Hablamos Juntos

Hablamos Juntos

Universal Symbols in Health Care

A partnership between Hablamos Juntos and SEGD, with support from the Robert Wood Johnson Foundation

Today, one of the most important issues facing healthcare administrators in the United States is providing services to people with limited English proficiency (LEP) and limited reading proficiency. A critical aspect of serving LEP and limited-reading populations is making healthcare facilities more accessible and easy to navigate.

Since 2003, SEGD and Hablamos Juntos have been working together to develop design and educational tools to support wayfinding systems in healthcare environments. These efforts are part of Hablamos Juntos’ ongoing mission to provide practical solutions to language barriers in healthcare.

Phase I

In 2003, with funding from the Robert Wood Johnson Foundation, Hablamos Juntos contracted with JRC Design (an SEGD member firm based in Phoenix, Ariz.) to complete an initial study to determine the feasibility of using symbols as an alternative to text-only signs in healthcare settings, and to make recommendations based on the findings.

The study concluded not only that symbols were a viable option for wayfinding in healthcare, but that a set of tested symbols, publicly available, would give designers and healthcare facilities a much-needed alternative to typical word signage.

Under the leadership of Jamie Cowgill, JRC also contracted and led the development of an initial set of 30 symbols. The project design team also included Kate Keating, Meg Faye, Jack Biesek, Gladys Brenner, and Jim Bolek. Wendy Olmstead provided technical expertise for symbol recognition testing, and completed data analysis based on the process developed by Harms Zwaga. JRC recommended SEGD join the process to form a technical review committee and to promote awareness of the study among designers. 

The technical review committee for Phase I included John Bosio, Hillier; Dan Clements, Karlsberger Companies; Ken Ethridge, ASI-Modulex; David Gibson, Two Twelve Associates; Lance Wyman, Lance Wyman Ltd.; and Roger Whitehouse, Columbia University School of Architecure.

As a result of the Phase I work, Hablamos Juntos and SEGD formed an ongoing partnership to develop and test the use of universal symbols in healthcare facility signage. The Phase I research, completed in 2006, resulted in a set of 28 Universal Symbols in Health Care. 

Phase II

After the release of the original USHC set, it became clear that the selection, design, and integration of symbols into one unified set—a set that could be adapted universally by healthcare facilities of varying size, function, and complexity—would be an ongoing process. Healthcare facilities that adopted the initial symbol set helped identify several key issues around their adoption and implementation. These included the need for additional symbols, guidance on the selection and use of symbols, and integration of symbols into a holistic wayfinding system including print and web-based support.

These questions became the focus for a second phase of research, begun in 2008. With continued funding from the Robert Wood Johnson Foundation’s Pioneer Portfolio, in addition to support from the SEGD Education Foundation, Phase II research was designed to encourage widespread adoption of the symbols by healthcare facilities serving LEP or limited-reading populations. The project had three primary objectives:

Support implementation of symbols-based wayfinding systems using evidenced-based practices in as many as four healthcare facilities.
Document the implementation experience, produce tested best practices for healthcare facilities, and promote awareness of symbols-based wayfinding as a solution for multilingual environments.
Add 20 to 30 new symbols to the Universal Symbols set.

Phase II research was completed in August 2010 by a large, multi-disciplinary team including specialists in wayfinding analysis and design, legibility, symbols development and testing, and healthcare facilities wayfinding. A consortium of four university design schools developed a process for researching, designing, and testing new symbols. An expert panel of wayfinding designers reviewed the research and provided technical oversight.

Four Innovator Health Care Facilities were partners in the Phase II efforts, providing test sites and full implementation support. The Innovator sites were Women & Infants Hospital, Providence, R.I.; International Community Health Services, Seattle; Children’s Mercy Hospital, Kansas City, Mo.; and Grady Health System, Atlanta.

Results of the Phase II research are documented in an implementation guidebook entitled Universal Symbols in Health Care: Tools for the Development of a Symbols-Based Wayfinding System, as well as in several technical reports, case studies, and the expanded set of 56 Universal Symbols in Health Care.


Executive Summary
Full Workbook
Team Credits

Innovator Facility Matrix
Design and Implementation Checklist
Symbol Poster
Interactive Best Practices

Part 1: Formulating a Symbols-Based Wayfinding Strategy
Part 2: Destination Criteria and Referent Naming
Part 3: Design and Development Using Symbols
Part 4: Design Testing and Analysis
Part 5: Symbol Support and Education

Symbol Design Curriculum Report
Symbol Design Research Report
Symbol Design Testing Report

Innovator Facilities Pre Audit Repor
Innovator Facilities Post Audit Report
Innovator MD Anderson
Innovator Concentra
Innovator Lankenau

Symbol Translation Amharic
Symbol Translation English
Symbol Translation Mandarin
Symbol Translation Spanish
Symbol Translation Vietnamese