Reflections on a design-led approach to reducing aggression in A&E

Governments around the world are increasingly interested in design, as a methodology for better connecting service delivery with citizen needs. Design and behavioural science can help governments make and test policies in more ambitious and collaborative ways. It is increasingly recognised that design not only assists in informing and initiating policies, but that the practical application of design methods can support the integration of policymaking and policy implementation.

Despite growing interest, design in policy development is only just emerging as an approach and is one of a number of new methods being trialled in central government. In relation to policy, evidence of how and when design adds value is limited and to date design has been used in only a handful of policy projects. However, there is a growing evidence base for the impact of design in improving frontline services, such as in healthcare service improvement.

Design Council’s collaboration with the Department of Health to reduce violence and aggression towards frontline healthcare staff offers a practical example of a design-led response to a policy imperative. It is increasingly recognised that design not only assists in informing and initiating policies, but that the practical application of design methods can support the integration of policymaking and policy implementation.

The impact of behavioural science on policy

Drawing on insights and methods from psychology, economics and neuroscience, behavioural science challenges the view that people always behave in a rational self-interest, arguing that people often make decisions with little conscious awareness.

This has major implications for how governments can achieve their objectives beyond incentives, legislation and information. In the context of A&E, there is a natural assumption that people who behave aggressively towards staff have made an active decision to do so. We assume they are unwilling or incapable of changing, which leads to standard approaches of more security or threats of punishment.

However, if we know that people’s intentions do not always translate into action, and that emotion plays an unconscious role in decision-making, we need to provide practical help for people to overcome these barriers or go with the grain of making better decisions. This means designing solutions that are grounded in what people really want and need.

Reducing violence and aggression in A&E

Much has happened recently in UK central government to introduce new methods to policy teams, including those offered by design. The Reducing violence and aggression in A&E: Through a better experience programme offers a practical example of how design and behavioural science can help governments become more open, ambitious and collaborative in how they make and test policies.

Crucially, the design solutions were co-designed, installed and evaluated within working A&E departments. In this, the programme has directly bridged the gap between policy thinking about how to manage staff safety on the frontline, and delivery against that policy objective through the application of design and behavioural science to create effective solutions.

Beyond the two pilot trusts (St George’s Healthcare NHS Trust and University Hospital Southampton NHS Foundation Trust) A Better A&E’s Guidance solution signage has been independently purchased and installed by a further three trusts to date. PearsonLloyd works with each trust to customise the solutions to the requirements of each department, reflecting the different processes and cultures that exist, and are also offering a template package to allow trusts to install the Guidance signage at a lower cost. Five trusts are currently trialling the template package with the first template installation having just been completed early in 2015. A further 20 trusts from across the UK and as far afield as Australia are interested in installing the solutions.

The evaluation findings from Reducing violence and aggression in A&E: Through a better experience further strengthen the evidence that cost-effective design solutions, informed by a deep understanding of human behaviour, can play an important role in improving patient experience. NHS England is exploring options to increase the uptake of these solutions. It is also hoped that learnings from this programme can be applied beyond healthcare, with the potential to demonstrate benefits in other public settings.

Find out more at www.ABetterAandE.com

This opinion piece is based on Miles Ayling and Catherine Makin's original article published on the gov.uk website in January 2015.