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“Now hear this…Shh!”

August 28, 2012

 “Quiet”. Apparently, I say this a lot! How do I know? The unedited reflection of a child innocently pointed it out to me when I was presented with a gift – a large decorative stone with the word “Quiet” elegantly engraved. Upon my opening the gift my niece very proudly exclaimed: “I thought you’d like it. You say that all the time!”

Zing! A moment of revelation! And she is right, I say that all the time. Sometimes when I say “quiet”, I just mean less noise. Other times, I mean “quiet”, absolute silence. I like quiet. There is calmness and an ability to think clearly when not distracted by the extraneous noises both natural and man-made. The buzzes and beeps and cacophony that television, radio and game consoles layer over the high-pitched and baritone low voices vying for my ears attention is exhausting to me. I want to retreat to a quieter place where I am not so assaulted by noise. So, at home I say “quiet”, a lot!

But, outside the cocoon of home, I have less control. I try and make “quiet” spaces in my day to offset the noisier spaces and that helps. But I haven’t always been able to do that. In days past, working in hospitals there was little time or ability to create the “quiet” spaces. And that is just as true today, hospitals are deafeningly noisy places. The World Health Organizations recommends patient rooms be below 30dB(A) . A Robert Wood Johnson funded study in 2007 – Sound Control for Improved Outcomes in Healthcare Settings–  noted that “background noise levels in hospitals rose from 57 dB(A) in 1960 to 72 dB(A) today during daytime hours, and from 42 dB(A) in 1960 to 60 dB(A) today during nighttime hours (Busch-Vishniac et al. 2005)”. And there are reports of decibel levels reaching 85 to 90. The two main sources of noise are mechanical equipment in use—alarms, paging systems, telephones, computer printers, ice machines, staff conversations, and noises generated by roommates and visitors, as well as, sound reflecting surfaces. Hospitals are noisy places and they are getting nosier!

Noise may be uncomfortable for people like me, but besides discomfort is there any other reason to be concerned? There is and the impact is on both patients and staff. Many studies site noise as contributing to adverse outcomes in patients including elevated blood pressure levels, increased pulse and respiratory rates, as well as, increased incidence of rehospitalization. And staff are also adversely impacted experiencing increased perceived work pressure, stress and annoyance; emotional exhaustion and burnout; difficulty communicating leading to errors and increased fatigue. None of it is good!

There is no one quick fix to the problem of noise in the healthcare environment. There will need to be a series of small changes that will ultimately lead us to a quieter place. Everything from decreasing the mechanical beeps and buzzes to the adoption of more visual communication such as LCD pager boards or mobile technology is needed as is the introduction of sound absorbing surfaces into the environment.

Included in the big picture solution is the need to provide “quiet” spaces. This is where workforce management technology can play a role. Because the “quiet” space itself doesn’t contribute to the solution, but the combination of the “quiet” space and the technology that supports the staff member getting to that space is what will. With workforce management technology, time can be planned to take advantage of the “quiet” spaces. Technology that insures staff take the needed work breaks and supports their patient load being covered in their absence will be part of the solution.

So make sure that staff breaks are planned and encouraged. And perhaps you could even suggest to each staff member that it is not necessary for them to use their voluminous voices to announce their departure for a break to the greater patient and nursing community on the unit, but instead go “quietly”…

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