Healthcare facilities are becoming ever more complex, making them more maze-like and unfriendly to their users. Factors such as poor vision, low literacy levels, and multilingual needs blend to become a nightmare when attempts at communicating complex medical jargon are made. Often the user is overwhelmed by the experience, feeling stressed and intimidated. In an ever more competitive marketplace, though, customers' perceptions of the facility are important; a medical facility should be perceived as a loving, inviting place that is integral to the healing process. Nowhere is this message communicated more clearly than at the point where the customer initially encounters the facility—at the wayfinding system.

The Uses of Wayfinding

Wayfinding uses the whole environment and patients' preconceptions to help patients find their way. It uses a wide range of clues, or cues, to help patients self-navigate into, around and out of a facility. These cues communicate on cognitive and subliminal levels; they include architecture, landscaping, color, lighting, and posted information in the form of signs. These elements work independently, yet in a shared environment, to direct people from one predetermined decision point to the next until the destination is reached. As individuals become acclimated to the spaces, the cues still function within the space as decorative features.

As indicated, signage is a crucial element in successful wayfinding. Effective signage identifies, informs, and directs; it contributes to a visual hierarchy for the entire built space. Examples in this article illustrate how this works. Attention initially, though, should focus on how effective wayfinding planning works.

Planning Wayfinding

Planning an effective wayfinding program requires a collaborative effort involving consultants and all levels of staff. An experienced wayfinding consultant should orchestrate the project, encouraging every discipline to bring its unique perspective and insight to the table. Thus, there are several members of this overall team, including, but not limited to, the project architect, the interior designer, the landscape architect, the wayfinding consultant, and the general contractor. Each member has a separate duty, but these duties come together to complete the wayfinding project, i.e.:

  • The project architect brings the overall project vision to all of the team members.

  • The architectural/interiors group takes the lead in determining the project color palette, as well as the building's overall form and function.

  • The landscape architect has to create a streetscape that works well with exterior elements of the building and functions well with exterior wayfinding.

  • The general contractor has to make all of the other functions work together; the design team, therefore, has to work closely with the general contractor to finalize plans for such issues as power requirements, coping with additional structures that may interfere with the plan, acquiring easements, and dealing with any permit issues that may come up.

From the standpoint of the signage designer, unique architectural features should be incorporated into the lexicon of interior and exterior signage, with signage contributing to a “streetscape” that accentuates principal features of the campus (figure 1). Signage, even if no longer needed as a communications tool, should blend in with the overall design.

Signage that echoes principal architectural features of the campus contributes to creating a unified “streetscape.”

Staff Involvement

Certain hospital staff members are key figures in the overall wayfinding project. There should be a designated project manager to coordinate the project team and sort out priorities, including budgets and timelines. Others involved include administration, planning, marketing, materials management, and the head of nursing, as well as other department heads and volunteers. Each of these positions has its own perspective on wayfinding. Thus, administration might focus on how the signage contributes to its marketing strategy (e.g., highlighting a women's health center); marketing reviews such details as corporate branding, including logos and colors (figure 2); nursing staff is concerned with the logistics of delivering care and moving patients accordingly; staff desires efficiency and clear communication in direct hands-on care; the engineering department would be concerned with durability of signage purchased and replacement/updating procedures; volunteers need in-service training and literature on giving proper directions (figure 3).

Signage serves the needs of marketing in boldly displaying organizational logos

Facilities need the proper tools to educate and unify staff in effectively communicating wayfinding instructions

The Planning Process

Demographic studies should be conducted to develop a target user profile, including prevalent linguistics and terminology. Medical personnel tend to want technical terms such as “Imaging” and “Otolaryngology” instead of the more user-friendly “EKG” (for example) or “Ears, Nose & Throat,” respectively. The cardiology unit can be called a “Heart Center” (figure 4).

Plain language descriptions of healthcare units/services aid the public in wayfinding

A wide range of origins and destinations needs to be defined and prioritized, and the best pathway for each delineated. The best route may not be the shortest; patients and families might be directed past the pharmacy or hospital shops on their way in and out. Patients probably shouldn't be discharged to the handiest exit if it happens to be located next to a dumpster. People under stress need simple guidance and support. Each decision point along the route needs to be looked at from the user's perspective—for example, is it an inviting space, properly lighted, and free of clutter? Is confusion minimized?

Consistency is another key to the success of a wayfinding program. Team members should consider all sorts of cues to unify the wayfinding plan—e.g., color coding, meaningful pictograms, and facility-wide numbering systems. Use of colors should be carefully planned so that the colors are readily perceived and arranged in a logical plan. Pictograms must be keyed to the understanding and cultural perceptions of users; not everyone will understand the relevance of a fish icon at first glace, but if it soon becomes apparent that the fish icon designates the second floor (figure 5), the message sinks in.

Consistent use of icons helps patients/visitors (especially if semiliterate) to locate themselves

All elements of the facility need to be taken into account in the overall plan. A simple example: News racks and ashtrays can be part of a fight for visual dominance; they should be part of the visual hierarchy, worked into the overall plan so that they don't interfere with signage or key decision points. Stop signs, no-parking signs, and other regulatory signs are too often an afterthought, and seen as an expensive one, at that. With planning, they can be integrated with the overall design at relatively little extra cost (figure 6).

Standard regulatory signs can be integrated easily into the overall design scheme, at relatively little extra cost, with foresight and planning

Designers should not be afraid to propose “wild card” or leading-edge concepts as options. They should tell clients that this might not have been tried before and explain how they might work to further their purposes—who knows what might come of it? Not long ago, touch screens were ruled out as off-putting and impractical; now they are commonplace at many banks and stores, and they are working their way into hospital wayfinding. It's because someone had the audacity to propose them as an option.

Design development and documentation involve typical signage layout and type styles, signage construction details, specific message schedules (lists and specs of signs to be fabricated), and corresponding location prints (numbers on the floor plan indicating sign locations). Even if early phases do not require presentation of all sign types, a good plan will anticipate future needs. These should be documented in a sign standards manual, and the documentation designed for easy updating and replacement of signs.

Current technology makes it affordable for many facilities to produce signs in-house; this should be done carefully to maintain the original design intent. Sign system standards should clearly distinguish when to use what sign type. Ultimately, the success of the wayfinding system will be measured by its users, answering for themselves this simple question: Is this facility easy to navigate?


Hospital staff needs to guard against allowing a deterioration of the wayfinding program and should occasionally re-examine and update it, as needed. A carefully designed signage program should be expandable, yet economical to maintain. HD

Randy Cooper is president and Roger Smith is vice-president of national accounts, Cooper Signage and Graphics, Inc., Snellville, Georgia.

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Healthcare Design 2003 November;3(4):37-40