Is Noise Relevant in Sustainable Development?

Sustainable Development discussions are often conducted exclusively in terms of saving energy and minimising carbon emissions, whether as direct effects from the specific project or in terms of embedded effects in materials.

However, Health and Wellbeing is seen as a fundamental part of sustainable development, to the extent that the BREEAM appraisal method specifically rates these aspects.

Noise is seen within this framework as having an adverse effect on health and good acoustic design is rewarded by the awarding of credits towards an overall rating. Noise has also been highlighted by the CQC as an important part of the Patient Experience with the reported situation worsening .

Noise has, in fact, been recognised as a contributor to recovery as far back as Florence Nightingale’s time when, in 1898, she devoted a whole chapter of ‘Notes on Nursing What It Is, and What It Is Not’ to the subject. Amongst a great deal of good advice and practice that would bear repeating in full today she says “Unnecessary noise, then, is the most cruel absence of care which can be inflicted either on sick or well.”

The key word here being ‘unnecessary’. Noise is a factor of day-to-day life yet it is important to view noise as a resource and not always as a pollutant, to recognise that there is ‘good’ noise that performs a function, to alert a dangerous situation or to soothe and aid recuperation when used positively. But, there is ‘unnecessary’ noise that is generated by careless actions or by bad design and specification. Indeed, any such design is inherently thoughtless or careless and the end user suffers whether staff or patient.

In the near future, it may be that re-use and refurbishment of existing facilities will predominate over new build. Good acoustic practice is vital to both approaches.

Whilst it may seem logical to apply the recommendations of the Department of Health best practice guidance (HTM 08-01) in new purpose built facilities, excuses can be made for not doing the same when looking at existing or converted properties. I would argue though that these facilities need the same levels of good practice no less than new buildings. If we have been converting factories, warehouses and commercial buildings to residential use with higher standards, there is no reason not to do the same with healthcare buildings.

These standards are always more easily and cost effectively achieved if provision is made from the beginning. An acoustic condition survey of your existing estate will allow you to plan future refurbishment in such a way that resources are concentrated on areas where maximum benefit can be gained.

And to return to my initial question,

There is no point building sustainable low energy buildings if nobody wants to work or be treated in them. Noise is a crucial issue in Sustainable Development and cannot be ignored.

For more information: please contact Robert Adnitt, robert@adnitt.com
www.adnitt.com

Improve the Patient experience

improvepatientexperience

Is noise, or silence, important in healthcare?

The Care Quality Commission 2009 Survey of Patients in NHS Hospitals revealed that patients' experiences had deteriorated or not improved with regard to noise.

• A higher proportion of patients were bothered by noise at night from hospital staff
• There has been no improvement since 2008 in patients being bothered by noise at night from other patients

This is only one aspect of noise (acoustics) in Healthcare. With high background noise levels on wards, alarm signals may be missed, communication can be difficult and the recuperative benefits of sleep may not be fully realised. Whilst the source of the noise may be from staff, patients and medical equipment, it may also come from traffic noise outside or from ventilation systems.

There are often potential problems too with confidentiality in consulting rooms or at reception desks. Poorly designed buildings may have walls or doors that do not provide sufficient privacy and public areas that echo or reverberate.

The issue of noise has attracted high profile media attention. Attention that is only likely to increase with awareness of potential health risks of noise under current research .

So how can the issue of noise and improving the patient's experience be addressed?
The DH Estates Health Technical Memorandum 08-01 sets out acoustic criteria for the design and management of new and existing sites and can be used at various stages during the whole building lifecycle.

There have also been initiatives in the US and in this country such as Shhh (Silent Hospitals Help Healing) to encourage staff to take ownership of the noise levels on their units.

However, a scattergun approach to treating problems is never the most efficient in an era of tight budgets and it is important to focus precious resources on high priority areas that can have the most impact.

Each Trust Estate, Hospital, Health Care Centre or Care Home will have individual needs that should be assessed first. The most appropriate solution may be a staff-led managed approach or this may be ineffective if the building is fundamentally flawed.

In upcoming blog entries, I will look at examples of each of the problems discussed above and suggest some solutions and approaches. I will also look at the concept of acoustic surveys to assess the current conditions in any Estate or building, so that High Priority Areas can be identified and resources targeted.

For more information, please contact Robert Adnitt, e: robert@adnitt.com w: www.adnitt.com
References
1. Supporting Briefing Note: Issues Highlighted By The 2009 Survey Of Patients In NHS Hospitals In England
2. Although there was no significant change between 2008 and 2009 in the proportion of respondents saying that they were bothered by noise at night from other patients, this has increased steadily, from 37% in 2005 when the question was first asked to 40% in 2009. Around a fifth of respondents (21%) said that they were bothered by noise at night from hospital staff, a significant increase of less than one percentage point from 2008. This figure has been increasing steadily since 2005 when it was 18%.
3. Hospital wards break world health 'noise limits' - http://news.bbc.co.uk/1/hi/health/8387836.stm
4. http://www.euro.who.int/en/what-we-do/health-topics/environmental-health/noise