The journey from home to a healthcare facility can be stressful and confusing for first-time or unfamiliar patients and visitors. They need to make decisions at each stage of the journey: traveling to the facility, finding parking, locating the Main Entrance, becoming oriented once inside, and proceeding to first destinations.
There is no one typical experience shared by people traveling to a healthcare facility. Patients and visitors may be traveling from a few blocks away, from across town, from a nearby city, or from even farther away.
This chapter begins by looking at the needs of patients and visitors as they travel to a healthcare facility by car, taxi, or public transit. We examine components of the exterior wayfinding system that assist patients and visitors in making their way to their initial building destinations. Since many patients and visitors drive to health facilities, we also discuss parking facilities. Next, we cover the Main Entrance area, a transition zone where patients and visitors move into the health facility itself. The chapter then describes common first destinations: the Information Desk, the Admitting Department, and a Visitor Information Center.
Traveling to a Healthcare Facility
The design of health facilities should consider the variety of ways patients and visitors will arrive—by car, taxi, van, bus or other public transit—and the need for bus stops, taxi stands, parking areas, and pathways from these to major building entrances. (Some patients will also arrive by ambulance.) Finding the healthcare facility, making one's way to the Main Entrance, and then proceeding to the admitting department or other destination, all relatively simple tasks under normal circumstances, become anything but routine when complicated by illness, injury, and/or emotional stress. Health facility design can add to stress, be neutral, or sometimes help mitigate it.
The arrival area at a health facility should be recognizable, provide a weather-protected Drop-off area, and have ample parking nearby. In this conceptual graphic, a canopy helps make the Drop-off and Main Entrance recognizable.
Arriving by Car
Many patients and visitors arrive by car, so it is important to provide the environmental and operational support they need. Several issues need to be addressed, including the ease with which drivers can find their way by following exterior signs and environmental cues; the location, availability, and cost of parking; and the parking needs of people with functional limitations.
Arriving by Taxi or Van
When arriving by taxi or van, patients and visitors will not need to worry about finding the way to the facility or locating the Main Entrance, since the drop-off area is usually close to the front door. Phone numbers for local taxi services should be posted near the Main Entrance and be available at information desks.
Arriving by Public Transit
If a public transit system is available, some patients and visitors will use it to travel to health facilities (Reizenstein, Grant, and Vaitkus, 1981). People who live nearby may use the bus system as a regular means of transportation. Visitors from out of town may find it more convenient to use the bus or hotel shuttle for their daily trips from a hotel to the healthcare facility rather than navigating to and from the facility, dealing with traffic, and paying for parking. (Although this discussion focuses on traveling by bus, the guidelines also apply to a rail system.)
Whether or not travelers are familiar with the local bus system, they need information about schedules, pick-up and drop-off points, and fares. Once they arrive at the bus stop closest to the healthcare facility, they also need to be able to find their way to the facility's Main Entrance.
A bus stop located adjacent to the Main Entrance of the healthcare facility will make it easier for users to find their way and will decrease the distance they have to walk. The bus stop should be easily visible from the Main Entrance, so patients and visitors will know how to return to it. Directional signs and maps at bus stops, including information designed for people with functional limitations, will aid wayfinding.
When patients and visitors leave a healthcare facility, they will also need a comfortable, accessible, weather-protected place to wait for their buses. They may have a lengthy wait, during cold or rainy weather. Ideally, the shelter should provide seating, weather protection, and heat, during cold weather. In addition, it should be well lit and safe, especially at night.
Bus schedules, route maps, fare information, information about public transit lines, and related website addresses should be available at the healthcare facility's Information Desk and within the bus shelter.
Exterior wayfinding signs provide unfamiliar patients and visitors with directional information at decision-points.
Photo credit: Courtesy of St. Joseph Mercy Ann Arbor
Exterior Wayfinding
Finding their way to a healthcare facility and navigating its roadways and parking areas can be difficult for first-time or otherwise unfamiliar patients and visitors. They need to be able to tell where to enter the healthcare facility site. They must be able to locate the Main Entrance drive and park their cars in a lot or garage. They must then be able to find the correct building within the complex, as well as the correct entrance. Each step of this journey requires “reading” the environment, negotiating decision-points (places where patients and visitors need to decide whether to go right, left, or continue straight ahead) and finding a series of destinations.
Without useful environmental cues and orientation aids (such as signs and maps), unfamiliar patients and visitors may become disoriented, resulting in a series of negative consequences (Carpman, Grant, and Simmons, 1984; Reizenstein et al., 1981). Information for arriving patients and visitors must be conveyed on site through signs, spoken directions, and cues in the environment itself (Rostenberg, 1987). (See Research Box 3.1.)
Some patients and visitors will seek online wayfinding information, use GPS or other digital devices, or receive written instructions or paper maps before a scheduled health facility visit. But not all patients and visitors are able to plan their visits ahead of time, including those coming to the Emergency Room as a result of accident or injury (Rostenberg, 1987).
Exterior Signage
Wayfinding sign messages in and around health facilities need to communicate clearly to unfamiliar patients and visitors. Signs direct users, identify key features of the environment, and inform them about what they should or should not do in order to make their way. Understandable signs help prevent confusion, frustration, and delay. The following example illustrates the problem with signs using wording that is confusing or otherwise incomprehensible to the people reading them:
On a family swimming expedition as a child, I raced ahead of my parents only to return with the statement that we could not use that beach. “A large sign,” I declared, “says ‘Presbyterians only—vegetarians not allowed.'” My somewhat startled elders found upon inspection that it actually said “Pedestrians only—vehicles not allowed.” (Marks, 1979, p. 94)
When patients and visitors first arrive at an unfamiliar medical complex, the sheer number of buildings may be confusing and hard to differentiate. (See Research Box 3.1.)
