Culture Change for Health Care Green Space Engagement

The proposed work builds on a project that aimed to encourage greater use of hospital grounds for health and well-being benefit. It will utilise materials produced within the project such as workshop frameworks, an engagement toolkit and greenspace intervention evaluation guidance to disseminate knolwedge to health services managers, clinical staff, other health care workers, environmental sector professionals and voluntary sector agencies about how to get staff, visitors and patients using healthcare buildings' grounds and adjacent 'public' greensapce for health and well-being benefit.

The main activities will be:

(i) Combined dissemination and training workshops for health service managers and clinical staff.
(ii) Cross-sector (health, environment, public and voluntary) networking and exchange events.

Each of these activities will be held at three sites within the NHS Forth Valley region; one in NHS Highalnd and an additional two sites in other Scottish health board areas.

We will hold workshops at which NHS staff, environmental sector staff and voluntary sector staff can learn about the knowledge and materials generated in our original project. The workshops will involve training in tools and methods for encouraging greenspace use through participatory planning; leading conservation and other outdoor activities; and monitoring and measuring the benefits of outdoor activities. As a result of the workshops, the stakeholders will devise a plan for activities and small changes that could be made at their healthcare settings (e.g. healthcare centres) to encourage people to use the outdoors for health and well-being benefit. These plans will outline the roles that stakeholders such as the NHS, Forestry Commission, Local Authority and local voluntary sector will play in the future development of greenspace activities. Taking part in the workshops will equip stakeholders with the tools needed to plan and deliver greenspace activities at various types of healthcare setting. This work will help build relationships between the health, environment and community sectors for the management and use of outdoor spaces associated with, or adjacent to, healthcare buildings. The work aims to bring health and well-being benefits to staff, patients and community members through their increased use of such spaces.

Stakeholders will benefit by direct engagement in our dissemination workshops and by applying the knowledge gained in their own healthcare settings:

1. Staff, Patients and Community Members (NHS Forth Valley)
We will engage with NHS Forth Valley staff, patients and community members in healthcare settings other than Forth Valley Royal Hospital (main case study site in original project). We will carry out workshops that draw on, and disseminate learning from, our original KE project but that do so in different types of clinical and greenspace setting. Stakeholders will benefit by participation in devising action plans for their own healthcare sites - including adapting our 'greenspace engagement' techniques, knowledge from the literature, led-activity ideas and evaluation methods to their sites. At the end of the workshops, each site will have a draft action plan for activities and physical changes that could bring more equitable access to the positive effects of greenspace. They will have been trained in outdoor conservation and health intervention techniques (through collaboration with the Forestry Commission); enabling staff to carry out led-activities with patients at their healthcare settings. Through multi-sector workshops we will help build the cross-sector partnerships needed to design and carry out greenspace activities at the healthcare sites.

2. Staff, Patients and Community Members (other NHS Regions)
Participatory dissemination activities will take place in NHS Highland and two other Scottish NHS regions (to be agreed with the Green Exercise Partnership through our Forestry Commission partner). Workshops will present learning from the project and research findings from the Arts, Humanities and Social Science. This will increase knowledge and awareness of issues around social and physical accessibility of healthcare greenspace for social, cultural and demographic groups. Workshops aim to kick-start greenspace activities at a variety of healthcare sites throughout Scotland. By disseminating knowledge from our original project, whilst also taking workshop delegates through participatory activities related specifically to their healthcare settings, locally relevant greenspace strategies will be devised. Each site will leave with a draft action plan for activities and physical changes to bring health and well-being benefits from their outdoor spaces. Staff will also receive outdoor conservation and health intervention training from the Forestry Commission.

3. Middle/Senior NHS Managers
Our original project found that perceived negative managerial attitudes towards use of hospital greenspace are a major barrier to staff use. By involving NHS managers in participatory dissemination activities, we aim to tackle this. Managers will learn about findings from the literature, our original project and creative, participatory engagement processes. They will be able to translate this learning to their own healthcare settings, in which they can take on active roles within the process of designing greenspace interventions and adaptations with other stakeholders. By facilitating collaboration between managers and other staff the perceived barriers can be challenged.

Our follow-on activities will, therefore, result in trained staff with the tools and knowledge to take forward plans to engage staff, patients and community members in the use of healthcare outdoor space for health benefit. This will lead to an increase in numbers benefiting from use of such spaces across Scotland. Participatory dissemination will embed culture and behaviour change around use of healthcare greenspace for health benefit. NHS, environment and voluntary sectors will benefit through better understanding of ways to include social accessibility in healthcare greenspace design - of physical spaces and outdoor health interventions.