Death by beep Bad sound design costs lives and how to fix it

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[Applause]

hi

i’m mike and i’m an audio geek

i spend about as much time thinking

about sounds as most parents do thinking

about their kids

because

sounds are beautiful sounds are

fascinating

on a practical note sounds from the

basis of something called an auditory

interface

you’re probably familiar with a visual

interface like a computer screen

so an auditory interface lets us connect

with technology using our ears rather

than our eyes

and that’s really really important for

people like train engineers and pilots

who need to stay in touch with a lot of

complicated machines while keeping their

eyes up ahead

when i first learned about that i

thought it was pretty cool that sounds

can also help keep us safe

but like i said i’m an audio geek why

does any of this matter to you

well

before long you or someone you love is

going to spend time in a hospital and

when that day comes there’s certain

aspects of your comfort and even your

safety that can be harmed by bad sounds

because believe it or not the today’s

state-of-the-art medical devices

routinely communicate with doctors and

nurses using sounds like these

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now that’s one beeping mess

if you haven’t thought much about the

problems with sound designs and medical

devices before today

that’s probably pretty common

but you should

because you could pay for that bad sound

design

with your life

don’t believe me

trust the fda

they did a survey which showed that over

a four year window bad sounds led to the

deaths of 566

patients

death by beep

let me try and explain

the current alarms for some reason use

sounds that are really annoying

and this leads doctors to turn down the

volume or sometimes even turn off the

sound so they can concentrate on

important issues of patient care

most of the time that’s not critical but

on some occasions it leads to deadly

consequences

take this example

once during a surgery the doctors needed

to temporarily disable the respirator so

they could get a clear x-ray image which

sounds scary but is actually normal in

these situations

unfortunately they forgot to restart the

respirator and since the alarms were

silenced no one noticed until it was too

late and that patient died

these kinds of stories illustrate the

problems with annoying sounds that we

tend to silence

but the issue doesn’t stop there

because another problem with the sound

annoyance is that we tend to tune out

annoying things particularly when

they’re happening over and over

so surveys have shown that on average

hospitals have two critical alarms per

day that are missed

just to put that in context when you

unpack that across north america alone

we’re going to have 5 million critical

misses just this year

the sounds are annoying enough for

doctors but the annoyance issues don’t

stop there because when they bother

patients they prevent them from sleeping

and that extends the time we have to

stay in hospitals

that increases the risk of complications

and also adds burdens to an already

overstretched medical system

so you’re probably wondering if the

sounds are really this bad why do we

even use these tones why not use speech

sounds or like a visual display like a

phone

well the thing is these tone sequences

are actually ideally suited for the

kinds of complex real-time information

that doctors and nurses need to keep us

safe

relative to speech sounds they lead to

faster recognition and they also prevent

patients from confusion over

misunderstanding for messages they’re

not really equipped to get

now because they’re based on sounds

doctors can keep their eyes where they

need to be for example on that breathing

tube that they’re carefully placing down

a patient’s throat

so

rather than why do we use these alarms

the question that keeps me up at night

is this

why does a multi-billion dollar industry

vital to our health and well-being use

sounds no more sophisticated than that

dump truck that backs up outside my

house every monday

part of the problem is really just the

name because when we call the medical

alarms they sound like they should be

annoying and urgent things like a fire

alarm should be annoying

but a fire alarm goes off rarely and

when it does you have to act immediately

and that’s really the opposite of the

situation with these medical alarms

because we know patients generate

hundreds of medical alarms per day and

rarely do they require immediate

attention

so rather than compelling urgent action

like a fire alarm they’re conveying

useful information they are a

quintessential auditory interface

and when we think about it that way

making them annoying just doesn’t help

anyone

now that we’ve gone over some of the

problems with the current device alarms

i want to talk about the solutions but

before we do that i feel like i should

let you know something

you see i’m giving you a lot of medical

information here but i never went to med

school and to be honest sometimes i pass

out when they have to draw blood

and if we’re talking about redesigning

complicated machines you should know

that sometimes i struggle just

assembling my own ikea furniture

that’s why i work with medical

professionals to make sure that my

interesting acoustic ideas actually make

sense in the hospitals you might be in

one day

i’m going to give you another scary stat

the emergency care research institute

puts out a list each year of what they

see as the top 10 health technology

hazards

they’ve named alarms on this list every

year for the past decade

four times in the number one spot

so this is a massive issue which is why

i have amazing colleagues all over the

world who are looking at how we can do

better

my team focuses on one specific problem

here and you probably guess based on

what i’ve said up until now that’s the

sound annoyance

it’s a challenging issue because there’s

a lot of different factors to consider

but fortunately

we have a secret weapon

and that secret weapon

is music

you see i’m not just an audio geek i’m a

professional musician and that means i

have spent thousands of hours practicing

performing and even conducting music

i’ve been privileged to study with some

amazing teachers and play alongside

incredible musical colleagues who are

equally obsessed with good sound

so whether i’m playing a recital or

conducting our percussion ensemble it’s

my job to recognize good sound when i

hear it

and trust me when i tell you those

alarms i played are not good sounds

they make my skin crawl just listen to

them for 10 seconds i can’t even imagine

how doctors and nurses do that for hours

and hours a day when they’re making

critical life and death decisions about

patient care

when i first heard about this problem i

was horrified

and then when i thought about it

i got sort of excited

because what could be more interesting

