Department of Health A Better A&E

Improving the experience of hospital Emergency Departments

A Better A&E is set of design solutions, now introduced at over 20 NHS trusts, aimed at improving the experience of patients and visitors in UK Emergency Departments.

Created by a multidisciplinary team led by Pearson Lloyd, A Better A&E responded to the prevalence of violent and aggressive behaviour perpetrated by patients and visitors to staff in the NHS at a cost of over £70m per year in staff absence, litigation costs and reduced productivity.  Recognising that poor visitor experience is a key driver of these incidents, Pearson Lloyd developed a three-pronged approach to creating a calmer and more relaxing care environment for everyone.  The solutions work to ensure both patients and staff have the best possible experience of the complex, high pressure environment that is A&E, where pain and worry can alter behaviour.

Rigorous evaluation at pilot trusts found that, when implemented, both patients and staff observed significant reductions in aggressive behaviour, with a 50% fall in incidents. There were also improvements in staff morale, retention and wellbeing, with stress-related staff absences falling significantly.


The key element of the programme is The Guidance Solution, that informs and guides patients through their time in the department using information graphics. Each element of this solution communicates essential information, greeting visitors on arrival and empowering them with knowledge about how the A&E department works, and what they can expect.  By answering questions and clearly signalling stages of the patient journey, frustration and aggressive behaviour are both reduced.

Alongside the Guidance Solution, the People Solution is an ongoing system of staff support to help establish new responses to the problem of aggressive behaviour, and the Toolkit gathers current best practice in the design and development of new ED departments.

Further information can be found at and

Threatening body language and aggressive behavior fell by 50% post-implementation.
Design Council Impact evaluation findings summary