The study, titled ‘Reducing aggression in emergency department waiting rooms’, by researchers at multidisciplinary design practice Hames Sharley, scrutinised the role that ‘place sensitivity’ may play in unwanted behaviours from visitors and patients. It followed research into aggression and violence in Australian emergency departments in 2022.

Dr Emil Jonescu, head of research and development at Hames Sharley, said the study could underline the value of inclusive design in real terms for emergency departments in Australia.

“The study essentially focused on developing a deeper understanding of the potential relationship between design and people’s behaviours in an emergency department setting,” he said. “In particular, we considered the modern neurodiversity spatial design approach and its ability to discourage and restrict unwanted behaviours.

“Foyers and waiting areas in hospitals are critical interfaces that influence interactions between clinicians and the community, comfort, activities, productivity, and community sentiment, but they can also be high-stress environments that lead to aggressive behaviour.”

Pointing to behaviour being shaped by both the environment and genetics, he proposed a multifaceted approach as a possible means to neutralise the potential for aggressive behaviour, while providing better support for patients and visitors.

Sensory processing disorder

Dr Jonescu said the study highlighted the growing importance and awareness of designing for neurodiversity.

“It’s been suggested that approximately 5-16 per cent of the population has some form of sensory processing disorder (SPD) and that 18 per cent of the population are neurodiverse, which implies that their sensory processing is likely to vary, and they would react differently to daring stimuli within the built environment,” he observed.

He explained that human beings process their environment through different filters, which then determines not only what they perceive but how they respond. In the case of hospital emergency departments, certain aspects may appear confrontational to one person, yet they may be of no concern or potentially even comforting to another.

Findings from the firm’s own sensory profile studies of workers in the knowledge sector suggested that most participants belonged to “Sensor” and “Avoider” groups, people who are considered hypersensitive to processing information in their environment.

Contexts that are prone to aggressive behaviours, such as emergency departments, are inherently disruptive, dynamic, and loud, the study states, and they should therefore be designed with access to refuge techniques, also known as de-escalation techniques.

Refuge spaces, says the study, would enable occupants to self-regulate their level of sensory stimulation to achieve an individual level of comfort. Low-sensory stimulation design includes aspects such as warm lighting, neutral biophilic colour and materials, quiet zones, calming visual distractions (e.g. aquariums, indoor gardens, natural dioramas, natural forms, serene artwork), calming sounds (e.g. birds, streams), and inglenooks.

“While we should consider this for all design contexts, studies such as these highlight the importance of designing for neurodiversity in particularly high-stress environments, such as emergency departments,” Dr Jonescu concluded.

This research follows a series of studies investigating future design possibilities for Australia’s health industry, including a recent study into enhancing the design of intensive care units to reduce noise, and in turn, better support the emotional and physical healing of vulnerable patients.