PROCEEDINGS of the23rd International Congress on Acoustics
9 to 13 September 2019 in Aachen, Germany

Time-based soundscape evaluation of third-class hospital ward
Anugrah Sabdono SUDARSONO1; Sugeng Joko SARWONO1; Aisyah SHABRINA1, Laudita Natasha
TAMRIN1
1

Institut Teknologi Bandung, INDONESIA

ABSTRACTIn Indonesia, the hospital ward is classified according to the number of beds inside the ward. Third class ward
is the lowest class, which consist of six or eight beds inside the ward. In this study, the soundscape of athird-class hospital ward is analysed on different time of the day. The analysis is conducted based on noiselevel measurement, sound source identification, annoying sound source identification, and semantic scales.
The noise level in the ward fluctuates between 51.5– 62.1 dBA with the highest noise level measured during
the afternoon. The dominant sound sources in the third-class ward, which are similar in the morning and theafternoon, are the sound of fan and visitor of the patients. The three most annoying sound sources in themorning are the sound of patients, visitors, and doors. This result is slightly different from the afternoon
survey, which shows that the three most annoying sound sources are the sound of the door, food cart, andvisitors. The semantic scales show different score in the morning and the afternoon. This study shows that thesoundscape in the third-class ward is changing from time to time, and the soundscape intervention must
consider the difference.
Keywords: third-class hospital ward, soundscape, perception

1. INTRODUCTION
Hospital, as a health service institution needs a conducive environment in order to give optimalservice. A conducive environment could be achieved by constructing a comfortable environment. Oneof the crucial aspects is the sonic environment. The previous study indicates that the soundenvironment can significantly affect both patient (1) and medical staff (2) in the hospital. The sonicenvironment of the hospital focused on the interaction between various sound sources and activities inthe hospital.
Several institutions have made a noise standard that needs to be fulfilled by the hospital. According
to the Ministry of Environment of Indonesia, the suitable sound pressure level (SPL) for hospitalenvironment noise is 55 dBA(3) whereas for the World Health Organization (WHO) is 35 dBA (4),while according to National Standardization Agency of Indonesia (SNI) the suitable sound pressurelevel (SPL) for patient’s room with more than 2 beds, are 35 dBA and 40 dBA for maximum level (5).
However, the previous study indicates that the noise condition is exceeding the standard. The
measurement of noise in ICU indicates that the noise is exceeding the standard (6,7). The similar
condition also happened in the operating room (8) and hospital ward (9)Most of the previous study regarding the sonic environment of the hospital focused more on theoverall sound level without further analysis of the perception in the hospital ward. The study
conducted by Mackrill et al. has analysed the soundscape of the hospital, although without considering
the temporal aspect (10). The temporal aspect is one of the critical aspects of hospital soundscape(apart from human perception, sound source, and emotional response) and must be considered (11).
The different activity on different time might give different perception, and the improvement of thesonic environment might be different. Therefore, this study tries to analyse the noise conditiondominant sound sources and perception in a hospital ward in a different time.

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anugrah@tf.itb.ac.id

2. METHODOLOGY
The surveys for this study were conducted in five third-class hospital wards. Third-class ward is alowest class of hospital ward in Indonesia, which consists of more than six beds [8]. This type of room
is usually crowded due to the cheap rate. The beds in this type of ward, usually next to each other andseparated by a thin curtain. The room usually used by patients who do not have to pay for the cure (paidby the government). Most of the patients in this room are in the recovery stage of their illness.
In this study, five wards (room 308, 309, 310, 311, and 517) are measured in the morning(09.00-11.00) and the afternoon (13.00-15.00). The measurements were conducted on two different
days. The layout of the rooms are shown in Figure 1 and Figure 2. The noise measurement wasconducted in ten minutes using the BSWA MPA 416 class one measurement microphone. The noise
was analysed based on the parameter of Leq, L10, L50, and L90 .

Figure 1 – Layout for room 308-311

Figure 2 – Layout of room 517
After the measurement, a questionnaire was distributed to the patients asking the perception of thespace, dominant sound source, and annoyance rating of the different sound source. Fifty-nine
respondents (28 males and 31 females) voluntarily join the experiment. Thirty-six patients joint theexperiment and 23 patient’s guard, who also stayed in the ward. The a verage age of the patients was42.5, with a standard deviation of 15.4.
The questionnaire consists of three part. The first part is that semantic scales consist of 13 scales.
The scales were developed through a focus group with the patients. The scales are shown in Table 17841

Table 1 – Semantic scale used in the experiment
IndonesianEnglish Translation

Mengganggu - Tidak Menganggu

Disturbing-not disturbing

Membosankan – Menarik

Boring-interesting

Menakutkan-Tidak menakutkan

Scary-reassuring

Tertekan – Menenangkan

Depressing-calming

Puas-Tidak Puas

Satisfied-unsatisfied

Ribut-hening

Noisy-silence

Tidak privat-privat

Not private-private

Tidak nyaman-nyaman

Uncomfortable-comfortable

Dinamis-monotonDynamic-monotonous

Sempit-luas

Cramped-spacious

Lambat-Cepat

Slow-fastPenuh-kosong

Full-empty

Kesal-Senang

Annoyed-pleased

The second part of the questionnaire asked about the dominance of different sound source and how
annoying is the sound source. There are eight sound sources which need to be rated: fan, door, visitor,food cart, mobile phone, eating utensil, curtain, and patients. These sound sources were selectedaccording to the focus group, which asked what kind of sound source which make the patients f eel
annoyed.

