Do you have a decent sign system, but visitors are still getting lost? It may be time to develop a coordinated suite of “non-sign” wayfinding tools that addresses problems conventional signs cannot. Signs often proliferate when either staff or visitors are experiencing wayfinding problems and voicing complaints; these visitor outreach tools address the root causes and help keep sign clutter in check.

Geisinger Health System, cited by President Obama as a national model of healthcare reform, recently built the Hospital for Advanced Medicine, a state-of-the-art addition to its central Pennsylvania complex. Geisinger retained Cloud Gehshan Associates (CGA) to develop a sign system for the new building, which could also be phased into the existing facility. The sign system was designed to handle the complicated main complex, as well as nearby satellite locations.


The tools should fit the problem

To better address the entire guest experience, Cloud Gehshan and its wayfinding specialist Peter Hecht, PhD, suggested that Geisinger implement print, Web, electronic, and environmental elements to solve navigational challenges more effectively, and with more flexibility and lower costs, than signs. These are now being phased in.


Wayfinding begins at home

Wayfinding is an experience that begins at home and ends when the patient exits the site. CGA’s wayfinding wheel summarizes this process. Each “step” in the wheel represents an opportunity and obligation to help the visitor get to the right place with minimum frustration and staff time.

Valerie Faden, the project director who led the wayfinding program for Geisinger, was an early advocate of this integrated approach. She has frequently used the wheel to explain to colleagues the breadth of the wayfinding effort and how it meshes with Geisinger’s mission of innovative service.


Pre-visit and travel

CGA suggested an appointment slip as the ideal way to start the visitor experience. Geisinger mails a reminder to patients in advance, but this improved appointment slip also reinforces which Geisinger facility to visit (because there are many in the area) and includes specific travel information, such as driving directions and an area map. The hospital website also is an important source of visitor information and will be updated to dovetail with the new wayfinding program.


This welcome mat is paper


Geisinger has a large site with a garage, surface parking, valet parking, and shuttle buses; the options can be bewildering to first-time or infrequent visitors. Compounding the problem are multiple building entrances, not all of which lead to all destinations. Site signage cannot begin to address the questions that arise for a visitor, but an appointment slip can. An appointment slip can brief the visitor in advance with customized information about where to park or drop-off, how the shuttle system operates, and which entrance to use. It can also address the issue of multiple appointments and the navigation to each. Helpful phone numbers also can be included since most visitors carry cell phones.

One important detail: the nomenclature on signs must exactly match the nomenclature used on the appointment slip so there is no cause for confusion.

Geisinger’s parking garage is new, and CGA’s interviews found that visitors were reluctant to try it, preferring the existing surface lots. CGA added friendly and distinctive level graphics that reference the five surrounding counties. To further assist, CGA designed “You Parked Here” takeaway cards so anxious guests have one less thing to remember and worry about.


Helping visitors self-navigate


Once inside the correct entrance, a personal welcome comes from the concierge staff. Visitors who prefer “self service” can scan the helpful signage: building directories, directional signs, and maps. But CGA also suggested non-sign wayfinding aids that can be used as needed: a takeaway brochure with map and complete hospital information, or a “quick guide” reference sheet with most-visited destinations and phone numbers. Visitors can refer to these pocket guides as they move about; they reduce the number of wall maps needed and also provide information about amenities, such as food service locations, chapel, and gift shops.


Circulation and destination

Multiple elevators and service locations are just two of the significant interior wayfinding challenges at Geisinger; another is the long distances patients must sometimes walk. To lessen the frustration, CGA suggested a visitor pass, which allows the concierge to check off the correct elevator and floor. The pass acts as a reminder and, just as importantly, gives a stressed or forgetful visitor something to show staff members along their way. To do their part, the signs should respond to guest needs at every decision point without being overly assertive.


