Designing out violence in the NHS
How a Design initiative has halved threatening body language and aggressive behaviour in NHS hospitals, while providing significant cost savings.
A Design Council project has produced a cost saving solution that also makes A&E departments calmer and safer for patients and staff.
Most of us have ended up in A&E at some point, whether by skewering a foot with a garden fork, with a poorly child, or for something more serious. It’s likely that, notwithstanding the reason for being there, the experience was not a pleasant one; there are often long queues of disgruntled patients waiting to be seen, and often less than patiently. Especially after dark!
Hospitals are big, busy, alien places to the average person. Doctors and nurses speak a language few of us understand, information is hard to come by, signs and notices are confusing and vague. Tensions can run high and violence and aggressive behaviour is common. Hospital staff experience more than 150 incidents of aggression per day, approximately 20% of them in A&E. The estimated cost exceeds £69m annually, staff turnover is high, money spent training often goes to waste, and sickness rates are costly.
The experience of A&E at Barts Health NHS Trust could not be more different. The usual tensions associated with people waiting for medical assistance are not there.
So what’s different? It was the first hospital in the UK to implement a Design Council and Department of Health initiative to reduce violence and aggression in A&E departments, and feedback has been very positive.
Designers draw on a number of principles and approaches to turn good ideas into innovative products, services, environments and experiences.
An example of improving patient experience through better communication and guidance.
By giving visitors to A&E a better understanding of how the department works, and a sense that their human as well as clinical needs are being attended to, they are less likely to become confused, frustrated and potentially aggressive as they progress through the system.
The design solution was a communication package of information about the department, waiting times and treatment practices. It includes on-site signage, patient leaflet, interactive media and touch screen applications, complemented by a live digital screen welcoming patients.
A vertical ‘slice in each space contains all the information relevant to the user at that stage in their treatment process, and becomes the recognised communication point for patients throughout the department. Rather than refitting each and every room, a ‘slice’ could be inserted, which would gently guide the patient or other service user along their journey.
To accompany the ‘slices’, a process map serves as the core of the communication language. This illustrates the patient journey as a series of steps moving towards the goal of treatment, with a wait before moving onto the next step. The steps are categorised into the four larger stages of check-in, assessment, treatment and outcome. Digital content using the same visual language, able to be updated automatically to provide more accurate and relevant information was also developed.
Designers work visually to make things simple and easy to understand. Through visualisation, designers simplify often complex ideas which helps communication and understanding.
Why was design successful?
Good designers spend time with the end-users of the products and services they create and involve them in the process. They do this to understand what it is that people actually need and want, rather than make assumptions. Through this process, designers often uncover hidden as well as known needs.
Designers build and test solutions early in the development process. This approach means solutions are refined and improved before they are rolled out, which mitigates risk, since the solution is less likely to fail.
The successful outcome of this Design Council project strengthens the evidence that research and strategy, combined with cost-effective design solutions, play an important role in improving customer experience. Beyond healthcare, these principles are just as valid and easily scalable to suit the particular business goal.
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Information sourced from: Reducing violence and aggression in A&E: Through a better experience Design Challenge. The project was completed in 2011 and was headed by a multi-disciplinary design team led by PearsonLloyd.