Wayfinding in Hospitals

WAYFINDING IN HOSPITALS
ABA 2506: RESEARCH METHODOLOGY II

RESEARCH PROPOSAL 01
WAYFINDING IN HOSPITALS.
(A CASE OF COMMUNITY HOSPITAL)
December, 2022.
AUTHOR: EDMUND KIPNGETICH.
REGISTARTION NUMBER: ABS 211-0016/2017
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ABSTRACT:
Wayfinding refers to process of using environmental and spatial information to navigate to a
destination, and in the process also enhancing their understanding and experience of the space.
Wayfinding is unique in that it crosses into so many fields such as urban planning, architecture,
marketing and it is particularly important in complex built environment such as urban centers,
healthcare and educational campuses and transportation facilities. As architectural environments
become more complicated, people need visual cues such as maps, directions, and symbols to help
guide them to their destinations. In these often high-stress environments, effective wayfinding systems
contribute to a sense of well-being, safety, and security. In addition to this, research suggests that
carefully designed wayfinding systems can even influence the well-being of those being treated in
hospitals and other healthcare facilities. Studies from the 1990s onwards have found that, in contrast
to the clinical white walls with which most of us are familiar, soothing environments decorated with
comforting colors and plants, flowers and sunlight are far better at healing. The study focuses on
wayfinding strategies that can be applied in a hospital to enhance user experience for patients, visitors
and staff who use the facility. Hospital patients are often fearful and confused and these feelings may
impede recovery. Every effort should be made to make the hospital stay as unthreatening,
comfortable, and stress-free as possible. This research intends to increase the knowledge in how
various wayfinding strategies that will influence the user experience in the hospitals. These strategies
can be summarized into five main principles: Creating an identity at each location, different from all
others, use of landmarks to provide orientation cues and memorable locations, creating well-
structured paths, creating regions of differing visual character and by not giving the user too many
choices in navigation. The research findings are backed up by the literature review carried out,
comparative case studies and brief analysis to come up with various wayfinding strategies that can be
applied in hospitals to help people find their destinations as well as engendering a sense of safety,
security and well-being. The findings from the study indicated that architecture plays an important role
in wayfinding in order to facilitate a successful wayfinding experience for users of the hospital
environment. From the findings, the study concluded that the existing system of wayfinding present at
the hospital studied required to be reviewed to make it more user friendly and responsive to the
requirements of the standards of universal access The recommendations were that the community
hospital to be designed should employ the various wayfinding strategies to successfully design the
community hospital.
The research carried out comes to the conclusion that carefully designing wayfinding systems have an
effect on the architectural design and cause it to change to ensure a better overall experience.
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TABLE OF CONTENTS.
ABSTRACT …………………………………………………………………………………………………………………………………………2
TABLE OF CONTENTS…………………………………………………………………………………………………………………………3
INSPIRATION……………………………………………………………..………………………………………………………………………5
1. CHAPTER ONE: INTRODUCTION

1.1 BACKROUND INFORMATION…………………………………………………………………………………………………5
1.2 PROBLEM STATEMENT…………………………………………………………………………………..…………………………6
1.3 PROJECT JUSTIFICATION…………………………………………………………………….….………………………………7
1.4 RESEARCH OBJECTIVES……………………………………………………………………………….…………………………8
1.5 RESEARCH QUESTIONS…………………………………………………………………………………..………………………8
1.6 STUDY ORGANIZATION…………………………………………………………………………….……………………………8
2. CHAPTER TWO: LITERATURE REVIEW.

2. 1 INTRODUCTION. ……………………………………………………………………………………………………………………9
2.2 HISTORY OF WAYFINDING…………………………………………………………………………….………………………10
2.3 HOW PEOPLE FIND THEIR WAY……………………………………………………………………………………………11
2.4 WAYFINDING EXPERIENCE…………………………………………………………………………………………………12
2.5 WHY PEOPLE GET LOST………………………………………………………………………………………………………12
2.6. IMPORTANCE OF GOOD WAYFINDING………………………………………………………………………………13
2.7 WAYFINDING DESIGN PRINCIPLES…………………………………………………………………….……………… 14
2.8 CONCLUSION……………………………………………………………………………………………………….……………14
3. CHAPTER THREE: RESEARCH METHODOLOGY.

3.1 INTRODUCTION …………………………………………………………………………………………………………………15
3.2 RESEARCH BIAS……………………………………………………………………………………………………………………15
3.3 RESEARCH DESIGN………………………………………………………………………………………………………………15
3.4 RESEARCH PARADIGM………………………………………………………………………………………………………… 15
3.5 RESEARCH METHODOLOGY …………………………………………………………………………………………………16
3.6 RESEARCH VARIABLES……………………………………………………………………………………………………….…17
3.7 SAMPLING TECHNIQUES ……………………………………………………………………………..………………………17
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3.8 DATA COLLECTION METHODS AND DATA COLLECTION TOOLS …………………………………………….…18

3.9 DATA MANAGEMENT AND ANALYSIS ……………………………………………………………………………….……20
3.10 DATA PRESENTATION …………………………………………………………………………………………………….………20
3.11 ETHICAL CONSIDERATIONS…………………………………………………………………………………………………..…20
3.12 LIMITATIONS OF THE RESEARCH APPROACH……………………………………………………………………………21
3.13 SUMMARY……………………………………………………………………………………………………………………….………22
4.CHAPTER FOUR: CONCLUSIONS & RECOMMENDATIONS……………………………………….………23

5.CHAPTER FIVE: BUDGET AND RESEACRCH PROGRAM…………………………………………….………24
6.CHAPTER SIX: BIBLIOGRAPHY AND REFERENCES………………………………………………………………25
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CHAPTER ONE: INTRODUCTION.

INSPIRATION.
Wayfinding can be challenging for many people, especially in complex buildings like hospitals, airports,
and office buildings (Arthur and Passini, 1992).
1.1 BACKROUND INFORMATION.

