Making the right noise with hospital design

It is easy to think of “design” first and foremost as the things we can see – the glossy atrium and shiny curtain walling. In the current climate, there is, of course, no money and little (publicly expressed, at least!) appetite for such things – but this does not mean that there is no role for good design in healthcare buildings. Acoustics is often the poor cousin at the design team table, sometimes seen as an item which can be value-engineered out altogether. This could be a false economy for a number of reasons, which I will discuss below; the topics we will cover here are also equally applicable to new build and refurbishment, to large hospitals and smaller community or specialist facilities, and to both public and private sector healthcare buildings. Of course, the inclusion of acoustic provision within a design has an upfront cost impact, but this can be mitigated by allowing the acoustic design to be fully integrated with the overall proposals rather than seen as a “bolt-on” late in the design phase. The salient point to remember can be summed up in a cliché – “Spend a little to save a lot.”

Current practice

According to Health Technical Memorandum (HTM) 08-01, acoustics provides design criteria for noise intrusion from external sources, internal noise due to mechanical and electrical services, privacy between different spaces, and reverberation control (how “lively” a room sounds). Key considerations in acoustic design of healthcare facilities are generally patient privacy and confidentiality, and reasonable conditions for rest. The guidance within HTM 08-01 provides an appropriate acoustic standard, and is well-considered. However, the experience of many acoustic consultants will be that, wherever possible, design teams will attempt to derogate away from this standard in order to reduce costs. In particular, reverberation control is often omitted or value engineered due to a sentence which says that it should be allowed for “where cleaning, infection control, patient safety, clinical, and maintenance requirements allow”. This “get out of jail free card” is often abused in order to reduce costs, with little thought to the long-term impact on patients and staff. To compound the potential acoustic problems which arise, there are also several sources of noise where it is not possible for HTM 08-01 to be prescriptive. This includes items such as the selection of quiet medical equipment, the use of audible nurse call systems, and noise from pneumatic tube systems. Recommendations are given within the HTM that quiet systems should be selected, and the routing of services should be considered etc, but as these are not mandated, and, in some cases