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Reducing violence and aggression in A&E: Through a better experience is a Design Challenge to improve patient experience and create a calmer and safer environment for A&E staff.

The problem

Violence and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff absence, loss of productivity and additional security. As many as 59,000 physical assaults occur in English NHS hospitals each year, a figure which continues to rise. With over 21 million patients attending A&E departments each year, increasing pressure on A&E departments can lead to negative experiences for both patients and staff. In the complex, high pressure environment of A&E escalating frustrations can be particularly difficult to manage and diffuse.

The insight

Many people become frustrated during their time in A&E because of a lack of clear, effective information and guidance. This, combined with anxiety and pain, reduce people's tolerance levels and make them more likely to behave aggressively toward the staff.

We know designers have what it takes to develop new systems that help reduce violence and aggression in A&E and commissioned a multi-disciplinary design team led by PearsonLloyd to develop solutions.

Our response

Extensive ethnographic research was conducted at three NHS Trusts. Patient journeys through A&E were mapped alongside incidents of violence and aggression. Insights were analysed to understand why patients might become aggressive and what types of patients might be more prone to becoming aggressive.

In response to the research findings the team developed three solutions to improve the experience of both patients and staff, reducing anxiety and promoting a positive hospital culture. 

1. The guidance solution

A comprehensive package of information about the department, waiting times and treatment processes via on-site environmental signage, patient leaflets, and digital platforms.

2. The people solution

A programme of reflective practice designed to better support NHS frontline staff to manage and learn from incidents of violence and aggression.

3. The A&E toolkit

A package of information and guidance for NHS managers, clinicians, designers and healthcare planners who want to develop and deliver a better service in effective and inspiring environments.

Visit to find out more about the solutions and how to implement them in your A&E.


Thorough impact evaluation shows that the design solutions have improved patient experience, reduced non-physical hostility and aggression, and provided good value for money. 75% of patients said the improved signage reduced their frustration during waiting times, and a 50% reduction in threatening body language and aggressive behaviour was recorded following implementation of the design solutions. It is recommended that other A&E departments in England consider implementing these design solutions to realise similar benefits.

In addition to the two pilot trusts, a number of sites across the UK have already adopted the design solutions.

Implementing these solutions  

The Guidance solution for A Better A&E has been installed in seven A&E departments to date, with a further four installations planned and plenty more Trusts interested.  PearsonLloyd are undertaking a pilot of their new template package for the Guidance solution with three Trusts.  The template package allows Trusts to install the Guidance panels for a lower upfront cost, which we hope will increase uptake across the NHS.

To find out more about the solutions and how to implement them in your A&E, visit


For more information please contact:

A&E toolkit