Architecture is a phenomenon between context, functionality and structure and aesthetics. Circulation
is a component of function and should be addressed in any building to ensure it serves its purpose.
Space is essential for the survival of human beings and it is through it that man creates environments
to fulfill one’s tasks. In order to carry out activities there will always be a space built with specific
functions. One of man’s main tasks is the act of moving be-tween spaces, which consists of moving
from one point of origin to a destination. Being able to find one’s way in a building is a prerequisite for
successfully fulfilling one’s goal in that building (Weisman, 1981). The process of determining a route
from one location to another and navigating that route is referred to as “wayfinding” (Chen et al.,
2009). Wayfinding addresses the memorability of location and orientation of spaces. Once a user
enters and navigates through spaces, they must be able to effortlessly identify the path to be taken
upon revisiting it. They must be able to guide a third person with no prior knowledge of the spaces,
without difficulty. Another important aspect is the ease of access and comprehensiveness of the
circulation and orientation. Users must be able to associate and create experiences parallel to the path
they take. The imageability helps users identify landmarks and important features to help navigation.
The process of way-finding is a dynamic relationship which involves the individual, one’s personal skills
and the environment in which one is inserted. Thus, wayfinding is a process of behavior, design and
operation. This report project will solely focus on the design aspect of wayfinding. Design involves the
elements and organization of the built environment such as the system of architectural information
that studies the morphology of the building. In order to facilitate the morphological definition of a
building, Arthur and Passini (Ribeiro, 1992) distinguish three phases to define wayfinding layout:
identification of spatial units; grouping of these units in zones; and, finally, sectorization no these areas
and the connection between them
Historically, structures were linear and had a clearly defined path to reach the desired destinations.
This was done by placing multiple spaces along the same axis commonly seen as a corridor or an aisle.
This can be seen to this day in the gridiron or linear planning of ancient civilizations like the Indus
Valley or the Egyptian civilizations, each closely associated with a river. This enhanced the intuitiveness
of the spaces and provided a satisfactory experience of the space. Plans relied more on functionality
and ease of access. They also created infinite vistas and had focal points to lead the user through the
structure.
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1.2 PROBLEM STATEMENT.

In the design of some of the complex buildings and environments such as hospitals, some designers
have designed structures that are disconnected and difficult for users to navigate. The
underdevelopment of directional guides more accurately describes common issues of wayfinding.
Wayfinding can be challenging for many people, especially in complex buildings like hospitals, airports,
and office buildings (Arthur and Passini, 1992). It can be easily challenging in stressful situations (e.g.,
Schmitz,1997; Kallai et al., 2007), such as when one is ill or under time constrains. Hospitals have
complex functions and programs, and thus their facilities can become mazes of disconnected,
disorienting spaces (Rousek & Hallbeck, 2011a). There are myriad difficulties that new employees,
patients, patient family members, and visitors of all sorts have while navigating their ways through
large hospital settings, including hospitals with over 400 patient beds (Cooper, 2010)
According to Mollerup (2009), there are four reasons why people have difficulty finding their way
around a hospital. Firstly, hospitals are complicated built environments. There was probably a clear
plan when the hospital was founded. However, later additions and changes may have compromised
the good intentions of the original planners. A second cause why many patients and visitors have
problems finding their way in hospitals is that they are first time visitors, or that the hospital has been
rebuilt, or its functions have been relocated, since their last visit. A third cause of wayfinding difficulties
in hospitals is the names of units on signs. They are often long, difficult, and similar to each other. A
visitor heading for the gastroenterological clinic, for example, may head for the first unit with a name
beginning with gastro. A fourth cause for wayfinding problems is that many patients and other visitors
have reduced capacities of one kind or another. Perhaps visual impairment, reduced mobility, or
reduced mental capacities are the causes for their reduced capacities. Finally, anxiety is known to
weaken the wayfinding capabilities of both patients and visitors (Mollerup, 2009).
Because stress is known to impair information processing (Broadbent, 1971), it can be assumed that
stressful situations impair the cognitive aspect of wayfinding (e.g., Schmitz, 1997; Thomas et al., 2010).
Wayfinding can also be especially difficult for individuals with physical or mental limitations, including
individuals with vision impairments, limited physical mobility, or reduced cognitive functioning.
Wayfinding problems have been associated with negative physical and psychological effects (Carpman
and Grant, 2002). For example, Shumaker and Reizenstein (1982) pointed out that in healthcare
settings, wayfinding problems can lead to confusion, frustration, anger, stress, elevated blood
pressure, headaches, and fatigue. There are safety risks for friends and family who are unable to find
the patients they are visiting, as poor wayfinding can lead them into restricted areas that can pose
either security problems or, worse, hazards to their health and the health of others (Cooper, 2010). A
specific example is delivering mothers who are unable to locate the labor and delivery floors and
therefore face risks for unsuccessful deliveries (Cooper, 2010). Ineffective wayfinding can leave
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patients and visitors with a bad impression of the hospital (Larsen & Tatarka, 2008). Being lost
undeniably leads to an increase in stress levels, which are already taxed by ill health or anxiety (Hale &
Stanney, 2014). The lost patient’s level of satisfaction drops, and with it the organization’s reputation
(Cooper, 2010). Although hospitals use certain wayfinding systems to help users navigate through a
space, particularly using signages, these signages are sometimes not commonly known or understood
by people, who most of them do not have any experience with medical terminology as they use
medical jargons. Furthermore, these signages present do not accommodate those who are unable to
read English, which is the most common language used, or those who cannot read at all. Navigational
challenges in hospitals can cause various problems in a hospital including; losses in efficiency that
translate into productivity and financial losses (Cooper,2010). Hospital employees who are travelling to
meetings in various locations of the hospital are often stopped in the hallways to provide directions.
These interruptions in movement may cause delays for the employees and impact productivity (Harris,
2014). It is therefore important to make wayfinding easy for all users using the facility.
1.3 PROJECT JUSTIFICATION.

As the health industry being part of the main sectors in a country, health facilities such as hospitals
should be designed in such a way that all users can feel safe and understand the space they are
experiencing. This project report explores the current problems posed by insufficient wayfinding within
many hospital settings.
The study makes more sense currently after the recent Corona Virus pandemic that hit the world in
2020. This saw an increase in the number of people from various parts of the country visiting the
hospitals hence the need to make wayfinding more efficient. The study also fills the existing gap
between the theory and practice of wayfinding
as well as solving the existing problems of
navigation experienced in hospitals and other
healthcare facilities by using interior design and
detailing.
Although hospitals use certain wayfinding
systems to help users navigate through a space,
particularly using signages, these signages are
sometimes not commonly known or understood
by people, who most of them do not have any
experience with medical terminology as they use
medical jargons. Furthermore, these signages
present do not accommodate those who are unable to read English, which is the most common language
used, or those who cannot read at all.
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1.4 STUDY OBJECTIVES.