Exterior Sign Legibility
Sign messages are not the only factors determining the effectiveness of signs. If a sign cannot be easily seen because of its location or be easily read because of its fonts or letter sizes, its effectiveness will be diminished. When sightlines to an exterior sign are obstructed by trees, or when a sign's background color does not offer sufficient contrast with its text, signs may be of little use.
A few suggestions may help ensure sign legibility:
Mount signs perpendicular to the flow of automobile traffic, so they can be easily seen by drivers (American Hospital Association, 1979; Follis and Hammer, 1979).
Locate signs within the viewer's 60-degree “cone of vision” (Follis and Hammer, 1979).
Consider the effect of a sign's color scheme since certain color combinations are more legible than others. The combination black-on-yellow is most legible, followed by (in order) black-on-white, yellow-on-black, white-on-blue, yellow-on-blue, green-on-white, blue-on-yellow, white-on-green, white-on-brown, brown-on-yellow, brown-on-white, yellow-on-brown, red-on-white, yellow-on-red, and red-on-yellow, with white-on-red least legible (American Hospital Association, 1979; Institute for Signage Research, 1979; Passini, 1977; Wechsler, 1979; Weisman, 1985).
Avoid color combinations that rely on red and green, since color-blind people (approximately 10 percent of the male population) may not be able to distinguish between these two colors (American Hospital Association, 1979; Institute for Signage Research, 1979; Passini, 1977; Wechsler, 1979; Weisman, 1985).
Consider the legibility of fonts and letter sizes. Letter-size requirements for pedestrian signs are different (smaller) than requirements for vehicular signs.
Provide outdoor signs that can be seen at night as well as during the day. There are a number of options for lighting exterior signs, including internal illumination, ground-mounted spot lighting, and reflective lettering.
Exterior Sign Messages
As patients and visitors drive to a healthcare facility, they need different levels of information at certain points along the journey. When they are far away, they need more general information and as they approach, they need more specific information. Such hierarchical systems common in large complexes, such as airports, help prevent patients and visitors from being overwhelmed with too much unnecessary information (Huelat, 2007; Selfridge, 1979).
Signs should successively direct drivers to designated highway exits, through the city or town, and to the Main Entrance of the healthcare facility. Along major arrival routes, hospital trailblazer signs should point drivers to the facility. At the site entrance, drivers should be directed to major building destinations. On site, exterior directional signs should provide information, as needed. As patients and visitors reach their building destinations, directional signs should direct them to parking options and building entrances.
Signs Related to Accessibility
Clear signage facilitates independent travel by directing people with mobility limitations to accessible parking areas, accessible routes, and drop-off areas. The international symbol of accessibility should be used consistently and as mandated by ADA guidelines, codes, or other regulations (Harkness and Groom, 1976).
Environmental Cues
Buildings and their surrounding landscapes can act as visual cues that help patients and visitors make wayfinding decisions (Huelat, 2007). When they see what they perceive as a path to their destination, they head toward it. (See Research Box 3.2.) Natural elements such as trees, hedges, and water or rock features can help draw visitors to certain areas (Huelat, 2007). Conversely, when views to destinations are obstructed by shrubs or trees, unfamiliar patients and visitors are unlikely to recognize their destinations and may miss them.
Exterior Handheld Maps
A well-designed exterior handheld map can help orient unfamiliar patients and visitors. Maps can be sent to patients before scheduled appointments, can be available on the facility's website, and may be picked up on site. Maps should also be made available by referring physician offices.
Drop-off circle option A shows an entrance to the visitor parking garage from the drop-off circle. Option B shows access to the visitor parking structure from the street, but no access from the drop-off circle.
Such maps need to be carefully designed to convey information clearly. They should include:
An area map showing arrival routes from nearby expressways and streets
A detailed map of the health facility site, showing buildings, parking structures and lots, adjacent streets, and public entrances
Written directions to the facility
This entrance area is recognizable from a distance and provides shelter as drivers drop off and pick up patients.
Photo credit: Courtesy of St. Joseph Mercy Ann Arbor
Main Entrance Drop-Off Area
Because a health facility's Main Entrance is likely to be the first area experienced by unfamiliar patients and visitors, it should provide a pleasant and friendly first impression (Arneill and Frasca-Beaulieu, 2003; Chance, 1997).
Many healthcare facilities, especially hospitals, provide covered Drop-Off/Pick-Up areas at the Main Entrance. Such areas make the Main Entrance easily recognizable and offer weather protection. Attendants may be posted there to offer assistance.
When designing a Drop-Off/Pick-Up area for a healthcare facility, consider the following:
Locate the Drop-Off area immediately adjacent to the Main Entrance.
Provide sheltered access to the building.
If a Drop-Off area is partially enclosed and likely to have poor air circulation, consider providing an exhaust evacuation system (Cobb, 1990).
Provide an accessible route between the Drop-Off area and the area inside the Main Entrance. Follow ADA Guidelines, opting for flat surfaces (Cobb, 1990).
