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Main External and Internal Patient Route: Orientation, Navigation and Wayfinding throughout the Hospital as Whole

In this article, we'll assess patient wayfinding and orientation throughout the hospital campus.
Approach to main entrance, South West Acute Hospital, Enniskillen, Co. Fermanagh, Northern Ireland

Photo Design Features

  • High quality external public space leading up to entrance as part of hospital public realm.
  • Clearly legible entrance provided by entrance canopy.
  • Natural elements such as trees and grass carried right up to the hospital entrance.

Design Considerations and Awareness
Creating calm, coherent, and legible spaces that provide orientation and support wayfinding is critical to a dementia friendly hospital. These conditions are dependent on the quality of the connective tissue of the external and internal spaces which make up the main route or path that take a person from outside the hospital to their destination or appointment within the hospital. While the quality of this route is dependent on range of elements, the following three elements are examined below: a supportive External and Internal Public Realm; Spatial Configuration and Building Form; and, Wayfinding.

Creating a supportive External and Internal Public Realm
Where the hospital public realm interfaces with the locality it influences the level of community engagement, relationality, and sense of familiarity that may benefit many people with dementia, accompanying persons, and visitors.

As you move onto the hospital and continue on your journey, the legibility, coherence and quality of this public realm determines the patient and visitor experience in terms of accessibility, usability, physical and sensory comfort, orientation and navigation.

A high-quality public realm can help manage the scale, complexity and busy-nature of a typical acute hospital through the creation of strong and coherent public spaces that frame the patient journey and link the various external and internal spaces, departments, and wards within the hospital. In this regard, clearly legible spatial and formal elements such as clear paths or routes; strong edges and containment; distinct zones; strong nodes such as squares or junctions for orientation; and clear landmarks, will provide a sense of orientation and help with wayfinding throughout the hospital.

In additional to these spatial and formal elements described above, the quality of materials, finishes, lighting, seating, and other details will enhance the hospital public realm and provide valuable orientation and navigation cues.

Contact with nature and natural processes has significant benefits for the health and well- being of people living with dementia. In this regard the public realm of the hospital should use the natural environment including the natural elements, flora and fauna to create a calm, therapeutic and orientating setting for patients as they circulate throughout the hospital.

Spatial configuration and building form
The overall spatial configuration and building form of the hospital determines legibility, coherence, proximity and the qualities of the places and spaces that constitute the hospital setting. These consequently effect how a person perceives, understands, accesses and uses the campus and building. It also influences how the building frames and communicates external environmental conditions including local context, weather conditions, seasons, and time of day.

Amnesia and agnosia are two common symptoms of dementia and these can often result in a person becoming disorientated in terms of time and place. In addition, many people with dementia will experience spatial cognition difficulties, visual hallucinations, and visual perceptual disturbance.

For a hospitalised person, these challenges are often compounded by the size, busyness, and unfamiliarity of the hospital; not to mention potential disorientation due to delirium, illness or medication.

To alleviate these impairments, the spatial environment should balance formal massing (building form, height, mass); differentiation of appearance (size, shape, colour, or architectural style); visual access (the visibility of one part of a building or space from various locations); and layout complexity (i.e. level of spatial articulation, number of separate spaces etc.) to ensure the space is easily to comprehend and remember.

Many of the most successful hospitals embrace the use of a series of, or a single central public space which establishes the organisational and circulation principles for the entire scheme. This can take the form of a hospital street, a public concourse, or a large atrium space.

For instance, a central, dominant public space, such as the long, full-height concourse, presents patients and visitors with a legible element around which the rest of the building is arranged and broken down into blocks. This central space creates both an internal public realm, and a hierarchy of scale within the building, allowing visitors, patients and staff to navigate more intuitively.

To support orientation to time and geographic location, the design of the spatial layout and building form should carefully consider natural light; access to External spaces and local scenes; and views of nature.

External and Internal Wayfinding throughout the Hospital as a whole Carefully designed and detailed circulation space determines how well users move and flow from one area of a building to another. How easy and comfortably a person can navigate within the hospital is key to successful circulation spaces. This section examines the role of external and internal wayfinding to support navigation for people living with memory loss, a cognitive and sensory impairments, or visuospatial and visuoperceptual difficulties.

Wayfinding is the problem-solving ability necessary in reaching locations and is predicated on higher order and task decision making, decision execution, and information gathering. Taking into the account the symptoms of dementia, including impaired memory, impaired reasoning and ability to learn, high levels of stress and an acute sensitivity to the social and built environment, the decision-making process that underpins wayfinding is often undermined for people with dementia. Furthermore, these wayfinding challenges may be compounded in the busy, large-scale and complex environment of the hospital and exacerbate a person’s level of anxiety.

A person with dementia will be better served by a simple spatial layout with a configuration that minimises memory and inference-based decisions, and one that allows a person to move from one decision point to the next without too much forward planning. The spatial organisation should reduce dependence on cognitive mapping by providing good visual access and clearly communicating the overall structure of the space.

Environmental communication’ can be achieved by clearly articulating key features and functional zones, clearly expressing the circulation strategy, creating spaces with distinct character, introducing key landmarks, and at a more detailed level the use of graphic information. Many of these elements have been outlined previously in relation to the hospital Public Realm and Spatial Configuration and Building Form, however they are reiterated below as part of the Building Block Model to reinforce their importance.

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Dementia Inclusive Hospitals from a Universal Design Approach

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