Wayfinding: hidden costs and challenges

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Dr Colette Jeffrey has been identifying and solving wayfinding problems in NHS hospitals for many years. Having written the official NHS Wayfinding guidance and worked with more than 25 NHS hospitals, she recently completed a PhD study that investigated why people get lost in buildings. This article explains why hospital wayfinding is so difficult, the tragic consequences of wayfinding failure, why wayfinding strategies are essential, and ways to make your sites easier to navigate.

Wayfinding problems are inevitable in multi-building, maze-like healthcare environments with thousands of first-time visitors. Knowing how much time staff spend directing lost people is the first step towards identifying key wayfinding issues and measuring the impact on operational efficiency. A short staff survey will help you understand the scale of the problems and calculate the hidden costs of misdirected staff time.

Can a first-time visitor find destinations at your site without asking for directions? If your answer is “Yes” there is no need for you to read on. If you are shaking your head, knowing people struggle to find many places at your site, please continue reading.

The hidden cost of wayfinding failures

A recent survey of 100 staff at a large acute NHS hospital found the Trust could be spending over £5.6m on staff helping people find their way, rather than doing their primary job. This substantial figure is based on the following simple calculation:

Average time staff spend directing people is 22 minutes per day.
22 mins a day = 84 hours per year (assuming 5 days a week, 46 weeks a year).
Staff earning a real Living Wage of £13.45 x 84hrs = £1,129 a year.
5,000 staff x £1,129 is £5.6m a year of staff time directing people.
1,000 staff x £1,129 is still over £1m a year of avoidable costs.
Staff on higher wages giving directions costs much more.

This staff survey was small-scale — larger surveys at other hospitals are planned — but the findings and potential costs are clear. Do you know how much time your staff spend every day directing lost people? Over a third  (37 per cent) of staff surveyed felt that giving wayfinding help was impacting their productivity.

At the study site, wayfinding problems were evident in Children’s Outpatients where staff reported dealing with 374 lost people over four days of data gathering. Seventy-two per cent were in the right area but at the wrong desk, but 10 per cent needed to find the Emergency Department on the other side of the site. At the Imaging desk, staff directed 113 people over four days, with almost a fifth looking for Main X-ray — a five to 10 minute walk along a difficult to describe route. Finding out which staff and services are being most impacted by lost people is worthwhile.

Surveys and consultations give useful insights

A good way to measure the scale and impact of your wayfinding problems is to ask your frontline staff and service users. They have extensive first-hand knowledge that senior management only get glimpses of. Questions that enable you to calculate costs and time spent include:

How often do you direct lost people?
How much time each day do you spend giving directions?
Are there any places lots of people ask directions to?
Do you find it easy to direct people?
Which places are hardest to direct to?
Do you think helping lost people impacts your productivity or service efficiency?

A survey created using Microsoft Forms generates a QR code for easy dissemination of the survey. An Excel spreadsheet of all responses makes the data easy to analyse. Attractive visual graphs of the data can be used for easy communication of findings to executive decision makers and budget managers at your site.

Staff are critical to wayfinding success

Many lost people look for someone to ask for directions, while many others will never ask for help and are  reliant on your wayfinding information to guide them.  Staff who look official wearing a uniform or seated behind a desk are most likely to be asked for help. These people need access to up-to-date wayfinding information, to be informed when site changes occur, and given training in giving simple, accurate directions. Eighty-six per cent of staff surveyed said they help someone every day for at least a minute. Conversely, 12 per cent said they never give directions because they are not sure where places are, and do not want to misdirect people.

Common problems when untrained people give directions are:

Using outdated terminology, abbreviations, or names not used on signs e.g. “go past the old Outpatients, turn left at X-Ray, and SDEC is on the left” when the signs use other terms such as Ambulatory Care, Diagnostic Imaging, and Same Day Emergency Care.
Giving overly complex directions (or too vague directions) when they struggle to create a mental map of your site layout and cannot describe key routes in simple ways.
Referring to indistinct landmarks that are not easy to recognise.

Getting lost affects patient satisfaction and experience

Being sent in the wrong direction, walking further than necessary, and having to ask for directions multiple times frustrates service users, impacts patient experience and therefore satisfaction ratings, and causes people to be late. If people completely miss their appointment because they could not find the way, it impacts service efficiency, is stressful for staff who are trying to meet performance targets, and in some cases leads to anger and aggression towards staff.

