Why Most Digital Indoor Wayfinding Tools Fall Short in Hospitals

How well someone can navigate a building depends largely on their knowledge of the space. This spatial knowledge can be categorized into three types: knowledge of a specific point in space (e.g., the destination), route knowledge (the path from their current location to the destination), and survey knowledge, which involves understanding the overall layout of the environment (Wiener, 2009).

When designing tools to help people navigate, you are essentially addressing a "spatial knowledge deficit." Only by understanding and mitigating this deficit can you create effective navigation solutions. This requires a deep understanding of the spatial cognitive processes involved in wayfinding.

Why Most Indoor Navigation Tools Fall Short

Most digital tools for indoor navigation perform poorly because they focus too much on technology and too little on human cognitive processes. Simply displaying a path on a map or projecting it as an AR overlay is not enough. Effective wayfinding—especially in complex environments like hospitals—requires far more than drawing a virtual line on the floor or showing a route on a map.

When we first started building our wayfinding system in 2014, we had similar assumptions. We thought we could model a building with a few simple data tables and that a CSV file generated from an Excel sheet would suffice. We quickly realized that this was far from the case. Modeling a building for accurate and effective route information is an incredibly complex process.

Building a Wayfinding Knowledge Base

Over the years, we built a robust wayfinding modeling engine and developed a growing knowledge base of wayfinding scenarios. Every hospital project presented new, bizarre situations that required unique solutions. Without addressing these intricacies, any system we developed would fail to meet user needs.

Hospitals, in particular, pose unique challenges for wayfinding. It’s unrealistic to assume that hospitals consists of a straightforward hallway layout with the occasional elevator or staircase.

The Challenges of Wayfinding in Hospitals

Consider the following scenario’s:

Complex Elevators and Stairs
Some elevators may open on one side on one floor, on both sides on another, or require specific buttons to open doors depending on the floor. Similarly, a lift might open to level 0 on one side but the back door opens to level -1 without actually moving vertically…. Similarly, in-level stairs can complicate navigation.

Intermediate Floors
A building might have an entrance at level 1 at the front but between level 5 or 6 at the back.

Interconnected Buildings
A connector bridge may link two buildings, where exiting at level 2 in one building could lead you to level 5 in the next. This is especially common in hospitals built on a hill, though we have also encountered it in hospitals constructed on flat terrain.

Dynamic Access Access
Doors to certain areas, such as emergency rooms, might not always be open. The same applies to entrances and exits, which may be closed after hours or follow irregular schedules, for example, due to staff shortages. Large spaces that accommodate thousands of passing routes might also be inaccessible during specific time periods due to events or even a church service.

Better Routes instead of Shortest Routes
You don’t always want to show the shortest path. Sometimes the shortest route passes through areas that are less desirable, such as a narrow hallway where patients wait near a clinic or a location where hearing tests are conducted, making it unsuitable for high foot traffic. Even though this path might be the shortest for dozens of destinations, you may want to reroute people to avoid these areas. However, for wheelchair users, you might prefer to keep the shorter path to avoid burdening them with a longer route that might not be an issue for people who are more mobile.

Real-Time Adaptability
When an elevator is under maintenance or a section of the building is closed for renovations, thousands of routes must be dynamically updated to provide alternatives. And what about rotating clinics? Hospitals are increasingly moving towards flexible use of space, where a reception desk might serve ophthalmology patients today and ENT patients tomorrow. If your wayfinding solution can’t accommodate this, it might be better to shut it down entirely.

Accommodate Multi-Step Routing for the Hospital Check-in Process
Hospitals often require patients to pass through staffed check-in counters or self-service kiosks, which can be located centrally in the lobby or deeper within the building. Your wayfinding solution must be smart enough to handle this by offering multi-step routing automatically.

Additionally, it should be able to differentiate at the patient level. Some patients may be allowed to proceed directly to their destination without needing to go through a check-in point. These patients should receive a different route, tailored to their specific requirements, without relying on personal information. This ensures a seamless and efficient navigation experience for all users.

Confidentiality Needs
This relates to the check-in process described above. A common variation involves situations where some patients are not allowed to know their exact destination upfront. This is because their insurance must first be verified. Only after this verification is completed are they provided with a code. This code either guides them via signage or acts as a password to unlock the next step of their route on their phone after checking in at a kiosk or desk.

Getting to the Hospital
Don’t forget to provide information on how to reach the hospital—this is often where the frustration begins. People need details about how to get to the hospital regardless of their mode of transportation. They also need to know where to park and which entrance to use, depending on both their mode of travel and their parking location, which in turn depends on where their appointment is within the building.

You don’t want to send someone to the main entrance, only for them to navigate through the entire building via a complex route, when they could simply park at a side entrance and take a much shorter, easier route inside. Your system needs to adapt dynamically to offer the best possible guidance in these scenarios.

Accomodating to Follow-Up Appointments
To reduce unnecessary visits to the hospital, appointments are often combined. This requires your system to support multi-step routing, which may even be initiated directly from the appointment scheduling system.

Oh, and it’s also helpful if patients can record where they parked their car. The route back to the car after a follow-up appointment may differ from the route they took to their initial appointment. Your system should account for this as well.

Conclusion

The use cases for wayfinding are endless. Addressing these complexities requires a vast wayfinding knowledge base integrated into the mapping software, which is then incorporated into the mathematical graph that underpins navigation data.

Indoor navigation, particularly in hospitals, is far more complex than it appears. It demands a deep understanding of spatial cognitive processes and the ability to model countless real-world scenarios. By building a robust knowledge base and continuously refining our mapping software, we aim to provide navigation solutions that truly meet the needs of users in even the most complex environments