Choose paving materials that are not slippery when wet and that will ensure a smooth ride for patients using wheeled mobility aids, such as wheelchairs.
Consider stationing an attendant at the Drop-Off area to provide directions and assist patients getting into and out of cars.
Design the Drop-Off area to allow ample room for cars dropping off and picking up patients, as well as for those driving through.
In areas that experience snow and ice, consider installing a snow-melting system (Cobb, 1990).
Provide ample parking near the Main Entrance and mark the route to and from parking with clear signage.
Locate a taxi stand near the Main Entrance in a place that will not cause congestion in the Drop-Off area.
Parking
Safety, physical comfort, convenience, and accessibility need to be considered when designing health-facility parking lots and garages (Chance, 1997). Decision-makers also need to consider parking rates and whether or not to offer valet parking.
Providing seating at building entrances is important for patients who wait as their drivers park or return from parking. This entrance features bollards, which contribute to safety by separating pedestrian areas from driving lanes.
Photo credit: Courtesy of St. Joseph Mercy Ann Arbor
Valet Parking
Many large medical centers offer valet parking as a service that offsets the difficulties for patients and visitors of searching for parking, walking long distances from parking to the health-facility entrance, and dealing with inclement weather. In addition, valet-parking attendants can greet patients and visitors, assist them with getting into and out of cars, load belongings and medical equipment, and provide wheelchairs, as needed. There is usually an additional charge for valet parking (Thames, 1987).
Parking Lots
Many healthcare facilities provide public parking lots in addition to or in place of parking structures. Drivers typically locate the building entrance they need and then seek a nearby parking lot. The Main Entrance, Day Surgery, Emergency, medical office buildings, and other destinations may have their own parking lots. There may also be large parking lots designated for “Public” or “Patient and Visitor” parking.
Within parking lots, accessible parking spaces should be marked with the universal symbol of accessibility and located close to building entrances. In order to use these spaces, drivers must have special hang tags or license plates.
Aside from finding the correct parking lot and a vacant parking space as they enter the healthcare-facility site, patients and visitors will be most challenged by finding their cars after their visit. Design decision-makers can alleviate the stress associated with “losing” one's car (i.e., forgetting its location) by providing identification signs that help drivers notice and remember where they parked.
Parking lots are typically illuminated by regularly spaced lights located at the top of tall poles. In addition to providing lighting during inclement weather and after dark, these poles provide useful locations for parking lot and row identification signs, which should be placed high enough to see over the tops of cars and vans. In smaller lots with only a few rows, only the lot itself needs a unique label. In larger lots where finding their cars will be challenging for patients and visitors, providing frequent lot/row identification signs will help ensure that they see a sign on the way in, as they exit their cars. If they take note of the lot and row, hopefully they will remember it on the way back.
Health facilities should consider providing emergency communication systems in parking lots, as well as in parking structures.
The following suggestions can help with the design of parking lots:
In parking lots with more than a few rows, provide row identification signs that are easy to read from a distance.
At health facilities with multiple parking lots, provide signs that clearly identify the lot and the row, and place signs frequently enough so that drivers will see a sign no matter where they park.
Provide shuttle buses and lighted shuttle bus shelters in large parking lots.
Provide emergency call devices at shuttle bus shelters and at other locations in parking lots.
Parking Structures
Many large health facilities build multi-story parking structures in order to provide a large number of sheltered parking spaces in a limited area. However, some patients and visitors are reluctant to use parking structures that they perceive to be confusing or unsafe, even if this is not the case (Anderson, 1994). Logical layouts, effective lighting, and well-thought-out signage can help make parking structures safe, secure, and easy to navigate (New Hospital Garage, 1996).
Healthcare facilities may wish to consider installing commercial safety systems in their parking structures. One author (Speyer, 1987) recommends the following steps:
Obtain a comprehensive appraisal of threat potential and security needs for the parking structure.
Develop and document a plan for “adequate or reasonable” security.
Implement a security system with the aid of a professional security company.
Make provisions for maintenance and annual testing of the system.
Keep records of security evaluations and protective measures taken.
Other parking structure concerns involve wayfinding. In addition to the basic layout and vehicular and pedestrian circulation patterns, the following suggestions can make parking structures easier to navigate:
Provide effective, uniform illumination on parking, driving, and wall surfaces (Kirkpatrick and Cudney, 1992).
Use lighting to highlight stairs and elevators (Kirkpatrick and Cudney, 1992; New Hospital Garage, 1996).
Select sign colors that will be legible under various lighting conditions (Kirkpatrick and Cudney, 1992).
Locate signs at key decision-points (Kirkpatrick and Cudney, 1992).
Provide pedestrian and vehicular directional signs to help visitors find important destinations such as elevators and stairs (Kirkpatrick and Cudney, 1992).
Clearly identify parking rows and parking structure levels. Whitewash walls and ceilings to reflect light and create a brighter atmosphere (Anderson, 1994; Kirkpatrick and Cudney, 1992).
Paint fire-protection elements red for easy identification (Kirkpatrick and Cudney, 1992).
Provide emergency intercoms or telephones at major entrances, exits, and lobby areas (Kirkpatrick and Cudney, 1992).
If patients or visitors require medical or other emergency attention within the parking area, help needs to be readily available. For instance, the parking structure floor-to-ceiling height must allow ambulance access. Installing and maintaining an emergency communication system, video cameras, and effective lighting within the parking area will provide an extra measure of security. Security guards or attendants should be available to help people in need.
