Wayfinding Symbol Usage in Signage for Healthcare Facilities

Chrys Gakopoulos

GIT 598 Graphic Information Systems Final Research Paper Spring Semester 2009

Table of Contents
3 4 6 9 Defining the Technology: Wayfinding Symbol Usage in Signage for Healthcare Facilities Questions Posed by the Technology Case Study Report References

Defining the Technology: Wayfinding Symbol Usage in Signage for Healthcare Facilities
Wayfinding is a system that helps people to find their way from one place to another. It facilitates how people navigate through a hospital space with ease, clarity and legibility of signs, and quick understanding of the pictograms. A successful system eliminates language barriers and improves timeliness of users making appointments and finding their way. By using a well planned system of pictograms (symbols which represents a concept by illustration), anxiety and stress is reduced by users of a facility. A common example of a pictogram is on public restrooms for "men" and "women." Pictograms have appeared for thousands of years as early as cave paintings. It has only been since the 20th century that there have been efforts to create uniformity in the symbols so meaning is clear, whether or not a person speaks the native language of a country. A standard set of pictograms is defined in the International Organization for Standardization, ISO 7001: Public Information Symbols. ISO is a non-governmental organization established in 1947 and is a worldwide federation for national standards for more than 140 countries. Other organizations include Standards Australia (SA), American National Standards Institute (ANSI), Austrian Standards Institute, British Standards Institute (BSI), Americans with Disabilities Act (law governing type, inclusion of raised, tactile letters, and Grade 2 Braille, placement, and color of signage.) Once a system is established, efforts must be made by design and hospital committees to publicize their effectiveness to organizations such as the American Hospital Association (AHA), American Society of Interior Designers (ASID), SEGD, American Institute of Graphic Arts (AIGA), and the American Institute of Architects (AIA) for possible implementation in other sites throughout the nation. Countries like Britain, India, United States, Austria, China, Australia, Switzerland, etc. play a key role in developing pictograms, testing them, and explaining them in booklet form or through translation efforts to educate the public. Professor Ravi Poovaiah of ITT Bombay developed a system to be tested in five hospitals in Bombay, India. (see case study). In order for signage icons to be worldly in usability, the message must be intuitive and easily understood by the viewer. In the 2000 United States census, 4.13% of the countrys population (10,513,832) reported that they couldnt speak English well, or not at all. In countries with high illiteracy rates, such as India and Egypt, pictograms have become commonplace, for example, in identifying political parties on ballots so that voters may cast their votes. Designed pictograms must be tested in countries and/or cultures for their comprehensibility. Even then, people need to be educated through printed translated materials, and other media. Today, most standards organizations have adopted ISOs use of standards. Results showing comprehension by 67% of a surveyed group is used as the magic number for a pictogram symbol to be accepted as a standard. While there are many design companies creating pictograms for specific situations, guidelines now exist for people to follow. Responsibility must be taken to submit to organizations such as ISO to be included in their database for knowledge sharing.

The future of the technology shows that signage with pictograms is an effective way to communicate across countries, languages and cultures. Booklets explaining the pictograms to be used are translated into the most appropriate languages and distributed to schools, adult centers and organizations, and communities. Although a symbol needs to be intuitive, it is still important to explain the meaning, especially in health care. Well-planned and tested wayfinding signs and station signs, help to create a pleasant experience during a visit to a hospital or campus. Coordination in the sign system, placement, and site architecture creates a feeling of quality and adds to the effectiveness of wayfinding and navigation throughout the site by a user. Today one sees bilingual signage added to the current standard. The technology is always on the move and there are companies developing the next generation of signage and wayfinding systems through the use of digital media. Companies such as 3M Digital Signage offer digital signage solutions that are proven in more than 23 countries. Their software is designed to support digital signage solutions from single screen installations to world-wide networks. http://solutions.3mindia.co.in/wps/portal/3M/en_IN/Digital_Signage/Home/ Sonys Thinker Inc. utilizes a database which streamlines wayfinding systems and provides international content delivery in real time within a digital portal both onsite and online. http://www.articlearchives.com/computing/software-services-applications/2181694-1.html

Questions Posed by the Technology

Question 1: What is the process in development of pictograms? Answer 1: Establishing a strategic approach, design direction, budget, and plan for the development and implementation of an Integrated Wayfinding System. Observations, recommendations, design, user testing Strategic plan Define the components to one another A master plan for each site: location of pathways, architectural features, furnishings, public art, that will be used to define the signage A list of requirements for an interactive wayfinding system Signage, pictograms, technology tools, and training materials Budget requirements Monitor and review the wayfinding system over time

Question 2: How are the graphics tested?

