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Journal of the Academy of Hospital Administration

Signage Program in Hospitals: A System for Quality Improvement Through Patient Access and Convenience

Author(s): Dr. Bidhan Das*, Ms. Pritindira Talwar**, Ms. Pranita Jain***

Vol. 16, No. 1 (2004-01 - 2004-06)

Key Words Signage Program in Hospital Quality Improvement

Key Message: Signage is an effective graphical interface between the user and intended facility. Effective signage promotes the healhcare facility as patient friendly *MBBS, MHA (AIIMS), Executive Director, Medical Communication Network, New Delhi.

This paper is a consequence to the signage Development Program undertaken by Medical Communication Network for the Uttaranchal Health System, under the aegis of the World Bank. The signage system hence designed has been adopted uniformly in all the state run hospitals and health centers in Uttaranchal. The following paper describes the importance of the signage system in hospitals as well as the crucial factors that need to be considered while designing and adopting such a system. Few samples of the signage so developed have also been presented, along with the discussion on the materials, layout, content and the costs involved for the benefit of the readers.

Access is an important part of quality of care. A crucial aspect for patient satisfaction is their comfort levels with the facility itself i.e. a person’s ease in navigating a facility, and the timeliness in receiving care. All these factors are greatly affected in the absence of an appropriate guidance and information system in the hospital

In our county the masses approaching our hospitals are mostly illiterate and come form the rural area. They waste a lot of time in the hospital while finding their way to different departments of the hospital and also in making enquiries for location finding. Besides the great degree of confusion that can occur, the new users coming t a hospital sometimes invariably end up standing in the wrong queues. This results in a loss of time and delay for the user as well as the healthcare provider.

Hospitals are public service institutions and as such are under obligation to serve the public with zeal and enthusiasm. The people who approach the hospital are those compelled by disease, injury sickness and other unavoidable circumstances. It should be the endeavor of each hospital to see that its patients and attendants do not run form pillar to post in enquiry and finding out about various departments. Clear and proper signage at strategic points can help patients in reaching their destination without losing much of their valuable time and save lot of their efforts in unnecessary enquiring from persons.


Significance of the Signage System:

The signage program can benefit both the users and the providers in many ways. These are:

  • It is an effective tool for patient information system
  • It is instrumental in the marketing of hospital services by clearly informing and making aware, the patients as well as their visitors of all the facilities available in the hospital
  • It adds on to the convenience for the patient with regards to navigation and access through the city and the hospital.
  • Health facilities that leave their visitors confused can alienate their client base. By providing an improved access to the services within the campus through an appropriate way finding systems can make them feel comfortable and helps encourage their return as well as leaves a favorable impression of the healthcare provider
  • It also improves staff efficiency by reducing requests for directions, thus relieving the already overworked staff and subsequently contributing to decreased chances of clash between the providers and the clients.
  • Reduces the number of enquires to be made by the patient before reaching the destination
  • Reduces the average time taken by the users to reach a particular service area 1
  • Makes the visit to the hospital more impressionable and pleasant
  • Promotes the image as a patient-friendly hospital
  • Gives a feeling of “inviting"

Designing of a Signage Program:

Considerations for Designing:

There are various factors, which need to be considered during the designing of the signage program.

Population Attributes

Certain characteristics of the population that the health facility serves, such as culture, and the demographic profile, are helpful in determining the type of signage system to be developed. This is essentially true for the, visual symbols depicted on the signage boards. (See sample No.13-ladies toilet). The masses should be able to identify and understand the objects illustrated and the regional culture is instrumental in this selection

Communication Needs:

The lingual, communal and societal backgrounds of people results in potential as well as real situations of communication impasse. Hence it is imperative to keep these factors prior in mind before designing of any communication systems essentially the signage program. For example, the language understood by the community is the main determinant for the messages written on the signage.

Cost/Budget

Being foremost in determining the material, magnitude and dimensions of the signages, cost remains the fundamental component entailing consideration while developing the signages. For example reflective and non-reflective materials can be used for similar signboards depending on the budget allocated

Key Aspects Taken into Account While Developing a Signage Program:

Physical Aspect:

It comprises of features such as Shape, form, Colour, magnitude, dimensions, texture etc of the signboards.

Shape, Size & Colour: Lettering, lexis and lines need to be selected for optimal reading. Choice of a type style should take into account legibility and compatibility with the pictographs and the environment.

The shape of designed boards should essentially be customized according to the location. Also the shape should not be complex in structure2. The colour scheme used needs to be uniform, simple and attractive which is in harmony with the hospital’s setting. For example for all the hospitals in Uttaranchal we have used Green and white as the key colours for display.

Usability Aspect:

Comprised of factors like siting, visibility, readability, and other human product interaction factors.

