Designing for emergency

According to research from the Design Council, violence in A&E costs the NHS a minimum of £69m a year in staff absences alone. A survey of NHS staff found that 15% of NHS employees have been subjected to violence from patients or their relatives, with an incredible 59,000 assaults happening every year. One reaction to these shocking figures has been to install protective glass screens or to up the number of security guards in A&E. But surely this is just a sticking plaster rather than addressing the core reasons why so many people get aggressive?

Back in 2010, the Design Council commissioned design studio PearsonLloyd to investigate. With an entirely open brief, the studio made the decision to go right back to the beginning, taking a step back to ask what was it about A&E that was causing so much anger? The studio’s nuanced approach included an extensive period of research, listening to patients and staff at all levels, and observing staff and patient interactions. This journey led them to understand some of the reasons for patient frustration and, ultimately, violence. Incredibly the studio’s solution reduced aggressive patient behaviour by 50% – but more on that later. 

It soon became apparent that part of the reason visitors to A&E were becoming agitated was a lack of information about what to expect from their treatment and journey through A&E. When would they be assessed? Could they leave immediately after treatment? And why were they waiting? As this worry and frustration grew it would erupt into bad behaviour. With this insight PearsonLloyd decided to completely overhaul the signage in A&E making it immediately clear to people what would happen to them from the moment they entered A&E to the moment they left. It was a bold step from a studio better known for creating furniture, but PearsonLloyd knew they could install all the beautiful seating in the world, but without addressing the communication issues, the waiting room violence would remain.

But how does it work? Dotted around key parts of the visitor journey, a large-scale process map explains to visitors where they are, what happens in that department and what the next steps on their journey will involve. It allows people to easily digest the patient journey and can be complemented with digital screens that can inform visitors with live wait times and other up-to-date information. The signage is spread throughout the different stages of treatment so patients always know what’s coming next. It sounds straightforward but in the first three trial hospitals, the new signage reduced aggressive behaviour by 50%. To date 16 NHS trusts have installed A Better A&E, and counting.

The second part of A Better A&E was to give NHS workers the space to reflect on the factors that prevent them from delivering the highest level of care – without blame. PearsonLloyd developed a new tool called the Incident Tally Chart, which staff could use to notify management of everyday obstacles to their work. PearsonLloyd founder Tom Lloyd says, “Such a strong impact with such simple and low cost solutions is incredibly exciting and a huge endorsement of the potential for design and design thinking to help solve real problems in the public sector.”

With 75% of patents saying that the new signage made the wait less frustrating, A Better A&E has been a huge success. Given so many in-person services can get frustrating because the process is slow and unfamiliar – think picking up a passport or applying for a driving license – it’s easy to see how PearsonLloyd’s system could be rolled out far and wide. 

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