Park-and-Ride Options
In urban areas, finding enough space for parking is an ongoing problem, and patient and visitor parking areas may be located some distance from the main facility. Although perhaps not an optimal solution, a remote parking lot with a frequent shuttle bus may be an acceptable option when visitor parking cannot be provided close by. For example, when visitors to the University of Michigan Medical Center were asked whether they would be willing to park their cars in a parking lot a mile away if it was served by a shuttle bus leaving every 15 minutes, two-thirds said that they would be willing to do so (Reizenstein et al., 1981). Other considerations when healthcare organizations develop a shuttle-bus system include security (especially at night), effective signage, and weather-protected bus shelters with comfortable seating. In addition—and regardless of the location of the parking lot—row/area and directional signs should be legible throughout.
Long-Term Parking Rates
To help recoup the costs of constructing, running, and maintaining parking garages, many healthcare organizations charge for parking. For the patient or companion visiting the facility for a short time, a standard parking fee may seem reasonable, but for patients or visitors spending several hours a day at a facility over a period of weeks or months, the standard parking fee may be seen as a burden (Reizenstein et al., 1981). In setting parking fees, a facility sends a symbolic message. Providing lower long-term fees or free parking for patients and visitors, subsidized by rates charged to other users, might be a useful—and caring—marketing strategy.
Transition between Parking and the Building Entrance Area
Once patients and visitors park in a lot, they need to figure out how to proceed from parking to the needed building entrance, which may or may not be in view. Pedestrian directional signs, identification signs, and exterior You-Are-Here maps will help patients and visitors get where they need to be.
Patients and visitors who park in a structure have a different set of wayfinding challenges. They must find the correct elevator and then determine the correct level on which to exit, in order to proceed to their building. Parking structures located right next to healthcare facilities may be connected on more than one floor. When parking structures serve several buildings, choosing the correct exit (and finding it again on their return) becomes part of the wayfinding puzzle for patients and visitors. In cases like these, it will be helpful to provide vehicular and pedestrian directional signs at decision-points on each level of parking structures. You-Are-Here maps, placed at strategic decision-points, will also help patients and visitors understand where they are and how to get to their destinations without experiencing stress and delays.
The following suggestions can help with planning the transition from parking to building entrance areas:
In health facilities with several public entrances, provide pedestrian directional signs and You-Are-Here maps at strategic locations at the edges of parking lots.
In parking structures that connect to buildings on more than one level, provide information about exit floors. Clearly identify exit points.
In parking structures that serve several buildings, provide pedestrian directional signs and You-Are-Here maps at pedestrian exits.
The Main Entrance Area
In many ways the Main Entrance sets the tone for the healthcare facility (Olsen and Pershing, 1981). It provides a transition zone from the exterior to the interior environment. The Main Entrance is a place to obtain information, become oriented to the layout of the facility, and wait for transportation. When sensitively designed, the Main Entrance area can provide a welcoming and calming environment (Arneill and Frasca-Beaulieu, 2003; Chance, 1997).
Becoming Oriented
As they enter a healthcare facility, patients and visitors want to know where they are and where to go next. Well-designed signs and maps near an Information Desk can help orient them to the facility and introduce its wayfinding system. This will help them recognize directional information as they encounter it throughout the facility.
Although some patients and visitors have little or no trouble finding their way, those who are unfamiliar with the facility may easily become lost (Carpman, Grant, and Simmons, 1984; Reizenstein et al., 1981; Shumaker and Reizenstein, 1982). A wayfinding system consisting of an obvious entrance area, signs, effective lighting, You-Are-Here maps, and other features can help direct visitors and patients from their parking spots or other drop-off points to their destinations (Rostenberg, 1987).
You-Are-Here (YAH) maps aid orientation in and around health facilities. Placing a YAH map at the pedestrian exit of the parking area allows people to gain an overall understanding of the site layout and plan the most direct route to their destinations.
When a You-Are-Here map is misaligned, as in the top drawing, users need to mentally realign the map, which can cause confusion. When a You-Are-Here map is correctly aligned so that forward in space is “up” on the map, it is easier to use.
Source: M. Levine. You-are-here maps: Psychological considerations. Environment and Behavior 14(2):221–37, March 1982. Copyright 1982 Sage Publications, Inc. Redrawn, with changes, by permission of Sage Publications, Inc.
In order to effectively orient unfamiliar users, it is essential that YAH map information be presented clearly and the map itself should be oriented so that forward in space is “up” on the map (Levine, 1992). For example, if the visitor is facing east while looking at the map, the map should be oriented so that east is at the top of the map. The map's location should be carefully selected. Being able to identify objects or structures on the map that they can also see around them helps viewers become oriented. Users need at least two points of reference on the map in order for it to be useful. A correctly placed You-Are-Here symbol is one point of reference, and a prominent building or landmark could be the other. Labeling additional objects and buildings will provide more reference points.
Access for People with Functional Limitations
Entering a healthcare facility may be challenging for people with temporary or permanent functional limitations who are trying to make their way from the parking area or drop-off point to the destination entrance (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979). In some instances, the journey may require travel from an upper floor of a parking structure, along sidewalks, and across a number of streets. A number of design features can help, including ample parking space width, location of accessible parking close to an exit, an accessible route that does not conflict with automobile traffic, and paving materials that are smooth, rather than bumpy. (See chapter 9.)
