The best and most complete answer to your question was delivered last week by Gary Madaras PhD, AIA, ASA, at the Acoustical Society of America conference in San Francisco. Bottom line: hospitals that followed the 2010 FGI Guidelines acoustical criteria appear to perform very well on the HCAHPS "Quiet at night" question. And published case studies of several of these are worth careful reading by planners and designers (examples: two projects that won awards of merit in the Sept. 2012 edition of Healthcare Design magazine have excellent acoustics; one project was led by Kurt Rockstroh FAIA, FACHA, president of FGI and the architecture firm SBA and is being analyzed now as part of a cost-benefit study; the other was done by NBBJ at MGH in Boston with assistance from a well-known acoustical consultant in NYC. Unfortunately, the reviews of these two projects failed to mention the improved acoustics or to describe what was done to achieve them). Gary Madaras' presentation last week, and a new chapter in "Sound & Vibration 3.0" (scheduled to appear from FGI and Springer Verlag in the spring), detail the kinds of decisions made by planning and design teams that make a difference and significantly improve HCAHPS scores. Sadly, many hospital planning teams have not yet realized that: (a) it makes sense to address the HCAHPS "Quiet at night" question, or (b) they assume that the problem can be solved purely through operational/equipment changes (this doesn't work). So while the 2010 Guidelines--containing the first comprehensive acoustical criteria in 60 years--were published three years ago, we are only now beginning to see hospital planning and design teams paying careful attention to the "Quiet at night" question proving that economic incentives are driving the change. As you know, we first talked to Press Ganey about this issue in 2004, so it has taken a long time to get hospital planning and design teams to understand the importance of making these needed changes.

Please note: (1) the Beryl Institute report you cite was written by Gary Madaras PhD (the expert I mentioned above, whose work is widely read and who is a contributor to the FGI Guidelines); (2) the Center for Health Design magazine "Healthcare Design" (in the September awards issue) cites TWO case studies where the acoustics improvement are significant and resulted from following the FGI 2010 Guidelines (facts noted by both hospitals); (3) several prominent people from FGI, Joint Commission, AORN, CHD and other organizations are presently engaged in the "alarm fatigue task force" that is currently underway; and (4) it is inappropriate to state--when there is clear, publicly available evidence to the contrary--in the Center's own journal--that "perhaps the HCAHPS noise question score will never significantly improve." That is plainly untrue.

Good points! These are complicated structures with lots of pieces to consider and each delivery approach comes with its own Pros/Cons. Certainly, acoustics are not given deserved consideration. As with much of the change taking place in healthcare planning and development right now, there seems to be a lag between the understanding of patient outcomes and surveys and their connection with the built and operational environments. Many times this disconnect is just as prevalent between caregivers and their administrators. Caregivers know what doesn't work and even sometimes have a clue what will work but the admin team who ultimately makes the decision to pay for the change is typically not informed. Further, the design and planning team is tasked with keeping costs under control in one of the most expensive building types and acoustics are an easy target for value engineering if even considered. We need to close this gap between design/planning professionals and healthcare providers. We all have our strengths but we're even better as collaborators. One objection I would make to the above is even the mention of carpet in a care wing. The infection control nightmare that this introduces is simply not acceptable.

Flooring is a multi-faceted issue with no simple answers. As for carpet, mobile equipment, and infection control, let's be reasonable. We are not in the habit of dragging patients across the floor so airborne particles rather than sterility should be the concern. Consider this--There are NICUs with carpet chosen for the noise dampening effect and no increased infection issues in many years of use. Cleaning methods and the noise and disruption they produce should also be considered in all flooring decisions.

Until this operational issue is addressed, most improved acoustical design is negated: CLOSE THE DOOR! I often think the worst day in healthcare design was when fire codes were changed to no longer require automatic closers on corridor doors. If you ask nurses why they keep doors open, they cite the need to hear their patients. Let's ask patients. Even better, let's measure the noise level with doors open vs closed.

In regard to "not all sounds are bad sounds", noise rather than sounds (or decibel level) is the issue. Natural sounds such as the wind in the trees may be very loud, but few humans would describe that as "noise." Unfortunately, we all live in such a noisy world of man made sounds that we are poor judges of the negative affect on our bodies. Perception of noise may not be the best measure. Caregivers, and even patients, often think they can tune out noise but the negative physiological effects are still measurable.