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