  1. Siting: For enhanced vision signboards need to be placed closer to one’s natural line of vision.
  2. Visibility, readability and human product interaction factors: The font size used for display boards should be clear and visible from distance. Human product interactions essentially suggests that sign boards ought to be sturdy and unbreakable2

Organizational Aspect:

It includes path of information, links, flow and structure of the health care facility. Also the various activities, interactions performed therein.

Linkages and flow of information within the facility. It has the power to unite and bring about a feeling of identity. The various signage need to be linked for proper information flow. For example a board at the entrance could provide full information about the hospital services and subsequently boards the hospital service and subsequently boards at each floor could display the services at that specific floor along with visuals and directions. (See sample nos. 17, 18)

Semantic Aspect

Which includes content, connotation and feeling to be conveyed to the people.

Content and meaning

Has potentials for constructing an effective graphical interface between the user and the intended facility. The displayed content needs to be concise and unambiguous conveying the message clearly. Instructional boards in hospitals can be proactive like “Thank you for not smoking”, “Help us in maintaining silence” (See sample nos. 4,6,11) instead of being passive like “No smoking and “ silence

The language used for the signage system was both Hindi and English. Hindi was predominantly used for the benefit of the large Hindi speaking population in the state.

Visuals:

Visual representations (as graphical symbols) have been used effectively as a communicative interface where it concerns human interaction with a public facility; especially in matters of identifying and denoting the various functions (of a given public facility).

It is always desirable that the communication of information issuing from these interfaces is not misleading or confusing ; it should, on the other hand, be revealed as fast as possible. In other words the information must be communicated properly, efficiently and conveniently. Therefore, besides the messages, the matching the corresponding visuals and icons have also been depicted for the benefit of the illiterate population coming to the hospital.

Functional Aspect:

Which generally expresses for what purpose signage boards are displayed. This comprises of directional, instructional, promotional or informative.

Steps involved in the Process of Desitgning a Signage Program

Step 1

Data gathering & Study of the region where the health care institution/s are present

As a first step a study of the primary, secondary and tertiary care institutions and facilities, which were considered as model centers, was conducted.

The second step included the study of sample health institutions and facilities in the region where the signage program, was to be implemented

Both the studies were accomplished using the following means:

  • Studying the environment, artifacts, building or the facility for signage etc.
  • Conducting interviews of the patients, visitors as well as the staff (related to the navigation and directional facilities present), videotaping, photographing, documenting, sketching
  • Referring to previous works, literature, books, journals, web documents etc.

Subsequently, the data collected and observations made were assessed, compared and guided under parameters namely literacy level status, lacunas present in the present signage system in the hospitals of Uttaranchal.

STEP II
A customized, simple, attractive internal and external signage system was then developed taking into account all the above parameters.

STEP III
Evaluation and Assessment of the Program

Systematic checking or pre-testing of materials was done which was instrumental in identifying the loopholes that occurred while designing the content, layout and selection of visuals. This was done by showing the exhibits developed, to a sample of the patient population in the state.

Problems with the content included, confusion with the overall meaning of the message as well as misinterpretation of the message and the visuals.

The necessary modifications were made accordingly and subsequently the designs were finalized for production after being approved by the state health authorities.

STEP IV
Commonly used materials for signages2:

  • Acrylic sheets - Signages need acrylic sheets that are white in colour and translucent so that this could be used for backlighting. It is suggested to use sheets of thickness 2 to 3mm for this purpose.
  • Vinyl Sheets - Self adhesive vinyl sheets are pre-coloured. Text and graphics can be cut using a drafting cutter connected to a computer that can generate these fonts and subsequently pate on Acrylic sheets.
  • MS (Mild Steel) Sheet - These sheets are made of metallic components. MS sheets can be used outdoors for directional and instructional signages. ’16 gauge’ is the ideal thickness for such kind of signages.
  • Concrete - Cemented triangular boards are ideal for directional signages in the outdoors.

Conclusions

A Good, effective and a simple signage system is an effective way for enhancing the image of the hospital as well as keeping the public informed of the services available. The effectiveness of the signage system can further improve with little motivation form the hospital staff to the public for using the signages so as to enable easy navigation through the hospital area.


References:

  1. Dr. Hem Chandra, Medical Superintendent; K. Jamaluddin, P.R.O.; Sanjay Gandhi PGIMS, Lucknow, Up. Internal Signage-An Effective Tool For Patient Information System; Official Journal of Indian Hospital Association, Vol. XXXVII, March/June 2000
  2. Prof. Ravi Poovaiah, IDC, IIT Bombay, www.idc.iitb.ac.in

Annexure 1

Sample Signage

**MBA (Hospital Administration). Asst. Manager, Medical Communication Network.
***MHA, Sr. Executive, Medical Communication Network, New Delhi.

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