Lost in the Trees on Wayfinding

I recently toured a newly-completed hospital and asked the architect who designed it about his firm’s approach to wayfinding.  He rattled off a series of textbook things they had done; a single point of entry, color/art themed elevator lobbies, views of the front entrance from the main point of arrival on every floor, color and art themes for department entry desks -  in other words, not nearly enough.  While I had noticed all of these elements and had no argument that they were viable wayfinding moves, I still felt disoriented in the facility.  Which way to go was not intuitive and the landmarks provided were only for major destination points, like the elevators, then I was on my own.  Even though I was being guided through the facility on a tour, I felt like I might have trouble if I got left behind and had to find my own way back.  How much more, then would an anxious patient or family member feel disoriented?
Even brand new greenfield buildings like this one suffer from deep floor plates and hallways that snake around, departments that are organized somewhat like mazes and lots and lots of walking to get to your destination.  It’s time for us to stop thinking that a few grand gestures to the idea of wayfinding are enough and start building our design around it as an infrastructure.

Many arrival points should converge at a single destination.  So often, we design fantastic front doors that open into amazing lobbies, forgetting how few of patients and visitors actually arrive this way.  What we think is a single point of entry in fact is not.  Most are coming from a parking structure that connects to the building at a point other than the main lobby.  Still more may be entering via an outpatient area or the emergency department.  Especially if the floor plate has morphed over time, these points of entry can be very remote from one another.  Creating a main circulation spine is important in order to link all of these entry points and help visitors to cognitively map the facility.   A single concourse similar to airport arrival gates that has drop off, but more importantly proximal parking along its length and immediate access to either a department or vertical transportation (which offers immediate floor access to a department) is critical to reducing distances and getting people oriented.

Design can’t stop at the public realm.  How many times have you entered a gorgeous lobby only to have your final destination be a clinic that couldn’t be more bare bones and, well, clinical in its appearance?  Patients staff and family all appreciate the lobby, but what would really make a difference is to have the clinical areas where they spend the bulk of their visit have that same attention to materiality, circulation hierarchies and amenity.  Just because you have arrived at the front door of your destination doesn’t mean that all wayfinding bets are off.  You still have to navigate this area, and you shouldn’t need an escort to find your way back out.

Getting to your destination should not be a vision quest.  Especially at large institutions, the sheer amount of walking from point A to B is staggering.  One institution I know of offers free parking for the first hour in their garages, which was laughable when it could take over 10 minutes just to get from your car to your final destination. At least at the airport they have people movers and those little carts.  In hospitals, you have to walk. For able-bodied me, this is an annoyance, for the elderly and disabled, it’s an obstacle.  For staff, it’s ridiculous- a waste of time and energy.  Being in a healthcare setting should be restorative not exhausting.  Think about how you organize departments, to minimize travel from one task/treatment area to another and about how you organize the facility to minimize travel times for joint clinics, and other modes/therapies.  You might want to consider having more multi-purpose or procedure rooms as well as larger workrooms for staff to allow services to come to the patient at a single point of care.  Healthcare institutions have to seriously factor distance into the equation and stop taking a “that’s the way it is” attitude towards expansion plans that increase travel distances or additions that create circuitous pathways.
I’ve discussed in a previous post on wayfinding that signage is no substitute for creating spaces that provide landmarks, zones, and mental cues to destination.  However, these wayfinding elements alone won’t fix the problem of bad spatial sequencing or poor adjacencies.  Wayfinding needs to be part of the conceptual planning of any new project, and may cause the scope of work to be tweaked to provide the most effective layout.  Until we embrace this simple fact, healthcare spaces will continue to overwhelm and confuse the people who use them-an opportunity to develop responsive design that is simply lost.