The not-so-silent threat to a positive patient experience

So you deliver high quality care to your patients and discharge them with positive outcomes, without infection or falls or medical error. Despite this, they aren’t satisfied with their experience and that dings your patient satisfaction surveys. What on earth is going on? Isn’t great medical care the point? Not anymore.

From a clinician’s point of view, patients should be most concerned about positive outcomes, low infection rates, and safety. That’s correct. However, patients assume that doctors and nurses have a given level of clinical expertise. That frees them to judge their experience on other things, like the temperature of their room, and noise. Now that reimbursement is part and parcel of patient satisfaction surveys like HCAHPS, these factors can no longer be ignored.

It’s like the Grinch said

Patients think about hospital noise much like Dr. Seuss’s Grinch thought about Whoville’s Christmas celebration:

“If there's one thing I hate...all the noise, noise, noise, noise! They'll blow their hoo-hoovers, they'll bang their gar-dinkers!”

It’s not just an impression; studies show that hospitals are a noisy environment in which to recover and heal. A studypublished in the Journal of the American Medical Association (JAMA) measured hospital noise and discovered it ran as high as 67 decibels in the intensive care unit to 42 decibels in surgical wards. A vacuum runs at 70 decibels!

The problem is that even without people, the hospital is a living, breathing organism full of its own noises. An acute care facility has equipment with alarms, overhead pages, carts with wheels and elevators with bells. Communication is essential and humans must be able to hear if a patient, or an essential piece of equipment, is crashing. Some noise is good, other noise is bad, and it can significantly impact patient health.

Premature infants show increased heart and respiratory rates as a result of the continuous loud noise they are exposed to in neonatal intensive care units.

ICU patients whose sleep is disturbed by noise may have prolonged stays in ICU and even worse, it may impact morbidity.

Patients and staff in general suffer. An article in H&HN magazine reported that noisy hospital environments increased patient agitation, aggression and delirium, increased pain, falls, and the risk of medical and nursing errors. Noise adds up to costly staff fatigue, increased patient safety hazards and lower overall patient satisfaction.

If a tree falls in the forest…

• ?This brings us to the question of what can be done to reduce noise, in order to improve safety, increase patient satisfaction (which in turn will improve your HCAHPS scores). Noise has to be examined and peeled like an onion, layer by careful layer on every unit. The checklist looks like this:Insist that equipment be well maintained and purchased for minimal noise.
• Educate staff about conversation levels to minimize impact on patients.
• Coordinate care so that vital signs and labs are taken at the same time to reduce the number of times a patient is disturbed. 
• Eliminate all but emergency overhead pages.
• Even without full scale renovations, call in an acoustics expert to explore short fixes.
• If you renovate, remove and add sound. Water and music enhance healing.

The age-old question asks, “If a tree falls in the forest and no one hears it, does it make a sound?” Perhaps the healthcare version should ask “If a hospital is noisy and no one listens, does it still impact patient care?” It does, and hospitals must listen to patients. It’s good practice, good medicine and good for patient satisfaction.

?When a patient has the opportunity to tell you how they feel about their care, they feel empowered, and acknowledged. Using HCXP for rounding and point of Care (POC) collection of feedback data, allows patients to do this. The result is a better patient experience and that ultimately leads to a better HCAHPS scores and a greater reimbursement. Find out more at HCXP, creator of a five point, 5 Star rating system for all in house satisfaction questionnaires and one comparison/benchmark reporting system.