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Be Well

Be Well: Taking hospitals to task for noise? That’s Obamacare

Tuesday, September 24, 2013 at 8:00 AM

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One of the lesser known provisions of the Affordable Care Act is that it links Medicare reimbursements to patient satisfaction surveys. Hospitals that get low marks lost 1 percent of their payouts last year. That will jump to 2 percent by fiscal year 2017. ideastream Executive Editor David Molpus talks with health reporter Sarah Jane Tribble about the new rules and how they have changed patient care at University Hospitals.

Photo Gallery

Doctors and students talk quietly outside a patient room in University Hospitals Lerner Tower. A blue, cloth sound panel helps absorb the noise in Lerner Towers. The circular design at Lerner Tower amplifies sound.

MOLPUS: Good morning, Sarah

SARAH: Good to see you, David.

MOLPUS: I’m not sure I’ve ever been asked after a hospital stay…how’d we do?  How was the service?  But you’re here to tell us that’s exactly what more hospitals are doing these days.

SARAH:  That’s right.  One of the lesser known provisions of the Affordable Care Act is that it links Medicare reimbursements to patient satisfaction surveys.  Hospitals that get low marks can be docked up to 1% of what the government would normally pay. And that’s not chump change when you’re talking about Medicare!

DAVID:  Tell me more about the patient survey hospitals are using.

SARAH:  It was developed a few years ago to get a standard measurement of care across the country - from the patients’ viewpoint.  The survey is given to patients after they are released from the hospital.  It includes questions about staff responsiveness and communication, room cleanliness, pain management and other critical aspects of care.  One common complaint is noise.

DAVID:  I suspect anyone who’s spent time in a hospital can relate to that!  The beeps, alarms, squeaky shoes.

SARAH:  Exactly!.  I spent a few days with my father in the hospital this summer. He’s recovering very well. But those days were exhausting. The first night he shared a room with a loud breather. There were beeping monitors, carts rolling by outside, nurses talking in the hall, the housecleaning folks scouring the bathroom.  And it’s more than an inconvenience.  Research has shown that noise can raise blood pressure and disrupt sleep which can make recovery take longer.

MOLPUS:  Obviously, a lot of sounds in a hospital are necessary, including beeps and alarms from monitoring devices.  So what can hospitals do? 

SARAH: Coaching staff to talk more softly for one thing.  Over at University Hospital’s Seidman Cancer Center the director of nursing, Wendy Miano, calls this…using your “library voice.” Here’s hers:

“I’m here to take care of you, I know the situation but I’m intentionally keeping my voice sound down to stay in control of the environment,” Miano says.

SARAH: Another technique UH is white noise. They pipe it out of an overhead sound system. 


SARAH:  Sounds like a running fan or air conditioner. 

It helps mask other noises, like voices.  So do rubberized floor tiles.  Here’s what it sounded like when I was standing just a few feet away from a conversation at a nurses station and a hospital cart was going by.  You can barely hear either.


UH and other hospitals also have found designs to reduce monitor noise. 

By the way, patients give the department I visited a top ranking in the surveys.

Not so for some other parts of the hospital. 


This is the fifth floor at Lerner Tower, which was built 30 years ago. 

The patient rooms are all in a big circle along the outside walls and there’s a busy nursing desk in the middle of the floor. Their sound can be heard in every patient room. And, conversely, the noise from patient rooms floats out to the middle.

They track 30 patients on these big heart monitoring machines that are located in the middle of the floor at the nurses’ station. It’s an ideal location for the nurses to hear. But the patients can hear this sound too.

MOLPUS: So, is UH losing money because of low patient ratings from noise?

SARAH:  No.  Their overall numbers are fine.  The quieter areas like Seidman Cancer Center help up for the noisier areas. 

I’ve put up pictures on our website and links to more information on the patient satisfaction surveys

Additional Information

University Hospitals used what it had learned from noise levels at Lerner Tower to design Seidman Cancer Center and improve sound levels throughout the system. And the effort is working: The number of patients who have given UH top rankings for noise levels at night - when patients care most - has increased from 45 percent to just more than 55 percent.

Patients can view the results of the surveys, known technically as the Hospital Consumer Assessment of Healthcare Providers and Systems. To see your hospital and compare it to others, go here.

To learn more about the surveys, the U.S. Centers for Medicare and Medicaid offers detailed reporting here


Community/Human Interest, Health, Be Well, Be Well Podcast

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