This document discusses the importance of considering the auditory environment in hospitals. It notes that hospitals can be noisy, defensive places that are technologically dominated and focus on treatment rather than the patient experience. Excess noise can negatively impact patients' health, memory, sleep and pain tolerance. The document advocates for a healing environment approach where everything a patient hears is considered, including unnecessary noise. It suggests hospitals implement quiet by design, decision, management and practice - such as using acoustic barriers, communication technologies, training and modeling quiet behaviors - to improve patient outcomes and experiences.

1. Curing the
Epidemic
in Hospitals

2. The Therapeutic Environment
may exist in nature, but it is
not inherent to institutional
care…to the hospital room.

3. The Hospital Environment
must be designed to be
therapeutic…it does not
happen by accident.

4. Florence Nightingale
wrote:
“What is the difference
between a room with
unchanging yellow walls
and a prison cell?”
“Apprehension,
uncertainty, waiting,
expectation, fear of
surprise, do a patient
harm...”
“...Unnecessary noise is
the cruelest absence of
care.”

5. Today’s Hospital
Environment is…
Defensive: Infection control
High-Tech: Technologically-dominated
Efficient: Treatment-based logistics
Generic: One-size-fits all motto
Disease-focused: Symptomatically driven
Provider-based: Patients must adapt

6. When patients enter the
hospital…
They know no one.
They do not know the rules.
They are acutely ill.

7. Patients learn
about the hospital
culture by looking
and listening…
and then putting
together what it all
means to them.

8. They hear so much.
Such as…

9. They hear so much.
Such as…
Telephones
Waiting area talk
Paging
Construction
Patient care
Conflict resolution
Outpatient appointments

10. And…so much more.

11. Everything the patient
hears...
…is assumed to be true
…is assumed to be intentional
…states an attitude
…becomes an expectation

12. Not all Noise is Equal!
What? Machine vs. person
Who? Friend, foe, or “other”
When? Night, day, or worst
Where? Home, hospital, car
Why? Neglect or intention, relevant or
irrelevant

13. Noise contributes to…
ICU psychosis
Medical errors
Hospital-borne infections
Higher costs/less satisfaction
Increased need for pain medication
Staff burn-out /high staff turnover

14. “Oops!” =
Startle Reflex

15. “Oops!” =
Startle Reflex
facial grimacing
muscular flexion
increased blood
pressure
increased respiratory
rate
increased heart rate
vaso-constriction

16. High noise causes…
Altered memory
Increased agitation
Less pain tolerance
Isolation
Sleep deprivation

17. A healing
environment takes
responsibility for…
…everything the patient
hears and overhears
…everything within line
of sight of the patient
…everything that the
patient feels when
touched
…everything the patient
smells and tastes

18. EPA says 35 dB at night,
but…often 75-80 dB
Too quiet or too noisy?
Depends on who you are!
Decibels vs. Perception

19. Sound “travels,” it is not “fixed”
Auditory environment is a series of
intersecting pathways
Sound can be managed, not controlled
Most hospital noise is behavioral, not
mechanical

20. Quiet by Policy
The myth of noise abatement
Mandating behavior works
Acoustic technologies lessen the
“loud”
Sound meter devices are effective
Is the least effective method
Don’t change the “what”
Red lights ignore the “what”
DOESN’T WORK!

21. Quiet by Design
Be sensitive to the needs of both patient and
caregiver and their relationship
Provide positive distractions
Minimize the negative impact of necessary
sounds, sights, smells, and touches
Minimize unnecessary noise
Take responsibility for everything the patient
hears and overhears

22. Quiet by Decision
Address the diverse needs of diverse
population
Offer flexibility in managing varied sound
sources and recipients
Support health and general wellness
Respect both objective and subjective
experiences
Prioritize patient/staff perceptions above
objective measurement

23. Quiet by Management
Acoustic treatments: higher specifications
Barriers not blinders: plexi-glass, not walls
Communication technologies: phones, pagers,
alarms
Purchasing standards: demand auditory
impact specifications
Maintenance schedules: support patient care

24. Quiet by Practice
Values: every sound
represents the hospital
culture
Set behavioral standards by
modeling and integration
without blame
Set communications policies
with every device
Conduct auditory awareness
training

25. The bottom
line?
Why does all this
matter?
Because….

26. The patient’s
perception is

27. Susan E. Mazer, Ph.D.
President and CEO
Follow my blog: www.susanmazer.com
Connect with me: www.linkedin/in/susanmazer
www.healinghealth.org