UAB Medicine, one of the nation's largest academic medical centers, lies within the larger campus of the University of Alabama at Birmingham. The mega-complex takes up a quarter of the downtown central business district, a staggering 100 city blocks.
No wonder UAB Medicine's sprawling campus intimidates first-time patients and visitors. Finding the right office or clinic or even the right entrance within its four million square feet of buildings is like finding a needle in a haystack.
The hospital industry has even coined a term for patients who must wend their way through the maze of a modern healthcare complex: wayfinding. The sheer number of hospitals, centers, and other facilities frequently disorients first-time patients and visitors, who are already under significant stress.
Even repeat or regular patients can run into wayfinding issues since medical campuses tend to grow over time. Every new building can disrupt existing navigation routines.
“Wayfinding is part of the design problem, where visitors start at Point A and want to get to Point B,” said Barbara Huelat, Design Principal at Huelat Davis, a healthcare architecture and design firm based in Alexandria, Va. “That seems like a very simple statement, but the complexity is that people don't always know where Point B or even A is.”
According to a report by Deloitte Digital, 30% of first-time visitors get confused and lost in hospitals. Even staff members have trouble with wayfinding. A quarter of staff report difficulties in finding critical destinations within the hospital.
Lost patients can affect a health system's reputation and bottom line. Hospitals are rewarded or penalized in part on overall patient satisfaction, as measured by the routine Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Those who have trouble merely reaching their final destination could vent their complaints through HCAHPS questions that ask about the hospital's overall rating and willingness to recommend the hospital to others.
Healthcare providers lose millions due to missed and late appointments every year, a portion of which may be attributed to wayfinding issues. Hospital staff members remain idle while waiting for late patients, who back up the schedule and create costly inefficiencies. A patient rushing to an appointment will often stop anyone in a uniform to ask for directions — usually a doctor or nurse — which takes time away from direct care and other duties.
A cost-estimate analysis of Emory University Hospital cited that wayfinding problems cost the institution over $200,000 annually. Another study showed that patients at a large urban hospital made fewer demands on staff when informative signs pointing out the locations of restrooms and the cafeteria were posted in the admitting area.
“An effective wayfinding system helps patients, visitors, and staff avoid problems, such as being late for appointments or meetings, missing destinations altogether, experiencing physical stress, and dealing with psychological stress,” said Dr. Janet R. Carpman, Partner and Wayfinding Consultant at Carpman Grant Associates.
An effective wayfinding system must create an environment whose design and operation guides people through a complex physical environment. They can include the traditional signage, landmarks, maps — but also the front desk volunteers who give directions and pre-visit information on a hospital's website.
“One of the problems that I've found in healthcare is that there is a lot of emphasis on the buildings as containers, and often considerations about wayfinding systems are brought up after the fact,” said Dr. Ann S. Devlin, a Professor of Psychology at Connecticut College who specializes in wayfinding. “They're overlaid on top of the buildings and not given enough attention beforehand.”
Designers often assume alphanumeric information (e.g. Building E3, Entrance A, etc.) is sufficient to guide patients and visitors. Devlin said stressed out patients often have limited cognitive capacity, or have trouble navigating using letters and numbers alone.
Some health systems fail to give consistent directions. One of Huelat's clients had a cancer center and a family practice building next to each other. Patients going to the family practice building always reached their destination with ease. Those going to the cancer center often became disoriented and arrived late for appointments.
A wayfinding evaluation study rooted out the origin of the problem. It turned out that the employee in charge of giving directions to the cancer center used a circuitous, back entrance route that confused most patients.
“One way of improving wayfinding is, after you come up with a solution, to have numerous focus groups with staff and write scripts for people in registration or front desk so they're all giving the same directions,” she said. “The hospital is a very complex environment, and we try our best to create consistent terminology for departments.”
Another stumbling block for visitors is parking. Because medical campuses have multiple parking structures, but not all are suitable for visitors, even knowing where to leave the car can get complicated.
An optimal wayfinding system must begin guidance from the patient's true origin — their home — instead of the hospital entrance.
Next: Evaluating the options for creating a better wayfinding system.
Meeri Kim is a freelance writer based in Los Angeles.