By Jeff Churchill and Payam Ashtiani
Noise has infiltrated every aspect of life thanks to the information age and the vast cacophony of sounds accompanying the latest technology. From beeps and bells to ringtones, digital devices help remind us to be somewhere, meet someone, or be informed of something. These noises all seem necessary to make our lives easier, convenient, and productive.

At the same time, environmental noise is increasing everywhere with more aircraft, road traffic, and construction in densely populated cities. Interior environments are also impacted, with noise from telephones, televisions, computers, and HVAC, along with poor sound reverberation, affecting our ability to hear and understand important sounds.

Information, communication, automation, and technology (ICAT) has significantly changed the way daily lives are conducted. The need for devices and connection to others has become completely integrated; people are used to keeping in touch with friends, coworkers, or family instantly, or posting updates on social media from anywhere. Navigating around a city to explore and discover new places or just getting to the next meeting is made easier with satellite GPS on a hand-held device. Driving, transit, and flying are second nature to an active person in the modern world. Humans are unlikely to give up their technology because of the noise associated with it.

Noise and its impact on health
While the building industry has made large advances in sustainable construction, ergonomics, and daylighting design to build better buildings, noise levels have remained secondary in the measure of a healthy environment.

Julian Treasure, the international speaker and author of Sound Business, ties noise to economic growth and acknowledges there is a need for noise. (For more on his work, visit www.juliantreasure.com). However, he called on architects, interior designers, engineers, policy makers, public service administrators, business leaders, and property investors to employ a truly integrated approach to noise. According to Treasure, “the World Health Organization (WHO) estimates noise pollution costs one million years of healthy life every year in Europe alone… [the] European Union calculates a financial cost of over 40 billion Euros [about $58.6 billion] a year, in terms of lost working days, healthcare costs, impaired learning, and reduced productivity.”(Visit http://juliantreasure.blogspot.ca/2012/12/building-in-sound.html).

Treasure identifies hospitals as having some of the worst acoustic environments, arguing the high noise levels impact healing. He has cited a U.S. study that found the average noise level in hospital wards to be close to 95 decibels—10 decibels beyond the noise level at which U.S. federal law requires ear protection for prolonged exposure.(For more, see Treasure’s TED talk, “Nine Ways that Sound Affects our Health, Wellbeing, and Productivity” at blog.ted.com/9-ways-that-sound-affects-our-health-wellbeing-and-productivity).

Other reports show that sound levels in hospitals can peak at more than 100 decibels. There is a correlation between noise and the perception of pain; more noise causes patients to believe they need painkillers. The Center for Health Design posted an article entitled “Noise Levels in Johns Hopkins Hospital,” which summarizes a 2005 study that reveals the Baltimore facility did not meet the WHO or American National Standards Institute (ANSI) standard for maximum sound pressure at any of the hospital test sites. The summary indicated the researchers’ “review of objective data … held true in hospitals worldwide as data gathered at various facilities over the last 45 years indicate a trend of increasing noise levels during daytime and nighttime hours.”(See I.J. Busch-Vishniac et al’s article in a 2005 Journal of the Acoustic Society of America (vol. 118, no. 6). Visit www.healthdesign.org/sites/default/files/article-pdfs/Busch-Vishniac_West_Bamhill_Hunter_Orellana_Chivukula-2005-CHD-KPS.pdf).

Hospitals in Canada face the same challenges. The goal is to strike a balance between technology and noise. While the latest technologies and innovations may make a healthcare centre more efficient, it cannot come at the cost of patient healing.

Designing the first fully-digital hospital
The redevelopment team for Toronto’s Humber River Hospital (HRH) started planning in 2008 with the objective to create a patient-centred care facility. It was a lofty goal since they would be doubling the size of the existing three facilities combined without receiving double the operating dollars. They wanted to develop a vision that focused on ‘lean, green, and digital’—ideals to ensure the 167,225-m² (1.8 million-sf) new construction would deliver a state-of-the-art acute care centre for the community. The HRH team decided to mitigate the impact of increased size by introducing advanced technology.

When the team researched other hospitals around the world, they saw snippets of technology being used to provide care. They felt they could take what they had learned from the other hospitals, combine it with technologies from other industries and create a marriage of ICAT systems to provide better patient-centred care.

Since the new facility opened in October 2015, it has received quite a number of accolades about the interoperability of the ‘gadgets’ streamlining hospital operations. As North America’s first fully  digital hospital and a recognized leader in the  integration of technology, automation, and healthcare, HRH needed to be mindful of how bringing these new technologies together would work without sacrificing quiet.

HRH engaged HOK Architects and Aercoustics Engineering to study the design and technical features to deliver a digital hospital that respected the environment.

The main planning requirement needed to resolve any potential conflicts with patients, staff, and technology to keep the hospital a place of repose and healing, ensuring the added technology did not add to environmental noise. An article entitled “Environmental Noise Sources and Interventions to Minimize Them: A Tale of Two Hospitals,” from Journal of Nursing Care Quality, identifies both patient and staff perceive voices as the most bothersome noise in the patient care areas.