Patient Experience and PALS teams receive complaints, but if only a few people criticise signs and wayfinding, this does not mean you do not have problems! Many people do not know how to complain, cannot be bothered to find out who to contact, or are so grateful and relieved after their appointment that they forget about the wayfinding issues they experienced at your site. Online patient, visitor, carer, and family group consultations will help you identify key problems, and co-design workshops either in person or online will help you develop wayfinding solutions that reflect the concerns of your service users.

A tragic consequence of wayfinding failure

In 2018, a 34-year-old new mother died when she got lost wayfinding from the neo-natal unit to the maternity ward in a large UK hospital. It took searchers over five hours to find her collapsed in a rarely used stairwell. Poor signage and a lack of physical barriers to stop unauthorised people using the stairs were found to be contributing factors to her death.

A year earlier in a shopping centre in Sydney, Australia, a 71-year-old man from Tasmania mistakenly entered a rarely used stairwell and became trapped. It took 21 days to find him, by which time he was dead.

Do you have any rarely used stairwells, building areas, or corridors that people could mistakenly access and lose their way? How quickly would you find them after they were reported missing?

A different, potentially tragic situation could arise in an emergency situation when staff with specialist life-saving skills need to urgently find a location at your site. If staff get lost, or fail to take the quickest route, there could be a harmful delay in the person getting the care they need. Have you identified and assessed wayfinding information along these potential emergency routes and destinations at your sites? Carrying out Wayfinding Risk Audits and developing Lost Person Protocols for each of your sites will help avoid future tragedies.

How Wayfinding Risk Audits identify safety issues

Wayfinding audits to identify safety risks are not a ‘nice to have’ or a ‘will do later’ task — they are essential for keeping people safe and for risk reduction at your sites. Audits should:

Identify public routes with access to restricted, rarely used areas, stairwells, exits, and rooms where someone could go missing.
Map high-risk junctions, decision points, and vertical circulation routes.
Walk the routes and identify potential high-risk decision points.
Walk the routes with first-time visitors, and people living with cognitive, sensory, or physical impairments. Ask if they are confused by any of the safety information or environmental features at the high-risk locations on the route.
Listen to staff interactions along the routes — are staff able to give directions that avoid people accessing high-risk areas?
Repeat audits at different times of the day.
Create a prioritised Risk Reduction Action Plan based on the audit findings.
Install new wayfinding information, environmental safety features, or physical barriers where necessary.

Identifying routes that connect linked services — such as maternity wards to neonatal units — is important. Risk assessing the potential for people to move from public to restricted areas is crucial. Do you need to install barriers and other environmental interventions, or new safety and warning signs, to prevent accidental access into rarely used stairwells? Wayfinding failure is an underestimated safety risk. Wayfinding systems should be treated as a safety-critical operational issue, not a cosmetic enhancement project.

Why hospital wayfinding is so difficult

Sites with multiple buildings linked by corridors and a maze of external pathways and internal corridors is common. People inevitably encounter wayfinding problems. Creating a mental map of complex sites is hard, especially when departments relocate, services merge, old buildings are demolished, and new ones added. Your mind maps (and your site maps) change frequently. Redrawing your maps is often challenging but it is essential for wayfinding success.

Site changes in today’s NHS hospitals cause:

Outdated signs after relocations, and when new buildings open.
Inconsistent naming conventions across Trust sites.
Lack of ownership for planning, funding, and updating wayfinding systems.
Out-of-date verbal directions being given by staff.
Limited budget for new wayfinding strategies and system maintenance.

Three factors influence wayfinding success — people, information, and environments

Wayfinding systems are complex, hybrid systems. Success is affected by the people you train, the information you provide, and the environments you create, including:

People giving directions — in person, over the phone or in writing — and a person’s individual ability to navigate and move around your site.
Information at your site — signs, maps, leaflets, and diagrams, and in digital formats — appointment letters, texts, emails, and websites.
Environmental interventions — canopies at external entrances, lifts and staircases that are visible from the approach, lighting at reception desks, flooring that guides people along key routes and describable landmarks located at key decision points.

These three inter-related, interconnected factors make hospital wayfinding systems difficult to manage, with different directorates, teams, and professionals often working in silos to design and implement each factor.

