In fiscal year 2013, the Centers for Medicare & Medicaid (CMS) began withholding a portion of hospital payments based on their performance. CMS makes adjustments to measures and domain weights each year to reflect an emphasis on those areas most in need of improved performance. Four domains will impact up to 2% of a hospital’s Medicare reimbursement in FFY 2017: process of care (core measures), patient experience (HCAHPS), efficiency of care and outcomes.
As a result of the HCAHPS measure, Texas Children’s Hospital engaged a consultant to benchmark with a national database of peer facilities as a means to quantify their patient experience. The results showed poor scores specific to wayfinding, and Formationwas engaged to assess the hospital’s existing graphics, signage and nomenclature.
The team’s research included spending four weeks interviewing stakeholders, performing patient/caregiver visit-alongs and shadowing hospital staff. The focus was on understanding the challenges and successes of the current ecosystem to include wayfinding materials and the larger Texas Medical Center, which is inseparable from TCH from a human (non-institutional) perspective.
Reflective of the disconnect between different units in the hospital, numerous wayfinding systems and methodologies were employed. While some of these were implemented systematically based on a unit (for example, outpatient clinic) or by a specific building of the campus, others were created bespoke by employees, often nurses and administrators, who established their own systems and workarounds out of a necessity to get their patients to the right place and on time.
Formation’s findings are documented in a report entitled “System Wayfinding Assessment & Recommendations,” a comprehensive look at the existing condition at TCH that provides a user-focused look at patient touchpoints, from hospital staff through mobile devices/website, printed collateral and space planning and environmental elements.
One of Formation’s major findings was that landmarks are very important in helping people navigate a complex hospital environment, and TCH needs to be more deliberate about where landmarks are placed and leverage the landmarks that already exist. The existing system, which utilizes large geometric shapes that correspond to building floors, is not recognized by the public as part of the wayfinding because of the large scale of the objects and inconsistent communication and reinforcement on signs (including inconsistency in color and dimensionality of shape).
Formation also found that some of the most inspirational parts of the facility were underutilized. They recounted the story of a policeman who would de-escalate difficult situations with emotional visitors by escorting them to a seating area rich with natural light, providing them a calm place to collect themselves in the wake of challenging encounters. Underutilized parts of the facility could be used in a more dynamic setting to create comfort, familiarity and some sense of normalcy.
Formation’s recommendations established an alternative reading of the hospital as a “sensory landscape” in which graphics and landmark interventions use color, form, texture, pattern, structure and sign elements to help travelers intuitively negotiate the scale of the campus. Formation is currently developing a series of proposals for interior elements (landmarks, interventions, thresholds, etc.) that are semi-autonomous to the campus in order to aid more instinctive wayfinding.
Philip LeBlanc (principal) ; Lauren Serota (research lead); Mandy LeBlanc (research assistant); Daren Guillory (design director); Tyler Swanner, Erich Theaman (designers); Dan Samora (Texas Children’s Hospital liaison)
4,900,000 sq ft