Indirect

• Less loss of family work

• Decreased special school needs

The first set of changes focused on noise produced by staff, family, and visitors and was signified by the theme—prominently displayed—of Quiet Pleases. The second set of changes targeted equipment noise produced by myriad alarms— "buzzers, bells, and whistles"—that were constantly erupting to signal possible danger. After all these changes were initiated, noise levels decreased in the intermediate care area within the ICN (Figure 2.2).

Beyond the impact on noise reduction (which was real yet modest), this initial improvement work gave all the ICN staff disciplines—physicians, nurses, nursing

Intermediate Care: 24 Hours EXCEEDANCE

Intermediate Care: 24 Hours EXCEEDANCE

dB

Note: The exceedance is the percentage of time the noise level exceeded each decibel level (C-weighted scale) during a twenty-four-hour period.

assistants, administrative staff—an opportunity to work together to learn principles and methods that could be used in the future. It gave them a sense that they could change their work, and it generated a visible, short-term win, promoted local improvement knowledge, created a guiding coalition, used the scientific method (which was revered in the local culture), and fostered respectful interdependence and shared leadership patterns, all of which built a solid foundation for continuing on the path toward excellence and transformation (Kotter, 1996; Schein, 1999; Weick, 1995).

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