Description

One trait hospitals have in common with cities is the impossibility for anyone visiting them to determine at one glance how to reach his or her destination. Often, different routes branch off from the main hospital entrance. All the corridors look exactly the same, and the signs bearing the complex names of a multitude of medical departments often make the search even more complicated. Patients wandering through these hospital spaces can experience increased stress and irritation. In fact, research inspired by the ideas of evidence-based design has shown that this problem of wayfinding can become quite costly; for when patients and visitors are obliged to ask the staff for directions, the latter are diverted from the tasks they are hired to perform. Craig Zimring discovered that the staff of a 300-bed hospital in Atlanta spent 4,500 hours per year dealing with such questions, which resulted in a loss of US $ 220,000.[106]

The basis for easy wayfinding is a proper logistical organization of the building. A clear zoning plan and layout are essential for enabling people to understand where they are and how they can reach their destination. Other measures — design-based distinctions that give various departments a clearly recognizable identity, signage systems, digital apps — may be very helpful in this regard, but they can never compensate for a chaotic, incomprehensible overall layout. How do people identify places? The theoretical groundwork needed to answer this question was presented in 1960 by Kevin Lynch in his seminal book The Image of the City. Although he wrote mainly about cities, his findings are also applicable to large and diverse buildings such as hospitals.

The initial requirement for successfully finding one’s way is a fixed point of reference. Wherever people are, they should be aware of the spatial relations of the surroundings with this one point. The key to grasping how wayfinding works is a process that Lynch termed ‘mental mapping’. Mental maps contain five elements: (1) paths — the routes people follow when moving through cities; (2) edges — borders and discontinuities; (3) districts — areas with a specific character that sets them apart from other areas; (4) nodes — places that offer a range of possible routes and demand special attention; and, finally (5) landmarks — easily recognizable buildings or objects. Hospitals that contain stable, distinctive and highly recognizable paths, nodes, landmarks, edges and districts are inherently more legible and easier to navigate than those that do not. It is difficult to mentally tag specific places in one’s mental map in hospitals which lack a discernable character or scalar hierarchy of these elements.[107] Recognition and identification of specific places in buildings can be enhanced by setting them clearly apart from other places through the use of colors, materials and furnishings.

A general layout that is easy to understand — and enhanced features that facilitate people’s capacity for making mental maps — should be supported by a clear and consistent signage system. Creating such systems has long been recognized as a crucial aspect in any large complex. In hospitals, graphic signs are used to inform patients and visitors. Apart from the ground floor, floors in a hospital are hardly ever continuous: in order to get from one place to another on the fourth floor, for instance, one often first has to go back to the ground floor. Naturally, this makes it more difficult to devise effective signage systems, and sometimes it is considered better to refer to buildings instead of traffic arteries (i.e. ‘districts’ instead of ‘paths’ in terms of Lynch’s mental maps). After establishing the principles of the signage system — in other words, to what it should direct patients and visitors — one must decide on the actual layout of the signs. The most important thing is to ensure that the chosen solution is applied throughout the hospital in a wholly consistent manner. Finally, it should be noted that touch screens can complement the designers’ toolkit, providing interactive support to help guide people to their destinations.

Maps are another obvious tool for facilitating wayfinding. They can be provided at the entrance and also be incorporated into a hospital’s interior decoration. But their effectiveness should not be overrated, as some people do not know how to read them. Finally, apps for mobile phones have been developed that help their users navigate through buildings in much the same way as they facilitate wayfinding in cities. They have revolutionized the latter process, but to tackle the problems of navigation in complex, multistory buildings they have to be custom-made. Moreover, they are obviously not helpful in places where the use of mobile phones is prohibited.

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Originally published in: Cor Wagenaar, Noor Mens, Guru Manja, Colette Niemeijer, Tom Guthknecht, Hospitals: A Design Manual, Birkhäuser, 2018.