A few months ago, we met Matt Evison, a chest physician in Greater Manchester, to explore the connections between lung health and physical activity. The conversation quickly grew into a much bigger one. There were so many ideas and possibilities to explore together.
One of the things Matt is fired up about is hospital life; for patients, staff and visitors! The way that hospitals are designed and run, inhibits movement and impacts negatively on health. The very thing we are all trying to improve. He tweeted this, a couple of weeks ago. We retweeted it and asked people to reflect on their own experiences of hospital life, and tell us all the ways that activity could have been enabled. Wow! Such brilliant input.
The ideas below have been crowdsourced.
Clearly, we can’t address all of these things at once, but if the headlines in 10 years time were to read:
“How an active hospital has transformed lives for patients, staff and visitors, saved £millions”.. how might we have got there?
Let’s look at the whole system influences on everyday movement in hospitals and see what could be done:
Policies, rules, regulations and codes
- Dress codes: shoes you can move in (staff)
- Uniforms that enable movement.
- Patients to get dressed into normal clothes wherever possible.
- People out of bed as much as possible.
- Up and about message, rather than ‘take it easy’.
- Explicit permission to move. Enable it. Encourage it.
- Explicit permission for those that can to go outside, use gym, do gardening.
- Post surgery activity and exercise ‘tuition’, buddying
- No smoking zone to be off site
- Shift patterns to enable active days
- Walk for meals, meds and toilets for those that can
- Staff policy 45 minutes per week paid time to be active- 2 walks a week?
- Standing desks
- Incentivise and enable active travel- bike to work, bikes and scooters for on site and home visits.
- Scooters to get around hospital site- quick, active and fun.
- Social prescribing approach throughout the workforce.
- Gym, quiet space for rehab- less clinical- more welcoming- pilates, yoga etc. Music.
- Follow Sport England’s Active Design guidance when building and refurbishing spaces.
- Stairs, not lift- for those who can- visuals to point people towards this.
- Lounge areas that people can walk to to socialise. Decent coffee.
- Walking routes around hospital grounds- Daily Mile. Signposted and clear.
- Fold away beds.
- Day rooms that are inviting people out of bed.
- Meals in day rooms, not in bed.
- Gardens, allotments.
- Dogs for walking.
- Play spaces.
- Walking routes.
- Open spaces outside wards to entice people out.
- Integrated public transport system
- Walking and cycling infrastructure built in
- Bike racks and lockers
- Bikes and scooters to get around site
Organisations and Institutions
- Gain commitment at the highest level- Chief Execs and Directors. Make the business case: staff sickness costs etc.
- Engage ALL staff from the start (nurses, allied health professionals, cleaners, catering staff, doctors, consultants, office staff, senior leaders, community and district nurses).
- Look at all aspects of workplace culture: perceptions, rules, permissions and policies.
- Look at what is measured and work out how to have an impact on it- eg staff sickness rates. Frame staff activity and wellbeing as a solution.
- Train staff in having enabling conversations. Make moving more a core message of all conversations with patients and staff (eg Surgery School)
- Recognise the opportunity that healthy competition presents to leverage engagement: eg league tables on reducing staff sickness, and % of staff managing their 2 walks a week.
- Skype appointments
- parkrun hospitals (like parkrun practice)
- Daily Mile hospital (for staff, visitors and patients where possible)
Social Environment and Influences: individual relationships, families, friendships groups, support groups, social networks.
- Change the conversation – make every conversation an enabling one. Strengths based. Supporting movement.
- Identify the critical influencers and welcome/draw people in all along the way. Be inclusive, open and keep asking people to ‘join in’
- Local community groups, charities etc part of hospital life. Make social connections with people for when they leave.
- Goodgym, intergenerational activity.
Individual Factors: capabilities, motivations, opportunities, knowledge, behaviours, attitudes
- Positive communications- noticeboards, leaflets, online advice all supporting and enabling movement.
- Classes and rehab less clinical
- Classes and opportunities for long term visitors to be active
- Buddying when leave hospital
- Self serve tea and coffee in social spaces
- Hospital TV to prompt moving and offer exercise tuition to do in your chair/bed
What might the outcomes be?
- reduced length of hospital stays
- reduced waiting times
- reduction in re-admittance rates
- increased activity levels of patients pre, during and post stay
- increased activity levels of staff
- increased activity levels of visitors
- happier, healthier, more productive workforce
- reduced absenteeism
- change in narrative (bed blockers and bed rest)
- change in narrative ‘we’ not ‘us and them’
- hospital as part of the community
- community organisations, charities etc offer integrated support
- last place you go, rather than first place
- a beacon of community health and wellbeing
If we could create exemplar hospitals, and share the learning along the way, imagine how we could change things together. We already have two hospitals who are keen to go on this journey.
Please help, by sharing your ideas and additions to these lists, in the comments below, and we’ll keep growing the list, and start working with our hospitals to bring about changes. Big and small.