Healing the hospital sensory experience
Staying in a hospital is not easy on the senses. (I’ve written a little about this before.) Having spent time on hospital floors as a volunteer, designer and patient I’ve experienced many of the harsh sensations that impact people (patients, families and staff )— things like bad smells, loud sounds, and scary sights. These contribute to a more stressful and less healing hospital experience, and I know we can improve.
I’d like to first break some of these problems down in more detail, and then we can have some fun thinking of wild ideas for how to make things better.
Sensory breakdowns in hospitals
Alarms and beeps from diverse machines are dissonant and constant. Some of these come from heart monitors; some from sensors that detect if a patient has gotten out of their bed (commonly installed for patients who are at risk of falling.) As a patient, it can be terrifying to hear the machine to which you’re attached suddenly and loudly start to create warning sounds. Recently I was attached to a heart monitor and it began to beep, first in a low tone and then in a more high-pitched, shrill tone. The nurse came over and said “it says you’re not breathing, but obviously you are.”
Figures vary, but from 90% — 99% of alarms that sound on inpatient units are false alarms; staff therefore become numb to them, a condition called ‘alarm fatigue.’ This puts patients who are in a true crisis at risk of being ignored by burned-out staff. False alarms also cause stress for patients and families, who suddenly are launched into fight-or-flight mode, not knowing whether this noise signals an actual emergency. And as we all know, stress is bad for your health.
My friend Yoko Sen, a musician who works on improving sound experiences in hospitals with her company SenSound, recently discovered that the sounds that commonly result from diverse beeping machines result in what has been called the Devil’s Tritone; an unsettling combination of notes that was actually banned in churches during the Renaissance. I just listened to an example of this chord, and it raised the hair on the back of my neck.
In addition to alarms, there’s noise from other patients. Sometimes they yell; I volunteered on a floor that commonly treated dementia patients, and some would shout incessantly that they wanted to go home . Patients may also cry out in pain, which can be scary or disturbing for others. Rooms that house two patients can be problematic; roommates may snore, turn up their TV too loud, talk on their phones loudly, or have visitors at all times of day; I’ve even seen one person play guitar while his roommate slept (“slept”) a few feet away.
Then there’s noise from staff: talking to each other as they walk through the hallways, and talking to patients in the patient rooms. This communication is necessary for good patient care, but it adds to the general cacophony.
Walking into a hospital, right away you notice a different smell profile. It’s antiseptic, a little bitter, with undertones of the artificial fragrance contained in soaps and cleaners. On patient floors, the smells become more intense and diverse. Bodily fluids and outputs like fecal matter can raise a cloud of stench spanning a good portion of a hallway. Patients with serious infections like MRSA or c-difficile can smell especially pungent; I’ve smelled an infection while standing 15 feet away from the patient’s room. As an olfactory-oriented person who lives an essential oil lifestyle, the smells of the hospital are an assault.
Walking the floor as a volunteer, I likely witnessed more troubling sights than most patients (though surely far fewer than staff). Casually walking past rooms I saw people with swollen and clearly infected body parts, and others who were very sick, wasting away and dying.
Harsh florescent hallway lighting is the norm, and the floor on which I volunteered had flashing lights outside of rooms that indicated when fall-risk patients had stood up from their chair or bed. These bright and flashing lights contribute to staff members’ stress and alarm fatigue.
The color palette is mostly beige piled on top of beige, a neutral and bland ‘business casual’ color accentuated in places by mauve and other pastel tones. Stark decor, neutral colors, basic furniture, and various machines and screens comprise the basic in-room experience. It’s an artificial, sterile environment; the opposite of nature.
It’s been awhile since I’ve stayed at a hospital myself, but I recall lying in bed with the standard lightweight blanket and sheet. I was hooked up to an IV and had a fluid drainage tube inserted in my chest. It hurt to breathe and walk. Many patients are in some kind of pain.
The rooms are ventilated but the air feels still. There’s no fresh air allowed; the windows don’t open in many hospitals.
Patients experience human touch from the nurses and staff, but I’m guessing that many patients (especially those who stay at the hospital for long periods) lack meaningful physical contact with other people. Hugging other people releases oxytocin, which has been shown to speed wound healing. So a lack of hugging may be slowing patients’ potential ability to heal.
There’s not a lot to say here, except: “hospital food.” Where I live in Vermont we are fortunate to have more of a farm-to-table hospital dining service, but many hospitals’ food compares to the hot lunch in your elementary school (dried out, mystery meat, etc.) For people with food sensitivities like me, there aren’t a lot of nutritious options. If food is medicine, many hospitals forget to stock the culinary pharmacy.
I’m making some additions to the usual 5 senses. First is the feeling of rest, peace, and recovery; it’s the opposite of stress. Interruptions at all hours (for vital signs, blood draws, and physician rounds) prevent patients from getting the sleep they need. This is one of the top complaints I hear from friends and family members who are hospitalized.
What are you supposed to actually do while you’re in the hospital? The sense of time for a hospitalized patient can feel off. An hour can feel like an eternity, or days can pass in a rapid haze. Boredom is an important factor. With nothing to do, patients may be more likely to focus on what’s happening to them physically, and unstructured time can lead to a lot of thinking — rumination, worry, relief, confusion, anger, gratitude. Sometimes thinking is constructive, but when it’s cyclical and happens without the benefit of full transparency and knowledge about what is happening to a patient or their body, it contributes to stress.
