Table 1.

Qualitative descriptions of existing and potential sleep‐friendly practices, n = 8

Theme	Subtheme	Representative quote
Universal culture/shared understanding	Defaulting to more interventions	“I think the culture is often one such that people just do the same [disruptive practices] they would do for the sicker patient for the less sick patient because they're worried, what if that patient gets sick too.”
	Success defined as a culture change	“I count that as a successful program because it has been long‐standing and I believe it has helped to shift the culture somewhat.”
	Ensure all patients have equal access to improved sleep conditions	“[…] one of the biggest sources of inequity in our healthcare delivery is that some patients are knowledgeable enough to […] ask for things, whereas other patients may not know that they have available earplugs [or] melatonin , because nobody has told them in a way that they understand it […] make sure that messaging is done in a consistent fashion to everybody in a language they understand, and that they're not made to feel like they're being needy for asking for these things.”
	Need for education, evidence, and implementation efforts to improve	“So that would require a lot of education and buy‐in. I would want to have data at our organization about how disrupted sleep is for our patients and then also data about the importance of sleep, especially for kids and hospitalized kids […] and then working on putting into practice ways to improve […] it would probably be a pretty lofty quality improvement effort at that point.”
Environmental changes	Universal sound and light timing	“[…] some standard time across most floors where lights would be dim in certain common areas, noise would be reduced […] to let everyone know it's night. That's probably the one I would focus on first.”
	Medical device noise	“We have incredibly noisy IV pumps that often start beeping in the patient's room.
		I am sure that somebody has invented an IV pump somewhere that beeps outside the patient's room so that people can go in quietly but we don't have them.”
	Alternatives to sounded alarms in rooms	"Telemetry alarms, accelerometer alarms, and bell alarms. Are there ways to alert a clinical staff of an event without necessarily just being sound?"
Hospital practices	Grouping tasks/establish standardized and customized practices	“[…] things like grouping tasks for individual patients like vitals, medications, or any other required assessments in the middle of the night. I would do more to make that uniform across the hospital, realizing that there would need to be customization [across units] .”
	Obstacles with early morning lab draws	“I think the bigger obstacles are just general patient flow and workflow. The biggest thing that I can think of off the top of my head is lab draws at like 4am or 5am that interfere with sleep […] this is the time that we have the most lab technicians, so we'd have to probably change up the lab drawing schedule.”
	Select “sleep‐preservation” mode in EMR	“I would say that every routine type of care should be structured […] to have a sleep preservation mode […] the providers should be prompted in a ‘one‐click' kind of fashion to be able to select whether the patient is going to be interrupted for vital signs or interrupted for blood draws if they are sleeping.”
External incentives	Progress through external grant and expert support	“So that's been driving [current efforts]; working with a group of lighting experts and then combining that with the people on the clinical side who really do want patients to sleep better,[….] But that's grant funded. So if it was just internal, I doubt we could have got it going .”
	External ratings	“one of the biggest factors that drives this is the fact that HCAHPS scores matter […] the patient experience does matter, and I think that concept has gotten traction in recent years and so I think where there are opportunities to just do simple cosmetic things to help the patient experience, I think we've done a pretty good job with it.”

Note: Section Chiefs of Hospital Medicine at USNWR Honor Roll Hospitals were asked to describe some of the successes and barriers of any patient sleep initiatives at their hospitals. They were also asked to envision the ways that they would improve hospital sleep and name what they would change first.