A mother of a pediatric patient once asked our hospital design team for direction and diversion: “Get me to where I have to go, and make me forget why I’m going there.” It’s a simple request, but in reality, a very tall order.

Visitors to healthcare facilities, our most complex building type, often roam, becoming lost either approaching or navigating these spaces. The traveler’s intuitive faculties are typically challenged because of a combination of things, from elevated levels of anxiety to confusion resulting from a cryptic set of directions, which are often exacerbated by a once thoughtfully placed signage system that’s been degraded over time with additions of irrelevant information. Hansel and Gretel thought to leave behind reflective stones to navigate their escape from a confusing forest—should patients have to do this, too?

Let’s first consider why it’s important for a facility (and its designers) to understand and manage a wayfinding system.

Is an effort being made to brand a facility as a patient-friendly service provider? Is money being spent on marketing specialty services? If so, how are those expectations met once someone approaches the building? Are the front doors clearly marked? Are there clear directional markers?

Upon entering, what clues are given about the quality of service being delivered? Is there immediate direction and distraction? Are guests greeted or left on their own, met only by a security guard asking for an ID? A discount store like Walmart sees value in a greeter system. Left without personal guidance, customers may not have the intended shopping experience in the comprehensive yet complex facilities.

After entry, healthcare patients and visitors traditionally head toward an elevator bank, often named by building or department. Have they been given a proper set of directions that allow for a simple cognitive map of the unfamiliar space? Can staff easily direct them to a department using fewer than four basic landmarks? Are there clear markers that are understandable and memorable? Is signage the only cue, or is there a hierarchy of memorable landmarks, describable works of art, consistently designed visitor portals, and moments of respite to reduce stress?

If long and complex travel distances can’t be avoided, stage the patient journey with personal and/or digital interventions.

As health reform changes the rules for medical care reimbursement, the patient experience will become a significant driver for design-related research. Using an evidence-based methodology, design teams will require additional data to fully understand the anatomy of the entire healthcare experience. Should we consider the impact of wayfinding in influencing the patient’s responses for environmental or performance evaluations? To put this question in context, Center for Health Design researcher Upali Nanda noted at a recent “Pebble in Practice” workshop how a patient’s perception of care delivery may influence the patient experience more than the actual recovery resulting from the delivery of care. Wayfinding might very well be a subtle but important first impression in the visitor’s perceived experience.

I urge you to give the complete concept of wayfinding its due, not only during new building programs but in ongoing facility audits, as well. Then, the next time Hansel and Gretel show up at your front door, have security relieve them of their pebbles, informing them that the pathway out will be as simple as the pathway in and that they will be met not only by clear direction but also pleasant diversion. Then track their satisfaction scores and report in.


Rosalyn Cama, FASID, EDAC, is president and principal interior designer of Cama Inc., in New Haven, Conn.She can be reached at rcama@camainc.com. For more information on The Center for Health Design, please visit www.healthdesign.org.