Signalling the best way forward

Signage should be a major consideration for hospitals, especially from a health and safety perspective. Mark Hughes, from the Health and Social Care group at the Institution of Occupational Safety and Health, looks at the importance of the correct use of signage in hospitals.

Wherever you look in hospitals there are signs. They tell you what you can and cannot do. They inform you of hygiene requirements. They show you which way you need to go to the department you require. Signs come in all different styles and formats, with some printed and some handmade. It cannot be disputed that signs are necessary in a hospital environment.

They are a great way to warn the many thousands of people who go through the doors of hospitals every day of some of the risks and specific precautions that need to be taken. However it is important that there are not too many signs as this can lead to ‘sign blindness’. By this, I mean too many signs mean people switch off and walk by, ignoring them and potentially missing important information.

When thinking about signs in a hospital one of the most important factors in getting messages across is to have a joined-up approach between departments, including infection control, health and safety, communications, specialist and other departments, charities, volunteer organisations, and so on. All of these departments want to get their message across to the right people. But without a joined-up approach they can tend to use different methods and styles, which can result in a lack of control and standardisation of signs. This in turn leads to ‘sign blindness’. If signs are not used properly it can cause problems for patients and visitors, which in turn can lead to frustrations being taken out on staff.

Health and safety
From a health and safety perspective there are obvious requirements for signs. For example, they can be used to warn of dangers such as nearby X-Ray equipment, or they can be used to warn of potential hazards such as wet and slippery floors. All of these signs are off the shelf and come in either the mandatory or advisory colours.

There are, however, many more signs than those which warn of hazards to patients and visitors. Among them are those which inform patients how long they may have to wait to see a medical professional. These can, in turn, be used to protect staff. When people visit a hospital they will expect to queue but if they feel they are waiting too long they may start to get annoyed and agitated, which can lead to aggression towards staff – something which is unacceptable.

Hospital staff are there to do a job. As with people in all other industries they should be covered by a culture of care, something the Institution of Occupational Safety and Health’s (IOSH) Health and Social Care group – and the Institution as a whole – strongly believes in. This includes preventing them being the target of aggression from the public. Signs play an important part in this.

If you take accident and emergency departments as an example, signs can be used to warn people how long they may have to wait depending on their injury and how it was sustained. For a sports injury, the wait may be as much as three-and‑a‑half to four hours – essentially the end of the queue as the injury is viewed as self-inflicted. If the patients are warned that they must expect such a long wait this reduces the chances of them getting annoyed.

As technology has moved on, we now find in most A&E departments the use of TV screens to keep patients informed of waiting times. This has been shown to reduce the amount of aggressive incidents towards members of staff. As referred to earlier, another group of signs which are relevant from a health and safety point of view are those warning of the dangers of the different types of waste and wet floors. Positioning is crucial with these. They are there to serve a purpose but if they are left where people only see them at the last minute, there is a risk of a slip or a trip.

If used and positioned correctly these signs do serve a purpose. Hospital floors, for infection control purposes, tend to be mainly vinyl. However when wet can they can become slippery, especially with the wrong footwear. So signs need to be displayed to warn patients, visitors and staff and must be displayed well in advance of the area in question.

We must also not forget hygiene signs in key locations. This includes those in toilets which have information about good hand-washing techniques and the use of hand gels. They can also include when to stay away from visiting, such as if you have the winter bug, which can create the risk of infecting others, but these signs must be clear and on their own and not swallowed up among many others.

Good signage is also useful for directional purposes, both inside and outside of the building. For patients, arriving at hospital can be an anxious time. Hospitals can be big and scary places with lots of buildings, departments and people. Once inside a hospital, there must be clear signs to different departments. Generally outpatients areas are split into various specifics like fracture clinics and the common approach for directional signs is to colour code them. This means it is a case of following the red or green lines along the wall or floor to the relevant clinic.

Such signs can also be handy for patients who have to make their way to and from different departments, for example if they need to have their bloods taken.

It isn’t just patients who signs play an important part for. They are also important for visitors such as patients’ relatives and patient transport like taxis, ambulances and volunteer drivers. Clear signs are needed for drop-off and pick-up points and car parking. The same is the case for the relevant wards and clinics as well as coffee shops and restaurants.

The need for signs begins from the moment people arrive at a hospital. Car parking arrangements must be displayed. There should be clear signs taking you to the right car park for the specific department or ward you are visiting, including clear car parking fees and how to get a reimbursement if applicable.

If hospitals don’t get these signs right it can cause numerous problems. As with waiting time information, directional signs are important in preventing patients and visitors from becoming frustrated and taking this out on staff.

Standardising signage
Standardisation of signage and ensuring they are controlled is key. A successful way of doing this is nominating someone within each department and Trust wide to be responsible for monitoring the amount of signs and their clarity. Those nominated must ensure that the important messages carried in signs are not lost among too many trivial signs.

The use of technology like TVs to generate messages and keep people informed is a move in the right direction, but we must not stick with the same message over and over again; there needs to be a program in place to continually update and remove unwanted and old messages.

Even when a sign is temporary it should still be made to a specific standard and it must be removed when it becomes out-of-date.

An example of this is in infection control isolation areas. It is crucial that once the problem has been removed so should the sign. The responsibility of those nominated people can also include ensuring hospitals make use of the information that they have, for example which languages they need signs to be in.

Hospitals gather huge amounts of information about people’s nationality, so they must use this to work out who use their services. By doing so means that in the most important cases they can have signs printed in the key languages for the demographics of the area.

This again can help staff avoid potentially confrontational situations. Having signs printed in relevant languages significantly reduces the chances of having people getting lost in a hospital because they don’t understand the signs. So, signs are more than useful in hospitals, vital even. But it is important to remember that having too many signs can actually have a detrimental effect when it comes to health and safety as people can become oblivious to them.

Signs should be used only when necessary and should be clear and readable. If this is the case, staff in hospitals are able to get on with their job without the risk of coming into contact with agitated patients and visitors. This is one way in which hospitals can meet the culture of care which staff should be covered by.

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