Article from the Boston Globe’s On Call Magazine, October 2001

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Have you ever considered what it feels like to be a new patient at your hospital? Not just how it feels to be sick or scared, but what it is like to have to navigate your way around a large and unfamiliar institution? If you haven’t, you may be surprised at how many different things you can do to make the task easier.

Rima Rudd, ScD, of the Department of Health and Social Behavior at Harvard School of Public Health has studied how people move through space. As principal investigator in Health Literacy Studies of the National Center for the Study of Adult Learning and Literacy, Rudd and several graduate students examined the navigation tools people use and how they use them to find their way to and around hospitals.

In the “Navigation Study,” which they conducted from 1999 to 2000, each participant was paired with a researcher and then asked to tour one of fourteen hospitals in the greater Boston area. The study participants commented on how easy or how difficult it was to find their way around the hospital. They specifically talked about the navigation tools they used. Understanding the results of the study can help you help your institution make it easier for patients to get around.

How People Got Around

One part of the study focused on pre-tour information. Participants called the hospital’s main number, looking for information about how to get to the institution using public transportation. Another part focused on the tour itself. Researchers met with participants in the hospital lobby. The first task the participants had was to find their way to the café. From there, they selected two other areas of the hospital to visit, choosing from the pharmacy, medical records, or a specific clinic. Finally, the researchers and participants looked at and discussed maps, signs, and other postings. Here are the sources participants used for information during the study.

The phone. Most of the time, the main number of the hospital is answered by a tape recording. The voice on the recording often speaks quickly, listing numerous options and alternatives. Many of the study participants reported frustration with these recorded messages and simply waited to be connected with a live operator.

Exterior signs. Some people reported difficulty finding street signs identifying the hospital. At times, they were confused about where the main entrance was. For example, when a sign said “Ambulatory Entrance,” some people became confused about whether this entry was intended for ambulances or for patients.

Maps. Most every facility provides maps. But maps are not always easy to follow. When participants tried to use the maps as a navigational tool, they almost always abandoned them and asked a person instead. While many maps are color-coded, the study participants found that the colors did not necessarily match the painted walls. In addition, some names on the maps did not match the actual names of the locations participants were looking for. For example, an area labeled “Ambulatory Center” on the map may in reality have been called “Outpatient Care.” To compound the difficulty, many participants reported that many maps were printed in a font size too small for them to read.

People to ask for help. Participants commonly asked people for directions. When they did they often learned what they needed to know from someone at a designated “Information Desk” or from a guard stationed in the lobby. When participants stopped an employee in the hall, however, they found that this person, who usually tried to be helpful, often could not adequately give directions.

Interior signs. There are many signs within a hospital. Some are painted on the walls, others hang from the ceilings or are affixed to doors or windows. Study participants found difficulty with the inconsistent placement of signs and said they did not always know where to look for information. People also found that hospitals often use embedded signs with multiple levels of information — similar to the headline, subhead, and text in newspapers. Many times the words on the top line are names of benefactors who donated money to the hospital. The next line down may be the official name of the center. It is only on the bottom line that a person can find the specific function of the space. Signage such as this can be difficult, especially for people with limited literacy or language skills who may have trouble identifying the most important words.

Putting the Results to Use

Based on findings from the Navigation Study, Rudd suggests five things healthcare providers can do to make it easier for patients to navigate to and around hospitals.

Record an easy-to-understand phone message. People should not be frustrated with recorded telephone messages. Speak slowly and clearly. Also, be sure to provide an easy way for callers to connect with a live person.

Use consistent terms. Decide, for example, whether food is available in a “café” or “cafeteria.” Use the same words in the sign at the doorway as you do on maps and in your verbal directions.

Select colors that are meaningful. For many people, colors are an effective tool to distinguish one space from another. Whether the colors are integrated into the floor or painted on the walls, make sure they are consistent with the colors on the map. In addition, have at least one other way to distinguish a space. People who are colorblind or visually impaired may not be able to use color as a navigational tool.

Place signs uniformly. Rudd says that people expect there to be some inherent logic in where signs are placed. Try to be consistent when hanging signs. People should not have to constantly shift their focus from walls to ceilings, floors, doorways, or windows.

Take a tour. Accompany a family member or friend as he or she navigates through your hospital for the first time. Let this person lead the way, showing you what it is like to be a newcomer. While you can’t say that what works for one person will necessarily work for another, this tour may help raise your awareness of potential navigation problems. “The best way to learn about your facility,” says Rudd “is to have someone else show it to you.”

How to Find Out More

Rima Rudd, ScD, is a member of the Department of Health and Social Behavior at the Harvard School of Public Health. She is principal investigator in Health Literacy Studies of the National Center for the Study of Adult Learning and Literacy. To learn more about the issues of health literacy, visit the Web site at www.hsph.harvard.edu/healthliteracy. This web site includes a literature review, a slide overview, and access to the video, “In Plain Language.”