Because the “quiet at night” HCAHPS question on average receives the lowest responses from patients, it is a common target for improvement activities by hospitals and health systems. As a recent article in Healthcare Finance titled “Everybody’s top complaint about hospitals? Noise, according to HCAHPS data” emphasizes, the loud equipment, beeping monitors and even squeaky wheels on catering carts are usually the first areas of focus for teams that are intent on reducing noise. But are these sounds the ones that really bother patients the most?
Last week, I spent multiple hours in a conference room on a hospital nursing unit. Working with a team to identify issues and opportunities for improvement, an important part of our discovery phase was conducting individual and small group interviews with frontline staff.
As the staff came in and out of the room sporadically when they found a few minutes to break away from their assignments, I had downtime between interviews. While I was working on email and related projects, the thing that struck me most was how much I could hear of the conversation between a patient and her visitors across the hall. I wasn’t purposely trying to eavesdrop, but it was impossible to not hear their conversation.
Obviously, if I could hear them, a patient alone in a quiet room can hear much of the conversation among staff members in the hallway.
The experience took me back to a night several years ago when I was unexpectedly admitted to a hospital overnight. While I was exhausted, I certainly couldn’t sleep. I wasn’t going to turn on the TV in the middle of the night, so my only distraction from the deafening quiet in the room was the chatter outside. I heard all about the fun party several nurse attended over the weekend and the frustrations with scheduling and working short.
To be clear, I’m not judging any of the topics of their conversation. I just know that they were not meant for my ears – and that the staff likely would have been mortified if they realized how much I could hear.
Following are three suggestions that can help teams better monitor and reduce the inevitable conversation noise that may sacrifice privacy and rest, especially at night.
Ask patients and visitors how much they can hear
This suggestion may seem too obvious, but in my experience we rarely talk with patients about noise. An ideal time to ask is during a nurse manager’s rounding on patients during their stay. After easing into the conversation with a focus on the patient’s current status and overall experience during the stay, managers should can probe a bit more. “Our team is really working on trying to reduce the noise on our unit, especially at night. Could you hear our conversations in the hallway last night?”
Elevate awareness and the priority of minimizing conversations in public hallways
Staff don’t purposefully engage in conversations that they don’t want patients to hear, so increasing the awareness around how much patients do hear in the hallway is a critical first step. Talking about the issue during a department staff meeting is a great place to start, emphasizing that minimizing conversations in the hallway protects the privacy of both patients and team members. Use time during the staff meeting to brainstorm ideas on how team members can best support one another in reducing noise. This helps build buy-in to holding one another accountable for minimizing private conversations in areas where patients and family members are within earshot. These ideas can be reinforced in daily huddles with the team.
Identify safe team conversation zones
When teams decide together where it is best to have private conversations, they are more likely to reinforce safe conversation practices and hold each other accountable.
For teams interested in improving their HCAHPS noise question scores, hallway conversations must be included on their list of noise-reduction targets. But more than just reducing noise, conversations should be monitored to protect both patient and staff privacy. More often than not, team conversations outside patient rooms are ones that should be for their ears only.