When Tom Rockers arrived at St. Anthony’s Medical Center in St. Louis as the facility’s new president and CEO in 2003, he had a mandate from the hospital’s Board of Directors to improve all facets of operations. It didn’t take long to determine that one fundamental change that needed to be made was a seemingly simple one: Improvements in signage and wayfinding on the medical center’s campus in South St. Louis County.

Carl T. Martinson

Carl T. Martinson

Early on, concerns about the hospital’s existing signage had bubbled up from the members of Rockers’ newly-formed Management Advisory Group (MAG). They clearly understood—from patient complaints, patient satisfaction survey data, and simply from their own personal encounters with lost visitors—that current signage was an issue that needed attention and a truly systemic solution.

In early 2004, MAG got the improvement process under way by interviewing five vendors. Ultimately, the hospital’s leaders selected Atlanta-based Cooper Signage & Graphics (CS&G) to direct the initiative.

Key initial findings

CS&G’s initial review of the signage and wayfinding system found several issues to address: Existing signs were cumbersome—including type sizes that were too small, text that was too long, and terminology that was neither consistent nor systematic.

Based on these initial findings, MAG and CS&G agreed that work would start with interior signage and a new wayfinding scheme to be implemented in the main hospital building.

A pilot program

In June 2004, a general remodeling of the main hospital’s first floor was scheduled to get under way. The MAG and CS&G signage team decided to use this remodeling work as an opportunity to test a new approach for internal signage/wayfinding. The team recommendation addressed all the previously-identified concerns by:

  • Creating a visual hierarchy, and providing a systematic and consistent way to update

  • Developing a functional, utilitarian scheme for wayfinding, specifically designed to keep people from getting disoriented and confused

  • Adopting graphic standards to make signage that is attractive, easy-to-follow and effective at reinforcing the hospital’s brand/image

  • Addressing patient/visitor concerns around their overall comfort, ease-of-navigation, and overall impressions of the facility—as recorded in the Press-Ganey patient satisfaction scores

Approximately 150 signs were installed by the end of January 2005 throughout the first floor of the Medical Center. The impact was immediate; the newly installed signage/wayfinding system helped patients, visitors, and staff begin to navigate the first floor with ease. In addition, several prominent directional signs now incorporate a logotype likeness of St. Anthony, the hopsital’s patron saint, helping convey the facility’s mission as a Catholic faith-based organization.

Patient satisfaction survey results confirmed that the new signage works. Patients noticed and appreciated its contemporary look and feel. They reported that it seemed more welcoming and less institutional—and it definitely made it easier to get around the hospital.

Phase two: Complete installation

Given the success of the pilot program, CS&G went to work developing a signage system for the remaining seven patient care and ancillary floors at the medical center.

One useful feature of the previous system is that many patient floors at St. Anthony’s carried a unique color palette. This existing feature was incorporated through the floor-specific color scheme into the new signage system for the medical center.

Patient and visitor comments were also drawn upon to implement another important change. In survey responses, visitors often reported that elevator lobbies were not well marked: When people got off the elevator, they weren’t always sure that they had arrived at the correct floor. This concern was addressed by developing large wall-mounted floor numbers. These new signs incorporated the St. Anthony’s logo, enhancing the medical center’s branding efforts. They also included information about what was located on the floor, giving visitors extra confidence that they were in exactly the right place (figure 1).

First-floor elevators with directional elements

A twofold challenge: Physician office building signage

Like many major medical centers, the St. Anthony’s campus includes a set of Physician Office Buildings (POB) connected to the hospital itself. This architecture and layout helps physicians and staff make better use of their time, but it adds to the physical complexity of the campus.

Two major signage issues were identified. First, getting patients from the parking lot to the correct POB elevator; second, getting patients from the parking lot to the main hospital building by going through the physician office building.

The flexibility and adaptability of the base signage system proved to be a key asset in solving the “correct elevator” challenge. Starting at the entrance, a series of ceiling- and wall-mounted signs directed patients to one set of elevators for those who were seeing a physician in Building A; and to another set of elevators for those whose physicians had their offices in Building B. Major directories—with easy-to-read lists of physician names—were also an important element of the wayfinding plan.

