Putting Children at the Heart of Everything


By Hannah Brewster

Hannah Brewster explains how art and interior design contributes to a patient focused environment at the award winning Childrens Emergency Department and Evelina Short Stay Unit at St Thomas’ Hospital.

A trip to A+E can be a very stressful experience. For children, who are often unable to understand the reason for being brought to such a busy and chaotic environment, it can be extremely frightening. Unfortunately, these strains and stresses aren’t limited to children. Staff and visitors alike are subject to high pressure, high tension situations often exacerbated by the lack of clear, effective information and guidance.

A report by the Department of Health, in conjunction with the Design Council, found that ‘violence and aggression towards frontline hospital staff is estimated to cost the NHS at least £60 million a year in staff absence, loss of productivity and additional security.’ As the number of such instances continues to rise, it is obvious that something needs to be done. Over 21 million patients visit A+E departments each year and the pressure this puts on the NHS is bound to increase the likelihood of negative experiences.

At St Thomas’ Hospital, we aimed to tackle this problem head on. The vision from the outset for the Emergency Care Pathway was to create an efficient, calming, and patient focused facility where art served as an integral part of the design. Building on the foundation laid in the Depart of Health’s report, our aim was, through clear wayfinding and approachable design, to alleviate as many of the frustrations felt by patients as possible.

Located in the heart of the complex hospital site, the facility had developed on an ad-hoc basis over the last 70 years. The Children’s Emergency Department is one part of a much larger overall Emergency Care Pathway project. An emergency department inherently consists of many sub-compartments and areas. It had become overly large and difficult to navigate, which only compounded the issues presented by the unpredictable complexities of the patient group.


A simple and clear wayfinding strategy was to divide sub-departments by colour and use local, well known London landmarks – so that people could identify with their surroundings. This was important as it can go a long way in humanising environments that are too often cold and clinical.

For children, many of whom are already uncomfortable and unnerved by their surroundings, being able to identify and relate to the art provides them with something to focus on. ADP worked with consultants Art-in-Site to integrate child-friendly artwork as part of the information system at Evelina Children’s Hospital. Cartoon characters and landmarks were created by Japanese artist Kiriko, are used on information slices that are both educational and connected to place. Characters peeking around doors and on building fabric also provide a playful distraction.

An interactive App helps children understand the emergency care process and why they are in hospital. Tips on how to avoid common accidents and why treatments are needed enables children to learn in an engaging and funny way. A mini game also helps them understand the importance of hygiene by helping a character call Evelina (named after the hospital) wash her hands.

From the outset, a conscious decision was made that the artwork should not be used as a gallery piece or statement installation. It was designed to integrate seamlessly into the fabric of the building: a fresh approach when compared to the ad-hoc and often jumbled nature of previous works at St Thomas’ Hospital. Materials specified also had to be robust and cleanable to ensure they met with infection control requirements and low maintenance.

The short stay unit forms part of the main Evelina Children’s Hospital on the site, and it was therefore important that the Evelina brand was evident throughout. The signage and artwork uses the bright and vibrant colours of the the Evelina brand, which is circular motif developed with the help of young patients fingerpainting.

This was important to provide a sense of identity and continuity for young patients who are moved between units. What can be a traumatic and frightening experience is often hugely improved through a sense of continuity. This could be through seeing the same staff day in, day out, or it can be achieved through art. By matching treatment rooms with colours taken from Evelina’s branding, we were able to reinforce the idea that care was being provided by a coordinated and coherent department.

At the European Healthcare Design Awards 2017, the Children’s Emergency Department and Short Stay unit as part of the Emergency Care Pathway at St Thomas’ fought off stiff competition to be rated Highly Commended in the Interior Design and Art category. While this is a great achievement for St Thomas’ Hospital and ADP, we should remember why it is we care so much about this project: the children. Patients who need all the help and reassurance we can give them.

Dr John Criddle, Clinical Lead at the Children’s Emergency Medicine Department, said that ‘working with ADP enabled us to achieve our ambitions for a flexible, high-spec space, which has delivered a clinical area designed with the child at the heart of everything and a superb environment for children, their families and staff.’ This echoes other comments we have heard from staff and patients alike, and reinforces our belief that the integration of art into our designs is the way forward.

With stresses likely to increase on an already strained NHS, hospitals across the country will no doubt continue to look for new ways to create calmer, safer emergency departments. At ADP, we are excited to continue designing exciting and innovative solutions that put the patient at the heart of everything we do.


Hannah Brewster

Hannah Brewster

Hannah first joined ADP as a
student and has since worked on
numerous complex healthcare
schemes and rapidly progressed
to become associate director.