Because hospital noise impacts patient recovery, hospitals must be quiet and calm. Hospitals must identify noise factors and discern which sources of noise are controllable. They can then use Six Sigma tools to measure, monitor and reduce noise.
A hospital must create a quiet, calm environment for patients by providing a physical setting conducive to recovery and an organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, healing and bereavement.
To accomplish this hospital employees must identify internal and external noise factors – is it voices, equipment or the building? The staff must also discern which noise sources are known controllable factors, known uncontrollable factors and unknown uncontrollable factors. The hospital must measure and reduce the noise in patient rooms within defined compliance levels.
Noise impacts patients in many ways including:
Continuous noise may alter a patient’s memory, increase agitation, lower pain tolerance and lead to feelings of isolation.
Noise may also impact hospital employees causing:
|Table 1: Priority Matrix – Identify Noise with Respect to Sources|
(Weighted Score, 0.40)
(Weighted Score, 0.50)
(Weighted Score, 0.10)
|Total Weighted Score|
|Emergency department (B)|
|Outpatient departments (C)|
|Inpatients area (D)|
|Nursing station (E)|
|Diagnostic centers (F)|
|Operation theaters (H)|
|Intensive care units (I)|
|Laundry and linen services (K)|
The matrix shown in Table 1 displays the source of noise in various locations of the hospital and records a mean weighted average, providing a clear picture of the noisiest hospital area and the worst noise source and establishing a clear priority of what to fix first.
|Table 1: Noise Location Stratification According to Time of Day|
|9:00 a.m.–1:00 p.m.|
|1:00 p.m.–4:00 p.m.|
|4:00 p.m.–7:00 p.m.|
|7:00 p.m.–10:00 p.m.|
|10:00 p.m.–7:00 a.m.|
|7:00 a.m.–10:00 a.m.|
By measuring noise during peak and off peak hospital hours, analysts can detect and correct the noise. Noise meter readings established by a pollution control board offer quantitative readings that help predict, and therefore prevent, future noise problems.
After identifying the primary sources for noise pollution, the following improvement strategies can be implemented:
|Table 3: Noise Sources|
|Sources of Noise||Primary Area||Secondary Area||Tertiary||Location|
• Unwanted movements of people(patients/ employees)
|• Frequent visiting of patient’s attenders in the nursing station/laboratory services for enquires|
• Pooling of students in the nursing station
• Mishandling of accessories, which creates excessive noise
• Load glucometer carts
• Staff tend to have mini-conference in the hallway creating noise
|• Frequent movement of people in parking facility creates unavoidable noise|
• Overcrowding of patient attenders in the canteen
• Noise due to renovation/repair work done in the hospital
|• Noise created by people from outside the hospital (public meeting announcements)|
|Equipment||• Ambulance noise|
• Patient vehicles
• Mobility aid sounds
• Telephone sounds
• Overhead paging systems
• Lifts operating noise
|• Equipment handling|
• Noise in laboratories
• Mobility aids and wheelchair sounds while transferring patients
• Lifts operating noise
• Telephones, trip alarms and intercom sound of beepers, bed rails, and ventilators
• Portable X-ray machine sounds, blaring T.V.
• Buzzers, beepers, multiple monitors, nurse call systems and doors
|• Frequent movements of vehicles|
• Handling of equipment in the laundry and linen services
• Noise created during transfer of incoming essential materials in the purchase departments
• Utensils handling noise in canteens
|• Vehicle sounds|
|Environment/ system||• Improper/confused facility arrangements|
• Lack of display boards showing facilities available in the hospital leads to unwanted enquires resulting in noise
|• Centralized nursing stations|
• Facility arrangements warranting noise in inpatient wards
• Excessive students to patient ratio creates noise during clinical teaching
|• Lack of knowledge in handling the equipments by workers involved in maintenance departments|
• Lack of space required for supportive services
|• Hospital floor, wall and ceilings are hard and reflect sound rather than absorb it|
Using quantitative and qualitative measures to identify and monitor noise levels in hospitals is critical to hospital efficiency. Reducing noise and maintaining a quiet facility will improve patient care and enhance the reputation of the hospital.
About the Author: Professor S. Arun Vijay is working as a principal physiotherapist at KG Hospital and Post Graduate Medical Institute. He completed his master’s degree in Physiotherapy (MPT) and Business Administration (MBA). Mr. Vijay is a certified Six Sigma Green Belt from the Indian Statistical Institute and is currently undergoing Black Belt training. He has done various quality improvement projects in the health care sector using Six Sigma methodologies. Mr. Vijay may be reached at firstname.lastname@example.org.