A Cure for Hospital Design

  • Strategies to Keep Patients and Their Visitors From Getting Lost Endless corridors that seem to lead nowhere. Poorly marked entrances. Multiple elevator banks and incomprehensible signs. Hospitals are realizing they have a design problem as patients and visitors struggle to navigate the maze of the modern medical complex. Confusing layouts and signage add to patients' anxiety at a time when many are feeling ill and are coming to the hospital to undergo tests and procedures.
  • Now, many hospitals are borrowing strategies from shopping malls and airports to make it easier for people to get around—a process design experts call wayfinding. Technical names for departments, such as Otolaryngology, are being replaced on signs with plain language—Ear, Nose and Throat. Interactive digital kiosks at entrances allow visitors to chart the course to their destination. At the Cleveland Clinic, the kiosks have a talking avatar that responds to touch-screen commands. It gives estimated walk times and allows users to print directions or send them to their phone. The clinic is also developing a wayfinding app for its main campus, including turn-by-turn driving and walking directions. Some hospitals are placing prominent landmarks along routes to assure people they are on the right track. At Houston's MD Anderson Cancer Center, for example, a large tree sculpture helps mark the way to the diagnostic center, blood-donor center, pharmacy, and chapel.
  • Marilyn Naiman, who was diagnosed with melanoma in 2009, says she received excellent care at the University of Pennsylvania's Abramson Cancer Center in Philadelphia, located in the sprawling Perelman Center for Advanced Medicine building. But she says it was difficult to find her way from parking-garage elevators to the ones in the lobby that led to the correct floor. She felt the hospital had poor signage and not enough of it; information booths were hard to find. "To be sick and dealing with cancer issues in a building that is not user friendly is your worst nightmare," says Ms. Naiman, 54, who lives in Yardley, Pa. Once she figured out how to navigate the center, she says she would help other patients who were "lost, scared and frustrated" find where they needed to be.
  • "Wayfinding is a challenge we have not yet 100% solved and we continue to work on it," says Kevin B. Mahoney, chief administrative officer for the University of Pennsylvania Health System, which includes Abramson. He says the building has had two patient-information desks and digital kiosks since it opened, and has added three full-time greeters on each level of the parking garage. Mr. Mahoney says he is studying how wayfinding works elsewhere, such as in malls and large hotels. "People can always find the Gap but it's not that easy to find Radiology," he says. Confusing layouts can result from years of hospital renovations and building additions. Randy Cooper, president of Loganville, Ga.-based Cooper Signage & Graphics and author of the book "Wayfinding for Healthcare," published by the American Hospital Association, says that when hospitals expand they often fail to update their signs for multiple new entrances, wings and unconnected buildings.
  • At Rapid City Regional Hospital in South Dakota, patients from distant ranching and farming communities frequently complained about finding their way through the 650,000-square-foot complex, says Timothy Sughrue, the hospital's chief executive. The hospital hired Mr. Cooper's company to update its signs. Medical jargon directing patients to Antepartum and Postpartum services, for instance, was changed to Labor and Delivery. Elevators were a problem at Rapid City. Respiratory therapy is on the third floor in the hospital's main tower, and pediatrics is on the third floor in a different wing. Patients and families ending up in the wrong place have to return to the lobby. The hospital installed detailed new signs at the elevator banks in the lobby with instructions in bold letters making clear which departments were in the different areas. Sarah Hermsen, the hospital's project coordinator, says there was a nearly 60% reduction in lost pediatric visitors ending up in respiratory therapy after the change.
  • Ms. Hermsen says new signs are modeled on an airport-style approach of "progressive disclosure," giving patients only the information they need to get to the next step in their destination. A sign at the West Elevator, for example, directs people to the second floor that includes all maternity and pediatric departments. Once on the floor, there are signs with directional arrows to individual departments. The Rapid City hospital, which spent about $300,000 on its wayfinding project, installed direction-finding digital information kiosks at each of the three entrances. Different patient areas were given a different color code. If patients or visitors look lost, employees are expected to stop what they are doing and offer to help, even to escort them to their destination.
  • UCLA Medical Center also offers personal escorts—college students doing internships—at its Ronald Reagan and Santa Monica medical centers. Clinicians at Cedars-Sinai Medical Center in Los Angeles were complaining that patients showed up late and stressed out because they couldn't find their way around the medical campus, which covers 24 acres, says Zeke Triana, director of facilities. He says a new wayfinding project will include installing landmarks such as a planned LaBrea Bakery restaurant, new landscaping, banners and artwork that will serve as "breadcrumbs" to reassure people they are on the right path. Even the new Advanced Health Sciences Pavilion, which includes a neurosciences center, needs wayfinding improvement: The building's elevators aren't immediately visible from the bank of elevators coming up from the underground parking garage. The signage "has to be more explicit," Mr. Triana says.
  • Universal symbols to help people find departments have caught on in some hospitals, especially when patients speak various languages. The symbols, such as a teddy bear to signal the pediatrics department, have reduced patient confusion at Children's Mercy Hospital in Kansas City, Mo., a hospital spokeswoman says. A wide variety of symbols was designed by Hablamos Juntos, Spanish for We Speak Together, in a project funded by the Robert Wood Johnson Foundation. Other providers, including Oakland, Calif.-based Kaiser Permanente, believe the symbols could add to confusion. Instead, Kaiser, which has more than 30 hospitals around the U.S., adopted a system of letters, images and colors that it expects will be clear regardless of language spoken, says John Kouletsis, who oversees facilities planning and design for Kaiser.
  • Kaiser also found that patients' first wayfinding concern is getting from home to hospital, and then finding the right building and entrance. Kaiser installed neon logo bands on buildings that are meant to be seen at a distance from freeways. And large vertical banners mark entrances—red for the emergency department, blue for the main hospital, yellow for parking and green for administrative offices. Mr. Kouletsis says the biggest and most imposing sign imparts the most important message: Welcome.