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Sound and Privacy in the Waiting Room

What is it about medical waiting rooms that seems to magnify the anxiety we already feel as we’re about to see a doctor or wait for a loved one to go into surgery? On a recent visit to the doctor’s office with my teenage son, what struck me most about the reception-area experience was the discomforting quiet. Out of respect for my son’s privacy, I found myself almost whispering to the receptionist so that the other patients wouldn’t hear any details about why he was there. I thought it odd that there was no background noise to mask our conversation—music, white noise, something—and I feared that my son’s responses to the receptionist’s questions (even though they were only the preliminary, pre-exam questions) might be truncated or otherwise edited by him to minimize embarrassment.

Turns out, this is, indeed, a wider problem. According to Anjali Joseph, Ph.D., Director of Research, The Center for Health Design, and Roger Ulrich, Ph.D., Professor, Center for Health Systems and Design, Texas A&M University, a perceived lack of privacy in some clinical environments causes some patients to withhold certain details about their private history. Read Joseph and Ulrich’s paper here.

No wonder that the Health Information Portability and Accountability Law of 1996 (HIPAA) mandates a “confidential” level of speech privacy in reception areas or in any other space where patients discuss their personal health. But how does a receptionist know s/he is speaking at a “confidential” level? Let’s face it, some people are just loud, and they may not perceive their speaking volume as a potential privacy issue.

Along with the actual protection of private information, the patient (or the parent, in my case) must perceive a level of privacy in a reception area to be truly comfortable. I would argue that patients are typically experiencing a heightened state of sensitivity and self-consciousness when visiting a doctor’s office. As a result, they may require unequivocal assurance that their personal information will not be overhead. And they would probably appreciate a little music or soothing nature sounds (birdsong, running water, etc.) to distract them and alleviate their anxiety. Which brings me back to the subject of a conversation-masking background sound.

In their Interim Sound and Vibration Design Guidelines for Hospital and Healthcare Facilities, the Joint Subcommittee on Speech Privacy of the Acoustical Society of America points out that “[c]onfidential speech privacy is not readily achievable in open plan spaces due to the lack of barriers, low ambient sound levels, and typical voice effort.” But there is a solution: “[s]peech privacy can be achieved with…[the] effective use of sound masking systems,which includes both music and white or pink noise, delivered via overhead speakers embedded in the ceiling. Read ASA’s guidelines here.

Seems simple enough. And yet, there was no such solution in place at my son’s doctor’s office, a brand new medical office building, no less, belonging to one of the largest American hospital networks. How was this critical detail overlooked, especially with the heightened level of sensitivity around privacy issues since HIPAA was enacted? Other aspects of the reception area experience—the pleasantly organic and muted color scheme, the cherry-wood finishes, warm lighting from table lamps, and so on—felt appropriately “tuned” to reassure me and make me feel at ease. Why, then, hadn’t they thought about sound? Or were they aware of sound’s importance but unable (or unwilling) to do anything about it?

I suspect two factors are at work here. First, based on conversations I’ve had with commercial architects, they and the healthcare clients who hire them are relatively unaware of the effects (both positive and negative) that sound has on people inside buildings. Beyond acoustical ceiling tiles and perhaps noise-dampening carpeting, the art and science of designing for the ears—“aural architecture” in this context—is not yet a mainstream consideration among architects and patient-care-design professionals.

Second, even if there were a good level of awareness of the importance of what people hear (and don’t hear) in healthcare facilities, the prospect of carving out a budget for optimizing the aural experience is likely slim at best. As pervasive as sound is, and as profound an impact that sound has on us in any environment, it’s too often dismissed as either an element over which we can have little control (sound travels around corners and through ventilation ducts), or, as in the case of overhead music or naturescape programming, as a “soft” amenity from which there is little clinically-proven benefit.

But, in fact, there’s quite a lot of evidence to justify an investment in the design and implementation of optimal aural experiences within healthcare facilities. And, in the Healthcare section of this blog, we intend to present the most compelling examples of that evidence so that more families, patients, and the staffs that care for them can benefit from medical facilities designed as much for the ears as they are for the eyes.

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