Curing the hospital

Like airports, hospitals present huge challenges for wayfinding. Not only are the premises usually large and sprawling, but those who use them are frequently stressed and in a hurry. And recently, the challenge to achieve optimum navigation has got a whole lot greater. Hospitals have become increasingly complex with a multitude of stakeholders, ranging from medical care providers to the cafeteria franchisee. The current hygiene preoccupations to counter hospital superbugs have led to another layer of signs on top of the already overloaded environment.

Even before these latest pressures, a US survey by Craig Zimring calculated that 4500 staff hours are given over each year to directions in a 604-bed hospital – equivalent to two full-time posts. It’s clear that inadequate signs aren’t a mere irritation – they can have direct impact on the medical service provided. So what’s the best way forward? Colour-coding, pictograms, multilingual signs? Or perhaps even satellite navigation that gives you a personalised wayfinding programme as you navigate the premises?

According to experts, the answer is rather less exciting – to place wayfinding at the heart of an architectural design that encourages intuitive navigation, and use signs within a far broader communication strategy that extends to the types of letters that patients receive for their appointments. Signs, everyone agrees, are just the tip of the wayfinding iceberg, while the wayfinding strategy itself should be fundamental to hospital design from the onset of the project.

‘It’s very, very difficult,’ says Colette Jeffrey, wayfinding design director of Enterprise IG. She should know – Enterprise IG has recently completed a wayfinding guidance document for NHS Estates and has implemented sign strategies at many hospitals, including Central Middlesex Hospital and Royal London Hospital. ‘Unless you work with the architect right at the start, you end up fire-fighting at the end and doing free-standing signs,’ she says, adding that architects rarely think about where the signs are going to go when they design a grand entrance atrium.

What’s needed is someone at each hospital who can champion the many aspects of wayfinding within the environment says Lorna Wain, design strategy manager at Guy’s and St Thomas’s in London, which is planning to introduce new signs.

As part of the £3m Face project to improve the hospital environment, Wain has been addressing such diverse issues as the most useful address – not necessarily the postal address – to give outpatients the information given in the appointment letter, and the most practical names for various departments. Another task is dealing with the visual clutter of ad hoc signs. All these factors contribute to successful signs. ‘We’re engaging with departments who see signs not as wayfinding tools but as promotional tools for what they are,’ she says.

Sadly, not everyone takes a strategic approach to wayfinding. At Kidderminster Hospital, architect Mungo Smith of health specialist Maap Architects was frustrated when his practice’s concept to send all patients a properly designed map with their appointment letter was not taken up. He’d seen this done to good effect in hospitals in the Netherlands and Scandinavia, where receptionists personalise the map for the patient by drawing a route on it for them to take.

He is also frustrated by hospitals seeing signs as an opportunity to further their corporate identities, rather than deliver information. There is no compulsory system, although Jeffrey recommends using sans serif, bold weight typefaces such as Frutiger, which Enterprise IG used at Central Middlesex Hospital, and no condensed fonts or italics.

Colours and symbols are used clearly and attractively at London’s new Evelina Children’s Hospital, where signs (designed by architect Michael Hopkins & Partners and manufactured by Drakard & Humble) incorporate colour-coding and icons such as beach, mountain and savannah to indicate different areas of the hospital. A strip of colour is applied at the bottom of each sign, rather than for the whole thing.

Such an approach is sensible, says Jeffrey, who similarly used accent colours at the Whittington Hospital in London. She warns that excessive colour-coding can overwhelm and be ineffective, and can cause problems with legibility because of poor stand-out. There’s also the problem of colour blindness. ‘If you link hospital signs with lots of colours the reality is just confusing. Keep it simple and try to work out where people are going to and what they’ll see in the environment,’ she advises.

And what of the future? Kasper de Graaf of Applied Information Group moots the idea of hand-held personalised navigation systems, or at least the delivery of information in the way that people want to receive it – whether terminals or physical maps. But whatever the medium of delivery, the message is clear – wayfinding has to be at the heart of the building design process for signs to have any chance of being effective. ‘Things are getting more complicated. But the best systems are there to simplify,’ he says.