Durham School of Architectural Engineering and Construction


First Advisor

Dr. Erica Ryherd

Date of this Version

Fall 11-30-2018

Document Type



Bliefnick, J. "EVALUATION OF HOSPITAL SOUNDSCAPES TO IMPROVE PATIENT AND STAFF EXPERIENCE," PhD Dissertation, University of Nebraska-Lincoln. 2018


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Architectural Engineering, Under the Supervision of Professor Erica E. Ryherd. Lincoln, Nebraska: December, 2018

Copyright (c) 2018 Jay Michael Bliefnick


Hospital soundscapes can be difficult environments to assess acoustically due to the continuous activity within units. Routinely, patients perceive these soundscapes poorly when rating their hospital experience on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys administered after discharge. In addition, hospital staff can be negatively impacted by the acoustical environments in which they work, affecting both performance and job satisfaction. This doctoral research addressed these issues across three phases by collecting acoustical measurements within three individual hospitals, comparing results with provided patient and staff survey information, and conducting laboratory tests of hospital noise perception. In the first two phases of this research, 38 patient rooms from 11 units within three hospitals were measured acoustically and correlated with HCAHPS ‘Quietness of the Hospital Environment’ surveys at room and unit-levels, revealing acoustical metrics linked to patient perceptions of hospital soundscape conditions. Metrics found to be most statistically correlated (p < 0.05), included the absolute LAMIN levels in patient rooms, which found significantly higher HCAHPS ‘Quietness of the Hospital Environment’ scores in units with average LAMIN levels below 35 dBA. Many other standard acoustical metrics (such as LAEQ, LAMAX, LCPEAK, and LA90) were not found to be statistically correlated between measured acoustical data and HCAHPS ‘Quietness’ patient responses, emphasizing the difficulties faced when evaluating hospital soundscapes. The third phase of this research involved the creation and administration of a subjective perceptual laboratory test designed to assess the annoyance perception of hospital soundscapes with varying dynamic ranges of noise. It was found that subjects perceived soundscapes with a wider dynamic range of noise and louder peak noise events more negatively than soundscapes with a more consistent sound level. Taken as a whole, this study provides new insights into the potential relationships between hospital noise and patient and staff satisfaction. The three research phases aimed to address this issue from different perspectives to provide a broad assessment of this very complicated issue. The data gathered and presented could be utilized to more accurately assess hospital soundscapes and ultimately aid in the design process of new hospitals to improve patient and staff satisfaction.

Advisor: Erica E. Ryherd