"Designing for Health" is a monthly, web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. This month's topic:

Peace and Quiet: The Serenity of Invisible Design

By: Carolyn BaRoss and Amy Sickeler

Having recently returned rested and focused from a summer getaway, I was struck by the level of noise in my day-to-day life. In contrast, vacation was filled with escape and serenity from the sound of ocean waves crashing to pleasant silence, Aside from the obvious respite from responsibilities, could this quiet have had an effect on quality of sleep, or on clarity of thought and perspective?

Upon reflection, to what degree can we design pleasing sounds and quiet into the built environment, to achieve similar, positive effects?

Designers are trained to manipulate visual elements, however, acoustical design is more challenging to assess. It is critical to the healthcare environment for many reasons: privacy, stress, sleep, healing and possibly medical error. Unpleasant and loud noise provokes visceral and measureable physiological responses, and there are compelling studies that demonstrate the negative effects of noise on patients and staff.

The Mayo Clinic has embraced the importance of acoustics in the healthcare environment. In Rochester, Minn., seven operational strategies for acoustic control were utilized:

1. Move shift change staff report to enclosed room away from the nurse desk.

2. Place foam rubber padding in pneumatic-tube document delivery systems.

3. Replace roll-type towel dispensers with folded towel dispensers.

4. Routinely close doors to patient rooms.

5. Modify cardiac monitor setting to allow lower volumes in patient rooms, add alarms that sound at nurse stations.

6. Use flashlights instead of overhead lights when entering patient rooms.

7. Educate staff about the issue and share noise-control measures.


For The Mayo Clinic’s new hospital in Jacksonville, Fla., the following architectural guiding principles were recommended by Mark Penz, acoustical engineering consultant from Kirkegaard Associates:

1. Wherever possible, absorbent material should be located as close as possible to noise sources.

2. Absorptive materials should be integrated into large open areas to curtail any excessive reverberation that might develop.

3. Sound critical walls should be carefully detailed to insure airtight, resiliently sealed penetrations around conduit, ductwork, etc; Open-air pathways will dramatically reduce the effectiveness of sound-rated partitions.

4. Background noise levels should be well calibrated to their respective spaces-high enough to mask distant speech, but not so loud as to prove offensive.

The team weighed options early in the process. Two key areas—the main lobby and the patient units—were informed by Mayo’s experience, and Kirkegaard’s recommendations.

The main lobby strikes a balance between acoustical brightness and quiet. This civic space features stone, glass, and terrazzo. Through the use of acoustical fabric-wrapped panels, absorptive insulation above soffits, carpeted alcoves, and a smooth, troweled-on material (NRC .80) at the ceiling plane, sound reverberation has been greatly reduced. During construction, a dramatic improvement in the sound quality was observed as these materials were installed. Classical music is heard clearly and at a comfortable volume. The pleasant sound of water in a fountain recalls the resort-like grounds of the campus.

At information and registration, fabric-wrapped panels separate registration stations and are installed behind and above desks and along the perimeter of the waiting room. Waiting areas require HVAC targets of RC 30-35 range to mask conversations from registration (a HIPPA requirement). Carpet and background music speakers, located in the .80 NRC perforated wood ceiling also help to diffuse conversations. Upholstered furniture is installed throughout.

In patient units, .95 NRC ceiling tile above corridors and over staff work areas helps absorb sound before it ricochets through the corridors. Soffits surround work areas and interrupt corridor ceiling surfaces over which sound can travel. Lower nighttime lighting levels encourage quiet activity.

Functional planning has an acoustical benefit. Dedicated teaching areas, at the center of each unit contain conference rooms with digital workstations for rounding to avoid group meetings in corridors. Staff utility and supply rooms are located on cross corridors, away from patient rooms. These provide quick access, but doors are not opposite patient bedrooms.

All patient rooms are private, and the resulting acoustical benefits are significant. The staff work zone within the patient room is located near the door and equipped with nighttime task lighting, allowing quieter evening access. The patient headwall construction includes two separated stud systems with acoustical batt insulation between, and acoustical sealant wraps around staggered utility backboxes, to reduce sound transmission between rooms. Door frames have rubber silencer pads attached to the door stops to soften noise from the closing doors. Windows for patient observation are located in satellite nursing stations, which are designed to allow visual control of all rooms, with patient doors closed to corridor noise.

Superior acoustical design in a healthcare setting contributes to overall perception of comfort of the space. Unobtrusive, even invisible from view, these features can yield delightfully quiet results. When accomplished, designers can contribute by creating a healthier environment for staff to work and for patients to recuperate.

|c|

Carolyn BaRoss, LEED® AP, is a principal at Perkins+Will. She is the healthcare interior design director and interior discipline Leader for the New York office. She and Amy Sickeler led the interior fit out for the new Mayo Hospital in Jacksonville, Fla. She can be reached at carolyn.baross@perkinswill.com.

Amy Sickeler, RID, ISDA, LEED® AP, is a principal at Perkins+Will. She serves as the director of design for the Atlanta office’s interiors department as well as the healthcare interiors practice leader for the office. She can be reached at amy.sickeler@perkinswill.com.

Data and content for this article was developed from the following sources:

“The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity” Roger Ulrich*, Xiaobo Quan, Center for Health Systems and Design, College of Architecture, Texas A&M University. Craig Zimring*, Ajali Joseph, Ruchi Choudhary, College of Architecture, Georgia Institute of Technology.
(*co-principal investigators and corresponding authors. Report to The Center for Health Design for the “Designing the 21st Century Hospital Project.")

"Double WHO's acceptable levels—Rising hospital risk factor: noise," Damon Adams, American Medical News—American Medical Association Volume 48, Number 48 December 26, 2005. References 2005 research project by Ilene Busch-Vishniac, PhD., and James E. West, PhD at Johns Hopkins.

"How Acoustics Affects Human Productivity," David M. Sykes, Ph.D. 2004


Past installments of "Designing for Health" are available here:

• "Shifting Culture, Shifting Service Lines: Is Tiger Woods the New "Grandmother"?"

• "Research Informing Design"