To ensure that the outcomes of the Reducing violence and aggression in A&E programme were as effective as possible, the Design Council and Department of Health recognised it would be essential for the commissioned design team to develop, prototype and test solutions and the programme in operational A&E departments.
Relevant and representative NHS Trusts - those which had experienced a problem with violent and aggressive behaviour, demonstrated enthusiasm for addressing the issue
and had funding to enable an A&E redesign project - were invited to participate in this programme.
The programme also needed research sites for the national collection of design-led ethnographic research, which informed the development of the design challenge briefs. They subsequently also worked closely with the winning design team to co-design solutions to the problem of violence and aggression. These were then prototyped and tested on site, with the same partner NHS Trusts hoping to act as test-bed sites for the emerging design solutions.
The Design Council shortlisted a total of 12 potential partner NHS Trusts and identified a strong fit with three: Chesterfield Royal Hospital NHS Foundation Trust, Guys and St Thomas’ NHS Foundation Trust and Southampton University Hospitals NHS Trust. These Trusts were considered to provide a representative cross-section of NHS Trusts in terms of size, demographics, patient throughput, operations and geography. They were not chosen because of especially high levels of violence and aggression –
several other Trusts suffer from this issue more severely (in terms of nationally reported statistics collected by NHS Protect).
Chesterfield Royal Hospital NHS Foundation Trust
Violence and aggression
Chesterfield Royal Hospital experiences more than 80 physical assaults every year20. The Trust experiences high levels of violent and aggressive
behaviour, and as a result it recently issued security staff with stab-proof vests.
Patients
The A&E at Chesterfield Royal Hospital has a patient throughput of 60,000 per year21. A 1900s build, Chesterfield Royal provides services for the population of
Chesterfield town and surrounding areas, incorporating North Derbyshire, which represents a relatively rural population.
Future plans
Chesterfield Royal Hospital NHS Foundation Trust demonstrated commitment to developing its A&E department so that it can provide the very best of
care to the local population.
Guys and St Thomas’ NHS Foundation Trust
Violence and aggression
St Thomas’ Hospital is on a city centre site and experiences 167 physical assaults per year18. Up to half of those occur within the A&E.
Patients
The A&E at St Thomas’ hospital has a patient throughput of 140,000 per annum19. Its socio-demographic is diverse with a large homeless population in the
local area, as well as high levels of unemployment. However, due to its location the A&E department also serves professionals, and a large number of tourists and visitors to the city of London.
Future plans
St Thomas’ Hospital is planning an extensive redesign of its A&E department, so participation in this project offered opportunities to design and test solutions within the existing A&E department which could be adopted into plans for the new department.
Southampton University Hospitals NHS Trust (SUHT)
Violence and aggression
Southampton General Hospital encounters over 100 physical assaults per year16, and reducing violence and aggression in A&E is a priority for the Trust.
Patients
The SUHT A&E department has a patient throughput of 110,000 per annum17. The hospital has a large catchment area, incorporating Southampton and south
Hampshire as well as providing specialist services for central southern England and the Channel Islands. Consequently the socio-demographic of the area is diverse. In the
immediate area of Southampton, there is a large number of students, as well as a sizeable aging population.
Future plans
The design of a new Paediatric A&E has left space to reconfigure the A&E department. This presented a real opportunity to identify and implement solutions in
the design of the future A&E department at the hospital.