Reducing Hospital Noise: What Do We Do First?
May 16, 2014
Last week I did a webinar for The Center for Health Design on the built environment, patient outcomes, and hospital noise. I spoke about the two-part patient experience in relationship to an existing hospital room: 1) what can be controlled (dynamic space); and 2) the fixed walls, windows, doors, floors, and ceilings (fixed space).
When it came time to discuss how to fix the problem of hospital noise, the question was asked, “What do we do first?” This is a great question and one that administrators stumble on every time they take on this issue.
1. Deal with the symbolic (and real) “squeeky wheel”
This includes the most obvious auditory annoyances that are related to equipment, slammed doors, etc. Fix what needs to be fixed.
And (not “or”!), make decisions to figure out how to minimize unnecessary noise. Evaluate practices that serve the patient and the noise factor associated with each.
2. Reach out to experts
Contact the Institute of Noise Control Engineering, a non-profit professional organization in Washington, D.C., that promotes engineering solutions for environmental, product, machinery, industrial, and other noise problems. Noise control engineers work with manufacturers, organizations, architects, facilities managers, and others to “quiet” buildings and neighborhoods.
Other resources include the Acoustic Society of America, which now has a subcommittee on Healthcare Acoustics led by Gary Madaras, Ph.D., of Making Hospitals Quiet. This subcommittee is reviewing the standards for noise and preparing to make recommendations on hospital noise as it is impacted by the built environment.
Acoustic engineers are the ones who can design a space for sound, privacy, and conversation. Noise control engineers look at the auditory impact of buildings and provide solutions. Noise control engineerss are acoustic engineers who focus on noise reduction; acoustic engineers do the same PLUS look at optimizing the auditory environment to support clear communication, for example.
David M. Sykes MA, ASA, INCE, managing editor, “Sound & Vibration Guidelines for Health Care Facilities,” has been instrumental in making positive and effective changes on speech privacy and noise control in “Guidelines for Design and Construction of Health Care Facilities” published by the Facility Guidelines Institute. Sykes is also a thought leader in reducing alarm fatigue efforts.
3. Investigate other solutions
However, no matter how effective a “product” is, the main factor is the culture and the outcome of the built environment of your organization. For example, if your pre-op area was built with the acoustics of an inside swimming pool, then that is what it will sound like.
Great if its a pool. But seriously distracting and noisy if it is a pre-op area.
Many sound control technologies were made for other industries and may or may not be appropriate to hospitals and clinics. Noise masking technologies, for example, must be attenuated to reduce perceived noise while at the same time maintain the needed transparency for alarms and other auditory cues to be heard by the nursing staff.
Assessments need to include multiple measures. Not only decibel levels (which are the easiest to document but provide the least actionable information), but also the perceived sound against the background level, time of day, and the acuity of your patients.
The C.A.R.E. Channel and C.A.R.E. with Music are both positive distractions produced to condition the auditory environment, minimize the impact of necessary noise, and create a veil of privacy. It’s nature imagery is also following the theories of supportive environments, providing a view that a patient can understand and, if they choose, dwell on.
Bottom line is that none of the above solutions will be effective if the hospital culture is resistant to change, does not accept and acknowledge that the sound of their culture may or may not be best for the patient, and does not take honest actions to improve the patient environment in order to improve the patient experience.
Without question, the “been here, done that” mentality comes from so many projects and so few sustainable outcomes. If you are determined to improve the experience of your patients, staff, and visitors because it is the right thing to do, then do it right this time. Otherwise, what you have been doing will stubbornly remain as it is.
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