Establishing the return on investing in design

Why evaluate?

There is a big difference between creating outputs and producing outcomes. Design should be a process that establishes intended outcomes before it is decided which outputs will help achieve those results.

The Reducing violence and aggression in A&E programme intended 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.

A design team commissioned by the programme developed two outputs which are intended to improve information provision and staff service in A&E departments. These solutions have been designed to be retrofittable to any A&E department and to be evaluated by any NHS Trust that implements them.

Methodologies

To quantify the effects that any proposed design solutions will have on any issue such as violence and aggression in A&E evaluation activities could include:

  • A survey of staff perceptions (before and after a design project) of the ‘power of design’. Evaluation intended to measure how being involved in the project had affected staff perceptions of design.
  • Forecast what return on investment (ROI) might result from the implementation of the proposed design solutions through an initial prediction provided by managers and clinical leads and use to set KPIs for the project. First calculate the likely costs of developing and implementing new design solutions, identify potential project risks and opportunities for cost reduction. To calculate ROI you can use the ROI calculator proposed by the NHS Institute for Innovation and Improvement.
  • Pre- and post-implementation structured observations
  • A patient, families and friends survey, a staff and managers survey
  • Qualitative interviews with key staff and managers.
  • Secondary analysis of existing datasets collected within national NHS, Care Quality Commission (CQC) and Security Incident Reporting Systems (SIRS) frameworks to provide comparisons between sites where design solutions have been implemented and those where they have not.