Effective wayfinding systems involves many directorates and teams

The three biggest barriers to having a consistent, clear hospital wayfinding systems are:

A lack of ownership.
A lack of allocated funding.
A lack of central management.

A small number of Trusts have appointed a Wayfinding Manager or Champion. A few have set up cross-directorate Wayfinding Working Groups. Some work with specialist wayfinding consultants. Most try to identify and solve wayfinding problems using in-house skills, with no action plan or strategy.

Most Trusts split responsibility for wayfinding across multiple directorates and teams, with:

Capital Projects teams responsible for new buildings that need new signs consistent with the rest of the site, and clear linking routes.
Estates & Facilities teams are responsible for signs, maps, and environmental developments that need new information. Reactive fixes are common.
Communications teams responsible for websites, leaflets, and printed maps that need to be consistent with signs and letters.
Patient Experience teams and PALS responsible for letters, reception desk staff training, and volunteers giving directions that need to be consistent with signs, letters, and digital information.
IT and Digital teams responsible for emails, texts, apps, and websites that need to be consistent with signs, printed letters, and verbal directions.
New Hospital Programme coordinators responsible for ensuring wayfinding in the new hospital considers how people navigate the existing site now, during and after construction.
Clinical teams responsible for ensuring staff use agreed simple names, avoid using abbreviations, regularly review typical patient journeys and flag up any operational wayfinding issues to the appropriate directorate, or to the Wayfinding Manager.
Chief Executive teams and frontline teams are all responsible for developing and maintaining an effective wayfinding strategy and consistent system.

Common hospital layout problems

Here are just a few issues faced by NHS hospitals in the UK. Many sites are dealing with three or four structural or operational issues. Understanding your priorities helps you to plan improvements:

Interconnected buildings, with separated lifts and stairs, floors that are not connected, and level names that do not align.
Buildings connected by seemingly endless corridors without describable features.
A sloped site with buildings having more than one ‘Ground’ level.
Multiple site and building entrances with unclear signs.
Building and area names that look or sound similar.
Identical looking corridors across different floors.
No describable landmarks for orientation or to use in spoken directions.
Area zoning, colour-coding, and simplification systems that staff do not use.

Real confusion occurs when any or all these issues are not resolved cohesively and effectively.

Understanding your site structure is useful

Large hospitals are like a small town or city. Urban planning theory is useful for defining your site structure. In a study of US cities, Kevin Lynch identified five elements that support the formation of a mental map and are widely used in commercial wayfinding design practice, and in wayfinding strategies:

Nodes (decision points and junctions).
Paths (routes and corridors).
Landmarks (recognisable describable features).
Districts (zones and areas).
Edges (boundaries and barriers to movement).

Applying Lynch’s theory to today’s hospital sites, you can start to identify the core structure of your site. Here are five examples of sites with different structures, but all five factors can be seen across each site:

Why a Trust-wide Wayfinding Strategy is essential

Developing and implementing a Wayfinding Strategy requires a committed multi-directorate team working together. You need people who can identify key wayfinding problems at your sites, listen to stakeholders, consult frontline workers, and become familiar with the NHS Wayfinding guidance available to download free on the NHS England website. The strategy defines what you need to do to reduce the risk of people getting lost, make wayfinding easier, and reduce the number of people asking untrained staff for directions at your sites.

A unique Wayfinding Strategy for your Trust and sites

No two NHS Trusts or hospitals have the exact same wayfinding problem. Your overarching Trust-wide strategy will communicate the agreed guidance on:

Pre-visit wayfinding information — letters, websites, emails etc.
Simplifying your site layout — zones, wings, colour-coding, area numbers etc.
Naming — simple and short, avoiding long medical terms and abbreviations.
Sign design.
Map and diagram design.
Landmarks for wayfinding.
Interior design and architectural features that aid wayfinding.
Staff and volunteer direction-giving training.
Future plans for the site that affect wayfinding.

Reviewing all names and abbreviations used at your sites is an essential first step. Listening to your frontline staff is equally essential.