GENERAL OBJECTIVES.
To determine various wayfinding strategies in hospitals.
SPECIFIC OBJECTIVES.
The specific driving forces to carry out this research are summarized below;
1. To identify various strategies through which wayfinding has been applied in hospitals.
2. To determine how various wayfinding strategies have been applied in existing hospitals.
3. To illustrate how the findings can be applied in the designing of a community hospital
1.5 RESEARCH QUESTIONS.

1. What are the standard design strategies employed to enhance wayfinding in hospitals?
2. What is the nature of existing wayfinding strategies in hospitals in the existing hospitals
designed?
3. How can architects come up with better ways of tackling wayfinding in hospitals?
1.6 STUDY ORGANIZATION.

The project report has been organized in the following format:
Chapter one identifies the problem statement being handled and place of research into context. It also
states the objective of the study, scope, project justification and limitations experienced and how they
were handled while carrying out the research.
Chapter two provides the literature review during the research from relevant publications and
research
Chapter three analyzes research methodologies and their application.
Chapter four carries the conclusions and recommendations from the study, which are related to the
ultimate objective of the study
Chapter five outlines the budget and research program
Chapter six cites all references used during the research process.
Fig. 1. Source: http:/ www.google.com, 2022
The figure shows the most common for of wayfinding elements

used in hospitals, signages. They however have a weakness as
they are only limited to people who can read and are familiar
with them, therefore a need to explore other wayfinding 8
strategies
2. CHAPTER TWO: LITERATURE REVIEW.

2.1 INTRODUCTION.
The evolution of hospitals in the western world from charitable guesthouses to centers of scientific
excellence has been influenced by a number of social and cultural developments. These influences
have included changing meanings of disease, economics, geographic location, religion and ethnicity,
the socioeconomic status of clients, scientific and technological growth, and perceived needs of
populations (Risse, 1999) (Fig 1.01). The origin of hospitals as an independent institution for the care
and treatment of the sick can be dated back to the fourth century AD. Throughout the Middle Ages,
but notably the 12th century the number of hospitals grew rapidly in Europe. Arab hospitals also grew
in number and were special because they admitted patients regardless of their race, beliefs or social
order. Universal health services is a goal set by the Kenyan government in 2018 (Fig 2). According to
the World Health Organization in 2015, “Universal health care refers to a health care system that
provides health care and financial protection to all citizens of a particular country.” The thesis
contribution to this would be from a wayfinding in hospitals perspective. The building design and
complex nature of hospitals often add additional sources of problems. For example, many hospitals
tend to be large, with incremental and uncoordinated growth patterns, environmental characteristics
that often create wayfinding difficulties (Rousek and Hallbeck, 2011)
Wayfinding in architecture refers to user orientation
and the selection of a path of travel. Modern additions
to the term now encompass a series of architectural
design elements that aid in orientation. This concept
gained traction in the sixties, coined by Kevin Lynch,
who defined wayfinding as, “a consistent use and
organization of definite sensory cues from the external
environment”. This was later expounded by
environmental psychologist Romedi Passini, wayfinding
began to include graphic communication that affects its
spatial relationships, tactile elements and provision for
Fig 2: A ward in Middlesex hospital in London
users with special-needs. “Good design arrives at a
(1808). Source: www.londonlives.org/, 2022.
realistic and viable vision of what a place might become.
To do so, it has to consider inter-relationships in the local environment. It has to look at the links
between spaces.” (A Design Wayfinder- The Design Council)
This chapter will consider publications made by Kevin Lynch, and Romedi Passini, an environmental
psychologist and architect, who later on expounded it by including graphic communication that affects
its spatial relationships, tactile elements and provision for users with special-needs since it gained
traction in the sixties.
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Hospitals and other healthcare facilities can often be frustrating to navigate from one point to another
due to their complex program and arrangement of space. However, those that utilize wayfinding
systems are generally much simpler and less stressful to navigate for both patients and visitors.
Wayfinding systems are designed to help and guide individuals to navigate through a space as
efficiently as possible. This means helping patients and visitors get from one area of a hospital building
to another, or from different buildings spread over a larger hospital facility A wayfinding system is
meant to familiarize users with their surroundings with the goal of making subsequent visits easier.
One study carried out by spatial expert Jain Malkin looked at how visual cues are used in every day
navigation outdoors, then applied this to the interior of a hospital building, promoting natural light,
highly visible yet unobtrusive signage and looped corridors instead of dead-ends for a more natural
wayfinding experience.
2.2 HISTORY OF WAYFINDING

