Too Noisy to Heal

Concerns about the “soundscape,” or acoustical environment, in hospitals aren't new. We use the term “soundscape” rather than “noise” because a good acoustical environment does not simply reduce unwanted noise; it also provides pleasing or distracting sounds, allows good speech discrimination, allows auditory privacy, supports music as needed, etc. Additionally, soundscape is an immersive concept. That is, it is not just specific sounds that are considered, but also how sound transmits and propagates through spaces, etc. So why aren't all hospitals designed with acoustics in mind? In this article, we will highlight what has been done, what we still need to know, and what you can do about hospital acoustics.

A problematic soundscape

Numerous articles have been written that express concerns over the loudness and chaos of background noise in hospitals. There is also evidence to suggest that a poor acoustic environment in hospitals can be related to negative psychological and physiological reactions in patients and staff.^1-3 For example, patients may experience reduced sleep,^4-7 a cardiovascular response,^8,9 an extended hospital stay,¹⁰ and the need for increased pain medication¹¹ due to the loudness of the sound environment. Staff have also shown negative reactions to noise such as burnout,¹² stress symptoms,^2,13,14 and hearing loss,^15,16 as well as decreased mental efficiency,¹⁷ decreased short-term memory,¹⁷ and difficulties discerning what others are saying.¹

Other studies suggest that improvements to the sound environment, such as adding sound-absorbing materials, correlate with improvement in the staff psychosocial environment¹⁸ and their perception of noise.¹⁹ Additionally, improvements to the sound environment have been related to improved patient sleep²⁰ and decreased incidence of re-hospitalization.²¹ Obviously, the soundscape should constitute a key consideration in hospital design as the health and safety of occupants is paramount.

Why are soundscapes so poor in most healthcare facilities?

So why are sound environments in healthcare settings often so poor? In part, this is because there are so many noise sources in healthcare settings and because surfaces are typically hard and impervious to allow cleaning. In part, this is also due to the extreme adaptability of healthcare providers. They have worked so long in noisy, stressful, and potentially dangerous settings that they don't know that a quiet, calm, and effective setting is even possible.

In addition, the sound environment is seldom a focus of the design process. If acousticians are involved in the healthcare design process at all, it is typically to reduce HVAC noise; they are seldom asked how to improve sleep, speech privacy, or the ability to communicate accurately or hear alarms. And healthcare acoustics is a new area of specialization; an acoustician with experience in concert halls or airports may not know the special requirements of healthcare.

More fundamentally, a solution to a poor soundscape typically requires the kind of systemic solution that is difficult for most hospitals to achieve. It requires attention to reducing or enclosing noise sources such as HVAC systems, pumps, and wheels on carts; changing communication systems to reduce overhead paging and unnecessary alarms; and talking more quietly. These can all be supported by an improved physical setting with selective use of sound-absorbing ceiling tiles, carpeting, and other sound-dampening materials.