Sound advice demands a receptive audience

With ever-increasing scrutinisation of public sector funding, currently being driven particularly by the economic and political imperatives of the new coalition government, healthcare providers and designers have to be able to demonstrate good value, and to consider the prioritisation of funds in everything we do. Acoustic design can be seen as a nicety, the icing on the cake, rather than a fundamental issue directly affecting both the patients and staff using the nation’s healthcare estate. So why should we spend money on acoustic design? The National Survey of NHS Patients consistently reports that up to 40% of hospital patients and staff are disturbed by excessive noise in hospitals, with around one third of patients feeling that they are not given enough privacy or dignity when discussing their condition or treatment on a ward. However, these are not new phenomena. The importance of acoustics in healthcare facilities has been recognised for over 150 years. In 1859 Florence Nightingale wrote: “Unnecessary noise is the most cruel absence of care which can be inflicted on the sick or well”. Hospitals are noisy places, and they are getting noisier, both in terms of the number of specific events, and the sound level of each event. There are a myriad of loud and disturbing noises in hospitals arising from the use of mechanical, pneumatic, and electrical tools and equipment – from staff shift changes and bedrails being moved up and down, to other patients in multi-bed wards, as well as noises from the building services, and intrusive noise from outside the buildings. Good acoustic design of healthcare buildings should be inherent in good overall design. So, what are the common issues in healthcare buildings where the acoustic aspects are most relevant? I personally would include patient privacy and dignity, sleep disturbance, sustainability, and energy efficiency, at the top of the list. As with many issues relating to human perception, these are at some level interdependent, but are considered separately in this article.

Patient privacy and dignity

Most acousticians will agree that internal speech privacy is an important factor in the usability of our buildings, as will the one in three patients who, according to the National Survey of NHS Patients, do not feel they are given enough privacy when discussing their treatment on a ward. Protection of patient confidentiality, particularly when it comes to electronic records, is sacrosanct according to the popular press, and woe betide any hapless medic or administrator who inadvertently discloses patient-identifiable information. It seems to be considered perfectly acceptable, however, that the first thing a patient has to do on arrival at a surgery or clinic is to be asked to give his or her name, date of birth, address, and details of which clinic they are attending, to a receptionist in full earshot of everyone in the waiting room.