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Presenters
Tom Harvey FAIA, MPH, FACHA, LEEP AP
Vice President/Partner, HKS Architects
President, Center for Advanced Design Research & Evaluation
Debajyoti Pati, PHD, FIIA, LEED AP
Rockwell Endowment Professor, Texas Tech University
Director Emeritus, Center for Advanced Design Research & Evaluation
Phyllis Kaplan
Senior Health Facilities Architect, U.S. Department of Defense
Defense Health Agency (DHA)
Portfolio Planning and Management Division
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Acknowledgements
Contributing Organizations
Military Health System
Texas Health Resources (IRB)
Texas Health Presbyterian Hospital Dallas
Study Contributors
Douglas Willis, RN, BSN, Safety Manager, THPHD
Sipra Pati, MA, Research Coordinator, HKS
Adeleh Nejati, PhD Candidate, TAMU
Shireen Kanakri, PhD Candidate, TAMU
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Learning Objectives
1. Identify the range of environmental
information sought by visitors during
navigation in hospitals.
2. Identify the types of physical design
elements used as cognitive anchors in
direction-giving behavior.
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Affects patients and visitors
• Impacts satisfaction
• Induced stress
• Physiological well-being
• Psychological well-being
Affects staff
• Compromises optimal use of staff time
• Communication challenges
• Challenge to float or agency staff
• May impact efficiency of care delivery
• May impact care safety
A Forethought OF Design
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The “Cognitive Map”
Known strategies:
• Survey knowledge
• Route knowledge
Image Credit: http://groups.ischool.berkeley.edu/mentalmaps/
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Mini Spatial Representations
“Adult human knowledge about
their macro-environment are
mini-spatial representations
with high interconnectivity…”
Image Credit:
http://www.lifesreplay.com/journal/2011/11/29/yuya-
takeda-falling-apart-complex-cities.html
The Development of Spatial Representations of
Large-Scale Environments Siegel and White, 1975.
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Most documented studies are at the urban scale
Kevin Lynch,1975. Image of the City. Components of
mental maps
o Path
o Edge
o District
o Nodes
o Landmark
Insufficient Focus on Internal Need
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Five Factors in
Wayfinding
Carpman and Grant, 1993
• Knowing where you are
• Knowing your destination
• Knowing the best route
• Recognizing the destination
upon arrival
• Finding the way back
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What We Don’t Know
1. Are these theories valid in interior
environments?
2. What information do people seek when they
navigate for the first time in an unfamiliar
environment?
• Wayfinding in places not frequently visited.
• Navigating the first time vs. subsequent times – the difference?
• What features are used to begin forming the cognitive map?
• Where is the start point of the action/travel plan?
• What features are used during execution of travel?
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Current
Designer’s Tools
Designers use a wide
array of strategies to
optimize navigation:
• Signs
• Maps
• Artwork
• Landmark
• Color
• Spatial configuration
• Alpha-numerical labels
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Tools of the
Navigator
Which strategies are used
during wayfinding?
o Understanding current location
o Knowing destination
o Developing route choice
o Realizing arrival at destination
o Findings one’s way back
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MHS FIRM
U.S. Department of Defense
Facility Innovation & Research Model (FIRM)
• Established an MHS FIRM Research Framework
• Tested through multiple Validation Studies
Identifying Elements of the Healthcare
Environment that Contribute to Wayfinding
U.S. Department of Defense Military Health System
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Question 2
What types of
information are being
sought by visitors as
they navigate in
healthcare facilities?
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Question 3
What role do design of
interior environmental
cues play in the
wayfinding process?
• Color
• Art
• Visible Landmarks
• Maps
• Interactive Kiosks
• Visual Signage
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Patient / Visitor Direction-seeking
Age groups – 5 decades starting at 20
Gender – 50% male / 50% female
Recruitment criteria…
• Never visited this hospital site
• No architects or interior designers
• No visual impairment
Subjects
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Understanding where
one is (where am I?)
Two types of ‘where I am’ situations
• Start point – Travel plan
• En route – Travel
execution
• Continuous assessment
Understanding where is the
destination (where to go?)
• Especially where it is in relation to
where I am
Two Broad Aspects to Wayfinding
1
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Understanding how to go to the destination
from where one is (at a point of time)
• Is there a way to predict that I am on the right path?
o Circulation system assessment (elevators, hallways…)
o Continuous ‘where I am’ assessment
• Is there a way to predict what the destination looks like?
(More importantly) how to get back to where
one is (was) – this is critical, since among all
the ‘where one is’, people seem to select one
or more former locations as anchor points.
Two Broad Aspects to Wayfinding
2
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Where am I?
Where to go?
How to go there?
People seem to rely entirely on
• Maps
• Signs
Elements Supporting Wayfinding
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Other Cues: Logical
Clustering of Functions
Space Planning
• Café must be close to
lobby
• Admissions would be
near the entrance/ lobby
• Children’s play area
indicates waiting area
close by.
Elements Supporting Wayfinding
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Logical pairing of interior
elements
Interior Architecture
• Admissions could mean ‘windows’/
windows indicated that it could be
admissions
Elements Supporting Wayfinding
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Architectural Features and
Visual Access
Architecture
• External view of an area – looking
at its width the subject inferred that
it did not have the capacity to hold
a waiting area or that they were
headed in the right direction
• Visual access of spaces via multi-
level atrium
Elements Supporting Wayfinding
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Developing familiarity
Develop mental map
• Where people made mistakes
• Funny or odd sounding names
Like while one is hiking in the
wilderness:
• People use any natural element
as markers
• Or create markers (leave pebbles
on ones path)
What Role Do Other Features Play?
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Other Design Elements Help Serve As
Familiarity Markers
What Role Do Other Features Play?
• Information desks/ counters (manned or not)
• Vertical circulation (especially when visually unique such as
escalators
• Artwork/ sculptures (people did not focus on the content/
subject of the landmark)
• Views to exterior and exterior elements (exterior signs and
labels, visible from inside, served important function)
All of these can be termed as landmarks.
Every landmark is a pebble.
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Nomenclature and Numbering System
• Represents the initiation of the
cognitive process
• Even before people look for signs
and maps
Key Concept 1: What’s in a Name?
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Anchor Point Use and Characteristics
• A place close to an exterior entrance and vertical circulation:
o Doesn’t need to be the entrance people used to enter the facility
• Multiple activities
• Presence of people
• (Expected) presence of maps and directional signs
• Even if this anchor point had not been very effective in offering
adequate help in locating their destinations, subjects still sought to
return to these anchor points to orient themselves.
o Home base.
o Where everything is
o Where I feel safe
o That’s where I get help
Key Concept 2: The Mother Ship
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Familiarity, Familiarity, Familiarity
(Think of the Jungle)
People tend to immediately start working on developing familiarity of
“nodes”, “edges” along a path
• With directional signs, maps, plausible location of maps,
information boards …
• Higher the complexity (types of activities, people, artwork)
easier the development of familiarity
Key Concept 3: Fight or Flight
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Path (streets, sidewalks, trails, other channels in which people travel)
o Where am I; where am I going (maps, directional signs…)
Edge (perceived boundaries such as walls, buildings, and shorelines)
o Hallway edge functions (familiarity)
District (large sections of the facility distinguished by some identity)
o Where am I; where am I going (maps,
directional signs…)
Node (focal points, intersections or loci)
o BOTH (MOST IMPORTANT)
Landmark (readily identifiable objects
which serve as external reference points)
o Familiarity
Key Concept 4: Cognitive Markers
