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56 I ICT TODAY FIGURE 1: Hospital noise is the top complaint among patients, staff and visitors, according to the HCAHPS. 1 excessive noise not only hindered the ability for patients to rest, but also raised the risk for medical errors. Other studies blamed hospital noise for a possible increase in healing time and a contributing factor in stress-related burnout among healthcare workers (ScienceDaily, 2005)." 2 Inevitably, there will always be noise in hospitals and healthcare systems. However, designers can help to reduce the noise pollution with a properly designed paging system supplemented with a properly designed sound masking system. DESIGNING A MASS COMMUNICATION SYSTEM Speech privacy is another acoustic concern. Conversa- tions occur between caregivers, caregivers and patients, and patients and visitors at administrative stations and in hallways and patient rooms. Patients know that if they can overhear conversations occurring in adjacent areas, others can hear them as well, making them uncomfort- able and less likely to discuss private matters with their caregivers. Patients also have a right to expect privacy. Addressing these acoustical issues help to create an environment that promotes healing and supports the proficient delivery of care—whether it is the noise of elevator doors opening, respirators, machines beep- ing/reporting, rolling carts, monitors, TVs, talking among the staff, patients and visitors or the overhead paging systems. However, when trying to communicate to a large group, overhead paging systems are one of the most effective ways to give instantaneous information in real time. With this goal in mind, hospitals and healthcare facilities should focus on the ability to streamline the communication process. What can they do to achieve this goal, especially with their paging systems? Designing a mass communication system with the thought of noise pollution in mind can be daunting work. One of the first tasks is to look at the existing assets for communicating and determine how they are being used during an announcement. Who needs to receive the infor- mation? How is it being communicated? What is the urgency of the message? How can the process be stream- lined so that those that need the information receive it while unintended recipients do not? Noise has become a well-documented problem in hos- pitals, so much so that The Hospital Consumer Assess- ment of Healthcare Providers and Systems (HCAHPS) now has a score for hospital noise that is tied to reimburse- ment from the Centers for Medicare & Medicaid Services (CMS) in the U.S. According to the HCAHPS, one of the biggest nuisances in a hospital is noise pollution. Exces- sive noise in healthcare settings can induce headaches, cause irritability, prolong wound healing and increase sensitivity to pain. Additionally, it reduces the intelligi- bility of speech and impairs communication, causing annoyance, irritation, fatigue and a reduction in the quality and safety of health care (Figure 1). Sources of noise include patients, staff and visitors talking, as well as the cacophony produced by TVs, alarms, carts, doors, medical equipment and mechan- ical systems. These sounds cause more than just irritation. A grow- ing body of research indicates that noise actually harms patients by elevating heart rate and blood pressure, as well as increasing muscle tension and metabolism. Noise also prevents patients from getting the rest they need for recovery. While it is not responsible for all disruptions, its contribution is significant. Sleep deprivation can cause agitation, delirium, decreased tolerance to pain and sup- pressed immune response, thereby increasing nursing calls and lengthening hospital stays. However, patients are not the only ones affected. Noise also tires staff and disrupts concentration, affecting workplace satisfaction and the quality of care. Researchers at Johns Hopkins University began to look into the noise problem as far back as 2003. "They maintained that