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The invisible environmental factor that greatly influences patient comfort

It’s been a while since properly folded hospital corners and “the white glove test” were the key indicators of good patient care. Quality assurance metrics have come a long way, and now patients’ best interests are protected and improved by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) standardized and publicly reported survey. So caregivers have even more reason to place the patient experience at the center of treatment.

In addition to the healthcare standards we’ve come to expect in evaluations of patient care facilities, recent HCAHPS refinements place new significance on a comparatively less tangible item on the inspection checklist: Quiet. The reason being that an environment which produces fewer disruptions and allows for more consistent patient rest contributes to faster recovery and lower readmission rates.

To measure this variable, HCAHPS poses a fairly simple question to patients: ”During this hospital stay, how often was the area around your room quiet at night?” The answer, however, is complicated. Even with the most considered attempts to control the various sounds that are a normal part of hospital operations, subjective expectations and varying tolerances for noise levels can be an overwhelming source of grief for certain patients. Furthermore, and perhaps one of the most compelling reasons to insure that the utmost comfort is provided during a hospital stay, because patient satisfaction has been tied to improved medical outcomes, the patient’s condition upon checkout will certainly influence their perception of time spent in treatment.

With noise levels now under closer scrutiny, hospitals are boosting emphasis on overall sonic atmosphere. To promote healing and a sense of comfort and well being, various departments are examining and eliminating potential sources of noise pollution on a broad scale, with squeaky wheels on carts as much a culprit as medical monitoring equipment.

Many facilities are imposing restrictions on sound levels related to people or equipment traversing hallways, messages transmitted over communications systems and even conversation and television programs overheard from one patient room to another. Designated hours for “Quiet Time” are also being enforced.

Despite these efforts, the public data from HCAHPS surveys indicate that more than half of the hospitals across the U.S. are failing in the area of provision of quiet comfort. The unfortunate fact is, it’s hard enough to sleep in a hospital with unavoidable noises from medical equipment and the very important need for vocal and aural paging communications amongst caregivers and patients.

Hospitals are definitely rising to the challenge of changing those survey numbers for the better, and far beyond the levels necessary to successfully obtain government subsidies and reimbursements. Many facilities are seeing the ratings as a tremendous opportunity to have the numbers to prove they are the best in a city or region. To be top of mind in the category of comfort and overall well being is a fantastic asset.

When it comes to the quiet factor in various wards, hospitals have hopped to it in terms of adding “Quiet Zone” signs to hallways, implementing noise meters at nurse stations and providing patient check-in kits with headphones, ear plugs and even CDs with relaxing music. Quiet hours are enforced, and advanced notice of any loud construction or repair work, including specific start and stop times, are provided. Additionally, volume levels on monitoring equipment can be reduced, or telemetry equipment can be remotely monitored outside the patient’s room. And then there’s always the simple act of closing patients’ doors if they prefer.

Many of these practices were put in place long before quiet was a measured variable on any sort of survey, but with the increase in focus on patient-centered care, they are adhered to with particular care. Just the same, it seems that issues with noise still literally keep too many people up at night.

So what’s next when it seems like every chance for quiet has been identified and missed? Well, if it is impossible to eliminate sound, it might be easier to cover it up. Camouflaging the hard aspects of voices and electronics with the addition of a rounder audio tone can make the more jarring aspects of unwanted sound disappear. There is a technological equivalent to ocean waves creating an almost impenetrable wall of soothing sound that blocks out all but what you want to hear.

Commonly called “white noise machines,” there are systems, known as sound masking, that can baffle the atmosphere across a space while still allowing for clear communications where desired. The “white noise” element has actually been mostly dispensed with in all but the most basic, rudimentary systems today. Now, with digital audio processing, it’s possible to tailor just the right softening tone for many different rooms, corridors and open spaces. 

Some sound masking systems also include paging capabilities, a fact which has prompted many hospitals to implement these technologies. Results are very encouraging. Several hospital clients of one sound masking company have noted a 35-40% reduction in distracting noises on their survey scores once a masking setup was configured for their spaces. Correlating with these improved scores is a boost in recovery and overall satisfaction with the facilities.

Additionally, one of the original purposes and attractions for sound masking is still playing a big role in necessitating its addition into healthcare environments. The ability to knock down the voice level of nearby conversations increases privacy and provides additional safety in complying with HIPAA regulations. With simple technical additions in pharmacies, administration areas and any treatment area where patients’ privacy might be violated, sound masking can protect on many levels. To better operate and maintain these systems, a networked sound masking and paging system can be operated from a single point of control via PC or mobile device.

In states where HIPPA requirements are more stringent, sound masking provides yet another perk. In Texas, for example, where it is dictated that there be several feet between patient admissions desks and those seated in the waiting room, some hospitals are finding that they can reduce their footprint by 30 percent when they use masking to boost privacy instead of physical distance.

Privacy of course is not just an issue that facility managers are having to cope with from a regulatory standpoint. Patients are becoming more and more keen to protect their information, and when a patient can hear their doctor speaking to another patient in an adjacent room, it can eliminate trust and cause reticence in their own visit with a physician. 

The appeal is wide and the requirements deep for increased quiet in healthcare facilities. Fortunately, a combined approach to improving patient comfort is setting new benchmarks for quiet.


David Smith (dsmith@lencore.com) is the Executive Director of Channel and Business Strategy at Lencore (www.lencore.com). Lencore is the leader in sound masking, paging, audio and mass notification solutions with products manufactured in the USA. David has presented at numerous events including IFMA’s WorldWorkplace, NFMT, InfoComm and Bicsi. Feel free to reach out to David with any questions pertaining to noise concerns or communications relating to mass notification