A Better A&E

Yesterday, the Design Council announced that a programme designed by PearsonLloyd to reduce aggression in A&E departments has proved a success in trials and should be implemented nationwide. We spoke to Tom Lloyd about the project.



As anyone who’s had the misfortune of waiting in one will know, Accident & Emergency rooms can be bewildering and frustrating places. Visitors often spend hours slumped in plastic chairs among victims of sporting injuries, fights and falls. And in amongst all the swearing and tears, there’s usually at least one person haranguing NHS staff about why their friend or relative hasn’t been seen to.

In such high pressure environments, it’s little wonder patients feel annoyed but often, their frustrations are directed at staff: according to the National Audit Office, violence and aggression towards hospital workers is costing the NHS £69 million a year in absences and reduced productivity.

In 2011, the Design Council launched a challenge to tackle this problem on behalf of the Department of Health. London design studio PearsonLloyd assembled a team of academics and healthcare professionals and proposed a three-pronged solution: an information package for visitors, training and support for staff encouraging them to identity factors that may hinder care capacity and an online toolkit offering best practice advice to managers and planners looking to re-design their A&E departments.

Trials of the scheme were launched at Southampton General Hospital and St George’s Hospital in London late last year and yesterday, it was revealed that it led to a 50 percent reduction in threatening behaviour and a 25 percent reduction in shouting.

Patients, too, felt the system made their treatment process clearer: 88 percent said it clarified the A&E process and 75 percent said signage reduced their frustration during waiting times. The Design Council has now recommended that the system be implemented in all NHS Trusts and PearsonLloyd says that for every £1 spent on introducing it, £3 will be saved in costs related to incidents of violence.

The information package devised by PearsonLloyd consists of signage, printed and digital communications. Signs placed around the hospital describe the A&E process and explain to patients why they’re waiting and what will happen next. This is supported by a printed leaflet containing additional information about the department and a tear-off feedback questionnaire, as well as digital displays that are updated automatically using hospital data to provide information on how busy the department is and what is being done.

PearsonLloyd’s work is based on 300 hours of ethnographic research supplied as part of their brief, outlining where and why aggression in hospitals might occur. “We took this as the basis of our work, and then built on it with our own research in A&E departments,” says PearsonLloyd co-founder Tom Lloyd.

“The clinicians in our team were able to advise on the details of frontline care delivery, but we were also able to work with three trusts from across the country – Southampton, Guys & St Thomas’, Chesterfield – to understand the broader extremes of the NHS. Any solutions we created had to be compatible and retro-fittable into any A&E department across the country, so we needed to understand how these could vary in design, culture and layout,” he says.

The idea for the guidance information package (signage, leaflets and digital displays) was born out of [Luke] Pearson and Lloyd’s desire to better understand how the accident and emergency system works, explains Lloyd. “Whilst trying to map the patient flow through the department, we realised that his would be very useful information for everyone,” he adds.

“When designing the graphics, we were very careful to steer clear of a medical aesthetic – the signage needed to look fresh and inviting, drawing patients in to read the information,” he explains. “Initially, the signs were envisaged as being a ‘slice’ of a room, where the walls, floor and ceiling would be treated in a coloured wrap that could be seen from afar and easily identified as an information point,” Lloyd explains.

Photograph: Simon Turner

Background colours – hospitals will be able to choose from a set of three – were chosen from a palette deemed to be ‘un-hospital’ like. Foreground text colours where chosen for their contrast and to be clearly legible in compliance with the Disability Discrimination Act. “We offer three colourways for the signage, which all ensure the correct contrast and give trusts the ability to complement their existing colour schemes,” says Lloyd.

Vertical information panels have a clear hierarchy of information with key information placed at the top in the largest font sizes. Secondary points are listed below in decreasing sizes and all is displayed 1-2 metres from the ground to ensure it can be read by all and won’t be obscured by bins, chairs or other furniture.

Adrian Frutiger’s Frutiger typeface was chosen for use on all communications “as we wanted an easy-to-read sans serif font that was friendly but had the right amount of authority and legitimacy,” explains Lloyd.


Photograph: Simon Turner

Graphics for the scheme also include a series of icons depicting hospital staff and patients. “A lot of time was spent developing these to ensure they were easy to understand and communicated the right message. We performed a number of design voxpops where we asked members of the public to rate different designs to inform our understanding of where confusion may occur,” Lloyd adds.

Designing a system that can be applied to any A&E unit is a complex task. PearsonLloyd worked closely with Southampton and St George’s throughout the trial period and says consultations allow the scheme to be tailored to the needs of each department. “[The pilot sites] seemed to really value the consultation stages, as this helped them to really question and analyse their own processes and ultimately create something more appropriate for their patients.”

Based on thorough research into hospital environments, the studio has presented a clever solution to common problem – and the system could have a significant impact on UK A&E Awards if it is rolled out nationwide. PearsonLloyd is now in talks with Trusts over developing pre-arrival web and app programmes to help people decide if they really need to visit A&E and hope the system is something that could be implemented in other hospital departments.

“To our knowledge, this is the first time something like this has been done within hospitals … we also feel there’s great scope to extend the idea into all public spaces where significant waiting (and confusion) occurs,” Lloyd says.

To find out more about the project and pilot scheme results, see abetteraande.com

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