The developments in wayfinding appear to fall into three overlapping eras:
I. Pre-Passini Era (1960 to the 1970s), -sees the inception and conceptualization of wayfinding,
dominated by thinkers keen to study cognitive structures responsible for information
processing and wayfinding is understood and explained in terms of spatial orientation and
cognitive maps (e.g., Lynch 1960, Downs and Stea 1973, 1977, Kaplan 1976, Siegel and White
1975).
II. Passini Era (late 1970s to 1990s) -wayfinding is conceptualized further by extending the
concept of spatial orientation. The era is dominated by thinkers keen to study the dynamism of
humans in space (e.g., Passini 1977, 1984, 1996, Wiseman 1981, Arthur and Passini 1992).
Wayfinding is understood and explained in terms of spatial problem solving.
III. Post-Passini Era (from the mid-1990s to date)-sees an extensive
operationalization of existing concepts, nothing new is offered in
terms of conceptualization. The era is polarized into two camps:
pro-Passinis (e.g., Carpman and Grant 2001, Huelat 2004, Brandon
2008, Rooke et al. 2010) and pro-cognitivists (e.g. Golledge 1999,
Raubal 2001, Haq and Zimring 2003, Holscher et al 2005).
The term wayfinding was first used by Lynch (1960) where he referred to
maps, street numbers, and directional signs etc. as “way-finding” devices
(Fig 3). His work, which is seen by many as being pivotal in how we
understand environments, was based on the concept of spatial
orientation and its prerequisite the cognitive map (Arthur and Passini, Fig.3: Lynch in 1960 referred to
1992). Lynch reasoned that the five key features (paths, landmarks, directional signs as wayfinding
regions and nodes are the main components of cognitive maps devices.
(Appleyard, 1969. Francescato and Mebane, 1973). Cognitive maps are Source: www.freepik.com/free-
photos-vectors/wayfinding-sign,
2022
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defined as mental representations or overall mental images of the spaces and layout of a setting
(Arthur and Passini 1992).
Wayfinding supplanted "spatial orientation" in the 1970s (Arthur and Passini, 1992). Romedi Passini
questioned cognitive scientists in 1977. He claimed spatial orientation doesn't include how people
move and change. Finding your way requires more than a static mental picture of your surroundings,
he explained (1960). Wayfinding was his idea for spatial problem-solving. People in architectural and
urban spaces face several issues.
Passini co-wrote Wayfinding: People, Signs, and Architecture with Toronto designer Paul Arthur in
1992. This book codified architectural and cognitive research on navigation (Hunter, 2010). Their work,
which builds on Passini's 1984 work, establishes the phrase "environmental communication" and
proposes that the built environment should talk to its users. Arthur and Passini were the first to
segregate architectural and informational wayfinding, writes Hunter (2010). Wayfinding is crucial at all
levels of planning, including regional, city, neighborhood, street systems, public transportation,
parking, building complexes, infrastructure, and individual building layouts (Hunter 2010).
Architects, planners, designers, wayfinding consultants, and academic scholars continue to focus on
outdoor and inside navigation, according to Peponis and Wiseman (2002).
2.3 HOW PEOPLE FIND THEIR WAY

Find your route in two steps (Mollerup, 2005). Locate yourself first. Mollerup (2005) offers four ways to
assess your environment. One's position can be identified by its distinct appearance, whether natural
or artificial. A stone path in a green area is an example; it's distinguishable from the grass.
Visiting an animal orphanage, one may distinguish themselves as being in the "carnivore's area" on a
map. Users can also use position indicators (Mollerup, 2005). GPS can calculate position, but not
indoors.
Next, plan your route. Travel hierarchy may be used in route decision-making. Smaller, less-traveled
routes grow and shrink (Calori, 2007; Mollerup, 2005). From Kasarani to Thika, one would use
progressively larger and quicker routes until reaching the freeway. Near the mall, they had to take
smaller, slower roads (paths).
Like complex building wayfinding. People instinctively prefer a larger, more traveled corridor (route)
with more information until they're close to their target, when they choose a smaller one.
Passini (1984) explains a user's path via an environment's changeability. Wayfinding is a dynamic
activity that can change from the user's plan. As the user walks around, he develops environmental
forecasts and compares them to real facts (Passini, 1984).Difference, visual access, and spatial
arrangement complexity affect navigation, according to Garling, Book, and Lindberg (1986).
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Navigation skills decline with age. Older kids can navigate well (Bell et al., 1996). Memory loss and
disorientation hinder geriatric navigation. Self-correcting independent of age or navigational skill. The
user can retreat and start over if they make a mistake (Bell et al., 1996).
The accuracy of maps varies. North is "up," west "left," east "right," and south "down" Northbound
drivers turn left (west) to go south. Users can't rotate all cognitive maps (Bell et al., 1996). Physical and
cognitive maps are next.
2.4 WAYFINDING EXPERIENCE

A user's primary purpose is to reach the target site, but additional factors add to a satisfying
experience. The user's environment must be satisfying.
Passini (1984) states complex navigation is rewarding when you solve problems, are delighted, and
learn something new.
Amos Rapoport (1977) noted that favored environments are perceptually rich, complex, and
interesting. Boredom hinders navigation and learning about the place (Passini, 1984). Solving
architectural and spatial navigation problems and exploring is rewarding (Passini, 1984). Poor design
can make complexity difficult to navigate.
Complex, featureless, or visually overloaded environments cause navigational challenges (Passini,
1984). Design discusses complexity. Others say complexity distracts and hinders concentration
(Rosenzweig, 1966; Thompson and Heron, 1954). Vernon and McGill (1957); Wohlwill (1966). Hard to
agree on wayfinding difficulty.
2.5 WHY PEOPLE GET LOST

People become lost in hospitals due of poor spatial judgment. Locational errors include erroneous
turns, miscalculating inter-point distances, and spatial sequencing and linking errors. Accuracy of
spatial judgement determines the frequency of locational errors and is affected by these factors.
(a) Familiarity: The unfamiliar observer hasn't memorized routes, landmarks, edges, etc.
(b) Complexity of the environment; affects spatial accuracy and kind and amount of inaccuracy at
a place. Complex settings are harder to comprehend and remember.
(c) Inadequacy of locational aids: Without locational tools, navigating the built environment can
be difficult. These environmental components help one make spatial judgments and navigate
properly. Inadequate locational assistance increases locational errors.
(d) Legibility This is how easily users can navigate a building (Weisman, 1981). Simple, coherent,
intelligible, perceivable, imageable characterize a legible environment. Understanding a
building's spatial layout requires legible entrances, horizontal and vertical circulation, and
prominent landmarks.
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2.6 IMPORTANCE OF GOOD WAYFINDING

Poor wayfinding costs the wayfinder (Arthur and Passini, 1992), (Carpman and Grant, 2001), and
(Huelat, 2004). They all agree that navigation in complicated situations causes stress-related symptoms
like elevated blood pressure, headaches, and exhaustion. The hospital construction boom allows
architects and professionals to rethink hospital architecture and healthcare delivery to:
• Reduce staff stress and tiredness.
• Improve care delivery.
• Increase patient safety.
• Reduce patient and family stress and improve outcomes.
• Improve healthcare overall.
• Improve hospital operations (Shoemaker et al., 2010).
2.7 WAYFINDING DESIGN PRINCIPLES