3. Result and Discussions
3.1 Equivalent Sound Pressure Level and Percentile Level
The sound level profile is identified by measuring Leq , L10 , L50 , and L90 in the morning and theafternoon in a different room. The overall result during the morning and afternoon measurement isshown in Table 2. In general, the measurement shows that the noise the hospital wards varied between
51.5-62.1 dBA. The values are exceeding the noise standard in Indonesia, and also WHO.
Table 2 – Noise measurement resultLeqL10L50

L90

Min (dBA)

51.5

53.0

48.9

46.6

Max (dBA)

62.1

64.7

59.655.3

Further analysis is done using Analysis of Variance (ANOVA) to understand the level difference
between different room. ANOVA shows that variation of noise in a different room the room is not
significant F (5,9) =1.35, p=0.33. Analysis using T-test indicates that the variation of noise (L eq, L10 ,L50 , and L90 ) are significantly (sig=0.000) affected by the time of measurement. The result isconsistent among the other noise parameters (L10, L50, L90). Generally, equivalent sound pressurelevel during the afternoon tends to be higher than the morning as shown in Figure 3. This factor causedby the activity inside the ward. The activities tend to be more crowded during the day compared to thecondition the morning.

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65,00SPL (dBA)

60,00

55,00

50,00

45,00
SPL

L10Morning (09.00-11.00)

L50

L90

Afternoon (13.00-15.00)

Figure 3 – Noise measurement in the morning and afternoon

3.2 Perception difference between morning and afternoon time
In this study, the perception of the sonic environment is analysed in two different times. Analysis ofsemantic scores indicates that the patients perceived the environment differently, as shown in Figure 4.
In the morning, the patients feel less boring, more satisfied, more private, more dynamic, faster, lessfull, and less annoying in the morning compared to in the afternoon. The patients of both two
different time (morning and afternoon) feels that the soundscape is not disturbing, not scary, andcomfortable. This result indicates that the perception of the soundscape changes at different time.
Further analysis is conducted by understanding the acoustic environment and the annoyance ofdifferent sound source according to the patients' impression.

Annoying

Disturbing
2

Boring

1
Full

Scary

0-1

Slow

Depressing-2

CrampedSatisfiedDynamic
Uncomfortable
Morning (09.00-11.00)

Noisy
Not-Private
Afternoon (13.00-15.00)

Figure 4 – Median score of semantic scale rating in the morning and afternoon
Analysis of dominant sound source indicates that the morning and afternoon shows similar
dominant sound source. The most dominant sound source is the visitor and the sound of the fan. In this7843

hospital, the patients are allowed to be accompanied their family. The visitor explained in th is study
represent the people who accompany the patients. In the afternoon, the sound of visitor become more
dominant since usually, they do more activity with the patients. This phenomenon also happens topatients. They do more activity in the afternoon, which make the sound of them become more
dominant, compared to the morning time. The dominance of the other sound sources seems to beconsistent between two different measurement time, as shown in Figure 5.
120
100
80
60
40
200
FanDoorVisitorFood Cart

Morning (09.00-11.00)

MobilePhone

EatingUtensill

CurtainPatientAfternoon (13.00-15.00)

Figure 5 – Dominant sound source at different times
Interesting result is shown from the annoyance rating of the sound sources. The result is shown inFigure 6. Generally, the sound sources annoyance is different between the morning and afternoon
condition. The phenomena are shown primarily on the sound of the door, mobile phone and patient.
The sound of the door is more annoyed in the afternoon, although the sound is as dominant as in themorning condition.
The most interesting result shown by the sound of the mobile phone. The sound of the mobile phone
is more annoying in the morning although the sound is not dominant. According to the rating of thedominant sound, the sound of a mobile phone is not dominant both in the morning and in the afternoon.
The sound of patients is more dominant in the afternoon, but it is less annoying. It might be possiblethat the patients expect the activity of patients become higher in the afternoon, so they are moretolerant with the sound of the other patients.
1,8
1,6
1,4
1,2
10,80,60,40,20
FanDoorVisitorFood Cart

Morning (09.00-11.00)

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MobilePhone

EatingUtensill

Curtain

Afternoon (13.00-15.00)

Patient

Figure 6 – Annoyance rating of a different sound source at different time
In general, the study indicates that the dominant sound source might not be the problem to thesound environment. In this case, the problem occurred due to the not dominant sound sources. The
result also might be different at a different time. The result shows that the soundscape analysis for theenvironment that makes people need to be in the environment for a long time need to be done
thoroughly with the consideration of different perception in a different time.

4. Conclusion
Soundscape analysis in a hospital ward in two different times (morning and afternoon) indicatesthat the soundscape is different. The sound level is higher in the afternoon. In the morning, the patientsfeel more boring, less satisfied, less private, less dynamic, slower, fuller, and more annoying in themorning compared to in the afternoon. The dominant sound source is similar between two different
times, but the sound source annoyance rating shows different scores. The result indicates that thesoundscape intervention in a hospital ward must consider the time.

ACKNOWLEDGEMENTS
This research is funded by Kementerian Riset, Teknologi, Dan Pendidikan Tinggi Republik
Indonesia under the scheme of Kerjasama Luar Negeri.

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