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The Department of Health (DH) has commissioned a project to explore how violence and aggression towards hospital A&E staff can be reduced by redesigning casualty departments.
Statistics released in November by the NHS Security Management Service (NHS SMS) showed that the total number of assaults on NHS staff rose by 3.6 per cent – from 54,758 to 56,718 – between 2008/09 and 2009/10. The cost of violence and aggression towards NHS staff is estimated to be about £69 million a year, once staff absence, loss of productivity and additional security are all factored into the equation.
Recognising the role that good design of processes and the built environment can play in addressing the problem of violence – particularly in the complex, high-pressure environment of A&E – the DH has asked the Design Council to investigate potential measures.
Called ‘Reducing violence and aggression in A&E by design’, the year-long project will involve designers, architects, health-care experts, patients and front-line NHS staff working together to develop and trial possible solutions. Teams will be invited to submit a proposal on how they would approach the challenge through value-for-money solutions that could significantly reduce the financial and human cost of violence against staff.
The selected design team, or teams, will then work with A&E staff and patients at three NHS trusts – Guys and St Thomas’ NHS Foundation Trust, Chesterfield Royal Hospital NHS Foundation Trust, and Southampton University Hospitals NHS Trust. The trusts have been chosen because they each have different profiles and allow the piloted solutions to be evaluated in a mix of environments.
As well as reducing violence and aggression, the Design Council highlights a number of other spin-off benefits from redesigning aspects of A&E departments, including increased staff morale; reduced litigation, security and insurance costs; reduced staff absence; and increased productivity and quality of care.
The winning design team, or teams, will develop a variety of innovative solutions aimed at giving patients, visitors and staff a better and safer experience in A&E. Measures will include: changes to interior design, such as redesigning layout and use of space, or introducing new products and furniture; improvements to information given to patients and their families; and redesigned clinical and non-clinical services and systems.
Commenting on the project, NHS chief executive Sir David Nicholson said: “There is a substantial financial and human cost to violence against staff and I look forward to seeing the results of this project, which will help A&E departments become calmer, safer, and more productive environments.
“Anything which can help defuse difficult situations, demand mutual respect, or reduce the pressure on busy staff is a welcome addition towards building a modern NHS, centred around high-quality patient care.”
Professor Matthew Cooke, the DH’s national clinical director for urgent and emergency care, added: “As an A&E consultant I have witnessed the effect of violence on colleagues. Verbal abuse is a daily occurrence and, unfortunately, physical violence against staff is not rare. This violence also increases the anxiety of other patients and their families in the emergency department at a time when they need a calm atmosphere to aid their recovery from their illness.
“Better design can help reduce violence, and reduce its adverse effects. I look forward to seeing the results of this project, which will not only make work safer for my colleagues but also enable us to provide better care for our patients.”
Health-care workers’ union Unison welcomed the focus on work environments but said other measures are also needed. Its head of health, Karen Jennings, said: “Work environments are crucial in preventing violence and stress, but these measures must come as part of a package. We want to see zero tolerance of violence against health staff. No one should feel afraid of being hurt in their place of work. Employers must push for more prosecutions and also listen to and respond to important concerns about staff shortages when raised by staff.”
The closing date for entries is 4 April, with shortlisted entries to be announced two weeks later. Innovations emerging from this latest project will be showcased in October, with the ambition to roll them out across England’s hospitals.