Just as a team approach is used to treat a serious medical condition, a team effort can result in a more effective wayfinding system for a complex healthcare environment. Unfortunately, teams can sometimes play shorthanded.

The need for a new wayfinding system usually becomes most apparent when a medical facility undertakes a major new addition or renovation. But the “wayfinders” themselves are often brought in after the architectural and interior design firms have fully developed the new designs. In contrast, by coordinating the wayfinding effort with the work of the architects and interior designers, and by beginning that collaborative process earlier, healthcare administrators can shepherd the creation of a more user-friendly and accessible facility.

Design professionals, hired as they are by the facility itself, are often more attentive to the needs of the institution than the needs of its customers. Wayfinding, done right, focuses on those customers. The collaboration that can develop during the design process results in a better finished product for everyone.

The need for better coordination has been evident in two recent projects involving Corbin Design: Community Regional Medical Center in Fresno, California, and Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina.

Community Regional Medical Center

At the Community Regional Medical Center, which sits on a 58-acre site in downtown Fresno, the addition of a new 400,000-square-foot Trauma and Critical Care Building triggered the need for a new wayfinding system for both the original ten-story hospital and the new building. Part of the ultimate success of this effort resulted from effective communication between Corbin and RTKL Associates, Inc., the global architecture and design practice that designed the project. Becky Douthitt, the project manager who coordinated Corbin's wayfinding work, said Corbin's designers frequently turned to Alexander Faurot, RTKL's senior project manager, for advice on mounting signage to the building exteriors.

The signage posed a particular design challenge because it included individual aluminum letters up to 44 inches tall and an 11-foot-tall Community Regional Medical Center logo atop the Trauma and Critical Care Building's main tower (figure 1). “Many of today's buildings are clad with materials that don't have the strength needed to support individual letters,” Douthitt noted. “We really needed the architect's insight to figure out what would work structurally.”

Gary Sutherlin, a project manager for Community Regional Medical Center, sat in on several of the signage committee meetings during which the new wayfinding system was developed. “I think they went through a very logical process and came up with a good system,” he said.

Building-mounted campus identifier (Community Regional Medical Center, Fresno, Calif.).

Left: Atrium, looking up (Community Regional Medical Center, Fresno, Calif.).

One problem for the wayfinding system, though, involved the room-numbering system that the architects had used on their plans, starting with the schematic drawings produced long before Corbin was hired. “That became ingrained into the engineering, fire, life safety, nurse call, work order system, building management system—the total automation and operations of the building,” Sutherlin said. Logical as it was for numbering construction drawings, the numbering system would do little to support wayfinding.

Meanwhile, the room-numbering system for patient rooms, proposed by Corbin as part of its wayfinding system, was geared more toward the public and designed to better reflect the location and progression of the patient rooms. In addition, it was “stackable”—the logic of the room numbers on one floor matched that of the room numbers on the floors above and below. This made for easier wayfinding and direction giving for staff working from floor to floor.

Ultimately, because the two numbering systems did not match, two different sets of numbers are now used to designate the patient rooms. The “wayfinding” room numbers are be located on a sign at eye level to the side of the door, to serve public functions, while the “architectural” room numbers that serve the institution's functions are etched on small stainless steel plates on the doorframe above each door (figure 2).

“We probably should have brought Corbin in earlier and settled on our wayfinding room-numbering system before we actually got into final construction documents,” Sutherlin said. “If we had all been aware of the importance of that coordination and had started early enough in the schematic design phase with the architects, that could have been incorporated easily.”

Despite the hitch, the new wayfinding system is proving an overall boon to the hospital, Sutherlin said.

Most of the exterior and interior wayfinding elements, for example, provide wayfinding information in English and Spanish (figure 3), and some sign types display up to four languages—according to Sutherlin, an important consideration in a region with more than 60 ethnic populations.

Interior signage here and at Wake Forest University Baptist Medical Center (discussed below) uses a modular system with paper inserts (figures 4 and 5). “The nice thing about that is that they're easily changed,” Sutherlin said. “Hospitals are dynamic—people and departments change and move around, and even department names change. The system has to be flexible because the hospital's needs are so dynamic and are constantly changing.”

