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In an age of austerity, and with two out of three hospital trusts running a deficit, it seems highly improbable that there is any spare cash floating around. Perhaps, though, the challenge is to agree what is essential, especially in older hospitals which have developed over many decades into almost unfathomable labyrinths. Wayfinding may not seem a priority, but a proper understanding of its role shows that it is a low-cost investment with high returns.
Two of the latest hospitals, South Glasgow University Hospital and the Queen Elizabeth Hospital in Welwyn Garden City show what can be done when funds are available. There are floor plans on the web site, so that pre-planning of visits is possible.
These days the value of involving users in the development of facilities across the NHS estate, whether they are patients, staff, suppliers, or supporters, has been recognised. The importance of this is not just the invaluable insights provided by the people who actually use the facilities, but they can also help achieve better solutions to problems at a lower cost. But how does wayfinding fit into this? Surely signs that have been fine for decades, can continue to serve in the future? And surely they cannot be seen as a priority when there are so many demands on Trust purses.
The issue is that whilst new facilities are well designed and planned, the vast majority of NHS facilities are old, and nearly all have evolved to meet changing needs. This means that what worked before, doesn’t necessarily work now. But there continues to be a need for people to enter, traverse and exit any hospital facility. In older facilities, a large amount of signage which lacks any consistent use of colour, typeface, design or symbols is not untypical. It is probably fair to say that as wayfinding has not been a priority for many years, if ever, there are a large number of hospitals which have become increasingly difficult to navigate as they have changed or expanded over the decades.
Independent studies prove that an inefficient wayfinding system for a hospital can cost up £350 per bed per annum. In a 900 bed hospital, that equates to over £300,000 every year. Imagine what that money could be used for.
The personal journey
So in considering wayfinding as an investment, with strong returns, hospital authorities need to understand where the best gains can be made with the least outlay. An audit is a sure start: observation can be very effective – are there junctions where people regularly don’t know where to turn, are there areas where staff have to spend an inordinate amount of time providing help and assistance, etc.
More formal research using questionnaires and interviews will help gain an understanding of peoples’ journeys, their needs, and how they interact with the architecture and spaces in the facility. Ideally, this will take place in advance of any refurbishment, so the results can be applied as part of that work. In practice that is not always possible, and the audit needs to take place on completion. The output should be revised wayfinding that integrates with the existing system, and doesn’t become something that is separate and applicable only to the new facilities. Taking this approach will enable staff and visitors to become familiar with the system more quickly, reducing any disruptions where there is an intuitive sense that the wayfinding system is not up to standard.
Beyond finances, there are safety issues – ensuring that visitors don’t head to inappropriate areas, and that staff cannot become disorientated in times of high pressure, as well as reducing congestion by managing (people) traffic flows.
Efficiency gains come from reducing late appointments and reducing the time taken for people to move around the facility between departments. There are emotional benefits as well with reductions in stress as people are more confident about coming into and moving around the hospital.
Good wayfinding can lead to increased patient empowerment and increased inclusivity with signs tailored to the needs of both older and disabled patients. There is also the question of how good wayfinding contributes to the branding of the hospital. In an age where ‘customer experience’ is a key driver for the NHS, such considerations are vital. Hospitals should regard wayfinding as just one ‘touchpoint’ in the broader patient care experience. As it is part of the journey it has to be made to join up with all the other elements and fixing isolated parts often falls short of changing the experience. The opportunities for feedback demonstrate that in all areas hospitals must be ready and willing to respond to patient and visitors comments.
Wayfinding starts with three key principles: providing orientation, direction giving and decision making. The wayfinding strategy must help people make sense of a place and use cues to find destinations and achieve various goals, and the implementation will see good signage at key points. But it may be more than just signage – volunteers can form part of a strategy as people like to have a personal touch that volunteers can provide. Colour coding of corridors and different areas can be very effective in providing immediately recognisable and easily understood destination points.
Often symbols can be used to break down barriers, and where wording is used, the preference should always be for layman’s language rather than medical terminology. This approach also improves inclusivity by making it easy for everyone regardless of their first language, age, or any disability.
The best wayfinding strategies recognise that a journey doesn’t start when someone arrives at the hospital, it starts even before someone leaves home. An optimal wayfinding strategy will adopt a ‘joined up’ approach, taking the person from the start all the way to the end point. So it is enormously helpful to have floor plans and journey planners on the facility web site – this means that from the outset the visitor has an idea of how to get to where they are going to. Direction signs from local roads guide people in, and then take them to the right car park and onwards to the hospital itself. Naturally, not everyone comes from the same direction, or uses the same entrances but too often, signage can often be located assuming everyone comes in the main entrance.
Making an entrance
Entrances to different departments need to be clearly visible, and once inside a hospital there needs to be a balance struck between how much visitors are guided by signage, and how much they interact with reception staff. From the arrival areas, people need to be clearly guided to their destination point, and given reassurance along corridors – and if they happen to make a mistake, given the opportunity to get ‘back on track’ at every relevant stage.
For outpatients with an appointment, they need to get from home, through reception and to the right department in a timely fashion.
Appointment letters should include not only the time of their appointment, and the department but also provide directions – public transport routes, the right car park, the best entrance and how to reach their final destination. Even a link to where that information can be found on the website can be very useful. Where texts are sent as reminders, a web link should always be included.
Finding the right direction
In the same way, breaking down a journey into manageable elements can be highly effective. So, for example, where someone is navigating across the hospital along numerous corridors, which probably all look the same to them, landmarks can be introduced to help people orientate and for people to be given instructions. These need not be signs, but could be refreshment points, works of art, changes of wall colouring – anything that is describable and can be included in the directions.
Getting wayfinding right is more critical in a hospital because they are stressful environments – visitors coming to see a sick friend or relative, staff needing to provide care in a time critical fashion, or even suppliers who have busy schedules to adhere to. No‑one is going to pretend that budgets are easily available, but if good wayfinding can demonstrate its financial benefits, it should move up the list of priorities.
Mid Cheshire NHS Trust’s ageing IT estate was causing significant problems. Amy Freeman, the Trust’s Associate Director of IT, identified a number of challenges that needed to be addressed when she joined the organisation in 2016.