Understanding and improving the perception of a hospital ward soundscape

The various aspects of hospital environments have been shown to affect individuals psychologically and physiologically. One aspect of this, sound, has been thoroughly documented through acoustic measurements along with the potential adverse effects high sound level has on patients and nurses. Yet within hospitals, the character of the sound – the soundscape or the auditory landscape – is often overlooked in favour of this focus on sound level. This project has led to an improved understanding of the character and perception of hospital sounds using a triangulation of methods, with the intention of contributing to knowledge on how to improving the soundscape. Firstly, an interview study with patients and nurses within a cardiothoracic (CT) ward at a UK hospital was carried out to understand perceptions of, and thoughts towards, the soundscape. This led to the development of a conceptual model linking the relationships between various concepts and components of perception thereby mapping the perception of the soundscape and the feelings it evoked. A key aspect to perception – the notion of coping through habituating to sounds, became the foundation for subsequent work testing positive interventions. These complex feelings elicited by the soundscape were then reduced into a twodimensional perceptual space, extracted from a listening evaluation using Principal Component Analysis. Labelled ‘Relaxation’ and ‘Interest & Understanding’, these axies can represent the emotional-cognitive response stimulated by the CT ward sounds. Finally, potentially positive interventions were assessed using listening evaluations with participants rating additional natural and steady state sounds, along with a cognitive intervention of sound source information (SSI). It was found that the interventions resulted in a small (ƞ2=0.05) but significant effect (p=.001) on the ‘Relaxation’ response. Natural sounds were most effective, with a less conclusive but still significant effect present for steady state sounds and SSI. The ‘Interest & Understanding’ dimension was non-significantly affected. Exploring this further, a between groups in-situ study assessed the benefit of SSI. The first group received SSI, the second received none. It was found that SSI had a small to medium significant effect (r=0.26-0.31, p=<.05) on ‘Interest & Understanding’ but not ‘Relaxation’. The project successfully developed a new way of assessing the perception of hospital sounds in a perceptual space. Using this approach it was concluded that natural sounds (here, the sounds of birdsong and a stream) provide a consistent way to improve the soundscape. However, a new approach of using SSI was successfully tested and was supported by a theoretical underpinning of cognitive reappraisal. Importantly, this offers an easier way to manipulate perception through potentially a reappraisal of the soundscape. Therefore, it was also concluded from the new findings and new theory that SSI could be used to create a positive response from people within hospital ward environments

Exploring a cardio-thoracic hospital ward soundscape in relation to restoration

Hospitals can provide stressful experiences for both patients and medical staff. A well-designed hospital soundscape should avoid adding to negative emotional states (e.g. stress), limit any detrimental cognitive effects (e.g. attentional fatigue), and enable restoration. Experiences of the cardio-thoracic ward soundscape, in a UK public University hospital, were explored via semi-structured interviews with 11 patients and 16 nurses. Thematic coding analysis resulted in 11 key themes including notions of restoration and emotional responses. The themes were used to develop a conceptual model to describe the processes involved in the perception and evaluation of the soundscape. The language used by patients and nurses indicated the emotional response to the soundscape was at times stressful and at others potentially restorative. Coping methods of accepting and habituating to individual sounds were noted. The impact of the patients' and nurses' ability to maintain these coping strategies are discussed in relation to restoration and the temporal variation of the soundscape. A period of 'quiet time' was in operation at the hospital and the importance of this was noted through various responses relating to emotion and restoration. The results suggest the soundscape has potentially, a beneficial role in facilitating restoration thus helping patients' recovery and medical staff's ability to remain productive. This research supports the need to study hospital soundscapes further so that design implications can be considered for the production of a more restorative environment, possibly through the masking/removal of unwanted sounds and optimising positive sounds

Proposing a conceptual framework to develop the hospital soundscape through visual communication

