The UF Health Shands Hospital "Metro"

On my first day at UF, I had an appointment with Tim Goldfarb, the UF Health Shands Hospital CEO at the time. The instructions were: “Drop off your car with the valet at the entrance to the hospital and take the elevators up to the 10th floor.” Entering the hospital through the doors by the valet stand, the elevator location was not obvious. I walked down a hallway to my right, entering a space that is now the UF Health Shands Children’s Hospital lobby, but no elevators were in sight. Retracing my steps in reverse down that same corridor and continuing past the valet entrance, I entered the hospital atrium. Still, from that angle, the elevators were around a corner and not evident. I could have asked for directions, but my Y chromosome prevented me from doing so. Wandering around, I finally found the elevators and was only a little late for my appointment with Tim.

Over a period of decades, the main set of buildings that now comprise the main UF Health Shands Hospital evolved by adding new wings and renovating existing space. Under the burden of the expanding maze of new and renovated facilities, the system of wayfinding simply became overwhelmed. Ultimately, recognizing that the services and destinations within our facilities were part of a large, complex system, Brad Pollitt, vice president for facilities, enlisted Penny Martin, Ph.D., N.P., EDAC, of Healthful Design, LLC, to develop a new wayfinding approach. “Penny had been working with our team on signs and image designs for the Children’s Hospital when we got into a discussion about wayfinding,” Brad said. “She had seen some large facilities successfully use a “metro map” design. Our teams that toured several peer organizations as part of the design of the Heart and Vascular Hospital also experienced a metro-based model in use at Boston Medical Center. Two experiences collided into a great idea.”

Given the limitations of our current wayfinding system and our unique maze of hallways and lobbies, we agreed with Penny’s suggestion to design a set of maps and accompanying signage to resemble a “metro” system, with colored pathways and destinations or “stops” labeled with unique numbers. Since colors and numbers are easily pointed out and understood without translation, and since many people are familiar with metro systems from other experiences, it was thought that the “metro” approach would greatly improve wayfinding for our visitors, patients and staff.

The basis for the design of these first-floor wayfinding tools is the London Underground, the first “diagrammatic map” produced for public wayfinding. This map was developed in 1933 by Henry Beck, an English engineering draftsman at the London Underground Signals Offices. He believed that passengers riding the Underground were not bothered about geographic accuracy, and were mainly interested in how to get from one station to another and where to change trains. Indeed, Beck came up with the idea for his famous map while at work drawing an electrical circuit diagram, which was more an electrical schematic than a true map. That is, like an electrical diagram, the principle Beck employed was to standardize the schematic appearance of the Underground map while preserving its important underlying relations, letting go of unnecessary detail.

As recounted by Ken Garland in his book, “Mr. Beck's Underground Map” (Capital Transport Publishing 1994), over the course of decades Beck devoted enormous thought, craft and hard work to refine the information design embodied by the London Underground map. The essential characteristics of Beck’s map — different colors for different paths with circles for intersections and lines for destinations — have been copied across the globe, addressing the needs of users with very diverse levels of visual, spatial and language ability. (Growing up in New York City, I relied upon the city’s subway map to get around, with its colors, circles and intersections eventually becoming imprinted in my memory. I had no idea until researching this newsletter that the NYC subway map, like our health center wayfinding map, was based on Mr. Beck’s work.)

Our own version of Beck’s pathbreaking insights is now embodied in the “UF Health Shands Hospital Metro.” A series of strategically placed directories allow the visitor to search alphabetically for their destination. A unique color and number is indicated to identify the color “path” or line and the stop number. This gives the visitor an idea of how far they must travel and an indication if they have traveled too far. The color of the paths is indicated on the station identifiers, and for the directionally challenged the numbering system avoids the need for compass directions. It is a very intuitive process.

This is an instance where getting direct input from our patients, through their participation on the Wayfinding Team, made a good product even better. One of the team members is visually impaired; she made suggestions to improve the original plan by the use of backlighting on key signs, thereby making the destinations easier for patients and visitors to read. Another patient advisor provided input on colors and how to assign the location numbers in a way that made the most sense to patients and visitors.

Christine Cassisi, director of patient experience in the Sebastian Ferrero Office of Clinical Quality and Patient Safety, recently expressed her excitement at the positive feedback that has come to her over the past month from people using the new metro wayfinding tools. A young patient was so animated by the signage she grabbed her mother by the arm and insisted she could guide her mother to their destination. She did and her mother was surprised that they were able to navigate seamlessly where they had struggled to find locations in the past. Christine reports that “patients like the number system since they often describe their destination by the name of the clinician they are seeing. The numbers are easier to remember as they navigate than the names of unfamiliar clinics or departments.” Patients also like the sense of control the map provides, allowing them to be self-sufficient. One patient said “I didn’t need help to find the lab. I always heard it was hard to find your way around here, but I just followed the signs.”

Currently, the Metro Map covers Level 1 and lists services on upper floors directing visitors to the appropriate elevators for access. After a trial period and some minor modifications, we will expand the concept to Level G and through the tunnel to the UF Health Shands Cancer Hospital and Trauma Center. Once the new Heart & Vascular and Neuromedicine hospitals are complete, they will be incorporated into the system as well.

Please let us know if you have any comments or suggestions about the current UF Health Shands Hospital Metro, or about ideas for the future.

The Power of Together,

David S. Guzick, MD, PhD UF Senior Vice President for Health Affairs President, UF Health