You are the night shift charge nurse on a busy surgical unit in a large, urban teaching hospital.  Surgeries occur around the clock, and frequently, noise levels are higher than desired because of the significant number of nurses, physicians, residents, interns, and other health-care workers who gather at the nurses station or in the halls outside of patient rooms.  Today, the unit manager has come to you because the hospital’s score on the Centers for Medicare and Medicaid Hospital Consumer Assessment of Healthcare Providers and Systems (hCahPS) survey for the category Always Quiet at Night falls far below the desired benchmark.  She has asked you to devise a plan to address this quality of care issue.  The management goal in this situation is to achieve an HCAHPS score on Always Quiet at Night that meets the accepted best practices benchmark, thus assuring that patients get the rest they need to promote their recovery.  The leadership goal is to foster a shared commitment among all health-care professionals working on the unit to achieve the Always Quiet at Night goal. Assignment:

Develop a comprehensive plan to address the quality of care issue related to noise levels in the surgical unit during the night shift in order to improve the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score on Always Quiet at Night.

In healthcare settings, noise has been identified as a major concern due to its potential negative impact on patient outcomes, including disruption of sleep, increased stress levels, and dissatisfaction with the healthcare experience. The Centers for Medicare and Medicaid Services (CMS) uses the HCAHPS survey to assess patients’ perception of their hospital experience, including the question about the quietness at night. Therefore, it is imperative to address the noise issue on the surgical unit during the night shift to enhance patient satisfaction and improve the HCAHPS scores.

Plan Implementation:

1. Assess the Current Situation:
– Conduct a comprehensive assessment of the noise levels on the surgical unit during the night shift. Use a validated tool to measure the decibels and identify specific areas or times when noise is highest.
– Identify stakeholders, including physicians, nurses, residents, interns, and other healthcare workers, and their role in contributing to the noise levels. It is important to understand their perspectives and potential barriers to addressing the issue.

2. Educate and Create Awareness:
– Develop educational materials and conduct training sessions to raise awareness about the impact of noise on patient recovery and the importance of maintaining a quiet environment during the night shift.
– Provide evidence-based information on the negative effects of noise and the benefits of a quiet environment. Emphasize the correlation between noise levels and patient satisfaction scores.
– Share success stories from other healthcare institutions that have implemented noise reduction strategies and improved patient satisfaction scores.

3. Establish Clear Expectations:
– Develop and communicate clear guidelines and expectations regarding noise levels during the night shift. These guidelines should include specific parameters for acceptable noise levels, required behaviors, and consequences for non-compliance.
– Engage all healthcare professionals in a dialogue about the importance of maintaining a quiet environment and the role each individual plays in achieving this goal.

4. Implement Noise Reduction Strategies:
– Introduce technological solutions such as sound-absorbing materials, white noise machines, and soundproofing curtains to minimize noise transmission and create a quieter environment in patient rooms and common areas.
– Encourage healthcare professionals to wear noise-reducing devices or use paging systems instead of speaking loudly. Implement a system for urgent communication that minimizes unnecessary noise.

5. Monitor and Provide Feedback:
– Regularly monitor noise levels on the surgical unit during the night shift to assess the effectiveness of the implemented strategies. Use the same validated tool used during the initial assessment.
– Provide feedback to healthcare professionals on their performance in maintaining a quiet environment. Recognize and reward individuals or teams that consistently meet the noise reduction goals.
– Use the data collected to identify areas for improvement and modify strategies as necessary.

6. Sustain and Evaluate:
– Continuously reinforce the importance of maintaining a quiet environment during the night shift through ongoing education and reminders.
– Regularly evaluate the progress by comparing HCAHPS scores before and after the implementation of the noise reduction strategies. Adjust the plan accordingly to ensure sustained improvement.

Improving the quietness at night on the surgical unit requires a multidimensional approach that involves assessing the current situation, educating and creating awareness, establishing clear expectations, implementing noise reduction strategies, monitoring and providing feedback, and sustaining and evaluating the progress. By addressing this quality of care issue, the surgical unit can enhance patient satisfaction, promote a restful environment, and improve the HCAHPS score on Always Quiet at Night.