Sound level measurement is used to assess sound within any environment, never more so than in hospitals. This is due to the negative effects that high sound level can have on patients and staff. However, other ways of exploring sound and the soundscape within the hospital context have been used: sound art has conveyed the experiences of heart transplant patients. Art may act as juxtaposition to objective sound level measurement but the two fundamentally attempt to depict attributes of the soundscape. Using theory from design and concepts from art a framework is presented for designing a positive soundscape experience. This is not through the addition of sound per se but through creatively communicating the information contained within a soundscape to enable the everyday listener to interpret a cacophony of hospital sounds more positively. In representing visual communication of sound as a design object, a new way to explore sound may exist

Digital crowdsourcing in healthcare environment co-design

Improving user experiences of healthcare environments via their participation has become a central theme in healthcare studies and strategic agendas. The co-design approach is often utilized to take into account opinions from different stakeholders including hospital staff. However, there are a number of competing stimuli and demands on staff at any point in time potentially making it difficult for them to participate in the co-design processes. Digital crowdsourcing may engage staff in participating in the design and appraisal of hospital environments when they have a spare moment by collecting small amounts of relevant data. In order to explore this, we have implemented a digital crowdsourcing co-design prototype. As users’ perceived acceptance of technologies is among the determining factors for a successful digital approach, in this paper, we report on participants’ acceptance of the prototype, aiming to reflect if and to what extend they accept this prototype to aid further development

Moving away from flat solar panels to PVtrees : exploring ideas and people's perceptions

Photovoltaic Trees (PVTrees) are artificial solar structures that look like sculptural trees and exist from small scale (size of a bonsai tree) to large scale (about the size of a wind turbine). The aesthetics of solar trees differ and they have been designed to provide different means of power to different urban and built environments. These range from powering mobile phones, electric cars, buildings and street lights covering small and large scale areas (one or a forest of PVTrees). This study brought together a research team of physicists and designers and to conduct focus groups with design based methods and prototyping (clustering of ideas, sketching and modelling) along with a computational 3D PVTree design tool. The focus groups consisted of capturing a) people's perception on PVTrees, idea generations and development of the 3D model and b) further discussion and evaluation of insights. A public exhibition followed to capture public perception on design concepts using 3D models, and a voting exercise. Overall it was found that PVTrees were received positively by the public with desires for them to be multifunctional by providing power yet also having a secondary function e.g. a shelter or seat. The paper details this, considerations for concept development, and the future direction of research in the area

Using a bespoke situated digital kiosk to encourage user participation in healthcare environment design

Involving users through participation in healthcare service and environment design is growing. Existing approaches and toolkits for practitioners and researchers are often paper based involving workshops and other more traditional design approaches such as paper prototyping. The advent of digital technology provides the opportunity to explore new platforms for user participation. This paper presents results from three studies that used a bespoke situated user participation digital kiosk, engaging 33 users in investigating healthcare environment design. The studies, from primary and secondary care settings, allowed participant feedback on each environment and proved a novel, engaging “21st century” way to participate in the appraisal of the design process. The results point toward this as an exciting and growing area of research in developing not just a new method of user participation but also the technology that supports it. Limitations were noted in terms of data validity and engagement with the device. To guide the development of user participation using similar situated digital devices, key lessons and reflections are presented

Design for behaviour change as a driver for sustainable innovation : challenges and opportunities for implementation in the private and public sectors

Over the last decade, design for behaviour change has become increasingly recognised as a strategy for enabling social change. Despite this, we are far from understanding its implementation, especially through the private and public sectors. This study has surveyed private and public sector stakeholders with regard to their current knowledge of, and approach to, design for behaviour change. The aim was to identify the challenges for professional stakeholders in understanding, accessing and implementing design for behaviour change. Underpinned by a literature review of design for behaviour change theories and approaches, an online survey and two focus groups with private and public sector stakeholders were conducted with particular focus on small and medium size enterprises (SMEs). The results identified that there is a significant disconnect between available theoretical knowledge of design for behaviour change and its practical implementation. Reasons for this include a lack of awareness and common language, of evidence based examples, and of evaluation methods and inter-sector collaborations. In response, a set of recommendations has been developed to propose ways forward for the wider understanding and application of design for behaviour change