Answer 2: The graphics are tested through user experience questionnaires and surveys given to users of a site who are both unfamiliar with the site and users familiar to the site, for their input during the ideation process and also when working with the designer. Companies such as fd2s have gone a step further and provide a self-evaluation document. Questions are divided into the categories of signage, printed materials, interactive tools, operations, or other that point out less obvious missed opportunities for improving the patient and visitor experience of wayfinding. The self-evaluation is designed to jump-start discussions about wayfinding challenges facing an institution, and shed light on possible solutions, see Healthcare Wayfinding Self-Evaluation now available by fd2s.http://www.fd2s.com/resourceDetail.php?resource=2 Question 3: How can the technology help in getting feedback on the pictograms developed? With online opportunities, the technology can help in getting feedback through blogs, discussion groups, and posting to a shared database such as flickr, picassa, or others to post designs and receive feedback. Question 4: Who are players that set the standards for signage on how the information is visualized and translated into the wayfinding size, color, materials used, text if used, etc. A wayfinding guide, Specialist clinics wayfinding guidelines: The outpatient journey, by Growth Solutions Group is for anyone responsible for managing the patient experience or building management. A book on wayfinding standards has been written, Standards_12 Wayfinding gives recommendations, illustrations, and recommended practices. The National Healthcare Sites corporate identity for wayfinding are discussed, and the guidelines support their initiative. Design firms specializing in wayfinding and environmental graphics are key players in design, communication, and submitting tested results and art to companies as the International Organization for Standardization, ISO 7001: Public Information Symbols. http://www.iso.org/iso/search.htm?qt=graphical+symbols&published=on&active_tab=standards

Question 5: Is there an online database of approved icons? International Standards Organisation http://www.iso.org Worlds largest developer of standards with a network of national standards institutes from 146 countries working in partnership with international organizations, governments, industry, business and consumer representatives. World Intellectual Property Organisation http://www.wipo.int The World Intellectual Property Organization (WIPO) as an international organization promotes and protects intellectual property encompassing science, technology and the arts. Bureu of Indian Standards http://www.bis.org.in/ The web site for the Indian Standards Organisation Intellectual Property Rights http://patentoffice.nic.in/ Registration of designs, trademark, patents, etc.

Case Study Report

Design of Signage Systems. Case Study for Hospital Symbols in India Original Author: Theory of Signage Systems, by Prof. Ravi Poovaiah, IDC IIT Bombay Company Covered in Case Study: Five major hospitals were chosen within the city of Bombay Where am I? Where do I go from here? We depend on visual systems to lead our way and keep us safe and free of anxiety. Wayfinding is the system that helps people to find their way from one place to another. A professional sign system was needed in hospitals in India to identify the most effective way to direct people through the hospital space. A process was discussed and developed and many factors were considered that affect the clarity and legibility of signs, such as typeface, color combinations, translation of the ideas into pictograms, and positioning. The case study was done in an India hospital because there was confusion that resulted with misunderstandings of written language due to varying levels of education in Indias population as well as 1,600 dialects and 14 major languages. There was confusion of the numbering system that was being used for identifying departments, counters, etc. By developing a system of informational icons, where users take part in the decision-making process, or giving information on how signage systems should be developed to communicate information to the people, the icons should be easily understood by all people. The designer takes all the information that has been gathered and narrows down and translates the ideas into a simplified system of two-dimensional pictograms. The impact of a poor wayfinding system People visiting healthcare facilities are often worried or anxious. If people get lost, feel disoriented or feel like they have walked further than necessary, that will add to their worry and cause further stress. The more stressed people get, the less information they will retain and therefore they will find retracing their steps on the return journey much more difficult. People worry that they are going to be late for their appointment as soon as they start to feel lost.

They blame themselves or the hospital for not being able to find the way. When they make a wrong turn, they ask anyone who looks like they might know the right way and may receive misleading directions. Without the implementation of the study, the lack of a visual communication system would continue to frustrate people and valuable time would be lost in either wrong lines, looking for the right direction, or even missing an appointment. At the beginning of the study, it was discovered that there was no data on message communications in the healthcare services. At the time of the study, Indian hospitals did not employ any system of symbols. This is the reason why five major hospitals were chosen, run either by the government or the municipality within the city limits of Bombay, for the study of symbol development. Application of Findings The findings of the study revealed that there were several problems from the absence of a sign system utilizing pictograms: confusion resulted from using a number/numerical system for identifying the departments, counters, etc. that was currently being used. 35-40% of the first-time users coming to the hospital to utilize health services, almost always ended up standing in the wrong line. patients waited in long lines only to find out they were there in error, often wasting over half an hour of time.

