From loud conversations to carts moving through the halls to pages and nurse calls, the peace and quiet patients need to promote healing is often in short supply in hospitals.
Aside from the obvious benefits to patient care that a quiet environment provides, hospitals have another reason to begin caring about quiet: their finances.
Beginning in October, hospitals’ Medicare reimbursement rates will be affected by how they score on a patient experience survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The 27-question survey asks patients to share their perspectives on items like communication with doctors and nurses, responsiveness of hospital staff, cleanliness and quietness of the hospital environment.
And nowhere did hospitals perform worse than quietness in a summary of the 2010 HCAHPS survey.
“It’s the lowest-scoring quality metric and people have been working on it for years, but collectively they’re not achieving their desired results,” said Gary Madaras, director of the Making Hospitals Quiet program, a group that helps hospitals find ways to reduce noise.
Fixing the problem requires a “paradigm shift” in hospitals’ thinking, Madaras said.
“Everybody thinks they know the right process, but our studies and experiences in hospitals show that what they think they know and what they’re trying is not resulting in the desired outcome,” Madaras said.
Here are five guidelines Madaras shared on how hospitals should shift their thinking about noise reduction.
Commit forever: Hospital executives must realize that, like infection prevention, noise prevention must have dedicated staff, time, resources and budget. One person must have noise prevention and sound quality as one of his or her primary responsibilities, be held accountable for them, and have them as part of their job description, performance reviews and compensation package. This isn’t something that a group of volunteers come together temporarily to fix.
Conduct a culture assessment of your hospital: A hospital must know who it is and the barriers to closing the gap to who it wants to be as an organization. Assess successful and unsuccessful changes in the recent past. Which types of approaches worked with your organization?
Anchor a noise reduction project in patient recovery: For executives and upper level managers, the desire to cut noise is often financially based, while mid-level managers are focused on boosting HCAHPS scores. Both of those are certainly valid, but for broad-based buy-in, focus on helping staff understand the negative relationship between noise and patient recovery. “Create awareness of this on a system-wide basis and watch mass buy-in and self-generated movement begin,” Madaras said.
Stop chasing silence: Silence is not the goal, nor is it achievable, nor should it be the focus of a hospital’s efforts. The patient’s perception of quiet is achieved when good sounds are louder than bad noises most of the time. Focus on improving the ratio of good sounds to bad noises.
Systematize: Hospitals need a real-time reporting and remediation system. Consider this a “noise hotline” system that documents each occurrence and feeds information back into a sound quality improvement action plan. For example, you might find that last month, there were X number of complaints related to night admissions. Such a system would prompt a review of the night admission process from a noise-prevention perspective.
[Photo from flickr user TechMaverick]