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Hospital project on noise, sound and sleep

Hospital project on noise, sound and sleep (HPNoSS) is a collaborative project that aims to provide a holistic understanding of sound in the hospital environment and the intimate relationship of noise to sleep, rest, treatment and recovery.

Patients sleep poorly in hospital, which negatively impacts on their recovery and experience. Sound is a significant contributor to poor sleep quality and quantity. Despite continued research on sound levels over the past 20 years addressing the problem of ‘noise’, recommended maximum sound levels for hospitals set by a number of national and international bodies are regularly exceeded. This also impacts on the sleep of patients and the practice of staff. Therefore, a fresh approach is required; an approach that allows sound and the soundscape to be viewed as a positive and malleable component of the healthcare environment.

HPNoSSHospital project on noise, sound and sleep is a project that ran April 2017 – December 2017. It brought together a team of academics, artists, engineers, nurses and patient advocates. The project aimed to provide a holistic understanding of sound in the hospital environment and the intimate relationship of noise to sleep, rest, treatment and recovery. HPNoSS helped to raise awareness of the issues around noise amongst nursing, medical and other hospital staff and explored creative and practical solutions that contributed to patient wellbeing and potentially improved recovery times. 

Through extending existing work around creative research in sound arts practice to healthcare, the project aimed to improve the patient and staff experience of staying, and working, in hospitals with implications for the wellbeing of both groups. In the short term, the work led to the development of innovative and practical solutions to improving the experience of sound in hospitals. In the long-term, there is potential for making concrete policy recommendations at national and international level, leading towards widespread implementation and development of a range of related solutions that could have a positive impact on the experience of noise and sound both within and outside of hospitals.

Project outputs

The pilot experiment consisted of a symposium, titled Workshop on positive hospital soundscapes, which aimed to capture preference and composition of positive features of a hospital soundscape through a participatory approach. 

The project was supported by two tech companies, one specialising in sound masking and the other in noise-cancelling, who loaned equipment to test during the symposium, such as speakers and headphones. This enabled the team to explore participants’ perceptions of different sound manipulation techniques, such as masking with sound, white/pink noise, noise cancelling or a combination of these. 

The team had support for the project from clinical teams at Chelsea and Westminster Hospital, West Middlesex Hospital and St George’s Hospital. They are in the process of organising access to different clinical environments in these hospitals, through which to obtain sample soundscapes. In addition, they plan to combine the sound logging exercise with field observations by visiting the hospitals to make qualitative field notes that can give context to and help with the analysis.

As of September 2017, the project had successfully connected with various clinical sites across London and had undertaken extensive qualitative and quantitative data collection in one of these. In addition, two high-quality recordings of 60 minutes each were made at an intensive care unit and following analysis used to recreate the hospital soundscape during a high-fidelity workshop at the King’s Chandler Simulation Centre. The workshop was attended by service users, clinicians, academics and industry partners from across the UK and as far as Hong Kong; and consisted of presentations, testing of interventions and assessment of participants’ responses to these, and focus group discussions. Both qualitative and quantitative data were collected, analysed and written up in a detailed report which you can read here. 

The next stages of HPNoSS will include clinical trials examining the feasibility and effectiveness of solutions identified during the stakeholder workshop. The project team is also currently developing two research proposals to possible funders to enable them to take their work forward. Further publications and research presentations are also planned.

Workshop and symposium on positive hospital soundscapes

Symposium details
Workshop on positive hospital soundscapes
London College of Communication, University of the Arts London
September 2017

This symposium brought together a diverse group of stakeholders to explore and capture preference and composition of positive features of a hospital soundscape through a participatory approach.

About the symposium

First, during the symposium, hospital soundscape preference and composition were tested using the sound recordings obtained earlier in the project. The team also tested different equipment such as speakers and noise cancelling headphones to gather equipment preference data from the audience. Using headphones, speakers and a screen interface displaying sound editing software, participants were asked to listen and interact with the hospital soundscape. In a participatory approach, they mixed together different sound components, including masking sounds, to allow the composition and spatial orientation to be explored. This focused on a specific component of the soundscape (e.g. the sound of a monitor) to explore masking and alterations to the sound source. They were asked to do this to make the sound more acceptable (positive) in their opinion.

Second, based on the composition, participants created prominent soundscape components (e.g. sound sources including masking sounds) that made up the perception of a ‘positive’ soundscape for that participant and were recorded within the software as an electronic file. This included information such as in sound character (frequency components) and spatial arrangement.

Third, once all participants had completed the process outlined above, the symposium were asked to rate each soundscape based on subjective preference as it is played back over stereo speakers. Subjective preference used the semantic differential rating scales that measured relaxation and interest in the hospital soundscape. Narrative discussion during this process was recorded, transcribed and analysed using standard thematic procedures to capture the rationale for composition along with emergent themes around perception and emotional response to the different compositions of the soundscape.

In total, there were 21 participants to the pilot experiment, six of which were patient advocates. As a result of the symposium and pilot experiment, recommendations and examples of positive hospital soundscape components were developed, implemented and tested in the clinical environment.

For regular updates on the HPNoSS project, follow the team on Twitter:




Project film


Project team

Dr Andreas Xyrichis is a Lecturer at the Florence Nightingale Faculty of Nursing & Midwifery at King’s. Andreas has a clinical background in intensive care nursing and has previously undertaken ethnographic (observational) work in hospitals’ intensive care units, which explored among other things the influence of the sensory environment on health professionals’ practice; for example, the distracting effect of alarms on collaborative behaviour.

Dr John Wynne is Reader in Sound Arts at the University of the Arts London. His work has been exhibited internationally in galleries and museums, and he won the 2010 British Composer Award for Sonic Art. He has been artist-in-residence at two leading organ transplant centres: the exhibition Transplant and Life, in collaboration with photographer Tim Wainwright, brings the patient voice into the medical museum, a site more commonly associated with specimens, hardware and clinical heroes. He is seeking to apply and extend his research into the perception of sound in hospitals while exploring the possibilities for creative interventions with the potential to improve patient experience. See his website for more information about his work and follow him on Twitter here. Find out more about John’s work: and 

Dr Jamie Mackrill is a Lecturer in Design Engineering at the Dyson School of Design Engineering, Imperial College London. Jamie has a background in exploring hospital soundscapes and appropriate interventions aiming to provide a more positive experience of the hospital soundscape; and is interested in developing appropriate and suitable methods to capture human response to different contexts. 

Professor Angus Carlyle is Professor of Sound and Landscape at the London College of Communication, University of the Arts London. Angus’ work explores the creative potential of sound as the basis of a documentary practice, building on approaches he developed through previous work.

Professor Anne Marie Rafferty is Professor of Nursing Policy at the Florence Nightingale Faculty of Nursing and Midwifery, at King's. Her interests include workforce research and policy; quality of work environments; nurse and patient outcomes; nursing history, international and colonial nursing; research and health policy. 

HPNoSS is a collaboration between King's College London's Florence Nightingale Faculty of Nursing & Midwifery, University of the Arts London’s College of Communication, and Imperial College London’s Dyson School of Design Engineering, supported by the Culture Team at King’s.

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