Interior cues

The emergency department at Geisinger is especially difficult to find, particularly for “walk-ins” trying to reach it through the interior. The concierge or other staff found themselves trying to describe the route to ill patients and, if necessary, physically leading them there. CGA recommended that Geisinger install a red vinyl wall base leading back to the ED so the concierge or other staff members could quickly explain, “follow the red line.” It is a much more immediate solution than directional signs and has been very successful.  



CGA developed new maps for Geisinger as another non-sign wayfinding device. The new maps duplicate the graphics and terminology used on the signs; they include only visitor information (not staff features) and show circulation selectively. Most significantly, the maps only show what a visitor sees when moving through the facility; this is especially important when a visitor is moving through a “superblock” with multiple attached buildings. 



Landmarks are helpful to staff giving directions and make the journey more memorable for visitors. Landmarks can be unique architectural features (a large lobby space), wall treatments (donor wall, murals, or artwork) or artifacts (flowers, fish tank, exhibit). Views to the outside can also act as landmarks and aid in orientation.


Elevator lobbies

In addition to critical wayfinding nodes, elevators are important landmarks. Elevator lobbies should look like lobbies, not hallways. Ideally, the interior design of elevator lobbies is unique, with distinctive wall, floor, and ceiling treatments. It is especially critical to have sufficient lighting at the elevators so visitors can read the elevator directories and reference maps and appointment slips.


Interior and architectural improvements

The number one way to reduce sign quantities and increase visitor comprehension is to make the facility layout less ambiguous. Flooring, wall, and ceiling treatments should work in support of wayfinding by highlighting decision points or destinations. The main corridors should be reinforced. Clear transitions between front and back-of-house areas are a must: slam doors, for example, should fold into the wall so they do not give the false impression that they lead into “staff only” areas.


Behind the scenes


Terminology, or nomenclature, is a critical “thread” that runs through signage, electronic, print, and Web applications. Medical terminology can be confusing to visitors, especially when multiple terms are used for the same destination (e.g., radiology versus imaging), when a large department (such as cardiology) has multiple subunits, or when the same service (such as an outpatient lab) is located in several places. If not addressed, both non-sign and sign wayfinding are compromised. CGA worked with Geisinger to achieve consistent nomenclature for print and Web applications, as well as signage.


Constant change

Signs don’t work when they are out of date and, since hospitals are constantly changing, a high degree of flexibility in the sign system was a clear priority. Many sign types, such as building directories and hallway directionals, require frequent updates. Others, like signs in the shuttle buses or for valet information, require less frequent—but still crucial—updates. For the fixed signs, CGA employed a catalog system for which the Geisinger sign shop, or a fabricator, can produce inserts.

When the facilities department requested even more flexibility for the lobby directories, CGA recommended that Geisinger move to an electronic directory that could be easily updated at any time. An important requirement was that the directory interface with the existing hospital IT system. The new system will have both display and touch-screen capabilities.


Policies and management

CGA believes that policies play a crucial role in the management of sign content, terminology, visitor communication tools, new sign ordering, and sign maintenance.

Geisinger is finalizing who will manage the ongoing implementation and coordination of the wayfinding elements, whether interior, architectural, marketing-related, Web-based, or signage. Maintaining consistency over time and among departments is a challenge; institutional memory can be short and priorities can be forgotten or misunderstood.

Another management challenge is the timing of related wayfinding activities—the printing of maps, for instance, is likely on a different timetable than interior renovations. Wayfinding managers must solicit input from different constituents, both at the project outset and later, as the program evolves.


Seamless wayfinding

A successful hospital wayfinding system should respond to visitor needs at every touch point with guidance and information. Visitor outreach tools can give detailed instructions and customized assistance that signs can’t. The collaboration of Geisinger’s facilities, IT, and marketing departments in welcoming guests is yielding a successful wayfinding program that supports the health system’s mission of superior customer service. The non-sign wayfinding tools, in particular, are increasing flexibility, lowering the costs, and increasing the success of the sign program. HCD


Architecture/interior design:  Ewing Cole.


Virginia Gehshan, FSEGD, is Principal at Cloud Gehshan Associates in Philadelphia. For more information, please visit