Bringing order to mega-growth

In 1998, Columbia Presbyterian Hospital made a bold business move: it merged with the Columbia University Medical Schools, New York Hospital, and the Weill Cornell Medical School to form New York’s largest healthcare system. Today this organization is split between two very distinct Manhattan campuses, separated by 100 city blocks. The NewYork-Presbyterian/Columbia University Medical Center site is located in the uptown Washington Heights neighborhood and has been known since its founding as a world-class hospital and research facility. Over the years this center has expanded into 25 acres, with 20 public clinics, scores of physicians’ offices, a 2,081-bed hospital, and a 254-bed children’s hospital.

A 2001 survey of NewYork-Presbyterian/Columbia patients found that most first-time visitors got lost trying to get to their appointments. For many reasons, including unchecked growth, lack of funding for public amenities, and simple oversight, the center evolved into a maze of unmarked buildings, conflicting information systems, and poorly maintained signs. New York’s top-rated hospital provided the best care but subjected many visitors to a challenging and frustrating travel experience. On any given day, the average visitors spent all or part of their travel time being lost.

Innovation and planning

In response to the challenges of the competitive healthcare environment, NewYork-Presbyterian/Columbia University Medical Center’s senior administrators commissioned a “visitor experience needs” analysis as part of a larger campus master plan. When it became clear that improving communications with visitors was the most affordable recommendation in the campus master plan, a new wayfinding program was approved and funded at the highest level.

Good design does not emerge overnight, however. Well before the program’s design, Sylvia Harris was hired as an independent project leader to develop a design innovation process to address all of the planning, strategy, and management issues that can typically derail complex design projects. The successes and challenges she encountered and the five-step design management process that was used are described in what follows:

Step 1: Assessment

The very first step in the process was to commission an assessment of the root problems of wayfinding. Working with environmental psychologist Peter Hecht, PhD, a team of researchers conducted visitor interviews and tracked, observed, and documented visitors in the process of getting lost. The team discovered that many patients and visitors got lost because they started out with the wrong information and entered the complex at the wrong building. Once those mistakes were made, only confusion followed. Another key finding was that many signs were inaccurate and misleading because there was no mechanism to fund or maintain signs along the public pathways. All of these factors were compounded by the fact that the complex had grown organically over many years, leading to a labyrinth of indistinguishable interior hallways.

Step 2: Management

It was clear from the start that this complex wayfinding project needed to be managed by a steering committee made up of stakeholders from the Hospital and the Medical School. Harris led the committee through a series of strategy sessions to create a campus-wide wayfinding policy addressing accessibility, campus character, branding, nomenclature, and language.

This committee also supervised the development of the project budget, staffing, and the hiring of designers. After several experiments with different models, the right management model was found. The key to the project’s success was the introduction of the new position of Visitor Information Manager, which was filled by Mercedes Perry from NewYork-Presbyterian and by Maria Delgado from Columbia University, who shared this role. These critical producers reported to the marketing department and kept the project focused and moving forward despite the inevitable distractions and delays.

Step 3: The strategy

Well aware that people navigate using a wide variety of clues and cues, the Steering Committee chose to develop an integrated approach to wayfinding and began to plan a program that did not rely only on signs and architectural cues, but also gave visitors access to helpful people and coordinated information systems. The Steering Committee vetted and hired Cloud Gehshan Associates (CGA), a well-respected environmental graphic design firm from Philadelphia, who designed the new signage and wayfinding systems. CGA, led by Virginia Gehshan, devised the following wayfinding strategy:

• Focus primarily on improving exterior navigation and help visitors find the right entries by creating highly visible exterior building addresses (figure 1)

• Create a new exterior signage program that features the brand signatures of both the hospital and the college (figure 2)

• Use off-the-shelf interior directional signs (in English and Spanish) for the ground floors of buildings with significant public traffic

• Develop a standardized signage program for directional and identification signs on upper floors to be implemented with minimal change with each interior renovation

• Create a new campus map to be used consistently on all out-going communications (figure 3)

• Provide training and improved support materials for security and welcome desk staff

Step 4: The design

The design team assumed that by clearly marking the campus perimeters, building entrances, and elevators, most visitors would be well on their way to finding their destination. Today, large freestanding pylons (figure 4) serve as beacons for major access points. Distinctive identification signs boldly displayed institutional brands, the street address, and building name for every major entrance. A simple off-the-shelf sign system with changeable paper inserts is now the standard for interior directional and identification signs. These signs include Spanish translations and Braille to support a wide range of visitors.

The medical center at 168th Street is made up of many institutions, each with its own brand signature. Today, all major signs and banners display the carefully coordinated graphic signature and colors of both the college and the hospital. This helps reassure visitors that they have, indeed, arrived at the right place.

The new campus map is the cornerstone of the wayfinding program. Creating a clear and simplified campus map that is used consistently for all visitor communications-from the Web, to sidewalk signs, to building passes and visitor guides-is a significant improvement. The project has additional goals of creating a central database of standard travel instructions that can be accessed by all staff secretaries and referral services.

The hospital staff is an integral part of the new wayfinding effort. Today, the gregarious security desk staff, which is truly the face of the institution, is given the tools to help translate the visitor’s travel notes into clear and useful instructions. Another important element of this initiative is the use of new, information-rich, paper, building passes that clearly lay out building and floor information in English and Spanish. Each pass also features a clear map on the reverse side (figure 5).

Step 5: Implementation

The project team has negotiated approvals from dozens of internal departments and stakeholder groups, as well as federal, state, and city agencies, to design, fabricate, and install over 200 signs throughout the exterior and interior ground floor of the complex. Today a new campus-wide exterior sign program and supplemental information materials are in place. As noted earlier, instead of creating custom signage for each interior renovation, a standardized signage program is being implemented with each new construction project. The entire initiative has been developed over seven years, cost approximately $4 million, and is at 70% completion.

Lessons learned

There were many setbacks and successes along the way, and lessons learned accordingly.

Lesson 1: Wayfinding is not just about signs. The best wayfinding systems do not rely only on signs for navigational support, but also leverage a wide variety of other mediums, including electronic media, printed materials, and knowledgeable staff.

Lesson 2: The management team can make or break a wayfinding project. A good integrated wayfinding program requires cooperation across many departments and disciplines. After quite a bit of trial and error, we discovered the right management mix for this organization (i.e., dedicated project managers reporting to the vice-president of marketing while collaborating closely with the facilities site director).

Lesson 3: Good communication does not have to be expensive. Our most successful innovation was to convert the existing plain building passes into information-rich wayfinding cards. At no additional cost, the passes were redesigned and bid out for reprinting at a cost savings. The new passes are now a cornerstone of our wayfinding program.

Lesson 4: Start the project at the end. Implementation was delayed for a year while the team waited for required sign-offs and approvals from the city and state regulatory agencies. Instead, exterior signage programs should start with a prereview of all of the regulations that might hinder the project in the future. Permitting and variances can be in the works well in advance of the implementation phase.

Lesson 5: A new wayfinding program is cheaper than a new building. A multimillion dollar wayfinding program is often hard to sell to cash-strapped healthcare organizations. However, a wayfinding makeover, when compared to the significant cost of an average $100 million building project, is money well spent that can have an immediate impact. HD

Sylvia Harris is the principal of Sylvia Harris, LLC, a planning and management firm specializing in visitor information service development. Contact her at

sylvia@sylviaharris.com. Mercedes Perry and Maria Delgado are the visitor information managers at NewYork-Presbyterian Hospital/Columbia University Medical Center.

For further information, e-mail perryme@nyp.org.

Healthcare Design 2009 May;9(5):60-68