Tackling violence & aggression in A&E

Design Council / Department of Health


Our in-depth research systematically documented the root causes of hostility towards A&E staff – reversing existing narratives to lay the foundations for a successful intervention which improved the overall experience of A&E for patients, visitors and staff alike.


Winner, MRS Healthcare Research Award (2012)

Winner, Association for Qualitative Research Prosper Riley-Smith Award for Qualitative Effectiveness (2012)


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, Revealing Reality 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 thought, but 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 were developed and positively evaluated at a number of pilot sites – with many more Trusts having since gone on to adapt & develop the learnings and outputs of the programme.