Hospital Noise Project IDs Sources, Challenges of Noise Reduction

CHICAGO, Ill. – Results of a new study evaluating noise reduction measures in hospitals across the U.S. point to ways to improve patient satisfaction and care.

The study, released in late April, examined how the noise reduction coefficient works and how hospitals are structuring their efforts, where in facilities administrators were focusing attention and what kind of success they were seeing.

The project was initiated following the Beryl Institute’s study that found noise reduction was the main factor that could be improved in patients’ experiences in hospitals.

“When asked what the top priorities were for their organizations’ patient experience efforts, the number one response was noise reduction,” said Jason Wolf, executive director of the Beryl Institute. “The biggest challenge in the publicly reported scores, noise reduction, seems to be garnering significant attention across the healthcare system.”

The Institute teamed with the sound specialists in Chicago-based Building Momentum Group’s Making Hospitals Quiet program to conduct the study, “Hospital Noise Project,” to determine what actions hospitals are taking to reduce noise within their hospitals and how successful their efforts have been.

Health care providers from 242 organizations participated in the study, conducted jointly by Wolf and Gary Madaras, director of the Making Hospitals Quiet program, which was established in April 2011.

“There is a new and increasing urgency for hospitals to address the longstanding noise plague that has negatively affected the quality of healthcare in the U.S. for over a century,” Madaras said. “Each hospital is going it alone and on average experiencing only fair to poor results … It will be very helpful to hospitals trying to reduce noise.”

Study Findings

About 90 percent of all respondents reported awareness of the noise problem – with varying levels of progress on a plan to address this issue.

About 43 percent of respondents reported dealing with the noise issue on a facility-wide level, and less than 40 percent at a unit level.

“The data also show that those that have been focusing on noise longer seem to take on a broader view with the greater level of respondents focusing on noise for three or more years identifying facility-wide efforts as their primary area of focus,” the white paper states. “This seems to suggest that earlier on in noise efforts, organizations find it easier to begin in manageable segments, focusing on unit level efforts either as pilots or phased approaches before moving an effort out to the larger organization.”

The research also found that in assessing levels of success in their own facilities, those who deemed their performance as fair or below had focused their efforts at the unit level, while those who considered their scoring good and great focused on the facility level.

“This might suggest that when addressing noise, hospitals are mistakenly assuming that a unit can be viewed as a silo, separate from the larger organization,” the paper states.

The primary source of noise was from carts and equipment, reported by more than half of respondents, and includes items such as monitor sounds, pumps, equipment with squeaky wheels, and even the rattle of oxygen tanks.
Other noise sources included talking among visitors and staff, and facility noise from elevators and telephones, among others.

In terms of challenges, respondents named behavior and change and culture as a leading obstacle, followed by the environment.

“The extent to which this response appeared represents a strong recognition of how expected and reinforced behaviors in an organization may be the most significant opportunity in reducing noise,” the white paper states. “Far above the next challenge it seems respondents were conveying that it was the individual members of our care communities that could do the most to make or break the noise experience in hospitals.

More than 20 years of research have shown that reducing noise levels in hospitals can improve clinical outcomes, and that the lack of quietness is the top source of patient dissatisfaction in U.S. hospitals, according to the Beryl Institute.

Beyond patient happiness, noise can affect the quality of overall health and recovery and increase the stress levels of staff, at times leading to mistakes.

The level of hospital noise is also scored on the Hospital Consumer Assessment of Healthcare Providers and Systems patient survey, which gives hospitals a financial incentive to improve the quality of their overall score: a national, standardized and publicly reported survey of patients’ perspectives of hospital care.

Beginning with discharges in October 2012, hospitals will be rewarded through a value-based purchasing program implemented by the Centers for Medicare and Medicaid Services. The HCAHPS score will be one of the measures used to rate a hospital’s performance standards. A hospital will be at risk of losing a significant amount of income – up to 1 percent – if its HCAHPS scores are not up to par.

“There exists a chasm between the abundance of evidence-based design research on the negative effects of noise in hospitals and the real world application of it inside existing, living breathing hospitals,” Madaras said. “Almost all of the recent focus is on new facilities, and those operating the 6,500 existing hospitals have been left to their own. We needed to create a bridge, the Making Hospitals Quiet program, to allow these hospitals to cross over to total sound quality.”