NHS hospital staff in the UK experience more than 150 incidents of violence and aggression every day. This problem is particularly prevalent in high pressure areas, with a fifth of all incidents taking place in Acute Trusts, which include Accident and Emergency (A&E) departments.
The estimated cost of violence and aggression to the NHS exceeds £69m annually, but this figure does not tell the whole story. Violent and aggressive behaviour affects staff, patients and other service users in a number of different ways. As well as decreasing job satisfaction and patient experience, it can also mask a number of additional costs. These include, for example, the lost investment in training staff who decide to leave, and the specialist security guards now employed by some hospitals to deter and deal with violence and aggression.
For the Reducing violence and aggression in A&E programme the Design Council worked in partnership with the Department of Health and the NHS to co-ordinate a team of experts, including a consortium of organisational consultants, user-centred researchers and emergency care specialists, who collaborated to identify opportunities for design-led solutions to tackle specific frontline staff issues.
The UK design, manufacturing and building communities were then invited to team up to respond to the Reducing violence and aggression in A&E challenge and a multidisciplinary team was appointed to collaborate with frontline A&E staff to design and implement their ideas.
The commissioned design team has worked closely with frontline staff at three NHS Trusts to understand the issues, opportunities and constraints faced by A&E staff. The designers have developed, prototyped, tested and, where possible, evaluated the impact of their designs. At every stage, they have worked directly with users and stakeholders.
Our specific goals for the programme were to:
- Support NHS staff and organisations in reducing the incidence of violence and aggression towards staff within their communities
- Directly or indirectly reduce incidences of violence and aggression in A&E and in doing so reduce associated litigation costs experienced by the NHS to compensate claimants (staff, patients and visitors) via clinical negligence and/or personal accident benefits
- Deliver tangible cost savings, reducing the actual and associated costs of violence and aggression incurred by the NHS
- Help bolster staff confidence and satisfaction by making real and perceived improvements to healthcare environments and facilities
- Help deliver improved patient care through calmer environments;
- Generate awareness and support a culture change among NHS staff and patients, focusing on mutual trust and respect
- Accelerate the identification and adoption of innovative design in NHS A&E departments.
The Design Council and Department of Health recognised that it was essential for the commissioned design team to develop, prototype and test solutions in operational A&E departments. We therefore partnered with three NHS Trusts, which are broadly representative of A&E departments across the country: Chesterfield Royal Hospital NHS Foundation Trust, Guys and St Thomas’ NHS Foundation Trust and Southampton University Hospitals NHS Trust. As well as providing valuable sites for research, the Trusts worked closely with the winning design team to co-design solutions to the problem of violence and aggression and act as test-beds for the emerging design solutions.
The first step in any good design project is to research the problem. The Design Council commissioned two ethnographic research companies to spend more than 300 hours in our partner NHS Trusts’ A&E departments, looking at how they worked from a user’s perspective. This research led to the identification of six Perpetrator characteristics pertaining to individuals who commit acts of aggression or violence and a set of nine Triggers of violence and aggression.