Wheelchair users may need to transfer from a car to a wheelchair. This process is easier if the parking space is on a level grade and if the space is wide enough (12 feet or ~3.7 meters) to allow the car door to open to its fullest position. Vans equipped with a side wheelchair lift need 16 feet (~4.9 meters). Although most accessible parking spots should be on a parking structure level with direct access into the health facility, occasionally wheelchair users will have to park elsewhere. It is important that they be able to enter elevator lobbies and elevators. If there is a curb, access ramps should be provided. Elevators should be at least 4 feet 3 inches by 5 feet 8 inches (~1.3 meters by ~1.7 meters) to accommodate a wheelchair. Elevator controls should be placed within reach, at a maximum height of 48 inches (1.2 meters) (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979). Always follow the most current ADA Guidelines. (See chapter 9.)
Since some patients need to borrow wheelchairs, it's useful to provide dedicated storage areas at health facility entrances.
Photo credit: Courtesy of St. Joseph Mercy Ann Arbor
Once people with functional limitations reach street level, they may still face barriers. People with vision limitations need to be able to follow the desired route and avoid physical obstacles in their path. They also need to be able to determine an effective route and safely walk along that route. Design features can help, including signage with tactile lettering or Braille; sidewalks free from obstructions such as street furniture and equipment; and sidewalk textural indicators relating to building entrances and transitions to streets. People with hearing limitations need to be able to follow the desired route safely without requiring spoken directions. It is particularly important that signs and maps be available to direct them to their destinations. Warning signals like those used on emergency vehicles should provide visual as well as auditory cues (Carpman, Grant, and Norton, 1984).
Sidewalk design is particularly important for people with mobility limitations:
Build sidewalks wide enough to allow two wheelchairs to pass easily, at least 5 feet (~1.5 meters) wide (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979).
Eliminate obstructions (such as grates) that may catch wheels or crutches.
Keep benches or other street furniture away from the circulation path.
Provide curb cuts at street crossings at a low enough grade to be accessible (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979).
Design grades to be flat enough to allow easy movement. If grades must be greater than 5 percent, provide handrails.
Avoid the use of brick and other uneven paving materials that might create a bumpy ride for wheelchair users or hazards for people using walkers or pushing strollers.
Sometimes Main Entrance areas can become congested and confusing. Consideration should be given to people, such as seniors or those with functional limitations, who have difficulty moving about, finding their way, or handling their belongings. Staff or volunteers may be needed to give directions, assist patients and visitors with belongings, or provide needed information.
To accommodate some of the needs of patients and visitors in Main Entrance areas, consider the following (English Tourist Board, 1983; Harkness and Groom, 1976):
Select doors that are easily negotiable by wheelchair users, people using walkers, or people with vision limitations. Turnstiles and revolving doors may prove hazardous to people who move with some difficulty and may be inaccessible for wheelchair users or people with strollers.
Provide doors that can be easily opened by people with little upper-body strength. The force needed to open a door should not exceed 8 pounds. Consider specifying automatic doors that open with a pressure-sensitive mat, a wall-mounted push plate, or an electronic eye.
Avoid obstructions at the Main Entrance. For example, mud mats and pressure-sensitive mats should be flush with the floor. This will allow a wheelchair or stroller to easily maneuver over them.
Provide space out of the flow of traffic for storing wheelchairs.
Ensure that restrooms are nearby and in view from the Main Entrance.
Waiting in the Main Entrance Area
Patients and visitors waiting to be picked up by a companion, taxi, van, or bus need a comfortable and safe place to wait and a view to the Drop-Off/Pick-Up area. Main Entrance areas need to be large enough to accommodate people arriving, departing, and waiting. These Main Entrance areas need to offer comfortable places to sit, convenient places to put belongings, and access to nearby restrooms. In addition, Main Entrance areas should provide taxi information, exterior maps, transit schedules, and signs directing users out of the building and back to the bus stop, parking lot, or parking structure.
This Information Desk is in immediate view as patients and visitors enter the health facility.
Photo credit: Courtesy of St. Joseph Mercy Ann Arbor
First Destinations
Patients' and visitors' first contacts with healthcare staff may be at an Information Desk, Admitting or Registration, or a Visitor Information Center.
Information Desk
An Information Desk may serve a variety of functions. It welcomes patients and visitors. It provides a place where they can ask questions about appointments, restrooms, patient room locations, hours of operation, availability of services, public transportation, parking, eating facilities, and the like. Attendants at Information Desks can help orient patients and visitors to the facility by providing maps and directions. Some healthcare facilities, such as those designed following the Planetree model discussed in chapter 2, may have dedicated information-services staff who formally greet patients and visitors, in an effort to create a more welcoming environment (Arneill and Frasca-Beaulieu, 2003).
The effectiveness of Information Desks can be increased by design:
Provide direct visual access to the Information Desk from the Main Entrance.
Provide legible signage identifying the Information Desk.
Provide visual access from the Information Desk to the Main Entrance so staff members can see entering patients and visitors.
Design the Information Desk to look different from other counters or windows in the Main Entrance area, such as the Cashier, the Security Desk, or the Reception area for the Admitting Department.
Make the Information Desk accessible and welcoming to all users. Allow enough surrounding circulation space to prevent congestion.