“Wayfinding” room number is beside the door; “architectural” room number is on the metal plate attached to the doorframe. (Community Regional Medical Center).

Identifier sign in English and Spanish (Community Regional Medical Center).

Wake Forest University Baptist Medical Center

Wayfinding was already a problem on the 86-acre campus of Wake Forest University Baptist Medical Center when a new $75 million cancer center and parking deck were proposed. “We had a lot of challenges,” said Hilda Haithcock, the healthcare provider's manager of interior design services. “We're on a hill in downtown Winston-Salem, and we're surrounded by the interstate and residential neighborhoods—in short, we're landlocked.”

Wake Forest encompasses well over 4 million square feet of space, spread among more than 100 buildings. Many of the buildings are connected. Because the buildings are on a hill, floor-level designations sometimes made little sense when moving from building to building. For instance, a visitor could enter one part of the hospital on the ground floor and have to take an elevator down to the main floor in another part.

Elevators throughout the medical center, as in many healthcare facilities, are hidden behind walls or at the end of corridors instead of being displayed more visibly in central locations. Since elevators function as vertical corridors, hiding them puts an unnecessary roadblock in the path of a person searching for a destination. Previous wayfinding efforts had amounted to little more than “sticking numbers and colors on things,” Haithcock said, only adding to the confusion. “There were symbols and letters and numbers on signs that nobody understood.”

The new Comprehensive Cancer Center brought further wayfinding challenges. While it connected to an existing building, that connection was from the fifth floor of the cancer center to the ground floor of the hospital.

Corbin Design was hired to develop a comprehensive wayfinding system that would simplify the task of navigating the medical center, while better coordinating signage throughout the system and making future updates and changes easier. “Having Hilda's interior design expertise, and the availability of staff architects who coordinated the efforts of the project architects, helped smooth the design and installation process considerably,” said Douthitt, who managed the Wake Forest project as well as the one at Community Regional. “When we needed design clarifications or more exact measurements, we turned to the staff architects who could provide them immediately.”

Interior signage uses a modular system with paper inserts (Community Regional Medical Center).

Another modular sign with paper inserts (Wake Forest University Baptist Medical Center, Winston-Salem, N.C.).

Building identification signs (Wake Forest University Baptist Medical Center).

Corbin's design team made it their first task to find Haithcock's office with no help from her, in order to appreciate the facility and its navigational challenges from the perspective of a first-time visitor. The designers then took many observations and recommendations to the first meeting with the client. One of their first observations was that the full name of the hospital did not appear anywhere on the hospital buildings, although the names of various medical facilities within the hospital did.

Corbin's work at Wake Forest went on to improve interior and exterior wayfinding by analyzing traffic patterns and destination names. In particular, Corbin's project team reviewed how public entrances were designated, how floors were labeled, and how people made the transition from parking garages to buildings. They also recommended the introduction of architectural landmarks to help patients, visitors, and staff better remember campus locations and develop more effective mental maps of the environment.

The resulting wayfinding system cuts through the signage clutter and building confusion in a number of ways, starting with providing exterior signs that better differentiate the three parking decks and vehicular guide signs that direct drivers to the appropriate deck based on their destination. “The parking deck operators have told me that people are having a much easier time getting to the correct deck and are not driving around in circles as much looking for their building,” Haithcock said.

Simplifying the often-lengthy names of the buildings also helped, Haithcock said. “We call things by one name now. The Richard Janeway Clinical Services Building is now called “Janeway Tower” (figure 6). The buildings are further differentiated by the use of photographic images of locations throughout North Carolina. A photo of the 180-year-old Ocracoke Lighthouse represents the Comprehensive Cancer Center, for example.

While some staff members have complained that the signage doesn't tell them how to get directly to a department in another building from the building they're in, Haithcock appreciates the simpler approach advocated by Corbin. The new wayfinding system is designed to create a more useable hierarchy of information, directing people to a building first, and then to the specific destinations within that building.

Accomplishing a simplified, effective wayfinding scheme required balanced teamwork between the wayfinding consultant, project designers, and owners—determining the need for the system, introducing it throughout various facilities, and selling it to the administration, faculty, and staff. HD

Jeffry Corbin is Founder and Chairman of the environmental graphic design firm Corbin Design