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ALWAYS Quiet
Quietness of the Hospital Environment
Vikki Choate, MSN, RN, CCM, RN-BC, CPHQ
Studer Group Coach
Nashville, TN
May 14 - 15, 2013
Learning Objectives
At the end of this session, participants will be
able to:
Define the physiological and psychological
effects of hospital noise on patients
Recall three best practices to decrease hospital
noise
Describe how Daily Huddles, Hourly
Rounding®, Bedside Shift Report, and Nurse
Leader Rounding may be leveraged to improve
HCAHPS ‘quiet at night’ results
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Is It a Hospital or a Highway?
Alarms on monitors
decibel level = 79
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Heavy truck traffic
decibel level = 80
A Patient Perspective – Straub Foundation
“If you have had the pleasure of a stay in the
hospital, you know exactly what I mean. Patients
rarely get any sleep. Every hour or so the
overhead fluorescents flash on as a nurse makes
his or her rounds. Pagers sound, machines beep,
alarms blare, and cart wheels squeak. Room doors
are open and the sound of staff chatter filters in.
One eventually leaves the hospital exhausted.”
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Hospital Noise
Unnecessary noise is “the most cruel
absence of care which can be
inflected either on sick or well.”
Florence Nightingale, 1859, Notes on Nursing
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Healthcare Flywheel®
Bottom Line
Results
Prescriptive
To Do’s
Daily Huddles
Bedside
Shift Report
Hourly
Rounding℠
Leader
Rounding on
Patients
Improved
HCAHPS
results on
‘Quiet at Night’
question
Purpose,
worthwhile work
and making
a difference
SelfMotivation
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®
Rev 4.8.11
Execution Framework
Evidence-Based LeadershipSM
Foundation
STUDER GROUP®:
Objective
Evaluation
System
Leader
Development
Aligned Goals
Implement an
organizationwide
staff/leadership
evaluation
system to
hardwire
objective
accountability
Create
process to
assist
leaders in
developing
skills
Must
Haves®
Performance
Gap
Aligned Behavior
Agreed upon
tactics and
behaviors to
achieve goals
(Must Haves®)
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Re-recruit high
and
middle/solid
performers
Move low
performers up
or out
Standardization Accelerators
Aligned Process
Processes
that are
consistent
and
standardized
Process
Improvement
PDCA
Lean
Six Sigma
Baldrige
Framework
Software
Organizations Coached by Studer Group
Outperform the Nation across HCAHPS
Composites
New
Update!
3Q11-2Q12
Studer Group Difference over Non-Partners
in National Percentile Ranking
Overall Rating
Willingness to Recommend
Pain Management
Nursing Communication
Communication of Medications
Clean and Quiet
Discharge Instructions
Responsiveness of Staff
Doctor Communication
19
12
16
20
17
5.5
percentile
points
higher
17
10
5
0
5
10
15
20
Studer Group Difference over Non-Partners
in
National
Percentile
Ranking
25
Source: The graph above shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since Oct 2008 and
non-partners for each composite; updated 5.2.13 using 3Q11-2Q12 CMS data.
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HCAHPS – The ‘Quiet’ Question
During this hospital stay, how often was the area
around your room quiet at night?
Never
Sometimes
Usually
Always
Do we really care only about night time noise?
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Did You Know?
World Health Organization recommends that
hospital noise levels should not to exceed 30 db
Studies show noise levels in hospitals may
range from 53 to 117 db
Peak noise levels of a busy surgical floor can
exceed 95 db
ICUs usually have the highest sustained levels
of noise with an approximate average mean
equivalent sound level of 56 db
Source: Ann R Coll Surg Engl. Noise pollution on an acute surgical ward. 2008 Mar;90(2):136-9.
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Why ‘Quiet’ is Important
Did you Know that noise?
Increases stress and anxiety levels, escalates fear
Elevates cortisol production which increases blood
sugar levels and decreases immune responsiveness
Causes sleep deprivation which can lead to mood
swings, confusion, or delirium
Increases heart rate and blood pressure
Increases gastric acid levels which give rise to
nausea, ulcers, and GERD
Increases susceptibility to infections
…..and this goes for health care workers as well!
Source: Nurs Adm Q. The effects of hospital noise. 2010 Oct-Dec; 34(4): 327-33.
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Noise Impacts Critical Communication
Noise jeopardizes important communication
between patients, families, and healthcare
workers
Miscommunication may leads to mishaps
Mishaps may lead to errors
Errors may have profoundly
negative effects on our
patients and their families
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What We Say Matters
Use key words on admission to manage
patient’s expectations around noise and rest
Develop key words to use proactively during
times of construction or renovation
Set expectations for key words to be used by
staff
Adapt key rounding questions for leaders to
validate effectiveness of ‘quiet’ tactics
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Driving Improved ‘Quiet at Night’ Results
Not new…..better!
Daily Huddles
Hourly Rounding®
Bedside Shift Report
Nurse Leader Rounding on Patients
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Daily Huddles
Develop ‘quiet at night’ goal
Engage staff to identify strategies to reduce
noise
Incorporate goal and tactics as standing
huddle agenda
Reward & recognize or coach to gaps in
performance
Update staff with results regularly
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Bedside Shift Report
Develop daily rest plan with patients
Note plan on patient communication board
Review effectiveness of plan at
each report, adjust as indicated
Use key words ‘quiet’, ‘rest’,
and ‘healing environment’
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Hourly Rounding®
Offer ‘quiet kits’
Add ‘Pumps’ to the 3 Ps and
anticipate alarms
Close patient doors after rounds when safe
Follow rest plan developed with patient
Bundle care to avoid interruptions and noise
Explain rounding at night is a standard of safe,
quality care
Use key words ‘quiet’ and ‘rest’
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Nurse Leader Rounding on Patients
Obtain specific feedback from patients
Act on opportunities to improve
Validate individualized rest plan and ‘quiet kit’
Use key words ‘quiet’, ‘rest’, and ‘healing environment
Reward & recognize or coach to gaps in performance
Share findings and trends during Daily Huddles
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A Case Study in Noise Reduction
Mary Greeley Medical Center:
• 220 bed regional referral center in Ames, IA
• Quiet at Night HCAHPS outcome lagged
significantly behind comparative data
• Many physical/mechanical noise issues
addressed, however no movement in results
• Needed new strategy to address the people
aspect of noise
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A Case Study in Noise Reduction
Developed HCAHPS Domain Teams
Formed ‘Blitz Team’
Established sustainability:
• Leader Rounding on Patients for quiet
• House Manager noise audits
• Celebration & lessons learned
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A Case Study in Noise Reduction
Implemented a ‘Quiet Committee’
Invested in signage,
communication boards,
and elevator door skins
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A Case Study in Noise Reduction
Installed noise monitoring devices
Visiting hour overhead message – “thank you for
helping us maintain a quiet, healing environment for
our patients
Established standards for phone and TV volume,
implemented Vocera etiquette
Dimmed lights
Closed patient doors
Obtained pillow speakers for TVs
Leaders modeled quiet behaviors
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
A Case Study in Noise Reduction
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Confirm Learning
As a result of this presentation, are we able to?
Define the physiological and psychological
effects of hospital noise on patients
Recall three best practices to decrease hospital
noise
Describe how Daily Huddles, Hourly
Rounding®, Bedside Shift Report, and Nurse
Leader Rounding may be leveraged to improve
HCAHPS ‘quiet at night’ results
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Thank You!
Vikki Choate, MSN, RN, CCM, RN-BC, CPHQ
Studer Group Coach
207.607.2218
[email protected]
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.