Provide a portion of the counter that is low enough—30–33 inches (~76–84 centimeters) high—for wheelchair users to talk comfortably with staff or to fill out forms (Harkness and Groom, 1976).
Provide direction-giving training for Information Desk staff. (See Research Box 3.3.) Consider providing handheld maps patients and visitors can take with them.
Admitting or Registration
Admitting or Registration are often among the first destinations for patients arriving at a healthcare facility. Some admissions procedures require patients and their companions to wait, fill out forms, have interviews with staff, and visit one or more ancillary services before settling into a patient room. During this process, patients and companions need a comfortable place to wait and a private place to hold confidential conversations with hospital staff.
Partial walls at an Admitting or Registration area help protect patients' confidential information by providing some acoustical and visual privacy.
Photo credit: Courtesy of St. Joseph Mercy Ann Arbor
The ability of the facility to meet these needs is linked with environmental design in the following ways (Valenta, 1981) (see Research Box 3.4):
To help ensure acoustical privacy, provide private offices, tall partitions, acoustic barriers, or spatial separations of task areas.
Store electronic and written records in ways that ensure patient confidentiality.
Provide staff and patients with a comfortable conversational distance between one another.
Keep passageways clear of obstructions, provide chairs that do not tip over easily, and eliminate furniture with protruding or sharp edges.
Provide accessible pathways to desks, seating areas, and circulation areas.
Visitor Information
Family members and visitors of hospital patients often experience stress for at least two reasons: worrying about their loved ones and coping with an unfamiliar setting, including rules, procedures, staff, and medical issues. Visitors are often the forgotten users of a hospital. Even though they are present in large numbers, they typically have no official role, no connection with the administration, and no space of their own. Their needs for information and reassurance may not be met (Reizenstein and Grant, 1981).
Visitors may be reluctant to approach the nursing or medical staff for information, fearing that they may not be able to make contact, may not receive understandable answers to questions, or that their patient may be penalized in some way by family members' questions. This fear and isolation leads some visitors to perceive their concerns as insignificant and results in reluctance to find solutions (Reizenstein et al., 1981). One approach to relieving this “invisible visitor syndrome” is to provide a central area where visitors can bring general questions and concerns. In some facilities, Information Desk staff or concierges provide visitors and family members with needed services and information about parking, overnight accommodations, restaurants, shopping, Wi-Fi, and the like (Reizenstein et al., 1981; Zimring, Carpman, and Michelson, 1987). A dedicated Visitor Information Center could provide visitors with more in-depth answers and more opportunity for interaction with helpful staff.
Summary
The journey from home to a healthcare facility can be stressful and confusing for first-time or unfamiliar patients and visitors. They need to make decisions at each stage of the journey: traveling to the facility, finding parking, locating the Main Entrance, becoming oriented once inside, and proceeding to first destinations.
Whether traveling by car, taxi, van, or public transit, patients and visitors are often under emotional stress and/or physical duress. They need legible signage with understandable wording. Wayfinding information needs to be provided in a hierarchy from general to specific. Other components of a successful wayfinding system include handheld and You-Are-Here maps, visual cues from buildings and landscaping, and signs containing information about accessibility.
Parking facilities must be designed and maintained for safety, convenience, and accessibility. Parking structures and parking lots require good lighting, visibility, and effective signage at key decision-points and destinations.
The Main Entrance area should appear welcoming, providing easy access to a Drop-Off area, weather protection, and attention to the needs of people with functional limitations. There should be room and accommodations for people waiting, effective signage and maps, and information about taxis and public transportation.
The main Information Desk should be accessible and welcoming to all users, visually distinct from other counters and windows, with direct visual access to the Main Entrance area.
The Admitting Department should provide for patients' visual and acoustical privacy and stress reduction. It should offer a comfortable place to wait and ample circulation space.
Design Review Questions
Traveling to a Healthcare Facility
Arriving by Public Transit
Will a bus stop be located near (adjacent to or easily accessible from) the facility?
Will a bus stop be visible from the Main Entrance?
Will signs and maps (including audible and tactile messages) be available to assist patients and visitors in finding bus stops? (American Hospital Association, 1979; Harkness and Groom, 1976)
Will there be a bus shelter?
Will the bus shelter be comfortable, large enough, and weather-protected, with ample seating and effective lighting at night?
Will bus schedules, route maps, and fare schedules be available to patients and visitors at the main Information Desk?
Will phone numbers for local taxi services be posted near the Main Entrance and available at information desks?
Exterior Wayfinding
Exterior Signage
Will destination messages be used consistently on exterior signs? (American Hospital Association, 1979; Marks, 1979)
Will exterior sign messages be short so that drivers can read them quickly? (American Hospital Association, 1979; Marks, 1979)
Will building names and other exterior sign messages be clear enough to be interpreted similarly by all users? (American Hospital Association, 1979; Follis and Hammer, 1979; Marks, 1979)
Will sign messages be stated in positive terms whenever possible? (American Hospital Association, 1979; Marks, 1979)
Will sign messages fit within a sixth-grade reading level? (American Hospital Association, 1979)
Exterior Sign Legibility
Will exterior signs be oriented perpendicular to the flow of traffic? (American Hospital Association, 1979; Follis and Hammer, 1979)
Will exterior signs be located so as to be within the viewer's 60-degree “cone of vision”? (Follis and Hammer, 1979)
Will the color relationship between exterior sign text and background provide sufficient contrast? (American Hospital Association, 1979; Institute for Signage Research, 1979; Passini, 1977; Wechsler, 1979; Weisman, 1982)
To accommodate people who are colorblind, will colors be used other than red and green? (American Hospital Association, 1979; Passini, 1977; Wechsler, 1979; Weisman, 1985)
Will letter sizes on signs be large enough, and messages short enough, to be read by drivers traveling at posted speeds? (American Hospital Association, 1979)
Will exterior signs be visible and legible at night as well as during the day?
