A reception service that establishes rapport between staff and patients and provides many different sources of information can help to manage patient and visitor expectations of how their time in A&E will be spent. If people aren't confused they may be less likely to become violent or aggressive. Visitors arriving at A&E for the first time may not know what to do, or understand the process for receiving treatment. Their expectations may also be very different to the reality of what happens. This may cause frustration, particularly if visitors inadvertently miss a step in the process that causes a delay to their treatment.
By working with designers, A&E can provide clear and relevant information about the patient journey and manage the expecatations of patients so that frustrations are prevented from occurring in the first place.
“Grilles and screens can cause greater stress in patients who are already feeling vulnerable.” “(The desk) can be a harsh, divisive and alienating barrier. Safety can be afforded to reception staff without putting up a screen.” [Reference: Department of Health: Intelligent Space Partnership (2002) ISBN : 0113224877 The impact of the built environment on care within A&E departments]
Many A&E reception desks have installed screens to prevent visitors from attacking staff, but these can actually exacerbate feelings of stress or aggression in visitors as they are often a barrier to communication. While acoustic privacy at check-in is important to maintain, physical barriers to communication such as safety glass and grilles can make visitors frustrated and they can feel like they are not trusted to behave well.
At Birmingham Heartlands Hospital visitors including those who have mobility impediments who may not physically be able to stand whilst checking-in are provided with seats so that they are able to sit at eye level with the receptionist, thus establishing a culture of respect.
“Able, approachable and experienced staff located at the reception desk - rather than inside an office or behind glass - will be able to welcome, direct and give general information. For hesitant, anxious, vulnerable patients - some of whom may have difficulties with mobility, language, vision or hearing - this is the most important element of their arrival.” [Reference: Department of Health. NHS Estates, Improving the patient experience: welcoming entrances and reception areas. ISBN : 0113224850]
Lighting design
“The reception area should be comfortably warm, well lit and free from unwelcome smells. It may be very busy at times but should be sufficiently spacious never to be crowded or excessively noisy.” [Reference: Department of Health. NHS Estates, Improving the patient experience: welcoming entrances and reception areas. ISBN : 0113224850]
Lighting can impact on visitor behaviour by changing the ambience of a space. Bright lighting should be used at entrances. This not only draws attention to the entrance to help those trying to locate it, but also creates a bright and positive impression of the department. It also has the benefit of aiding CCTV imagery.
“Routes by which visitors enter and leave the department should be tightly controlled so that privacy and dignity of patients is not compromised and to ensure that visitors do not access sensitive areas.” [Reference: Department of Health: Intelligent Space Partnership (2002) ISBN : 0113224877 The impact of the built environment on care within A&E departments]
"Controlling doors and entrances to an A&E department can be an effective way of controlling many security threats. Lack of control of access can make units vulnerable to vandalism, theft and intruders.” [Reference: Effective management of security in A&E, NHS executive]
Controlled access to sensitive parts of the A&E department can help reduce feelings of stress or worry for patients and for staff because they maintain each patient’s privacy during diagnosis and treatment and they allow staff to feel secure that only people they have let in are in the treatment areas.
However, controlled and private areas can lead to frustration among people waiting if they see other patients get checked-in and moved to resus more quickly than them, and seeing people arrive with serious conditions or injuries can be distressing.
At Birmingham Heartlands Hospital the reception and the main seating areas are open to everyone, and staff guide visitors through secure doors to other areas of the department when necessary. A separate controlled entrance for ambulances allows patients arriving with serious injuries to be moved to resus without going past people in the waiting area.
“Staff have by far the most significant effect on patients’ and visitors’ experiences of hospitals. It is important that those staffing the entrance and reception area are professional, friendly and competent to carry out their tasks.”[Reference: Department of Health. NHS Estates, Improving the patient experience: welcoming entrances and reception areas. ISBN : 0113224850]
A visitor to A&E will encounter lots of different sorts of staff. They might be expecting clinicians to diagnose their problems or offer treatment as well as staff at reception to provide information. A personal greeting from a member of reception staff can help deliver useful information and direct visitors quickly to their right course of action.
Visitors will also often see security staff who are on hand to intervene before any potentially violent situations get out of hand, but they should present themselves in a non-intimidating, helpful and friendly manner in order that their presence is not a cause for frustration in the first place. Security staff appointed to the A&E department could also carry out other tasks such as assisting visitors with wheelchairs or liaising with ambulance staff.
Staff too benefit from the presence and support of a security team. Panic buttons or other ways of instantly alerting and calling them to an incident as well as physical barriers to stop some of the impact of a violent incident are essential to design in to any A&E departments. “In emergencies reception staff should have immediate access to and support from security personnel.” [Reference: Department of Health. NHS Estates, Improving the patient experience: welcoming entrances and reception areas. ISBN : 0113224850]
“Panic buttons or other means of calling for assistance should be provided for the receptionist.” [Reference: Effective management of security in A&E, NHS executive]
How could designers help you develop a meet and greet service that helps patients feel calm and confident that they’re in the right place?
Digital design
The unpredictable nature of patient numbers, means that queues can suddenly develop at unexpected times. Self check-in using a simple touch screen computer system is now a commonly encountered in our day to day lives. Self check-in booths allow extra capacity to be built into the system, so that those visitors who are physically and mentally able, can check in and relieve pressure on reception staff. This could also be used for entering basic patient information.
At a New Jersey hospital that asked patients to start completing their own records as part of the sign-in process triage time decreased and 10 to 15 minutes of time was saved per patient on overall flow. [Reference 10]
Queue theory tells us that when people are ‘in-process’, queues feel shorter as compared to when they are not in process.[Reference 4] So using a ticketing system can help people feel like they are beginning the check-in process. It also allows them to take a seat and rest in a more comfortable way while they queue, a more compassionate way to let a person with an injury or illness wait.
The design and placement of self check-in or ticketing facilities needs particular attention: “care should be taken in using touch-screen or other interactive terminals, especially in existing facilities. The space required for the equipment and user is significant and so should not be located where it may obstruct or cause congestion.” [Reference 11]