Because of the availability of parking, many visitors would enter the POB, thinking they had arrived at the main hospital building. As a result, these visitors often needed help getting to the main hospital lobby (figure 2). Again, strategically placed ceiling- and wall-mounted signs were used to eliminate much of the confusion.

St. Anthony’s Medical Center main lobby

A familiar look and feel at off-campus facilities

In addition to the main medical center, St. Anthony’s operates three Urgent Care Centers (UCC) that also provide office space for physician practices. Interior signage at these St. Anthony’s-branded facilities was similar to that used in the POB buildings on campus. At each facility, the wayfinding challenge included devising a simple strategy for getting people to the correct building entrance, whether for the UCC or for the physician’s office.

Exterior signage was a particular concern. A user-friendly design was needed, so that people who arrived at the UCCs seeking treatment for minor emergencies and illnesses would know they were in the right place. Large building-mounted and freestanding signs helped solve the challenge, by easily attracting attention at any time—day or night. Additional monument signs—located just off the street in the parking area—handled the need for directing visitors to the physician office located in the UCC buildings (figure 3).

“Image-driven” off-site branding resulted in a significant increase in business within weeks of updating the exterior signage

Along with the UCCs, the St. Anthony’s family had also recently grown to include an important outpatient facility focused on women’s health (figure 4). The signage challenge at this facility was complicated by the fact that the Women’s Health Center also housed an outpatient surgery center, a senior center, and physician offices.

Outpatient facility/medical plaza

This challenge was tackled with a multifaceted strategy. A large building-mounted sign was installed to identify the Women’s Health Center. This gave the center it extra prominence, both because Women’s Health represented a new service area at St. Anthony’s, and because a competitor’s facility had been opened just down the street. However, it was also important to let people know what else was inside the building. Therefore a large freestanding sign was installed near the entrance to the building. This secondary sign provided complete information about all the major services and activities located in the building.

Keystone achievement: A new campus identity

Originally constructed in the mid-1970s, St. Anthony’s has been expanded several times over the years. It’s considered a community icon by many who live in South St. Louis County. But by the early 2000s, the campus had lost much of its “curb appeal”. First impressions were not very welcoming: The medical center had evolved into a very hard look—a “big white box on a black asphalt parking lot”—that was not well differentiated from nearby office buildings or strip shopping centers.

In 2006, St. Anthony’s announced another major addition to the medical center, and as part of this initiative, an ad hoc team was created to develop a new “look and feel” for the campus. The team consisted of the project architects, senior administration, construction management, and CS&G.

The team’s recommendation included dramatic new landscaping and an extensive set of identity sculptures and entrance portals. These new features combine to serve as identifying points—letting visitors know that they have arrived at a place apart.

Work began on the campus identity project in late spring 2007. The first order of business was to secure permits—including variances to local signage ordinances that had been put in place since the hospital was originally constructed. It took superb cooperation between team members to ensure the timely procurement of all permits and variances.

Next, while other team members proceeded with topography modification, site drainage issues, and utility issues, CS&G went to work designing and building two 25-foot, gracefully curved aluminum cross (figure 5) sculptures that would serve as focal points for identifying the St. Anthony’s Medical Center campus.

Cornerstone elements featuring cross sculpture identifying St. Anthony’s Medical Center’s perimeter

CS&G also began work on two unique entry portals through which all traffic entering the campus would pass. New wayfinding signage was also installed, orchestrated to coincide with the opening of a new pediatric emergency room at the hospital (figure 6).

Cardinal Glennon’s Pediatric Emergency entrance located on St. Anthony’s Medical Center’s campus


On one level, signage is a simple thing. When it’s done well, people may not even notice its presence. The signage simply works, and people get where they need to go—with no frustration or confusion. On the other hand, when the signage isn’t up to par, it sends the wrong signal to visitors and customers, creating a difficult first impression that may be hard for the organization to overcome. The implemented signage and wayfinding solutions at St. Anthony’s have led directly to improved customer satisfaction at all of St. Anthony’s facilities. HD

Carl T. Martinson is former Vice-President of Marketing and Development for St. Anthony’s Medical Center in St. Louis.

For more information on CS&G’s Design/Build Solutions, visit http://www.wayfindingforhealthcare.com.

Healthcare Design 2008 November;8(11):40-46