According to Carpman and Grant (2002), it is important to construct and graphically explain wayfinding
ideas based on evidence. Designers should not assume that navigational concepts hold true at all
scales, as Peponis and Weiseman (2002), point out These should reflect shifts in navigational practices
across populations, contexts, and user types (i.e., indoor vs. outdoor, first-time vs. regular visitors).
Huelat (2007), uses visuals to convey her principles, illustrating components of a building (Facility
Amenities, Graphics, Signage, Architecture, Interior Architecture, Interior Design, Landscape, and
Master Plan) that, according to her, function together to form a unified navigation system It is possible
to create aesthetically pleasing hospital environments. The routes chosen by the users let the buildings
flow more naturally. A good navigational system makes use of this, and its parts are interdependent in
the same way as bricks in a wall are. The following components make up effective wayfinding:
I. Zoning
(a) Good zoning considers the facility’s growth and expansion.
(b) Zoning establishes good circulation pathways.
(c) Zoning ensures that related activities are clustered together thus minimizing on confusion.
II. Route Complexity:
(a) Grid-based buildings with uniform angles.
(b) Open-core buildings offer visual and acoustic access to circulation systems.
(c) Corridor windows for visitor orienting.
(d) Clearly marked entrances, elevators, ramps, stairs, and clear walkways.
(e)Asymmetrical floor plans are easy to recall.
(f) Front-door-visible information desks shall be at each public entrance.
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III. Landmarks:
a) They have to be unique (size, shape and color) in a building so as to be effective; they can be lighting
fixtures, materials, kiosks or art pieces.
(b) They should be placed at decision points and perceived from as many directions as possible thus
the ones located at intersections work best.
(c) Landscape features such as trees, water features create memorable landmarks.
IV. Color and Lighting:
(a) Ample lighting makes signs more visible, it can also provide direction on circulation
pathways.
(b) Distinct colors can be used for landmarks, graphics, signage, and other visual cues to reinforce
wayfinding.
(c) Varying color codes with departments or floors can facilitate wayfinding.
V. Graphics and Signage:
(a) Use familiar pictograms for reinforcing the text and providing “you-are-here” (YAH) symbols is
important.
(b) YAH maps and signs need to be placed along paths and positioned near decision points.
(c) Maps should be placed at entrances so that visitors orient themselves at these points and decide
their destinations.
(d) Maps should be perceived from a distance, easily accessible and oriented so that what is forward
on the ground is up on the map.
2.8 CONCLUSION.
The reviews of literature of research carried out on wayfinding show that wayfinding is an integral
concept in the design of hospitals. Lynch (1960) presents external environment wayfinding metrics that
are also applicable in internal wayfinding environments such as within hospitals buildings that if
incorporated well enough may contribute to people finding their ways intuitively reducing functional
inefficiencies. Passini (1981) provides a framework of wayfinding models applicable within hospital
environments. The proposed research fits within this research context of spatial wayfinding. The next
chapter presents an overall approach to the research technique to be used in the research detailing
methods and tools employed.
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CHAPTER THREE: RESEARCH METHODOLOGY

3.1 INTRODUCTION
This section outlines the methodology that will be used to gather data for this project. The viewpoint
and methodology of the researcher are described, as well as the justifications for specific
methodological choices. The nature and methodology of the study being conducted are described in
the second section of this introduction. The fieldwork for the research study can then be concentrated
on a region that is easier to manage. The research process is described, along with the tools and steps
that are required. For later use, the data must be logged and recorded. There are various ways to
present this information, and once it has been utilized, a plan for its storage or deletion must be in
place with all ethical procedures considered.
3.2 RESEARCH BIAS.

The Research is going to carried out from a relativist perspective in Epistemology and ontology. This
research bias is by the researcher hence the choices and opinions made in this section of the Research
will be made with this bias in mind. All of the decisions and assessments in this part of the Research
will be filtered through the researcher's inherent bias.
3.3 RESEARCH DESIGN

Research design is a plan, structure and strategy of investigation so conceived as to obtain answers to
research questions (Mugenda, 2012). Sometimes, it is referred to as a research strategy, which is
synonymous with research design a term coined by Groat and Wang, (2002).
The proposed research study will employ qualitative research approach. The topic in question falls
under social sciences, which tends to favor qualitative methods because they seek to comprehend the
world through the eyes of its participants. Part of the research entails examining this phenomenon in
order to learn how hospital spatial navigation influences the efficiency in hospitals.
This study will therefore heavily rely on qualitative research approaches including use of data collection
methods such as observations, interviews, focus groups and secondary research. The study will heavily
employ these in quest to collect data on wayfinding in hospitals.
3.4 RESEARCH PARADIGM

Wayfinding, being a social science deems it to be subjective in nature. As such the research will be
undertaken from a constructivist point of view. This is also supported by the fact that the perceptions
of the subjects involved is likely to be varied, thus providing unique and personal insight that may be
instrumental to the research. The perception is also mostly grounded by its context, specific to
residents in Nairobi, and not elsewhere in the world. Furthermore, there’s not a single truth but rather,
multiple ones depending on the respondents involved. As such, the researcher acknowledges the
15
existence of multiple truths, but it keeps on being reconstructed every time depending on various
findings.
3.5 METHODOLOGY
Based on existing case studies, this investigation seeks to comprehend the hospital navigational
practices that ultimately facilitate recovery. Six approaches were highlighted in the literature review,
and the researcher will discuss how these interventions improve both patient satisfaction and staff
efficiency. The strategy of the research methodologies will include:
a) Finding out the existing conditions,
b) Finding out what is required and,
c) Finding out what is needed.
The research will be carried out using the case study method majorly, which will be characterized, by a
purposeful selection and triangulation of the cases (Johansson, 2003), and use of narratives to collect
data.
3.5.1 CASE STUDY METHOD.
The case study method will be used to conduct the research, and it will be distinguished by the careful
selection and triangulation of the examples (Johansson, 2003). The case study method is the finest to
employ since it creates opportunities for comparing and contrasting similarities and differences, which
enables us to develop the best guidelines for design objectives. The information we gather through this
comparison analysis is then based on a number of variables and the participants' responses to those
variables. In order to clarify and corroborate the information, there will be a triangulation with
previously examined literature.
Two local case studies were chosen to represent a variety of communities.
We chose these two hospitals because of their high treatment standards (both are level 5) and the
large number of people (over a million) in their catchment areas. More than that, they see an average
of a thousand patients per day. Two examples of this are; Thika Level 5 Hospital, Thika town (Fig. 4) and
Mama Lucy Kibaki Level 5 Hospital, Nairobi (Fig. 5)
Fig 4: Image of the

reproductive health
unit at Thika Level 5
Hospital.
Source:
www.google.com.20
22
Fig 4: Image of Mama Lucy Kibaki Level 5 16

