How Sound Affects Your Hospital Experience and What Needs to Change
Human-centred design can transform hospital visits by putting patient’s needs first. Learn how sound affects hospital experiences and what the future holds for patient first care.
Sound, sight, taste, smell, and touch are all very much a part of any hospital visit. This post will focus on how sound affects your hospital experience including noise levels, alarm fatigue, and privacy, and you’ll find initial human-centred design ideas that could help put patients first.
The content below comes from Overlap Designer Dave Dowhaniuk. Dave studied patient experience, human-centred data visualization and sonification, and eLearning during his postgraduate studies at both OCAD University and the University of Bremen, in Germany.
“The sense of hearing cannot be closed off at will. There are no earlids. When we go to sleep our perception of sound is the last door to be closed and it is also the first to open when we awaken.”
– R. Murray Schafer The Soundscape: Our Sonic Environment and Tuning of the World, 1977
When you enter a hospital, it often feels quiet. There are busy people moving softly past at various speeds; it’s only when you take the time to actively listen that you realize the halls, lobbies, waiting rooms, and atriums are full of the sounds of people trying to be quiet.
People have hushed conversations, nurses scuttle past in their clogs, maintenance staff’s mops softly click and clack while they sanitize the floors, and there’s the ubiquitous hum of the purifying HVAC system.
As you move into the more private areas, the cacophony of sounds builds with the addition of concerned loved ones, automated beds, respirators, heart monitors, and other lifesaving devices. Often the loudest areas end up being near the patients and their visitors.
Removing all noise isn’t the solution either. Everyone is already trying to make as little noise as they can. Alarms alert us when something is wrong, respirators and other mechanics’ have moving parts and must make their whizzing and whirling noises.
How can hospitals create a patient first perspective of the hospital soundscape?
Soundscape, coined by Canadian composer/artist/researcher R. Murray Schafer, meaning the sound environment of a space comparable to the visual environment of a landscape.
A visualization representing the different sounds that build on each other to create the soundscape of Yosemite National Park. Photo: National Parks Services.
Let’s dig into hospital noise levels, alarm fatigue, and privacy.
Noise Levels
Environments that are filled with loud noises make it difficult for us humans to relax. They trigger our flight or fight responses, causing us to, by no fault of our own, be on edge.
This means that we have heightened stress and anxiety because of these ambient stressors. We sleep less soundly, and therefore it takes longer for us to heal and leave the hospital.
To read more about the neurological effects of noise pollution on our health check out Dr. Janice Blumer’s case study.
The World Health Organization (WHO) recommends continuous background noise in patient rooms to be at 35 decibels (dB) with a night time peak of 40 dB, but many studies show much higher volume levels.
45-68 dB was most commonly reported which is comparable to a busy urban street corner. Some studies have recorded hospital shift changeovers to be as loud as 120 dB, which is comparable to the sound of a chainsaw.
Continue reading about the WHO’s Guidelines for Community Noise here.
As I mentioned before, the noise in a hospital isn’t intentional. People try to be as quiet as they can, but some emergencies call for noise.
The sanitation needs of a hospital often call for hard, smooth, and solid non-porous materials. This allows for easy to clean surfaces, but these qualities are also excellent for sound-reflection. The materials increase the already loud noises which echo and reverberate down long hospital corridors.
Diagram created by Ryan Wheless, from his blog Systems, Sites, and Buildings.
So, what can hospitals do to be more human-centred and patient first?
Future Solutions
There are increasing technological advances in noise absorbing and dampening materials, surfaces, and coatings. Many hospitals are blanketing their floors, windows, and walls with sound absorbing coatings. They’re also replacing ceiling tiles for noise dampening versions and using thicker, more sound absorbing fabrics for curtains and room dividers.
Are there other noise dampening techniques that hospitals could use? Maybe there are technologies from other fields such as radio recording studios or construction hearing safety devices that hospitals could learn from.
Diagram created by Ryan Wheless, from his blog Systems, Sites, and Buildings.