It was concluded that a well thought out plan of visual symbols could go a long way to avoid these confusing and frustrating conditions. If companies take on a basic approach and create a strategy, focus group for testing, and research on standards for signage, a well thought out product will result. The initial process in the case study identify where symbols are necessary feedback between users and designer at each stage of the process visits to the sites where symbol systems need to be developed photographic documentation of the facilities along with the users of the facility observation of the staff as they navigate the space making sketches observing interactions between staff and users of the facility talking to users about their experiences with navigation and taking notes from the feedback Methodology In order to generate possible solutions three methods were employed. from users: The users (patients, visitors, hospital staff) were asked to propose solutions. Key words associated to the message areas were documented. These were then to be visualized by the designer. from designers: Secondly, brainstorming sessions were held involving designers and others to come up with solutions for pictograms in the category to be represented. from existing solutions: Thirdly, existing international solutions were documented from research. Ideas were accumulated for each message area.

evaluation by the people: The next stage consisted in going back to the users for an evaluation. Without volunteering any information, the users were shown the complete set of possible solutions for each message area. They were asked what the pictograms represented and to identify the ones that gave them confusion. The results were tabulated and analyzed. It was discovered that only a few were considered more appropriate then the others. These few were then passed on to the next phase of the process. ergonomic and system attributes: This phase is the ergonomic study to find the best visual distance, amount of blackness perceived, minimum thickness of lines, and the required enlargements. Decisions at this level would set the stage so that it became a standard to be used in all symbols for a given environment (e.g.; the patient in black and the hospital staff in white, the roundness of form, the thickness of border, etc.) redrawing of symbols: The pictograms are redrawn incorporating ergonomic features and established standards. Each symbol is to be compared to make sure the set matches in styling. The designer reworks and refines them so that they are graphically compatible with each other. re-evaluation by designer: The designer evaluates the pictograms. redrawing of the symbols: The designer corrects and redraws after evaluating. testing on site: The final stage involves user tests on site for checking out the effectiveness of the designed pictograms. a questionnaire is filled out by users tdifferent elements are tested such as symbols, typeface, type size, and color combinations people with disabilities are also surveyed for ease of navigation with the wayfinding system site survey test

Wayfinding pictogram signage applied to many other situations Architects: Blueprints of Wayfinding Sign makers: Materials Map and Directory makers: Public spaces Motor Vehicle Department Environmental Graphic Design firms: Create Integrated Wayfinding Masterplans Shared Information Museum wayfinding Mall Retail Centers: Identity and environmental graphics Zoos and Botanical gardens wayfinding systems Airports Conclusion When graphic information technology assists in helping people design systems for healthcare that facilitates ease of navigation, safely, and communication signage is clear in its meaning, this success breaks down language barriers. Anxiety levels are reduced and people make it to their appointments which increases efficiency in staff time and the users time at the facility. As information visualization continues to grow, review of processes and user evaluations and surveys are routinely necessary. Digital wayfinding systems are making their way into buildings which can be updated in real time. What is found from the studies is that uniformity in symbols is important in their method of communication.

References

Gibson, D. The wayfinding handbook information design for public places. Specialist clinics wayfinding guidelines: The outpatient journey, August 08, from www.gsg.com.au Wayfinding: Effective wayfinding and signing systems, Guidance for healthcare facilities. Produced for NHS Estates by Colette Miller and David Lewis at Information Design Unit Ltd. Integrated wayfinding systems, from http://www.fd2s.com/serviceDetail.php?service=11 Standards_12 wayfinding. Produced for NHS Estates by Colette Miller and David Lewis at Information Design Unit Ltd. Sony continues expansion of FeliCa System Integrator Application developer program. PR newswire, 2008, October 21, from http://www.articlearchives.com/computing/software-services-applications/2181694-1.html Symbol usage In health care settings for people with limited english proficiency. Jamie Cowgill, SEGD, Jim Bolek, SEGD, JRC Design. (2003, April). Frutiger, A. (1928) Signs and symbols, their design and meaning. 3M Digital Signage The Next Generation Visual Communication Media, from www.3mdigitalsignage.co.in