additional requirement for repair and maintenance on these wards can become a problem for the wider community. If rooms in a ward are unavailable pending the completion of essential repair work, patients requiring urgent care may experience a delay in receiving the treatment they need, placing further pressure on families and other carers, as well as on the NHS staff trying to deliver services.

In recent years a research collaboration has set itself the objective of improving this intractable situation, by bringing together a ‘non-traditional’ selection of stakeholders to work towards a highly practical set of outcomes.

How did the research project come about?

The research project was the brainchild of Altro – a long-established supplier of flooring, wall, and door coverings, which specialises in developing products for healthcare sites. The most recent research project grew out of an earlier study by the company (the ‘Hidden Needs’ project) which set out, several years ago, to collect ethnographic data on the requirements of different patient groups in a wide range of clinical settings in the UK. When visiting high-secure healthcare facilities, the researchers noticed unconventional usage of Altro products in these specific settings. For example, Altro Whiterock (a product designed as a wallcovering) was sometimes installed to protect ceilings. In other wards, Altro flooring products had been employed on walls.

Antonio Lourenco, Global Product manager at Altro, explains: “The health estate managers for the acute sites we visited were conversant with how the products should be used, and had installed them as recommended in other parts of the hospital. However, when we began to discuss the reasons for unconventional use of the products with ward personnel and estate managers, it emerged that there had been an urgent need to improvise in these high secure settings. The day-to-day challenges in these particularly demanding zones of the healthcare site were such that teams were ‘working around’ the

to understand the limitations of existing products in facilities where challenging behaviour by patients is a daily reality. The wider research project embraced a wider range of stakeholders, however.

Important insights into product lifecycle

Altro Screed, again shown within the Possibilities Studio, is a ‘solvent-free epoxy resin system that provides a moderate level of chemical resistance’.

limitations of the products currently available from manufacturers, and improvising urgent ‘fixes’ to meet the everyday demands for hygiene, robustness, durability, and safety. It became clear to us that as designers of products for this environment, with the ability to solve many of the problems experienced on a day-to-day basis, we needed to carry out further research to understand how design needed to evolve to meet requirements in these challenging applications.”

A ‘non-traditional’ participant The initial step involved creating a framework for the research. While HBN 03-01 strongly recommends the involvement of a wide range of stakeholders in the planning and design of new mental health facilities, product design specialists do not feature in this list, and would not, traditionally, have this level of intensive observation and collaboration with NHS staff.

Altro Pisces – shown here fitted at the ‘Possibilities Studio’ in Letchworth, is ‘a domestic-look, specialist flooring for a home- from-home warm feel in wet environments’.


Antonio Lourenco says: “We were fortunate in that we have long-standing links with health estate managers in NHS Trusts and private hospitals across the country, as Altro products have been installed in healthcare applications for many years. When we described what we hoped to achieve, there was immediate support from our contacts in the healthcare sector. Response, right from the outset, was brilliant – both from those managing the buildings, and the clinical and support staff working with patients. They described to us the problems they were experiencing when rooms were unavailable for use due to the need for repair. We all shared the determination to find solutions to these very real problems.” Initial discussions took place between members of the Altro Technical Services Team and healthcare estate managers. The Technical Services Team’s members are typically installers of floor and/or wallcoverings with more than 20 years’ experience. They were able to analyse the detailed input of those directly involved in the repair and refurbishment of acute units

“Our earlier Hidden Needs project had delivered a number of important insights by analysing three key moments in the lifecycle of a product, and saw us interview the three different groups of people involved in these interactions,” Antonio Lourenco explained. “These key moments included specification, installation, and everyday use. So, our new research project adopted the same framework, drawing insights from an extremely wide network of stakeholders. In addition to architects involved in specifying products, installers who were fitting the products, and the staff experiencing the day-to-day performance of products, we extended our study to seek input from organisations such as the Ministry of Justice and the Design in Mental Health Network.” Detailed research was carried out at 21 healthcare sites in total, and extensive use was made of video, audio interviews, and photography, to record opinions and insights. “We all agreed that it was crucial that the research be carried out within the acute mental health facilities themselves, rather than at Altro’s headquarters,” Antonio Lourenco commented. “It was important to ensure that this was a study drawing on tangible evidence specific to the requirements of a particular healthcare setting. This was essential to ensure that the final outcomes of the study would deliver the maximum benefit for everyone who had devoted their time.”

Complex ethical issues

Antonio Lourenco explains that securing the time and attention of busy clinical and support staff in these units was one of the most problematical aspects of the project. He said: “Engaging with clinical staff to carry out in-depth research is never easy, especially when it involves significant amounts of time out of their busy

Altro says its Altro Whiterock hygienic doorsets, faced with PVCu, ‘are the answer in areas where hygiene is crucial, or where doors take a lot of abuse’.


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