Developing a wayfinding strategy involves around nine stages, though sometimes stages are undertaken concurrently:

Stage 1: Audits, Consultations, and Surveys to understand journeys, risks, and problems at your sites.
Stage 2: Simplification strategy to reduce information on signs and so people have less to remember e.g. zones, areas, landmarks, lines, or colour-coding.
Stage 3: Naming strategy to align signs with other communications.
Stage 4: Trust-wide wayfinding strategy with agreed top-level principles
Stage 5: Sign and map design strategy for clear, simple, consistent information.
Stage 6: Staff training strategy for giving clear, simple, consistent directions.
Stage 7: Future site plans for new developments and wayfinding system adaptations.
Stage 8: Phased prioritised implementation plan

10 Year Health Plan raises wayfinding challenges

The NHS plans to move services from hospital sites to community-based locations. This increases the number of places a Trust needs to help staff and service users to find. For many, finding a clinic in their local community will be easier and quicker than a large hospital site. However, people who do not read their pre-visit information closely, or have not lived locally for long, may go to the wrong site, or may find wayfinding becomes more difficult. If your community-based reception desk staff record for a week or two how many people got confused, miss their appointments, or arrive late because of wayfinding issues, you will assess the scale of the problem for your site users. The results may be surprising. The hidden costs may be significant or acceptable. The data will help you identify problems and priorities.

Analogue to digital — what are the wayfinding solutions?

The NHS moving from analogue to digital makes sense financially and environmentally. Providing wayfinding information in digital formats is potentially more flexible, accessible, and inclusive. However, people without digital devices or the skills to access the digital wayfinding information will continue to need printed information. These service users will be excluded by a digital-only system.

A trial of a digital wayfinding solution took place at Leicester General Hospital in 2024. The study tested the solution in four areas of the hospital. The report on NHS England’s Digital webpages concludes: “The solution is currently not able to identify individual users to track their live location to inform the blue dot [showing your location] capability. Potential fixes have been explored but have raised additional issues around data security and server space. At the conclusion of the trial this issue had not been resolved.”

Indoor navigation systems need very accurate positioning of the navigator, and a reliable network that stays connected without signal delays. Otherwise the navigator will have moved, making the guidance of little use. Technology, AI, and digital innovations are progressing at an unprecedented speed. No doubt there will soon be new digital solutions and reliable indoor data networks making systems more reliable, useful, affordable, and accessible.

Hybrid navigation solutions combining physical and digital

Personalised multi-platform, digital, and physical solutions offer the most inclusivity and flexibility for wayfinding. Physical signs remain essential but increasingly work alongside digital tools. Possible future solutions include:

QR-codes on physical information could be scanned to show your position and the best route to follow.
Interactive digital maps with a line or audio cues to follow.
Apps within the NHS App with indoor navigation functions.
Appointment emails with links to navigation apps.
Digital parking systems with routes to relocate your car.
Real-time bus information and routes to find the right bus stop.
Personalised real-time wayfinding information.

Five quick wins to improve wayfinding at your site

Ask your staff how much time they spend directing people, and what can be done to make wayfinding easier at your sites.
Train your reception staff, volunteers, and porters to give clear directions — they are a crucial part of your wayfinding system. Ask what resources would help them direct people more easily.
Create describable landmarks at key decision points and junctions along your main corridors. They need to be distinct and easy to recognise — they can be anything! Ask staff to use these new landmarks when giving directions.
Check your hospital postcode(s), street name(s), and online maps — do they guide people to appropriate locations at your site? Change them if needed.
Make your external building entrances distinct, with large signs at eye level and visible from all approaches.

Wayfinding failure has direct operational consequences so act now

Getting lost impacts safety, security, compliance, risk, and site-user satisfaction. Improving your wayfinding system will reduce:

Staff time spent giving directions.
Late or missed appointments.
Patient anxiety and staff frustration.
Disrupted clinic schedules.
Staff interruptions from lost people.

The benefits are clear:

Improved patient experience and satisfaction.
Reduced staff disruptions.
Greater operational efficiency.
Enhanced safety.
Reduced risk of getting lost.

Measure the scale of your current problems by monitoring the number of:

People asking for directions at key junctions.
Reception desk interruptions.
Missed appointments due to navigation failures.
Complaints received by PALS about getting lost.

Done well, wayfinding is almost invisible. Done poorly, it affects everything. Most importantly, better wayfinding systems ensure that people feel welcome and can navigate healthcare environments, regardless of their ability, and with confidence and dignity. In today’s NHS hospitals, solving your wayfinding problems is not ‘something we will do when we have some spare budget’ but an essential, caring, and kind task to start now.