According to Craig Knowles, three out of four people visiting a hospital are heading toward a destination they've never been to before. Not surprisingly then, he says, one of the biggest complaints hospital visitors have is getting lost.

“Most people who are coming to your hospital have never been there before and are very stressed,” says Knowles, general manager of LogicJunction, a Beachwood, Ohio-based software company specializing in hospital way-finding tools. “Hospital buildings get placed wherever they find real estate, and then a campus can just grow and grow. Everyone is always building and tearing down or moving.”

LogicJunction started in Atlanta and then moved to the Cleveland area and got into the hospital way-finding business around 2009 with a custom-built touch-screen kiosk at Lake Health's West Medical Center in Willoughby, Ohio. “At Lake West, they had to shut down the main elevator in the hospital,” Knowles recalls, so the information was inputted into the way-finding kiosk and visitors were given alternate routes. Instructions are given via text or audio spoken by an onscreen avatar that has multiple language options.

LogicJunction then recreated that application in triplicate with three kiosks installed at Lake Health's TriPoint Medical Center in Concord Township before tackling its first mega-project: Cleveland Clinic.

“The Cleveland Clinic has many, many buildings and is always in a state of flux,” Knowles says, explaining that the way-finding system there keeps track of the ever-changing landscape and has become a popular tool for new staff orientation.

The company is now doing the same at 615-bed Sarasota (Fla.) Memorial Hospital, which is in the middle of a $250 million, 220-bed replacement renovation project that includes a new $186 million patient tower.

“They're building a huge addition right in the middle of everything,” Knowles says, explaining the need for a sophisticated way-finding tool.

Although LogicJunction's technology can send travel instructions as a phone text message or as an e-mail, Knowles says iPhone applications may not be worth the cost (about an additional $150,000 to $170,000) just because of the demographics of the target audience.

Not all way-finding elements are high-tech. They can include your standard directional signs and, for campuses that evolved in a somewhat haphazard fashion, they can incorporate new architectural features that help tie together disparate sections and create a sense of unity.

Another approach is the use of design elements such as this rooftop wave used at Veterans Affairs facilities in Long Beach, Calif.

“With new construction, I find it to be a much easier project than a renovation,” says Chris Bauer, managing principal of focusEGD, a Dallas-based environmental graphics design firm, who describes how landscape features, artwork or atriums, major building entrances, cafes or other constructed features can be used as landmarks that help orient first-time visitors.

Bauer also recommends breaking down large buildings into “zones,” such as what was done with the 250-bed, 2 million-square-foot Seattle Children's Hospital, a seven-story structure built into a hillside that allows it to have entrances on its first, fourth, fifth and sixth floors.

“Wherever you're coming in from, you feel like you're on the first floor,” she says, adding that the size of the 1953-vintage building (retrofitted in 1978) also increased the need for way-finding. “Two million square feet,” she says. “The general public can't get their arms around that, so it's broken into smaller zones.”

Often, these can be simply labeled Zone A, Zone B and so on, but at Seattle Children's there is the balloon zone, giraffe zone, rocket zone and whale zone. Similarly, in the process where the National Naval Medical Center in Bethesda, Md., is merging with the Walter Reed Army Medical Center in Washington to become in September the Walter Reed National Military Medical Center, Bauer says her team adapted by “learning the language” and culture of the military healthcare system—even though they may have thought it wouldn't be understood by a majority of the general public.

They also had to be subtle and sensitive in changing a Navy hospital into an institution serving all military branches. She says military-themed icons were created to guide visitors through the seven new zones of the hospital such as the Hero Zone, which includes tributes to decorated medical personnel from each branch.

Bauer says they were asked to do the same for the new $394 million Naval Hospital Camp Pendleton (Calif.) replacement facility that is set to open in 2014, but she says zoning would not work there. So, instead, an “anchoring” technique is being employed using the main north and south elevator banks. “Not every technique is appropriate for every building,” she says.

At the Veteran Affairs Department Long Beach (Calif.) Healthcare System's new Blind Rehabilitation Center, Outpatient Clinic and Educational Resource Center, a design featuring roofs with extended canopies designed to mimic undulating waves was incorporated into the new buildings that quickly establishes where the entrances are while adding a unifying element to the campus.

“We took the opportunity at Long Beach to give them a whole new image and a whole new unifying look to the front of their facility,” says Scott Mackey, associate principal at Lee, Burkhart, Liu architects. “Signs are OK, but it's a whole lot easier to orient yourself with a major architectural form—when you see those wave forms, it draws you to them aesthetically.”

He calls the waves “a grand gesture” and notes how, originally, the new facilities were to be built on vacant sites independent of each other and with a hodge podge of building facades, but now there is “a structural visual identity.”