Hospital. Source: www.google.com,2022
Comparative case study method will involve the analysis of the cases based on the parameters set in
literature review as follow;
(a) Zoning: facilitates future growth and expansion, good circulation, and clusters related activities to
reduce confusion.
(b) Route complexity: organize buildings around a simple orthogonal grid with regular angles, an open
core for visual and auditory access to circulation systems, windows in corridors to aid visitor
orientation, easily identifiable entrances, understandable circulation systems, clear pathways, regular
but asymmetrical floor plans, and information desks at each public entry.
(c) Place landmarks at decision points; make them unique in size, shape, material, and color.
(d) Color and lighting: Provide adequate lighting to make signs more apparent and guide circulation
pathways. Use unique colors for landmarks, graphics, signage, and departments.
(e) Graphics and signage: Use familiar pictograms at decision points, position maps at entrances, and
orient maps so forward on the ground is up.
(f) Edges: Must contrast with surroundings to be visible.
Each variable will be observed by documenting its existence or absence in each case study. The case
study technique will allow us to examine and contrast the two hospitals' wayfinding strategies.
3.5.2 NARRATIVE METHOD.
This method will involve interacting with the users of the hospital facility to fulfill various objectives
stated out while carrying out the study.
3.6 RESEARCH VARIABLES

Reviewing existing literature in Chapter 2 helped the researcher zero in on the following criteria that I
applied to my case study analysis. Among these are; Zoning, Route Complexity, Landmarks, Color and
Lighting, Graphics & signage and Edges
3.7 SAMPLING TECHNIQUES

STUDY AREA.
For the purposes of this research, the Thika Level 5 Hospital and the Mama Lucy Kibaki Level 5 Hospital
were selected because of the following reasons:
a) Mama Lucy Kibaki Hospital's placement is strategic; it serves as a case study for the city of
Nairobi's central business district and is positioned near Eastlands neighborhoods. The Thika
Level 5 Hospital is conveniently placed in the heart of Thika town, making it an ideal choice for
this study.
17
b) the researcher has first-hand knowledge of the difficulties of navigating this terrain. This
sparked an interest in elucidating the causes of this phenomenon in order to devise workable
remedies to the issue.
In order to use the narrative approach in the research, a random sample of one-third of the
facility's visitors will be selected at random. I plan to formally approach various subsets of the
target demographic in an effort to build a snowball sample. Methods like convenience and
purposive sampling, which are not based on probability, must be used instead.
Individuals in the study population will be assigned quotas based on their affiliation, and
demographic information will be collected independently for each subset. Using this method, we
can perhaps amass more reliable data.
STUDY POPULATION.
The target population for this research will majorly be made up of people who use and visit the facility,
i.e, patients, hospital staff and visitors, all above 18 years of age. For the part of the study that involves
conducting observations without drawing attention to themselves, this study plans to use a mix of non-
probability and probability sampling.
3.7 DATA COLLECTION METHODS AND DATA COLLECTION TOOLS

Gathering evidence to support your argument requires using reliable sources (Yin, 2003). As a result,
this research relied on a wide variety of secondary resources to bolster its claims. Before conducting
the site visits, the research largely relied on published and unpublished publications. The research
literature paved the road for identifying the factors that affect hospital navigation. In order to make an
apples-to-apples comparison of the hospitals, a comparative case study method will be applied.
Accordingly, information was gathered to shed light on the aforementioned study's predetermined
parameters. These methods include:
a) Observation
For a long time, observations have been a go-to method for data collection (Yin 2003). Supplementing
other methods, observation sheds light on inconsistencies between what people say they do and what
they actually do in interviews and casual interactions (Pettigrew, 1990). Direct observation as a data
gathering strategy is beneficial because it is non-intrusive and does not necessitate participant
participation (Adler and Adler, 1904). Another perk is that researchers can make use of their full
complement of senses when investigating natural environments or uncontrived circumstances. Both
structured and unstructured observation methods will be covered in this approach to data collection.
The goals will be answered using structured methods, while all other contextual data will be gathered
using unstructured methods. Observation will be used to gather information about physical attributes
18
of typologies including their measurements which aided in the site planning and unit planning of the
hospitals.
In this case, I would observe the behavior of anyone visiting the facility, and observe how they navigate
in different areas, depending on the existence or absence of wayfinding cues. The observation will take
place between 8.00 am to 6pm, so as to ensure that data collected is not influenced by time constrains.
This will also be advantageous as this is the time when most people visit hospitals, aiding to acquiring
reliable data.
Data Collection Tools: Cameras, Observation checklists, Tripod stand, Sketching pads and pens.
b) Interviews
The users who agree to participate in the interviews will be asked about the wayfinding methods and
techniques they use to locate the locations they need in hospitals, the reasons behind their choices of
methods and routes, their preferred methods of navigation, and any changes they would make to the
facility's wayfinding system in order to improve their experience. Interviewers will approach users
directly to recruit them to take part in the interview.
This will be based on a number of questions that I will develop through desk research to guide this
investigation. So as not to mislead the interviewee, I will structure it in a semi-structured approach
which involves asking a general question on the particular variable with the follow up questions based
on the responses of the interviewee. The inquiries I make will help steer dialogues that will support
some of the information in the literature review. Hospital employees and patients will be the main
responses targeted. I will add to the discussion in the data analysis by taking notes in response.
Data Collection Tools: Memory Card, Audio recorder, Camcorder, Hand notebook, Pens.
c) Questionnaires
I will administer structured questionnaires at the two hospitals, to some of the personnel, patients, and
visitors. The open-ended and closed questions will be designed to shed light on the approaches taken
by staff, patients, and visitors when navigating medical settings.
Data Collection Tools: Hard copy Open-ended and closed-ended questionnaires, pens
d) Review of secondary data:
Information about wayfinding that has already been collected and published in books, journals, and
articles will be examined in order to facilitate additional inferences. The aforementioned research
strategies will serve as a platform for disseminating and generating ideas on enthusiasm for the
investigation.
19
3.8 DATA MANAGEMENT AND ANALYSIS

