Loma Linda University Medical Center (LLUMC) has a distinguished hundred-year history of innovation in medical science and patient care. Each year it admits more than 33,000 inpatients and serves roughly half a million outpatients. It operates some of the largest clinical programs in the United States in areas such as neonatal care and outpatient surgery, and is recognized as an international leader in several medical disciplines.

In 2005, LLUMC embarked on a medical center campus master plan to manage its dynamic growth and to sustain the alignment between its strategic vision and its facilities and culture, with Vice-President, Facilities and Environment Jesse Mock as project executive.

In its request for proposals, LLUMC made it clear that its leadership sought a full, integrated master plan that supported the organization's commitment to patient-centered care and a faith-based mission. Interior design and wayfinding were included in the master planning process. Anshen+Allen, Aesthetics, Inc., and Mettis, Inc., were selected to guide this work.

With almost two million square feet, three hospitals, and several medical office buildings, LLUMC presents wayfinding challenges that can sometimes be daunting. In seeking a holistic wayfinding analysis, LLUMC's leadership recognized what other healthcare facilities often do not take into account: Beyond the ease or difficulty of getting where they need to go, customers derive powerful and lasting impressions about the organization itself from their wayfinding experiences, experiences that begin at the campus entrance and end only after the patient has left the facility. Is it a cold place or a caring one? Is it part of a larger community or isolated from it? Is the medical excellence of its reputation matched by excellence in attention to the wayfinding needs of patients and visitors? Does the community easily recognize the faith-based ministry that is part of the healing process?

In general, frustrating wayfinding experiences diminish patients' overall satisfaction with their visits and with the quality of the care they are receiving. Unfavorable perceptions can influence patients' attitudes during interactions with staff, making employee jobs more challenging, and they can also create a negative paradigm about the institution in patients' minds, making them less tolerant and more critical during their visits.

LLUMC's leaders were also aware that the interior design of the existing facilities needed significant update and that the establishing a master finish and furniture plan would assist with the many anticipated remodels and new projects. What they did not fully realize—but soon came to see—was that analysis, planning, and design choices related to wayfinding would inform the interior design master plan and allow the creation of a truly visionary project.

The project began with the formation of an interdepartmental Wayfinding Committee to assist in identifying the current challenges and to make decisions about the eventual recommendations. In most hospitals, leaders understand the separate elements of wayfinding and care about making them better. Often committees and/or designers are at work to improve different parts of a facility's overall wayfinding system, but in most cases overview and integration are lacking. This had been the case at LLUMC.

After institution-wide oversight had been created, the assessment process included a detailed mapping of the patient journey to understand the current experience and how it would change with the campus expansion envisioned by the master plan. Group and individual interviews with all major department heads added vital additional information, and interviews with senior leadership placed the project into the context of LLUMC's key priorities and strategic objectives.

Current systems and conditions were documented, including parking, valet, concierge, admitting, interior finishes, artwork, displays, and signage. All elements that contributed to or detracted from a great patient experience were identified, whether those elements were in the physical environment or were part of the organization's operational practices (such as how directions were given). Studies of patient and staff satisfaction were conducted to ascertain the institutional financial implications of its current wayfinding methods and to provide a baseline for evaluating the effectiveness of the new wayfinding system.

This broad and deep institution-wide assessment culminated with a report of findings and recommendations. Some solutions could be applied immediately for significant improvements in customers' experiences; others were incorporated into the master plan. The short-term solutions and longer-term recommendations addressed, among other things, new valet parking, interior design reinforcements to the wayfinding program (such as elevator and department destination treatments, pavilion portal treatments, and inlaid flooring graphics), ways of dividing the campus into identifiable areas and related recommendations for pavilion and elevator names, and design themes and icons. All of these were supported by exterior and interior signage (figure 1).

Before (A) and after (B) versions of the transition point between the main hospital and the children's hospital at Loma Linda University Medical Center.

Themes for the pavilions were based on words that would be inspirational to patients or honor major donors. This opened up opportunities for displaying artwork, imagery, and stories conveying the medical center's history and its international missionary role to make customers' navigation of the hospital not just easier but soothing, informative, and even enjoyable. More specifically, in line with patient inspiration and honoring philanthropy, the Wayfinding Committee dedicated much thought to identifying, naming, and theming the five pavilions: Serenity, Hope, Inspiration, Schuman, and Slater (figure 2).

Specially designed icons identify each of the five pavilions at LLUMC.

The pavilions became the core elements driving the interior design master plan (figure 3). For each pavilion, colors, icons, finishes, furniture, and artwork were purposefully selected to reinforce the pavilion's distinct identity (figure 4). Neutral colors were used for corridors that connect the pavilions and link other key elements, such as the main entrance and the primary elevators.

The floor plan shows wayfinding corridors and how the space is divided into pavilions.

Three (A, B, C) examples of how colors, icons, finishes, furniture, and artwork were purposefully selected to reinforce each pavilion's distinct identity.

LLUMC is now in the second year of its 10-year master plan, which includes seismic and cosmetic remodels of the medical center, as well as several large additions to the campus. An interdisciplinary committee guides the interior and wayfinding master plans, examining all decisions for their evidence basis and their contribution to a seamlessly excellent customer experience, from arrival to departure. LLUMC is coordinating the interior design and wayfinding programs with each remodel, so that the master plan unfolds consistently as each project is completed.

Having this integrated system in place gives LLUMC more purchasing power and provides a consistent, systems-based grounding for decisions about each project.

Not everyone understands wayfinding in the same way. To some, it is little more than signage. For others, it encompasses the entirety of the customer experience, providing the best lens through which that experience can be understood, along with the means and methods for improving it. At LLUMC, thanks to visionary organizational leadership, customer-centered wayfinding has gone from being understood as part of the interior design master plan to becoming the heart of that plan. HD

Annette Ridenour has invested nearly 30 years in transforming the built environment and creating healing experiences using evidence-based, patient-centered, and holistic design principles. Aesthetics, Inc., her San Diego interdisciplinary healthcare design and consulting firm, provides regional arts programs, wayfinding analysis and planning, interior design, and donor-recognition systems and strategies. Annette cofounded the Blair L. Sadler International Healing Arts Competition and is coauthoring a book about the arts in healthcare. She is currently writing a book on wayfinding, based on years of leading- edge work in the field. Annette also coauthored a chapter in the book Humanizing Healthcare, edited by Marie A. DiCowden, PhD.