Ten key lessons for those seeking to reduce violence and aggression in A&E.
Creating effective design solutions always start with good insights into the problems that need to be tackled and why they are occurring. When preparing a brief for a design team, it is essential to gather the very best background information possible.
This will come in many formats, including numerical data and qualitative customer feedback. Perhaps some of the most useful and telling information for a design team can be gathered from spending time understanding the issue from the point of view of the current users or providers of a product or service.
In Reducing violence and aggression in A&E, ethnographic research delivered valuable insights and briefing your designers to spend time with the people affected by a problem and learn about it from their perspective will enhance the effectiveness of the solution they deliver.
On the face of it, this research may seem difficult to set up and achieve – especially in already pressured environments such as A&E – but it is precisely this fundamental knowledge of the issue that ensures design solutions really are as effective as possible at addressing needs and solving problems.
When a design team is brought in to help solve a problem, it is very likely to be because no obvious solution exists within the visible horizon of the client team.
For Reducing violence and aggression in A&E, the Design Council’s research highlighted that while attempts had been made to reduce violence and aggression in a variety of ways, no previous design projects had been carried out specifically to address violence and aggression in A&E departments. Design teams bring a knowledge of how solutions have been developed to similar problems by other sectors or in other situations that can provide the inspiration to unlock innovation. The Reducing violence and aggression in A&E project looked for inspiration to other public services, including transport, the prison service, social welfare, and the wider healthcare sector.
3 Some big issues need to be put to one side
Understanding what should be excluded from a brief is sometimes just as important as knowing what to put in it. In the case of larger, complex projects, filtering out significant organisational, systemic or social challenges is important to allow a design project to focus on the challenges that can readily be tackled within the parameters of the project. Failure to do so could serve to distract and ultimately waste valuable investment in design.
In the case of Reducing violence and aggression in A&E, the Design Council ran a workshop following the research debrief in order to understand the macro drivers of violence and aggression and what could not reasonably be resolved through the constraints of this design project. This is not to say that design cannot tackle these wider issues, but rather they were deemed too considerable to be addressed within this project. That workshop identified root causes of behaviours and discovered that some of the drivers were large and systemic in nature. These larger issues were flagged as being outside the scope of the project and were 'parked' accordingly.
When the output of a design project is not immediately obvious – for instance if you are not commissioning a new product but instead commissioning designers to explore an issue and then develop appropriate solutions - it is important to manage the expectations of project stakeholders.
High levels of communication and collaboration between all stakeholders are important to manage expectations through a wide understanding of the scale and complexity of the issue being tackled and therefore of the potential for a diverse range of possible solutions to be delivered. It is also important for all partners to understand how much time and effort they will have to commit to collaborating with the design team in order for them to define their approach.
There is a degree of Catch-22 between developing a business case for a design project and between analysing the potential business impact of a certain design output. It can be difficult for organisations to craft business cases in detail without knowing what sort of outcome the design project will deliver, but those designs are difficult to develop fully without a clear set of commercial parameters and objectives.
While it is important the objectives are identified before a design project begins, it may not be cost-savings or increased revenue that are the most important aims. It may be more important to identify opportunities for a design project to enhance existing live projects such as capital build projects or even HR or staff training projects.
It is always comforting to feel that your opinion is being listened to, and a good design process will be based on real-world feedback and insights from frontline staff. More often than not excellent ideas and solutions lie in the hands of staff and the design development process can enable these ideas to come to life. Furthermore, because of the highly iterative and visual nature of the design process, staff are able to quickly understand and comment on how ideas may be realised.
In the case of the Reducing violence and aggression in A&E project, frontline staff were engaged from day one through the ethnographic research and the ongoing co-design process. Staff embraced the opportunity to discuss the issues they face in their working environments, especially as they could see real value in a process that aimed to make improvements to their working lives.
Design solutions often need to be applicable to a wide range of settings and systems, but to work most effectively at solving a particular problem, these solutions also need to be flexible. Many local factors affect the issue of violence and aggression in A&E so while it is important that you can access solutions that have been tried and tested it is also essential that you can flex this solution to meet your specific context.
To ensure that the design outputs from the Reducing violence and aggression in A&E project could work across different locations recommendations on design implementation provides a palette of options will have been generated for different Trusts to employ.
Although your key focus may be on reducing violence and aggression in A&E there will be other measures that can be affected by a design project. QIPP and Clinical Quality Indicators for A&E have been introduced to inspire large scale transformational change and designers can help you deliver this by involving all NHS staff, clinicians, patients and the voluntary sector with the aim of making efficiency savings so that money and time can be reinvested in frontline care to improve the patient experience.
Any design programme should be embedded in current thinking and priorities within healthcare. It should supplement existing work rather than exist as an isolated programme, and this will give the outcomes greater impact and longevity.
Protoyping instead of piloting can help remove barriers to change. A key factor to enabling an idea to be adopted is the degree to which the idea is robust and proven. But often an idea needs to have been adopted in order to be evaluated, but evaluation is in turn a barrier to adoption.
A central premise of design is that models of ideas should be quickly and cheaply made up and tried out early on, when they are easily iterated and improved. By prototyping and testing in this way, early indicative results can be delivered which can give the confidence to move to a full installation and corresponding evaluation.
Design isn’t necessarily about physical artefacts. Instead, it may determine the style of a service or the tone of communication with an audience. When redesigning A&E the aim may be to reduce the occurrence of violence and aggression which is a finite and therefore measurable concept. But other impacts could include improved staff morale, a more cost effective system or wider social impact, perhaps more difficult to evaluate.
It is useful to establish criteria for measuring the effectiveness of a piece of design work as well as the broader design project. The results of this evaluation can influence future iterations of the design or future project work. One key insight from the Reducing violence and aggression in A&E project was that multiple stakeholders owned single aspects of the A&E service. Since design projects need to understand how systems work and are connected to other systems it can identify opportunities for different hospital functions to collaborate on delivering new improved services. Working in new, cross-functional ways can be facilitated by appointing champions within A&E departments to maintain and encourage the adoption of solutions and or a design approach to problem solving in a continued cross-functional way.