This sense of ‘time’ was an addition from a participant in a design workshop I co-led last year (on improving the patient sensory experience, of all things!)
What can we do?
There are infinite possibilities for improving these sub-par patient experiences. Given the research showing that nature heals, I’ve started brainstorming potential solutions to help heal the sensory experience in hospitals. Some of these ideas are outlandish, but this is a fun thought experiment.
- We should strive for quiet, sound-proofed single patient rooms. This is an obvious one; it would prevent roommate noise, and is also shown to reduce transmission of infection.
- Yoko, who I mentioned, is currently working with various device makers to ensure their alarm sounds create more harmonious and less dissonant combinations.
- What if there were no alarm sounds at all? Nurses and other staff could be notified of potential problems via other means: perhaps tactile notifications from a wearable device (which also gives more context on what’s happening) combined with some sort of visual stimulation for situational awareness in the hallways.
- Yoko often speaks of silence; loud or disturbing sounds may be distressing, but total absence of sound can also be stressful. We might consider adding nature sounds, soothing music, or white noise to help provide a peaceful and calm atmosphere.
- Yoko and her team created a restful Tranquility Room for staff members at Sibley Hospital that allows them to escape and reset (I encourage you to check it out!) This type of visual and sound installation would also be interesting to try in a patient room.
This musician is redesigning the future of healthcare with sound
WATCH | A Washington, D.C., based musician is helping to change the sounds we hear in hospitals. Yoko K. Sen is an…
- I don’t want to neglect simple and relatively inexpensive solutions like earplugs or noise-canceling headphones; headphones can also serve up soothing noises.
- Better air circulation in patient rooms would help remove bad smells.
- We should let fresh air enter the rooms.
- Essential oil diffusers could fill a room with good smells; if patients had a little menu of choices, this could also help them feel a sense of control over their experience.
- For rooms that hold multiple patients, could we invent an essential oil mask that would allow individuals in the same space to create their own olfactory environment?
- What if you could set a nature theme, and a smellscape could automatically play along with it? For example, if I choose a woodsy nature theme, a smell like cedarwood could pump into the air.
- Speaking of nature, plants help improve air quality and could help with general stuffiness/stinkiness.
- We should offer fragrance-free soaps (and no artificial fragrance, ever.)
- We could offer nature-themed pictures, posters, and clings on the walls. Ideally the walls could be one big nature scene (and even more ideal: the patient could decide which scene they like best.)
- Plants could be incorporated into the room — at least air plants. Or perhaps plants in a little ecosystem box, so the box can be sanitized if needed.
- VR goggles could take you to your destination of choice —this experience could include smells, sights, sounds, and maybe even tactile sensations (a wind could blow on your skin.)
- Printed curtains with nature scenes could create an immersive environment without technology.
- Bird feeders at the windows could provide access to nature.
- Rooms should get as much natural light as possible.
- To the extent possible, patient windows should look out onto green space. If that’s not possible, nature-themed clings could simulate a natural view.
- TVs could offer a station with nature videos playing. (I’ve stayed at a hotel that had a nature video channel, and it was extremely relaxing.)
- We could install hallway murals — for patients who walk the halls, and even more importantly for staff. We could gather inspiration from biodomes, aquariums, museums, etc.
- Plants could be installed in the hallways and nursing stations — these would help reduce staff stress and improve the experience for patients who are walking around on the unit.
Better tactile feelings
- Weighted blankets are supposed to reduce anxiety; these might be a great addition to hospital rooms.
- Let the windows open so a pleasant breeze can blow through.
- Massage therapists could make rounds.
- Volunteer huggers could go around and offer hugs. (Ok there is a potential for that to be very weird, but maybe it could work.)
- Hospitals should serve fresh, farm to table food that includes lots of fresh veggies and salads and tasty vegetarian fare.
- We should offer kombucha, kimchi, and other probiotic foods that can help with gut healing.
- Can we get some bone broth up in here? (chicken soup has real health benefits)
- Vital signs could be checked via remote sensors that patients wear or that are placed in their environment; this way, nurses would not need to enter the room at night (at least as often.)
- If nurses do need to enter, they can wear night vision goggles so they wouldn’t need to turn the lights on.
- Physician rounds should be more patient-oriented and scheduled to prioritize rest; hold them after 8am, for example.
- Limit or cover blue light and LEDs; let people sleep in total dark.
- Smart beds could sense if a patient is trying to get up; they could adjust to the right height and low lights could come on.
- Natural UV lights could change with the time of day to support better sleeping and rest.
Better sense of time
- Researchers speak to the power of ‘positive distractions’ to help improve reduce patient stress. Positive distractions may include TV, immersive creative activities that bring about a sense of ‘flow’ (such as puzzles, art activities, etc.), or talking with friends and family. When I volunteered in an inpatient unit, televisions up and down the hall tuned in each day to watch Ellen. Comedy can bring relief.
- We might reduce unnecessary rumination by improving communication and being more transparent about what is happening (or not happening) at any given point in time. That is a big request and would require an overhaul of current processes and tools, but it’s worth mentioning.
- Interactive walls in the room could allow patients to view natural scenes, play games, stretch, and perhaps even interact with others.
Well. None of these ideas is really very groundbreaking, and many of them have already been implemented at certain hospitals. But the combination of them, in addition to other fixes around communication and transparency in hospitals, could make a huge difference in how we help patients heal.
What do you think is missing from this list?