Exterior Sign Messages
Will the sign system be designed to give drivers different levels of information (from general to specific) at different points along the journey? (Selfridge, 1979)
Will offsite trailblazer signs and directional signs direct drivers to the facility from nearby expressways and along major arrival routes? (Selfridge, 1979)
Will directional signs direct drivers to parking and major destinations, including the Emergency Entrance? (Selfridge, 1979)
Will pedestrian directional signs direct patients and visitors from parking to building entrances and back? (Selfridge, 1979)
Signs Related to Accessibility
Will signage direct people with mobility limitations to accessible parking areas and accessible routes and Drop-Off areas?
Will the international symbol of accessibility be used consistently?
Environmental Cues
Will buildings and building entrances be distinctive and recognizable?
Will landscaping allow unobstructed views to signs, intersections, and building entrances? (Carpman et al., 1985)
Exterior Handheld Maps
Will handheld maps include an area map showing arrival routes from nearby expressways and major streets?
Will handheld maps include a detailed map of the healthcare facility's site, showing buildings, parking structures and lots, adjacent streets, and major entrances?
Will handheld maps include written directions to the healthcare facility?
Main Entrance and Drop-Off Area
Will a Drop-Off area be located adjacent to the Main Entrance?
Will sheltered access to the building be provided at the Main Entrance?
Will the Main Entrance area be accessible to people with mobility limitations?
Will smooth paving materials be selected so people using wheeled devices (such as wheelchairs, walkers, and strollers) can avoid a bumpy ride?
Will an attendant be available to assist patients making their way between their cars and the building entrance?
If the Main Entrance contains a confined canopy with poor air circulation, will an exhaust evacuation system be provided? (Cobb, 1990)
In areas that experience snow and ice, will a snow-melting system be provided? (Cobb, 1990)
Will the Drop-Off area be designed with ample room for cars dropping off and picking up patients and for those driving through?
Will nearby parking be provided?
Will a taxi stand be located nearby in a place that doesn't contribute to traffic congestion?
Parking
Valet Parking
Will a valet parking service be provided? (Thames, 1987)
Will valet parking attendants be trained in hospitality and customer experience? (Thames, 1987)
Parking Lots
In parking lots with more than a few rows, will row identification signs be easy to read from a distance?
At health facilities with multiple parking lots, will signs clearly identify the lot and the row? Will identification signs be placed frequently enough that drivers will see a sign no matter where they park?
For facilities with large parking lots, will shuttle buses and lighted shuttle-bus shelters be available?
Will emergency call devices be provided at shuttle-bus shelters and at other locations in parking lots?
Parking Structures
Will patients' security needs in parking structures be assessed? (Speyer, 1987)
Will a plan be in place for a parking-structure security system? (Speyer, 1987)
Will provisions be made for maintenance and annual testing of the parking-structure security system? (Speyer, 1987)
Will records be kept of security evaluations and protective measures? (Speyer, 1987)
Will emergency intercoms or telephones be provided within parking structures at major entrances, exits, and lobby areas? (Kirkpatrick and Cudney, 1992)
Will uniform illumination be provided throughout the parking structure? (Kirkpatrick and Cudney, 1992)
Will lighting be used to highlight parking-structure destinations such as stairs and elevators? (Kirkpatrick and Cudney, 1992)
Will sign colors be legible during the day and after dark? (Kirkpatrick and Cudney, 1992)
Will wayfinding signs be located at key decision-points? (Kirkpatrick and Cudney, 1992)
Will pedestrian and vehicular directional signs be provided?
Will parking rows and parking structure levels be clearly identified? (Carpman, Grant, and Simmons, 1984)
Will walls be whitewashed to reflect light and create a bright environment? (Kirkpatrick and Cudney, 1992)
Will fire-protection elements be painted red for easy identification? (Kirkpatrick and Cudney, 1992)
Will the parking-structure floor-to-ceiling height allow ambulance access to all areas?
Will video cameras be available to provide surveillance of the parking area?
Park-and-Ride Options
If patient and visitor parking is not within easy walking distance of the facility, will shuttle buses be available at frequent intervals?
Will a comfortable, safe, weather-protected place with seating be available for those waiting for shuttle buses?
Long-Term Parking Rates
Will the facility consider instituting reduced or free long-term parking fees? (Reizenstein et al., 1981)
Transition between Parking and the Main Entrance Area
In health facilities with several public entrances, will pedestrian directional signs and You-Are-Here maps be located at strategic locations at the edges of parking lots?
In parking structures that connect to buildings on more than one level, will there be information about exit floors? Will exit points be clearly identified?
In parking structures that serve several buildings, will pedestrian directional signs and You-Are-Here maps be placed at pedestrian exits?
Will effective illumination be provided along pedestrian routes from parking lots and parking structures to building entrances?
Will building entrances be clearly identified?
The Main Entrance Area
Will the Drop-Off and Main Entrance area provide effective weather protection?
