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Wayfinding in Healthcare

Art pieces can add both beauty and a geographic reference point.

Periodically Ehc is engaged to conduct work "above and beyond" the traditional campus master plan. Wayfinding is one of those issues with which facilities often struggle, and the result of poor spatial orientation leaves patients, visitors with frustration and a disappointing first impression.

Looking back at client studies, the disconnect typically comes between the desire to create an environment where respect, care, treatment and healing had been the watchwords and instead creating a maze of doors, elevators, hallways, signs, bells, intercom messaging, large, unfriendly waiting areas, open holding areas, equipment parking, crowded care spaces, and unfamiliar faces.

In newer replacement facilities, these conditions have been significantly improved and often eliminated, but many older hospitals still face the wayfinding problem. The future of healthcare transformation points to smaller and more family friendly facilities. This paradigm shift is occurring at a rapid rate as systems merge, consolidate and re-distribute resources into more nimble and accessible shorter stay, ambulatory care styles of design and construction.

In our earlier planning engagements, we learned that leadership was extremely frustrated with this growing list of complaints that they received from patients, guests, family members and friends. A loss of customers became a concern as well, since newer facilities just didn't seem to have the same problem. Many of the complaints related to signage, access, flow patterns/hallways, crowded rooms, slow elevators, safety/security measures, inconvenient disruptions and an overall "unwelcoming" image. These are also the factors mentioned by clients when describing the need to conduct a campus master plan (CMP). What are the differences between a CMP and a wayfinding plan (WFP)?

  • A CMP Leads to major hospital improvements, relocation of departments and the re-sizing of services. Hallways are re-routed and major spatial conditions are improved. A CMP is more expensive.
  • A WFP leads to signage updates, directional support, facelifts, technology apps and process improvements leading to better practices and changes in human behavior. A WFP is less expensive.

In most cases, the original hospital that was constructed some 40+ years ago, has grown exponentially over the years, and evolved from the "place where you were born" to the larger, unwieldy campus you are now visiting. Buildings have been added, adjacent to other buildings, and hallway connectors and elevators haven't been developed to define clear and navigable traffic routes. The building has become a "campus of multiple buildings," and the hospital has grown into a "new town environ" made up of numerous, diverse buildings and services - all vying for entry/exit, convenient linkages, walkways and pathways, but without the benefit of a CMP.

The first, immediate intervention for this dilemma requires a detailed WFP. The analysis begins with a 40,000-foot look at the market through programs like Google Earth and MapQuest to see the regional aspects of the campus in relationship to the larger community. Wayfinding begins on the drive from home to the hospital with community considerations including signage and bus routes and continues with campus considerations including directional assistance to parking lots and garages, front door drop-offs, emergency entries, and a myriad of other destinations in and around what might have become a sprawling campus with medical office buildings, outpatient clinics and imaging centers, a freestanding cancer center or rehabilitation space, laboratory or even separate admitting and billing entrances. For those onsite to visit an admitted patient, the routing might be easier, but the security process could be a nightmare.

We have found that on an acute care campus of medium size there are 30 or more destinating points one might seek out. The good news is there are a number of ways to reduce the stress and avoid the negative experience by improving the situation. First, assess the situation, interview the stakeholders, study the campus conditions (buildings, roads, entryways, signage and existing conditions) and carefully record the visual implications. The resulting images tell a story that begins the initial improvement process.

There are also excellent tools and resources to help with the process. The Veteran's Administration has developed an "Integrated Wayfinding and Recommended Technologies" program. This report is one of the best example of best practices for the public and private sector. In the introduction, the VA suggests: "An expanded definition of the term wayfinding recognizes that visitors use multiple cures and tools to find their destination ... from the spatial relationships manifested by the architecture to the lighting and the interior spaces. A new class of wayfinding tools has emerged with the technology revolution. Global positioning systems (GPS) devices, websites, apps, and on-site touch screens can be effective tools to help people along their journey. The smartphone has become our own personal navigation device."

With forethought and planning, there is no reason why facilities ... even those that have grown convoluted over years of expansion ... can't significantly improve wayfinding and the overall experience for patients, visitors and staff.

A Case Study

Interviews with stakeholders are revealing and often paint a picture of the campus that is both process and people oriented. The ability to capture this message and relay it to the board of directors, who are typically the ultimate decision-makers when it comes to allocating funds, is key to implementing a wayfinding master plan. Below are several quotes from initial interviews with a hospital client in the Atlanta area, which was a classic example of the smaller hospital that grew into a major campus:

  • "Floors don't align, elevators are poorly designated, and destinations aren't understood by staff."
  • "Why can't we have clear maps and floor plans with routes designated without extraneous materials?"
  • "Can't find the Mother/Baby area, and the cafeteria is in an off-beat pathway to the basement."
  • "All signs are different, seem to be in conflict, and the lighting is horrible."
  • "We love the plants and flowers and the sculpture ... helps us find our way back from the basement."
  • "We were here to visit my mom, took forever to find the elevators and then we waited and waited."

To address these concerns and improve wayfinding, Ehc took the following 12 steps:

  1. Review the existing CMP, WFP and Strategic Plan (SP ) ... integrate the findings, goals and objectives.
  2. Communicate the "agreed to WFP Process" to ensure awareness and understanding of actions to be taken along with best-in-practice milestones.
  3. Inventory existing exterior and interior signage (record visually and prepare impressions).
  4. Identify the words and terms used for messaging (seek consistency and simplicity of message).
  5. Re-align placement of signs, hierarchy of message, building character, and directional imagery.
  6. Prepare a comprehensive interior finish, artwork, and graphic standard.
  7. Develop criteria and recommendations for facelift, branding, and community image enhancements.
  8. Prepare WFP orientation maps, instructional materials, and conduct volunteer staff training.
  9. Work on "wellness" incentives to encourage building user modifications and fitness measures.
  10. Explore music, art and cultural themes that benefit the traveler who is making the trip.
  11. Develop a "green" and sustainability theme for the community.
  12. Develop "universally understood" methods and conduct routine WFP updates.



VA Integrated Wayfinding


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Campus Master Plan, CMP, Easter Healthcare Consulting, Ehc, Hospital Campus, Jim Easter, Wayfinding, WPF
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