Many new hospital waiting rooms are feasts for the eyes. But what do they sound like?

In my last post I described a healthcare waiting room scenario in which the lack of any masking sound made it difficult to have a private exchange of information with the receptionist. The lobby was too quiet, and, judging by the hushed tones with which my lobby fellows spoke to one another, they felt at least as uncomfortable as I did.

As I mentioned before, the facility we were in was practically new, and you could tell that a good amount of thought had gone into designing the visible elements: the color palette was appropriately, low-key, “organic” and harmonious; the wood finishes, refined yet homey; the lighting, warm and coming discreetly from table lamps instead of fluorescent tubes overhead.

But all of these comforting visuals couldn’t make up for the fact that what I was hearing—or not hearing—made me ill-at-ease. It’s as if the architects forgot to consider the ears in designing the space, and in my previous post I surmised that this was perhaps due to two factors: either a simple lack of awareness of the impact that our aural experience of a space has on our emotional state, or perhaps a perception that there is insufficient “hard” evidence to justify the effort and expense of conceiving and implementing some kind of aural enhancement of the space. But evidence of the benefits of designing healthcare spaces as much for the ears as for the eyes is plentiful. What’s more, many experts agree that the waiting room is the logical place to start.

Karen Dijkstra, for example, a Research Fellow in the School of Psychology at University of Plymouth, asserts that the medical “waiting room may be the most appropriate place to apply anxiety-reducing techniques.” Why? Because “it is the place where anxiety and worry about the consultation and possible treatment are likely to be built,” and “relaxed patients are more easily treatable for medical practitioners.”1

Dijkstra goes on to endorse the use of a “music intervention” in these settings, citing, among others, a study by David A. Tansik and Robert Routhieaux that demonstrated that “playing classical music in a waiting room (compared to the same waiting room in which no music was played) results in less anxiety and stress in patients as well as in more positive cognitive evaluations of the waiting room.”2 To be clear, Dijkstra isn’t talking about sound masking for the sake of privacy, but it’s easy to imagine that a little background music would deliver that benefit as well.

Myra Fouts, RN, MSN, OCN, CNAA, and Diane Gabay, RN, MN at Cedars-Sinai, draw similar conclusions in the May/June 2008 issue of Oncology News:

Incorporating music into the healing environment…can have an analgesic effect, reducing blood pressure, heart, and respiration rates [in patients]…and reducing the stress of visitors in hospital waiting rooms.3

According to Fouts and Gabay, peaceful music and other soothing sounds (birdsong, a babbling brook, etc.) are an integral component of the “healing environment,” which, beyond its technical utility, is “psychologically supportive and conducive to reducing stress for families, patients, and caregivers.” Along with natural light, pleasant views (e.g., of nature scenes), and the use of pacifying or uplifting colors, Fouts and Gabay argue that a thoughtfully designed, carefully controlled aural experience helps create a healthcare environment that is actively therapeutic, with the capacity to positively affect clinical outcomes while helping friends and family feel more at ease.3

Turns out, this is textbook stuff. In Chapter 3 of the undergraduate nursing textbook Critical Care Nursing: Synergy for Optimal Outcomes (2007), Renee Rubert, L. Diane Long, and Melissa L. Hutchinson address the importance of managing sound in healthcare settings. The critical first critical step in this process is eliminating or minimizing noise, “one of the most insidious environmental stressors found in the hospital environment.”4 But, once this is accomplished,

therapeutic sounds can be introduced, such as music, heartbeat sounds…pleasant sounds from nature like ocean waves and rain showers, or even “white noise” that lightly stimulates the hearing receptors, making other background noises less obvious.4

Note that the purposeful introduction of sound serves two purposes: one is physiological, slowing listeners’ heart and breathing rates and thus reducing their stress levels, and the other is acoustical, masking stress-inducing noise so that it is less noticeable and thus less aggravating. (One could also easily see how this would help keep conversations private as well.)

This Isn’t Music Therapy

I should point out that the authors cited above are advocating the use of therapeutic ambient sounds in healthcare environments; they’re not talking about sound or music therapy, per se. This is an important distinction to make, as the latter requires trained specialists to administer, whereas the introduction of “pleasant sounds” into a healthcare environment requires only the willingness to do it (and a modest budget for equipment and content licensing, of course).

The point is that enhancing the aural experience of a healthcare environment isn’t a clinical intervention, which must be vetted and approved by doctors, nurses, or therapists. It’s more an operational matter, related to interior architecture and holistic patient-experience design. While it is understandable, then, that wider adoption of music therapy within mainstream healthcare practices will take some time, dependent as it is on a vigorous clinical vetting process, decisions about adding soothing music or nature sounds to a reception area should be relatively easy.

OK, I can hear all you healthcare professionals out there laughing at my naiveté. “The adoption of something new is never easy or fast in institutionalized healthcare,” you’re thinking. And after working with Kaiser Permanente for the past seven years, I understand that to be true. But if evidence of therapeutic ambient sound is so abundant and it doesn’t require the kind of clinical trials that a proper intervention calls for, why hasn’t it been more universally adopted by now?

We welcome your insights. If you have some experience with the consideration and implementation of evidence-based design practices in healthcare, please send us your thoughts. In the meantime, we’ll keep sharing our thoughts about the value of designing healing healthcare settings that patients, their families, and staff experience through their ears.

1 Dijkstra, Karen, (2009) Understanding Healing Environments: Effects of Physical Environmental Stimuli on Patients’ Health and Well-being”. University of Twente, The Netherlands.

2 Tansik, D. and Routhieaux, R. (1999) “Customer stress‐relaxation: the impact of music in a hospital waiting room”, International Journal of Service Industry Management, Volume 10, Issue 1.

3 Fouts, M. and Gabay, D. (2008) “Healing Through Evidence-Based Design.” Oncology News, May/June issue.

4 Rubert, R., Long, L. D., Hutchinson, M. L. (2007) Creating a Healing Environment in the ICU. In Kaplow, R. and Hardin, S. R. (Ed.) Critical Care Nursing: Synergy for Optimal Outcomes. Jones and Bartlett Learning.