Will mud walk-off mats be provided?
Will the Main Entrance area be spacious enough to minimize congestion?
Becoming Oriented
Will wayfinding signs guide patients and visitors from parking and drop-off to the Main Entrance?
Will exterior You-Are-Here (YAH) maps be available to orient patients and visitors to the layout of the site?
Will directional signs and interior YAH maps be provided near the main Information Desk, at elevator lobbies, and at other potentially confusing interior areas?
Will YAH maps be placed at pedestrian exits from parking areas?
Will building names be clearly identified on YAH maps?
Will YAH maps be oriented so that forward in space is “up” on the maps? (Levine, 1982)
Will exterior YAH maps include memorable features of the environment? (Levine, 1982)
Access for People with Functional Limitations
Will sidewalks be wide enough to allow two wheelchairs to pass easily? (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979)
Will obstructions (such as grates) be eliminated so they don't catch wheels or crutches?
Will benches or other street furniture that may make maneuvering difficult be kept away from the circulation path?
Will curb cuts at street crossings be provided at a low enough grade to be accessible? (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979)
Will grades be flat enough to allow easy movement? If grades must be greater than 5 percent, will handrails be provided?
Will brick and other uneven paving materials be avoided so they don't create a bumpy ride for wheelchair users or hazards for people using walkers or pushing strollers?
Will the Main Entrance area be accessible to people with mobility limitations and those with roller bags or strollers? (English Tourist Board, 1983; Harkness and Groom, 1976)
Will the doorway be usable by people with mobility or vision limitations? (English Tourist Board, 1983; Harkness and Groom, 1976)
Will automatic doors be provided at major entrances? (English Tourist Board, 1983; Harkness and Groom, 1976)
Can doors be opened by people with little upper-body strength? (English Tourist Board, 1983; Harkness and Groom, 1976)
If the force needed to open the door must exceed 8 pounds (to avoid having it blown open by the wind), will there be an automatic door? (English Tourist Board, 1983; Harkness and Groom, 1976)
Will the Main Entrance area be free of obstructions? (English Tourist Board, 1983; Harkness and Groom, 1976)
Will mud mats and pressure-sensitive mats be flush with the floor? (English Tourist Board, 1983; Harkness and Groom, 1976)
Will newspaper machines, chairs, and other furniture be located out of the main circulation path? (English Tourist Board, 1983; Harkness and Groom, 1976)
Will there be a place to store wheelchairs out of the flow of traffic? (English Tourist Board, 1983; Harkness and Groom, 1976)
Will elevator lobbies be easily accessible? If there is a curb, will an access ramp be provided? (Harkness and Groom, 1976)
Will elevators be wide enough to accommodate a wheelchair? Will they comply with ADA guidelines? (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979)
Will elevator controls be within easy reach of someone who is seated? Will they comply with ADA guidelines? (American Hospital Association, 1979; English Tourist Board, 1983; Harkness and Groom, 1976; Kamisar, 1979)
Waiting in the Main Entrance Area
Will ample space be provided in the Main Entrance area for patients and visitors to wait for transportation?
Will patients and visitors have a view to the Drop-Off/Pick-Up area?
Will comfortable places be provided for patients to sit? Will space be provided for patients' belongings?
Will restrooms be available nearby?
Will taxi phones and transit schedules be available?
Will signs and maps be provided to direct people out of the facility, back to parking, and out to major roads?
First Destinations
Information Desk
Will the Information Desk be in direct view from the Main Entrance?
Will patients and visitors be able to distinguish the Information Desk from other counters or windows located in the Main Entrance area?
Will the Information Desk be clearly identified?
Will staff at the Information Desk have a clear view of the Main Entrance?
Will there be ample space surrounding the Information Desk so the circulation area does not become congested?
Will the Information Desk accommodate wheelchair users? (Harkness and Groom, 1976)
Will staff be trained in direction-giving? (Olsen and Pershing, 1981)
Admitting or Registration
Will there be a comfortable place for patients and companions to wait? (Valenta, 1981)
Will interview areas in the Admitting Department be designed to ensure patients' acoustical privacy? (Valenta, 1981)
Will interview areas be designed to facilitate conversation and self-disclosure? (Valenta, 1981)
Will furniture be arranged so those having conversations can face one another and not be obstructed by equipment? (Valenta, 1981)
Will electronic and written records be stored in ways that maintain patient confidentiality? (Valenta, 1981)
Will staff and patients face each other at a comfortable conversational distance? (Valenta, 1981)
Will accessible pathways be provided throughout the Admitting area? (Valenta, 1981)
Will private offices, tall partitions, acoustic barriers, or spatial separations of work areas be provided to reduce noise and increase privacy? (Valenta, 1981)
Will passageways be kept clear of obstructions? (Valenta, 1981)
Will furniture be selected with safety in mind? (Valenta, 1981)
Will chairs and other furnishings be stable? (Valenta, 1981)
Will furniture with sharp or protruding edges not be selected? (Valenta, 1981)
Will staff be able to control the temperature within the Admitting Department? (Valenta, 1981)
Will staff be able to control lighting within the Admitting Department? (Valenta, 1981)
Will natural lighting be available? (Valenta, 1981)
Will the wayfinding system guide patients and their companions from the Admitting Department to other areas of the facility? (Valenta, 1981)
References
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Will a bus stop be located near (adjacent to or easily accessible from) the facility?