The narrative technique (Allen, 2007) and the content analysis approach (Luo, 2019) to data analysis
will be used because of the exploratory nature of this study, supplemented by thematic analysis. The
purpose of employing these techniques is to deduce the underlying ideologies of the participants'
narratives and the make-up of the photographs they provided for analysis.
a) Narrative Analysis
So that the material may be understood and built upon, I plan to go through all the data acquired
through the interviews and questionnaires, code, identify themes, and then produce a final summary
of these results from my perspective. To ensure the veracity of newfound themes, narrative analysis
necessitates ongoing contact with the secondary literature.
b) Content analysis.
My plan is to review the visual data (photographs and sketches) I collect after conducting observations
in order to become acquainted with the material and to establish coding units. As a next step, I'll apply
the coding units to the data and make a tally of how often each unit appears so that I may draw
conclusions. This will help in creating a more unbiased examination of field data.
c) Thematic analysis.
I would document evaluations and interview transcripts will be analyzed using a thematic content
analysis to learn more about the navigational aids and systems already in use. To analyze patterns and
trends, content analysis is a method that is both quantitative and objective (Schutt, 2006).
3.9 DATA PRESENTATION

Upon completion of data analysis, the findings will be presented in the following formats; Data
tabulations and tables, analytical sketches, architectural plans, sections, elevations, and details, and
journals and books all constitute different types of visual
3.10 VALIDITY AND RELIABILITY OF DATA

The validity of any research method, including the case study approach, is of paramount importance.
Case studies allow researchers to combine results from several sources to ensure all of their numbers
are accurate (Yin, 1984). The purpose of using these four methods of data gathering was to strengthen
the reliability of the study's overall results.
3.11 ETHICAL CONSIDERATIONS

Researchers' minds have been preoccupied with the question of how to best study the many subfields
that make up the social sciences. This line of thinking encompasses not just the most effective means
of conducting research, but also the most ethical means. I will achieve this in the following ways:
20
Obtaining consent for research

Each person will be given the opportunity to give their informed consent before any interviews or
questionnaires are administered. The subjects will have all the data at their disposal to make an
informed choice as to whether or not to participate as a volunteer in the study. This is how I plan to
guarantee that all human participants in my studies are giving me their full consent after being fully
briefed on the nature of the research they are participating in.
Ethical Issues for Consideration in Paper Publication
Researchers in the social sciences should highlight their findings, ideally in the form of an article in a
peer-reviewed journal. This is mainly relevant while carrying out literature review.
Anonymity.
The interviewees' identities will not be revealed in any way whatsoever. They will be identified by
numbers or letters, like subject ‘X’, for example. To protect the respondents' (research participants')
anonymity, we won't be using any of their information in any of the reports and publications that
result from our study.
Security of the information
The researcher will utilize methods such as password-protected files, encryption when transmitting
data over the internet, and locked cabinets to ensure the security of their data. Once the study has
been completed and all relevant data has been utilized, all the data collected will be disposed in a
proper manner.
3.12 LIMITATIONS OF THE RESEARCH APPROACH

However, there were a number of obstacles that needed to be overcome before the research could be
completed. The following are examples of restrictions:
Time: there is not enough time to collect all the necessary data in the time allotted for the
investigation. The research period, September 2022–December 2022, was insufficient for the study's
goals; to address this, the authors conducted more extensive research and spent more time on the
study method by drawing on previous research and doing comparisons. This was also taken care of by
selecting as the case study the Thika Level 5 Hospital, which is centrally located and can be reached in a
short amount of time.
The availability of case studies is constrained by financial constraints. To solve this problem, we
selected a case study in the area closest to us—Thika Level 5 Hospital.
Problems with Accessing Case Studies This is one of the least discussed issues in the local community,
hence there may be problems obtaining case studies. To solve this problem, researchers looked at how
directional signage was implemented in non-medical settings.
21
3.13 SUMMARY
This chapter laid out the planned methodology for the case study, which includes a combination of
document analysis, in-person interviews, online surveys, and use logs. An overview of the study's
design, specifics of the tools and processes used to collect data by method, analyses performed on the
gathered data, and considerations of any ethical concerns were all covered in the methods section.
Case studies, which permit in-depth exploration of a single location, were ultimately chosen as the
primary research method, with narrative methodology serving as a supporting framework. With this
method, we can better understand how users navigate healthcare facilities, which is the ultimate goal
of our investigation.
After describing the approaches that will be taken in the study, the next chapter draws some broad
findings and wraps up the proposal.
22
4.CHAPTER FOUR: CONCLUSIONS & RECOMMENDATIONS

4.1 INTRODUCTION
The study's primary goal is to catalog the various approaches to hospital architecture that have been
shown to improve patient navigation. As we have seen in the preceding chapters, hospital wayfinding
can be described as the act of navigating to a certain location, whether that location is known or
unknown. The author examined the writings of Arthur, Passini, and Huelat to compile a summary of
the literature on the topic of healthcare facility navigation. The findings discussion summarizes the six
obtained parameters.
4.2 RECOMMENDATIONS
It is clear that there is a need for local involvement in the planning and design of healthcare facilities
based on findings from a research of design solutions used to improve wayfinding in hospitals.
Based on the literature review, the researcher has drawn the following proposals that, if implemented,
would greatly improve hospital wayfinding and will be explored at length below, roughly, under the
following two precepts:
(a) Design strategies.
 Zoning: This is the foundation for an effective healthcare facility navigation scheme. It needs to
make room for development and expansion in the future without jeopardizing current
circulation standards.
 Route complexity: A simple orthogonal grid with consistent angles makes buildings easier to
navigate. Open core buildings allow visual and acoustic access to circulation systems.
 Landmarks: Hospitals should include landmarks especially for first-time users.
 Color and Lighting: Use floor markers to demarcate places, especially important hallways and
departments, to aid wayfinding. Signs at site or building entrances should be color-coded.
 Graphics and signage: Backgrounds and text should always have great contrast for legibility.
Yellow and orange; purple and pink are similar shades in the same color-coding scheme.
 Consistent, understandable signage is key.
 Edges: They must contrast with the surrounding environment to emphasize leaving one space
and entering another.
b) Recommendations for future research on wayfinding in healthcare facilities.
The researcher studied hospital wayfinding, which contributes to a holistic therapeutic environment.
The author proposes studying other hospital healing factors, such as. Hospitals, etc.
The finances of this study, and how they will be used, will be discussed in greater detail in the next
chapter for the stated objectives to be established.
23
5.CHAPTER FIVE: BUDGET AND RESEACRCH PROGRAM

