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  • Case study

Can changes in hospital design reduce ER violence?

Quality of Life Observer

- Healthcare

- Mar 31 2014

London-based design studio, PearsonLloyd, ventured that aggressive behavior in emergency rooms could be reduced by using simple design elements to address the source of the problem: confusion. And they were right. Threatening body language and aggressive behavior fell by 50% following the implementation of the redesign.

Aggressive behavior in hospital emergency rooms, can lead to staff absence, loss of productivity, increased security needs and lowered standards of patient care – costing the UK’s National Health Service at least £69 million each year. When the UK Department of Health and the Design Council sought out a cost-effective solution that could be quickly and easily rolled out into any hospital, PearsonLloyd came up with the winning design solution.

“For some reason [emergency rooms] are spaces where people feel like they have the right to get angry and start shouting,” says PearsonLloyd director Tom Lloyd. We thought that by trying to calm the space down and take that away there would be less likelihood of violent incidents."


The importance of information

As preliminary research revealed, aggressive situations in emergency rooms often arise from a simple lack of knowledge. As such, designers at PearsonLloyd realized that the success of their design must center on informing patients. The firm proposed design adjustments to assists patients and their families who were unable to understand medical terms, overwhelmed by the process or just couldn’t figure out why someone who arrives an hour later gets to see a doctor before them.

“It sounds so simple,” says Lloyd. “But we wanted system that could be retrofitted at very low cost and quite high speed in almost any department in the country.”

Visually calming

The pilot program at Southampton General Hospital and St George’s Hospital in London posted informative and highly visual signage throughout the hospital to simplify medical language, illustrate how each department functions and explain what patients can expect during their visit. Several monitors were also installed with live estimated wait times.

A resounding 88% of patients felt that the signage clarified the process, while 75% of patients said it reduced their frustration during waiting times. The results of the pilot program also indicate improvements in staff morale and retention as well as an overall increase in wellbeing in the workplace.

Put the patients first

With so much attention paid to speed and efficiency in the high-pressure environment of an emergency room, the humanized or emotional aspect of patient care can easily fall away. To improve the quality of care, PearsonLloyd’s design incorporates a new approach to staff training. With a focus on patient communication, staff is encouraged to create a positive experience by greeting patients upon arrival and answering questions.

Newly designed charts also encourage staff to keep a vigilant record of abusive situations, allowing management to identify trends that can eventually facilitate procedural changes. The post-pilot results showed a reduced number of patients who felt they had been forgotten by the staff. This improvement in patient care not only reduces tension and hostility, but also prevents potential escalation into more serious incidents.
1. More on average emergency room wait time in the UK
2. More on average emergency room wait in the US and Canada


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