Who would imagine that a duck and the letter H might have something in common? But these two images have extremely close ties. Both mark a destination with meaningful distinction; both serve as a beacon for potential users.

The duck is a gift shop selling Long Island duck souvenirs. The H is a gateway for patients and visitors to a hospital. Both “brand” the businesses they represent, and the linchpin holding these symbols together is the methodology and architecture of Venturi, Scott Brown and Associates (VSBA).

Over the past four decades, VSBA has promoted the symbol in architecture as a meaningful expression of a building's function. As a result, the Long Island Duckling (figure 1) was highlighted in Robert Venturi's 1972 book Learning from Las Vegas as a prime example of “a building becoming sculpture.” The H that appeared 33 years later as a billboard entry symbol to the main entrance-or as part of the “decorated shed,” as per Venturi's concepts-of Lehigh Valley Hospital–Muhlenberg in Bethlehem, Pennsylvania (figure 2), was designed by VSBA in association with our firm, FreemanWhite, Inc.
Photo courtesy of Lehigh Valley Hospital–Muhlenberg.

The hospital building is designed to be functionally efficient for staff, patients, and visitors. However, explicit and independent decoration is applied to the simple massing of the building, as in Venturi's “conventional shelter that applies symbols.”

While Lehigh Valley Hospital may be the first hospital in the United States to capitalize on what might be considered a hospital's most meaningful wayfinding symbol, the unconventional use of this letter was far from arbitrary. For decades, VSBA's designs have sought to include the history of architecture, as well as the complexity and richness of the urban landscape in which the resulting buildings are sited. “The big sign and the little building is the rule of Route 66,” wrote Venturi. Hence, it was no coincidence that our collaborating with VSBA would result in a big blue H facing Route 22 to signify Lehigh Valley Hospital.

The Long Island Duckling in Hampton Bays, Long Island, New York.

The History of the H

While the use of universal symbols for highways and public areas began in Europe as early as 1900, the largest boost to the acceptance of pictographic signs likely came in 1964 with the Tokyo Olympic Games. Thirty glyphs were introduced to overcome the language problems inherent in organizing such a large international event. Forty years later, Americans have become familiar with the pictures associated with “gas station,” “school zone,” and “restaurant” as a gas pump, two book-toting children, and a knife and fork, respectively. Likewise and predictably, the appearance of the H in the United States was similarly timed to the advent of highway signage for hospitals.

In the early 1960s, California was considered the state with the most highly evolved car culture and highway system in the country. As a result, California was also the first state to introduce the white capitalized H on a blue background to its interstate highway system to direct motorists to emergency healthcare facilities. By the end of the 1960s, the H had become an International Highway Sign and a universally recognized insignia communicating the availability of a hospital that accepted all emergency cases.

The Wayfinding H

With the H becoming the ultimate wayfinding symbol for hospitals within the English-speaking world, the H gracing the façade of Lehigh Valley Hospital may well form the quintessential gateway to healthcare. First, its meaning is exact (being the first letter in the word “hospital”). Second, it can have multiple views and, hence, multiple uses; from a distance it's an informative billboard announcement and, closer, it's a welcoming guide from the parking lot to the main entrance. Finally, within the icon itself is embedded a vast array of emotional and psychological meanings that far surpass its basic definition: Among its many meanings, the H alliteratively conveys health, healing, and hope, as we all wish our hospitals to convey.

Lehigh Valley Hospital–Muhlenberg in Bethlehem, Pennsylvania.

The Branding H

When packaged-goods companies alter their products, they also change packages to reflect the product's new face or image by featuring (in words and/or with visuals) competitively superior benefits. It is no different when a hospital designs a new facility or undertakes a major renovation-this is the perfect time for a hospital to redefine its image among its various constituencies, be they patients, staff, volunteers, community leaders, or physicians. Hospitals can reposition themselves and create stronger images in their environs—by design. They can underscore a depth or specialization in service lines or highlight technologic underpinnings or feature exemplary staff.

This is what the large blue H does for Lehigh Valley Hospital. It is the ultimate hospital brand and represents all the variously positive connotations of health within the facility's walls. And, as do all strong brands, the H has aided Lehigh Valley Hospital in its growth objectives. With the opening of the new building, the hospital has realized larger volume increases for cardiology services and overall hospital utilization, as well as substantial interest from area physicians (30 nonstaff physicians toured the facility within weeks of opening).

The Hospital Beyond the H

A large H or a beautiful building alone is not enough to guarantee quality healthcare. The best facility designs are a manifestation of an organization's strategy, operations, values, and culture. These are mixed together in various portions to provide a unique solution. As architect/engineer R. Buckminster Fuller said, “When I'm working on a problem, I never think about beauty. I think only how to solve the problem. But when I have finished, if the solution is not beautiful, I know it is wrong.” The Lehigh Valley Hospital collaboration resulted in a beautiful healthcare solution represented by an exemplary hospital gateway: an H pictograph representing (at least) 1,000 healthy wayfinding words and/or images.

The H: More? Less?

Modernist architect Ludwig Mies van der Rohe contended, “Less is more,” and for that reason would, I believe, have found the simple H appealing. Venturi, who responded with “Less is a bore,” would probably support the magnitude of meanings conveyed by the H. As for me, I'll have to give Venturi a call and ask if he might regard the H of Lehigh Valley Hospital as perhaps “more using less.” HD

Frank Brooks is the Chairman of FreemanWhite, Inc., an architectural engineering firm specializing in healthcare and headquartered in Charlotte, North Carolina. To reach him, phone 704.586.2326, e-mail

fbrooks@freemanwhite.com, or visit