Hospital Wayfinding Within Medical Tourism Facilities

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By Maria K Todd, MHA PhD

CEO & Founder,
The Mercury Healthcare International group of companies

As a former hospital administrator, and now an authority in health tourism operations, marketing and process efficiency – I find myself in hospitals around the world for hundreds of hours per year.  One thing I always tend to make note of is wayfinding methods in hospitals and clinics where the primary language is other than my own native tongue – English.  Wayfinding is a person’s spatial behavior or orientation. Spatial orientation is the static relationship to space or the environment. The concept of spatial orientation is the predecessor of wayfinding.

Lucky for me, I can now read and understand wayfinding words printed in Cyrillic, Greek, Spanish, German, and English, I know that for the most part as an American, that’s very rare. I also instinctively can usually find my way as I understand hospital design, and as a firefighter – we trained frequently on situation analysis, including knowing where you are and where the exits are at all times.  So wayfinding is important from several perspectives:

• Wayfinding is a requirement of all well-established accreditation schemes. JCI even dictates how high from the ceiling the signs must be.
• Wayfinding enhances the patient experience to feel in some control – Each visitor—whether he or she is a patient, family member, or healthcare provider—enters the medical facility with a personal reality; each has his or her own level of “knowing,” and different levels invoke different needs. Some visitors—a first-time visitor who has never been in a hospital or has never had a healthcare problem—may not realize how different and confusing a healthcare facility is compared to a shopping mall or airport. For these people, the local or medical tourism hospital may be more foreign than a distant country. The visitor lacks experience, and this can lead to great confusion.
• Some visitors, aware of their ignorance, don’t want to know how to navigate. They want an escort to their destination. If you don’t provide it, you will lose patient delight points. Other visitors, who lack appropriate knowledge, know they don’t know yet are too shy to ask questions so they will try to navigate on their own. You see couples arguing in the hallways and elevators when this happens. Just like in the car.  Still others enter the healthcare system knowing that they are ignorant but are unwilling to stay that way. They will be proactive and seek out information. They may read up on their illness, get a map, and plan intently for the visit – these are the ones who would download an app with beacon technology, if offered.  They actively seek to become a knowledgeable consumer of healthcare services. They want options and answers. These people want to deal with the hospital experience and the illness on a cognitive level.
• Wayfinding enables people to navigate the complex, high-tech medical environment of a healthcare facility at a time when illness, stress, and fatigue have depleted their emotional, physical, and cognitive resources. This design element promotes healing because being able to understand their environment provides visitors with a sense of control and empowerment, key factors in reducing stress, anxiety, and fear—feelings that undermine the body’s ability to heal.  “It is important to consider that wayfinding problems have their own particular cost in the healthcare environment. Stress caused by disorientation may result in feelings of helplessness, raised blood pressure, headaches, increased physical exertion, and fatigue. In addition, patients may be affected by the wayfinding troubles of visitors who, because they became lost, may have less time to spend with patients.” (Carpman and Grant, 2001).
• Effective wayfinding brings financial and efficiency benefits as well. Costs associated with wayfinding problems are often hidden. For example, consider the indirect cost of lost productivity as concerned staff members take time away from patient care to give directions or walk lost visitors to their destination. One study at a major tertiary hospital estimated the cost of wayfinding problems at $220,000 per year (Zimring 1990).
• Another indirect cost of poor wayfinding is that lost visitors are late or miss their appointments as people who visit the hospital infrequently misjudge how long it takes to navigate the unfamiliar environment (Zimring 1990).
• Successful wayfinding systems can contribute to better Press Ganey and HCAHPS scores
• Wayfinding systems include signs, interactive display stations that included touch screens designed to be user friendly and easy to navigate and beacon-enabled apps that can be downloaded to a tablet and used the same way one uses a mobile phone GPS. But the app can also enable things like ads and coupon promotions for baby picture packages in the nursery area, reminders of visiting hours, coupons for the coffee shop, public workshops and class invitation push notifications, and more.

The components of a good wayfinding system

Tools of good wayfinding are components designed to support spatial orientation and cognitive mapping. Redundancy and overlap of these tools are also helpful to assist people with varying cognitive skills. They do so in four ways.

