And, according to figures from the NHS Security Management Service, the number is increasing every year, with more than 150 assaults a day on staff. The cost of this is estimated to have reached more than £69m a year in staff absence, loss of productivity and additional security.
I think it is foolish not to think there is a link between the environment and the way we feel and behave
Leading the Design Council project, Chris Howroyd said: “I think it is foolish not to think there is a link between the environment and the way we feel and behave and previous research shows design can have an impact.” The project will involve designers, architects, healthcare experts, patients and frontline NHS staff working together to develop and trial potential solutions at three NHS hospital trusts – Guy's and St Thomas' NHS Foundation Trust in central London, Chesterfield Royal Hospital NHS Foundation Trust in Derbyshire in the East Midlands, and Southampton University Hospitals NHS Trust in Hampshire in the South East.
If you consider the £150,000 offering in terms of impact, it is a drop in the ocean compared to what the NHS spends dealing with violence and aggression
Teams are being asked to bid for up to £150,000 each to fund the development of a number of solutions that will give patients, visitors and staff a better and safer experience in A and E. The solutions will be based on three key areas:
- Changes to interior design, such as redesigning layout and use of space or introducing new products and furniture
- Improvements to communications systems and the information provided to patients and their families
- Redesigned clinical and non-clinical services and systems
In an interview with BBH this week, Howroyd said: “The bottom line is to reduce violence and aggression in A and E and we will be looking for anything that shapes the experience with reference to design.“We will look at the layout, including how the space is used and furnished, and the information provided to the patient during their visit.
“Waiting time is the most-frustrating thing about A&E and a key flashpoint for violence, particularly where someone is perceived to have jumped the queue. Some people take exception to that.
What we are trying to do is put together common solutions that can be applied across all NHS estates
“We also want to look at providing information at the right time, in the right format and in the right way, whether through staff or other means. And we will also look at systems and how A&E departments work in practice.”
Research has already been carried out at the three hospital sites, although the results of this have not yet been revealed. Howroyd said: “We have put together huge reams of information and data and are now waiting for the design teams to come forward. We will work with them to come up with development solutions that are viable, feasible and cost effective
“The money available depends on the quality of the teams entering and how many we pick. We are hoping that consortia will come forward made up of designers and industry partners. We really want to take user-centric design to the next level.”
The three chosen hospitals are very different in nature, from inner city to more-suburban sites, and have a diverse mix of patients.
“What we are trying to do is put together common solutions that can be applied across all NHS estates and that is a key part of the criteria for teams to consider,” said Howroyd.
The value of design is, and has been, undervalued in the NHS and healthcare sector generally. We are also behind other countries in valuing the impact of design for the provision of healthcare and the experience of patients and staff
“I believe it will be a multi-disciplinary, holistic approach that is needed. We need to look at the physical environment and make it feel more loved and respectful. We need to look at how care is delivered and how staff interact, and we need to make sure that people are informed and are going to the right place. If you consider the £150,000 offering in terms of impact, it is a drop in the ocean compared to what the NHS spends dealing with violence and aggression. If we can show an active reduction in aggression in at least one of the sites, we can show a metric in pound notes. We are not looking for something aesthetic or fluffy. We want something really tangible. The value of design is, and has been, undervalued in the NHS and healthcare sector generally. We are also behind other countries in valuing the impact of design for the provision of healthcare and the experience of patients and staff.”
Once selected, the design teams will have 100 days to come up with a solution, which will be trialled at the showcase hospitals. Commenting on the initiative, Sir David Nicholson, chief executive of the NHS, said: “NHS staff save lives every day and are committed to providing the best possible service to patients. It is completely unacceptable for them to be assaulted or work in fear of being physically or verbally assaulted.
There is a substantial financial and human cost to violence against staff and I look forward to seeing the results of this project, which will help A&E departments become calmer, safer and more productive environments
“There is a substantial financial and human cost to violence against staff and I look forward to seeing the results of this project, which will help A&E departments become calmer, safer and more productive environments. Anything which can help to diffuse difficult situations, demand mutual respect or reduce the pressure on busy staff is a welcome addition towards building a modern NHS centred around high-quality patient care.”
And Professor Matthew Cooke, national clinical director for Urgent and Emergency Care at the Department of Health, welcomed the increased focus on the physical environment, telling BBH: “Better design can help reduce violence and its adverse effects. I look forward to seeing the results of this project, which will not only make work safer for my colleagues, but also enable us to provide better care for our patients.”
Design teams are being invited to submit proposals on how they will approach the challenge with solutions that will offer good value for money and could significantly reduce the financial and human cost of violence against staff.
It is hoped an improved environment and better processes will lead to an increase in staff morale, a reduction in litigation costs and security and insurance fees, a reduction in staff absence, an increase in productivity, a calmer environment and an improved patient experience.
The closing date for entries from design teams is 4 April, with shortlisted entries to be announced on 18 April 2011. The winning designs will be showcased during October before being rolled out to the wider NHS.