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Design & Health Scientific Review
Accident & Emergency:
Reducing violence and aggression by design
Working with the NHS and Department of Health, the UK’s Design Council has devised a strategy
to help solve a costly and difficult problem – the high level of violence and aggression in A&E
Chris Howroyd, The Design Council
NHS hospital staff in the UK
experience more than 150
incidents of violence and
aggression every day. This problem is
particularly prevalent in high-pressure areas,
with a fifth of all incidents taking place in
Acute Trusts, which include Accident and
Emergency (A&E) departments.
The estimated cost of the problem to the
NHS exceeds £69m annually, but this figure
does not tell the whole story. Violent and
aggressive behaviour affects staff, patients
and other service users in a number of
different ways. As well as impacting on job
satisfaction and the patient experience, it
can also mask a number of additional costs
– for example, the lost investment in training
members of staff who decide to leave, and
the specialist security guards now employed
by some hospitals to deal with incidents.
The Design Council worked in
partnership with the Department of
Health and the NHS on a year-long project,
Reducing Violence and Aggression in A&E.
Objectives
The programme’s specific goals were to:
• Support NHS staff and organisations in
reducing the incidence of violence and
aggression towards staff
• Deliver tangible cost savings, reducing the
actual and associated costs of 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 staff and patients,
focusing on mutual trust and respect
• Accelerate the identification and
adoption of innovative design in NHS
A&E departments.
The Design Council and Department
of Health saw that it was essential for the
commissioned team to develop, prototype
and test solutions in operational A&E
departments. Three NHS Trusts, broadly
representative of A&E departments across
the country, acted as partner Trusts. As well
as providing valuable sites for research, the
Trusts worked closely with the winning team
to co-design solutions to the problem and
act as test-beds for the emerging solutions.
Andy Smith
Violence and aggression in A&E cost the NHS £69m a year, plus costs such as specialist security staff
Methodology
In order to understand the issue, the Design
Council commissioned two ethnographic
research companies to spend more than
300 hours in the partner NHS Trusts’ A&E
departments, looking at how they worked
from a user’s perspective. This research
led to the identification of six perpetrator
characteristics pertaining to individuals who
commit acts of aggression or violence and a
set of nine triggers.
Some individuals are more likely to behave
aggressively or violently than others. People
with mental health problems and people
who are drunk or under the influence of
drugs are the most likely perpetrators
of violent or aggressive behaviour. When
visitors behave violently or aggressively, staff
70 January 2012 | WORLD HEALTH DESIGN www.worldhealthdesign.com