1. Some people are cognitively focused, relying on maps and written directions.
2. Others respond to verbal communication, where one person explains directions to another.
3. Others respond to visual cues such as landmarks, colors, and noticeable features.
4. Some gain understanding primarily through personal interaction with people.

As I walk through hospitals and clinics around the world as a consultant, I am particularly sensitive to each building’s natural circulation system. Some are intentional and design integrated, others simply habitual, based on paths selected by users. A good wayfinding system takes advantage of that, and such a system consists of numerous components that rely on each other for a solid foundation. Good wayfinding assembles these blocks in an understandable manner.

The system includes more than the average observer might notice:

1. A Master Plan – facilities change over time with additions, space repurposing, and technology requirements ( some larger and larger, while others pare down considerably.)
2. Landscape elements
3. Interior architecture and design (use of color, line of sight, and other landmarks that create visual cues)
4. Signs, including but not limited to:
   • Informational (i.e., where to find assistance, hours of operation, etc.)
   • Directional (i.e., for the radiology department, turn left)
   • Identifying (i.e., identifies an area, such as the oncology department)
   • Regulatory (i.e., radiation in use)
5. Graphics –  Wayfinding graphics should repeat the messages from signs. This technique helps communicate with those who do not read. Common symbols—those for telephones, ATM machines, and changing stations—also help in wayfinding. Wayfinding graphics should consistently use the facility’s logo, and the logo should appear on signs, printed material, and badges worn by staff. This consistency shows that all messages come from the same facility. It also aids in security vetting. Fonts used should be easy to read.
6. Amenities – The final block of the wayfinding system is the facility amenities, which include all services that make wayfinding easier. The best wayfinding amenity is people on staff who show they care about visitors’ ability to find their destination. Visitors usually feel comfortable questioning staff members, and conspicuous name badges should identify them. Optimally, appropriate staff can identify lost visitors and offer help before the wayfinder even asks.
7. Maps – Maps should include the name of the facility, major locations, an arrow that shows which direction is north, and a you-are-here identifier. For medical tourism facilities, this means maps that can be read in more than one language. Maps become even more useful when a staff member reviews the map with the visitor and traces an appropriate path for him or her. Maps should be posted at key entrances, elevator banks, and at transitions between buildings. Directional signage supports the map’s directions at all major intersections.

Here is a helpful checklist you can use to self-audit your wayfinding scheme. It may be helpful to have several staffers conduct the audit and a few volunteer strangers who have never really navigated the facility in the past. Offer them a tote bag or a small taken gift for their time and attention to your audit exercise.

Does your facility:

• Apply the progressive-disclosure model of wayfinding?
• Identify all parking, buildings, and entrances?
• Use consistent graphics, color, and logos?
• Offer a user-friendly handheld map, and repeat that map in lobby directories?
• Incorporate environmental cues such as landscapes?
• Include windows in corridors for outdoor orientation?
• Design main entrance drop-off areas?
• Offer valet parking?
• Provide easy and well-identified parking?
• Clearly delineate handicap parking and access routes?
• Establish clear routes to primary destinations?
• Train all staff in giving directions—the same way to the same place?
• Have a highly visible visitor-information center?
• Develop a sensible room-numbering system?
• Identify all destinations in the same vocabulary?
• Use symbols and icons to bridge language barriers?
• Provide clear, concise, and consistent signs that have strong contrast and visibility?
• Clearly light all signs?
• Use lighting to feature landmarks?
• Provide easy access to patient education?
• Offer learning centers with extended hours, high visibility, and a friendly staff?
• Differentiate public elevators from staff and clinical elevators?
• Display clocks in primary waiting areas?
• Provide telephones in emergency areas, waiting areas, entrances, and dining areas?
• Clearly identify restaurant and toilet facilities?
• Provide guides and wheelchair transportation for visitors in need?
• Avoid convoluted corridors?
• Remove clutter from corridors?
• Post estimated journey times and distances?
• Have an app that can be downloaded to mobile phones that acts as a GPS with spoken directions to turn right or left?

 

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