Being happier being quieter; reducing noise in the Intensive Care Unit through behavior change of staff

Abstract

Noise reduction in the Intensive Care Unit (ICU) is an important goal as it impacts the health and comfort of the critically ill patients as well as the health and concentration of staff. Research shows that a considerable amount of noise produced in the ICU can be influenced by ICU staff. However, until now there are no interventions that sustainably change the behavior of staff to reduce noise. This project aims to do so by creating a design that will make ICU staff be happier being quieter. The project is conducted within the context of the Clear Mind project at Philips and the Delft Institute of Positive Design. The Intensive Care Unit In the ICUs of hospitals, critically ill patients are monitored and treated by specialized staff. The ICU doctors set up the medical plan for the treatment which is executed by the nurses. Nurses are supported in their activities by several medical devices that create alarms. Noise in the ICU These alarms contribute to the noise in the ICU that exceeds several health guidelines. The excessive noise has a detrimental effect on the patients' health that is already in critical condition: even in sedated people, excessive noise leads to stress and disturbance of sleep which slow healing and are thought to be connected to delirium. Delirium is a state of confusion in patients that increases their length of stay and mortality. Reduction of noise in ICUs is thus necessary to improve the patient outcome. Research shows that next to alarms, a significant amount of noise is produced by staff activity and conversation. Interventions that change the behavior of staff to reduce noise have not yet achieved a significant and long-term reduction of noise. This project investigated how to sustainably reduce noise by changing staff behavior through design. Behavior change Literature research showed that a behavior change in staff could be created by increasing their motivation or ability to reduce noise and a trigger that activates the desired behavior. It was furthermore found that in order to make the behavior change sustainable, staff had to be positively motivated. This lead to the design goal of making the ICU staff be happier being quieter. Context research conducted at an ICU revealed three stages in the ICU routine into which a trigger had to fit in order to be effective: direct (visual) patient monitoring, indirect (aural) patient monitoring and review of patient condition. It was also found that staff could influence noise contribution caused by alarms, personal conversation, open doors and professional actions and activities. The motivation and ability of staff underlying each category were then revealed by user research. The major staff priorities were found to be about relating to colleagues, doing meaningful work and ensuring patient health and comfort. Iterative design Based on the insights of context and user research, initial ideas were generated and tested in focus groups to validate the design strategy. After it proved effective, ideas generated during a design workshop led to design directions and selection of a direction. It was concluded that the motivation of staff to reduce noise had to be increased before their ability. Mock-ups of initial concepts to increase motivation were tested with ICU staff and refined through design and another focus group with staff. Final concept Field research and iterative design resulted in the final concept, called the silence level. Before use, the motivation of staff to reduce noise is increased through education. The concept then enables staff to monitor the silence level during their routine via integrated and ambient feedback in effective locations. The silence level motivates staff positively because the focus is on creating silence instead of avoiding noise. Furthermore, the silence level refers to patient health and comfort, which motivates staff, and the different actions staff can take to improve the silence level, which gives them the ability to act immediately. The evaluation of a working prototype with ICU staff showed that the design worked as intended. The next step in the development would be a long-term test in an ICU.