Alarm Fatigue
Beeps, bloops, buzzes, and other sounds that help us monitor different health indicators from our nervous system allow medical practitioners to easily comprehend patient signals. There are two main types of these systems:
Constant audio streams, such as heart or breath rate monitors, allow us to understand a patient’s baseline rate and highlight irregularities in the body’s patterns and rhythms;
Notification alert noises, such as motion or intravenous medicine alarms, are meant to shock and alert those close by to a possible emergency situation.
Alarm fatigue is a big problem not only for patients but medical staff as well.
Shockingly, the Joint Commission estimates that 85-99% of these alarms do not require any clinical interventions. Instead of alerting, these false alarms actually desensitize those who hear them too frequently.
Read more from the Joint Commission on medical device alarm safety in hospitals.
For more on alarm fatigue and desensitization read this article from Anesthesiology News.
Desensitization is exasperated by the chance that medical practitioners will focus on the machines, monitors, and their constant stream of numbers and audio/visual data rather than what the actual patient is telling them.
The result is an unintended objectification of the patient leading to a potential loss of empathy.
Beyond these initial types of alarms, there’s also the intercom based paging systems. This messaging system is used to alert and provide information to a variety of hospital stakeholders, including practitioners, support staff, and even visitors.
Intercom pages are often meant for specific teams or departments but are frequently broadcast all over the hospital.
It all adds to the cacophony of alarms, machines, voices, and other environmental sounds.
This constant stream of alert noises and intercom pages also make it difficult for medical practitioners to focus their attention.
So, what can hospitals do to be more human-centred and patient first?
Future Solutions
Once at a Hacking Health Café, I was in conversation with an engineer and an emergency room doctor where, to my surprise, I learned that the different medical devices and monitors are designed and built by different departments and/or companies. They noted the solution for fixing the devices was often to make the alarm louder and more jarring. It is this way of problem framing and solving that can cause hospitals to be more machine and illness-centered.
To become more human-centred hospitals can demand more collaboration from their equipment manufacturers or insist on more ability to personalize sensors and alarm triggers for each patient.
Hospitals can also ensure that medical practitioners are taught how to personalize the levels for each patient. This simple but important step can save people a lot of unnecessary stress.
Research is being conducted on how this data might be better represented if they put the patient first.
For example, medical engineers and doctors at Holland Bloorview Kids Rehabilitation Hospital are looking at how to detect anxiety in children with Autism Spectrum Disorder through a particular representation of physiological indicators.
Sound Designer Yoko Sen is researching how to better integrate the different sensors in the hospital so that they are in harmony rather than competition.
In my own MSc thesis, I built and tested a prototype to find new ways of mapping data to sounds, specifically representing physiological data with nature sounds.
Privacy
Removing all of the alarms and using noise dampening materials may make the hospital quieter but I will argue that complete silence is also not putting the patient first.
We are often embarrassed by the reasons we seek medical advice. Studies have found that up to 5% of patients in shared rooms withhold private important medical information over fear unintended people might hear. Patients in single rooms were found to not withhold any information.
So, what can hospitals do to be more human-centred and patient first?
Future Solutions
Using human-centred design might mean incorporating more noise absorbing and dampening dividers and coatings. Hospitals may also want to offer patients noise cancelling devices such as white noise machines, recordings of nature sounds, or even low-tech but comfortable earplugs.
Patients could have the option to turn on white noise or a selection of natural environments. These noises have been shown to mask the sounds of busy places. Nature sounds have also been shown to reduce agitation and physical signs of anxiety and improve the perceived hospital experience.
As with the shift towards evidence-based medicine, healthcare is moving towards a ‘patient first’ evidence and human-centred design process.
For a more in depth look at innovative hospital designs read Ulrich et. al. literature review.
What’s next?
It is an exciting time for hospital design!
This post has outlined many possible solutions surrounding noise and soundscapes for how you and your hospital can become more human-centred. As with any human-centred design project, the first place to start is with the people. In the case of hospitals that means healthcare practitioners, patients, and communities.
The Overlap team loves to use tools such as Empathy Maps and Feedback Grids to obtain human-centred insights.
Learn how to use an empathy map and download your own template here.