for a lifelong audio geek than using my

musical knowledge to actually save lives

i mean finally i can be that acoustic

superhero i always dreamed about as a

kid

the challenge here partly is just that

the sounds are annoying and when you

think about it music is the opposite of

annoying

i mean how many hours a day do you spend

listening to music

music proves that it’s at least possible

to design complex streams of sound in a

way that isn’t so aversive

and when you think about it as a

musician trying to design sound in a way

that’s not annoying is a pretty low bar

but it’s not a bad place to start and

that’s how i got involved

so now i want to show you what we’re

doing to try and help with this problem

biologists will use a microscope to show

the complexity of things that might seem

simple on the surface so we’re going to

do that now with a simple sound and when

we deconstruct this simple individual

note from a violin you can actually see

there’s a world of complexity

all the components are moving sort of

doing their own thing but also somewhat

in synchrony it’s like they’re part of a

team

it’s beautiful

sorry i warned you i’m an audio geek

i’ve analyzed a lot of sounds like this

and i can tell you it’s not just the

violin all musical sounds are complex

so in contrast to this let’s see what

those medical device sounds look like

as you can see here they’re sort of

taking a very different approach all the

components start and end at the same

time there’s very little temporal

variation

it looks nice in that figure but it

sounds awful

so what i can’t help but wonder about is

this

if we know the beeps sound bad and we

know music sounds good

and musicians like complex sounds

why is it that medical device

manufacturers consistently go in the

exact opposite direction

the more that i thought about it i

realized there’s two parts here

the first issue is just historical

in the early days of these machines

beeps were all we had so they became

what we expected the machines to sound

like and no one ever really expected

them to sound any different

now a lot of medical technology has

advanced incredibly over the past

several decades so why is it that the

sounds are stuck in the past

this i think reflects in part a terrible

misunderstanding of what’s important in

an auditory experiment in an auditory

interface

sort of a mouthful so let me unpack that

my team surveyed over a thousand

auditory experiments in top journals and

we found that most use simple sounds

similar to those ones i just showed you

but the thing is what matters in an

experiment is often the precision

controlling the exact duration of that

tone

researchers don’t usually care about

aesthetics i mean no one ever signs up

for an experiment for a fun night out

so in the lab we’re not concerned about

annoyance

but those experiments last for about an

hour and that’s shorter than any

hospital visit that i’ve ever had

so the things that are helpful for an

auditory experiment like precise control

over the sound don’t matter in a

hospital but what matters is the fact

that these sounds are annoying the

bejesus out of everyone

so we’ve gotten here through this

two-part double whammy

unfortunately this misguided belief in

the virtues of sonic simplicity has led

us to overlook the fact that the

engineering limitations that got us to

the beeps to start with no longer apply

this brings us to a terrible sonic

situations in hospitals all over the

world

but music shows us a better path

every time yo-yo ma draws that bow

across a cello string every time adele

fills an arena with her voice musicians

viscerally demonstrate the power of good

sound

this shocking

painfully obvious insight that the

quality of sound matters in auditory

interfaces is actually a driving force

in my team’s research

some of our experiments manipulate the

current alarm sounds sort of massaging

each tone making each note more complex

more musical

we don’t change the pitches or the

rhythms so doctors who know the old

alarms will recognize the new ones

immediately

but there is one difference and that

difference is really important if you’re

listening to these for hours on end

because we find over and over in many

experiments participants consistently

rate the new sounds as less annoying

than the old ones

think about it this way rather than

those beeps i played for you before you

could now be surrounded by sounds that

are like quick musical gestures

and which would you prefer if you’re in

the hospital for a week trying to

recover or if your elderly parent needed

to rest after surgery or your newborn

desperately needed sleep

what if you had to monitor these sounds

for hours a day which is simply part of

the job for anesthesiologists all over

if i’m sedated while going under the

knife

i want to do everything possible to

minimize the annoyance and maximize the

concentration of the person in charge of

waking me up

wouldn’t you

i’ve thrown out a lot of scary thoughts

today so i want to transition now to a

more hopeful note

because i’m really excited by the fact

that hospitals the world over are filled

with these medical devices

because you see even small benefits can

be leveraged into major gains for public

health

now a lot of the changes are going to be

costly or difficult or challenging

but there’s one that’s as cost efficient

as it is straightforward as it is simple

and so i’m standing here today begging

the medical device industry

please

fix the

sounds

if you remember only one thing from this

talk

please make sure it’s this

bad sound design cost lives

and for every unfortunate death by beep

there’s patience out there taking longer

to recover than they should be

burned out doctors more exhausted than

they need to be all because the sounds

have been designed more annoyingly than

they have to be

i hope the next poorly designed beep

that you hear is not in a hospital but

just from a truck backing up or at an

atm or at a supermarket checkout counter

because if i’ve done my job here today

that annoying sound

is going to remind you of me

and that’s okay

i’m fine with that i’m happy even

i just hope that if you remember this

talk you’ll take a moment and wonder

what can i do to help us get to a better

sounding world

because the answer to that question

just might be the most surprising thing

you’ve heard from me today

if you’re interested in saving lives

improving public health and advancing

the state of this multi-billion dollar

industry then what you need to do is

support the arts

pick up an instrument join a band and if

performing isn’t your thing check out a

concert you’re guaranteed to have a good

time

because i’m convinced that some of the

most important innovative new insights

to this complex public health problem

positioned right at the intersection of

engineering and medicine

just might come from listening a little

more carefully

to music

thank you

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you