Design Council – Tackling Violence and Aggression in A&E

Design Council

Tackling Violence and Aggression in A&E


Client: Design Council

Project: Tackling Violence and Aggression in A&E

Insight: Contrary to common assumptions, alcohol is not the most significant factor in triggering violence and aggression towards A&E staff. Our in-depth research systematically documented the root causes of hostility, revealing that frustration with the experience was often more significant. 

Outcome: Inspired by our research, a range of low-cost design interventions are being piloted in three A&E departments, with expressions of interest from fifty more.

Winner – MRS Healthcare Research Award (2012)
Winner – AQR Prosper Riley-Smith Award for Qualitative Effectiveness (2012)


‘ESRO possess the rare ability of being able to reveal the heart of the issue, whether behavioural or environmental, in the most complex, often inhospitable, of environments.’

Programme Manager Health, Design Council

Stationed on the NHS frontline, A&E staff bear the brunt of 55,000 recorded violent incidents each year. Such violence has been estimated to cost the NHS over £100m a year. 

Faced with the ineffectiveness of existing measures, targeted almost exclusively at binge drinkers, ESRO conducted over 300 hours of qualitative research in A&E departments, at the busiest times of the year.

Our research showed that seriously violent incidents are relatively rare, and the main trigger to aggressive behaviour is not alcohol, as previously perceived, but rather a set of subtle environmental cues that can test the tolerance levels of almost anyone who experiences them. 

Our findings prompted a fundamental shift in the focus of the Design Council’s programme, moving the discussion towards creating a better all-round experience for A&E patients. Based on our findings, a range of new design solutions have been developed and are being piloted at a number of hospital sites, with over 50 trusts expressing interest in adopting the approach in future.


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