5.1 BUDGET
In this part, we detail everything we'll need to complete the study during the course of the three-
month project timeline (May 2022-July 2023).
ITEM SPECIFICS TOT. COST (KSHS) PERIOD OF AMOUNT (KSHS)
AQUISITION
Research Equipment Camcorder 60,000 1ST May – 10th May 170,000
Audio Recorder 20,000
Camera Kit 75,000
Tripod Stand 15,000
Supplies Sketching Pad 1,000 1st May – 10th May 4,300
Notebook 1,500
Stationery (Pens, 1,800
pencils, erasers)
Travel & Per diems to areas of 6000 per day 1st May – 12th May 40,500
Accommodation study (inclusive of all meals
and travel)
Other expendables. Miscellaneous costs 12,000 1st May – 25th July 2,500
(emergencies, access
fees, variations)
TOTAL AMOUNT 186,300 217,300
5.2 RESEACRCH PROGRAM

Project Period - 3months (20th Jan 2023-March 09 2023)
The planned research can't be done without adhering to the timetables for individual tasks laid out
below.
Research activity Proposed research timelines

Development of the research 1 st May to 14th May
Literature review 15 th May to 31st May
Development of questions for data collection 15 th May to 31st May
Pilot study 1 st June to 14th June
Data collection 1 st June to 14th June
Data analysis 1 st June to 14th June
First draft write-up 15 th June to 30th June
Final draft write-up 1 st July to 14th July
Submission of final dissertation 1 st August
24
6.CHAPTER SIX: BIBLIOGRAPHY AND REFERENCES

Arthur, P., & Passini, R. (1992). Wayfinding: people, signs, and architecture.
Butler, D. L., Acquino, A. L., Hissong, A. A., & Scott, P. A. (1993). Wayfinding by newcomers in a complex
building. Human factors, 35(1), 159-173.
CARPMAN, J. R., & GRANT, M. A. (2001). No more mazes: Five learable skills for finding your way
around confusing places. Unpublished manuscript. Ann Arbor, MI: Carpman Grant Associates.
Gibson, D. (2009). The wayfinding handbook: Information design for public places. Princeton
Architectural Press.
Gross, M. D., & Zimring, C. (1990). Buildings, memory, and wayfinding. Environmental Design Research
Association, 21, 85-93.
Holahan, C. J. (1978). Errors in Cognitive Mapping: A Behavioral Interpretation. In Environment and Behavior (pp.
141-156). Springer, Boston, MA.
Johansson, R. (2007). On case study methodology. Open house international.

Lawton, C. A. (2010). Gender, spatial abilities, and wayfinding. In Handbook of gender research in
psychology (pp. 317-341). Springer, New York, NY.
Mollerup, P. (2005). Wayshowing: a guide to environmental signage. Lars Muller Publishers.
Peponis, J., & Wineman, J. (2002). Spatial structure of environment and behavior.
Shumaker, S. A., & Reizenstein, J. E. (1982). Environmental factors affecting inpatient stress in acute
care hospitals. Environmental stress, 179-223.
Slone, E., Burles, F., Robinson, K., Levy, R. M., & Iaria, G. (2015). Floor plan connectivity influences
wayfinding performance in virtual environments. Environment and behavior, 47(9), 1024-1053.
Yin, R. K. (2003). Design and methods. Case study research, 3(9.2).
25

Wayfinding in Hospitals

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WAYFINDING IN HOSPITALS

ABA 2506: RESEARCH METHODOLOGY II

1. CHAPTER ONE: INTRODUCTION

2. CHAPTER TWO: LITERATURE REVIEW.

3. CHAPTER THREE: RESEARCH METHODOLOGY.

3.8 DATA COLLECTION METHODS AND DATA COLLECTION TOOLS …………………………………………….…18

4.CHAPTER FOUR: CONCLUSIONS & RECOMMENDATIONS……………………………………….………23

CHAPTER ONE: INTRODUCTION.

1.1 BACKROUND INFORMATION.

1.2 PROBLEM STATEMENT.

1.3 PROJECT JUSTIFICATION.

1.4 STUDY OBJECTIVES.

1.5 RESEARCH QUESTIONS.

1.6 STUDY ORGANIZATION.

Fig. 1. Source: http:/ www.google.com, 2022

The figure shows the most common for of wayfinding elements

2. CHAPTER TWO: LITERATURE REVIEW.

2.2 HISTORY OF WAYFINDING

2.3 HOW PEOPLE FIND THEIR WAY

2.4 WAYFINDING EXPERIENCE

2.5 WHY PEOPLE GET LOST

2.6 IMPORTANCE OF GOOD WAYFINDING

2.7 WAYFINDING DESIGN PRINCIPLES

CHAPTER THREE: RESEARCH METHODOLOGY

3.2 RESEARCH BIAS.

3.3 RESEARCH DESIGN

3.4 RESEARCH PARADIGM

Fig 4: Image of the

Fig 4: Image of Mama Lucy Kibaki Level 5 16

3.6 RESEARCH VARIABLES

3.7 SAMPLING TECHNIQUES

3.7 DATA COLLECTION METHODS AND DATA COLLECTION TOOLS

3.8 DATA MANAGEMENT AND ANALYSIS

3.9 DATA PRESENTATION

3.10 VALIDITY AND RELIABILITY OF DATA

3.11 ETHICAL CONSIDERATIONS

Obtaining consent for research

3.12 LIMITATIONS OF THE RESEARCH APPROACH

4.CHAPTER FOUR: CONCLUSIONS & RECOMMENDATIONS

5.CHAPTER FIVE: BUDGET AND RESEACRCH PROGRAM

5.2 RESEACRCH PROGRAM

Research activity Proposed research timelines

6.CHAPTER SIX: BIBLIOGRAPHY AND REFERENCES

Johansson, R. (2007). On case study methodology. Open house international.

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