When people need treatment at A&E they expect to be able to find the department and check-in quickly and easily.
The entrance and reception areas, and the services they provide, set the tone for a patient’s experience of their time in A&E and any further stay in hospital. People often arrive at A&E in pain or discomfort and they can expect to check in and receive treatment almost immediately. This isn’t always realistic. Together, these factors can result in increased levels of stress which manifests in violent or aggressive behaviour.
By working with designers, A&E managers can create a welcoming and easy to use entrance space using furniture and interior design to deliver a positive first impression and set the tone for the rest of the A&E experience.
People produce a cognitive map of any space they enter into, and "The more we know about how humans ... can navigate, wayfind, sense, record and use spatial information, the more effective will be the building of future guidance systems, and the more natural it will be for human beings to understand and control those systems," according to Reginald Golledge in Wayfinding behaviour: Cognitive mapping and other spatial processes, 1998. Cognitive maps assist people needing to find their way in new, never visited spaces too, because they can apply previously learned information from a similar environment to the new context. Wayfinding and cognitive mapping are inseparable and most humans carry many cognitive maps in their head at any one time and by providing signs or environmental cues to help people find their way, and access useful information, hospitals can make it easier for people to access their service. This will mean they do not get frustrated at the start of their A&E experience.
“It is important that the design of the department supports the natural wayfinding of people using the facility as staff, patients or visitors. This will help to ensure that people find their way to locations such as the reception and waiting areas, and also that they do not inadvertently access sensitive areas of the department such as paediatrics or resus.” [Reference: The impact of the built environment on care within Accident & Emergency Departments, Intelligent Space Partnership 2002]
Why is understanding the concept of a cognitive map and what goes into developing one important to designers of the built environment? Buildings with design features that help build a robust cognitive map for individuals can be highly important to wayfinding, particularly as it applies to remembering a space if the wayfinder revisits it. They can also assist in returning people to their point of origin. Robust cognitive maps are important to people with intellectual and cognitive disabilities as well as to persons with poor memories or those who become easily confused. In addition, building a robust cognitive map is critical to building evacuation in emergencies. When people are distraught, which is particularly true in emergency evacuations, they tend to remember distinct features in the built environment that can help them exit and provide excellent reference points for communicating with emergency first responders.
A&E departments have many different entry points. For example, entrances for ambulance arrivals and walk-in arrivals, as well as access from other areas within the hospital. To enable security to be enforced, it is recommended that there are as few entry points as possible. [Reference: Effective management of security in A&E, NHS executive]
Designing the entrance to convey a positive impression that the A&E department will deliver both a quality service and a healthy environment can also relieve levels of stress and worry right from the beginning of the patient’s experience of A&E. This can have a beneficial effect on levels of violence and aggression: “design and control of entrances can have a major impact on the patients’ journey and running of the department.” [Reference: Department of Health: Intelligent Space Partnership (2002) ISBN : 0113224877 The impact of the built environment on care within A&E departments ]
“[CCTV] can assist in identifying the condition (both in terms of injuries and behaviour) of the person wanting to gain access.” [Reference: Effective management of security in A&E, NHS executive]
“Self-awareness has its consequences for various behaviours, and increased self-awareness leads to a higher agreement with a positive group.” [Reference:
Differential self-awareness theory]
Clear natural sightlines from the reception desk across the entrance and waiting areas and towards clinical areas can help reception staff feel empowered to take control of these areas and their atmosphere so that people who seem agitated or distressed can be talked to before they become violent or aggressive. CCTV can be used to keep an eye on parts of the entrance and reception areas that staff can’t see clearly and mirrors could reflect views of hidden parts back towards the waiting area so visitors can help keep an eye on what’s happening. It has been demonstrated that when people can see their reflection they are more likely to conform to society and its behavioural norms. [Reference ?] So the use of strategically positioned mirrors could help contribute towards reducing violence and aggression when others around them are behaving calmly.