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Designing Hospital Wayfinding Systems,
Touchscreen Kiosks, Environmental Cues
and Mobile Apps: An Evaluation of a Mobile
Wayfinding Application
Christy Harper
(&)
, Tyler Duke, Andrea Crosser, Angie Avera,
and Spencer Jefferies
End to End User Research, Houston, TX 77032, USA
Christy@e2eUserResearch.com
Abstract. This paper is part of a larger body of work researching wayfinding
systems in large, complex, hospital environments. The focus of this second
phase of research was to discover usability issues that impact the effectiveness of
a mobile wayfinding application used by a large multi-building hospital com-
plex, as well as provide informed recommendations to enhance users’navigation
performance. Four researchers conducted a heuristic analysis composed of
twenty dimensions across six categories including language, effectiveness of
wayfinding instructions, consistency between the environment and application,
interface interaction, accessibility and cognitive workload. Primary recom-
mendations consisted of adding a universal search option, orienting navigation
cues to user view, and providing assistance to find a help desk. Results from this
paper will provide a guideline for the development of mobile wayfinding
applications for large hospitals and similar settings.
Keywords: Wayfinding Healthcare Usability Design
Heuristic evaluation Human factors Mobile application
1 Introduction
Wayfinding is the process of understanding where you are in the environment, deter-
mining where you need to go, identifying the most optimal route to get there, and
recognizing when you have arrived [1]. Wayfinding aids in complex environments, such
as medical care facilities, are necessary for individuals to find their destinations in a
quick and efficient manner. However, even with the assistance of aids, wayfinding has
been shown to cause stress for people who are unfamiliar with these complex envi-
ronments [2]. Studies have since aimed to determine the most effective types of aids.
Wayfinding aids have progressed from the use of signs and environmental cues to the
use of technology such as interactive touchscreen displays, kiosks and mobile software
applications [3]. The purpose of these interactive mobile applications is to simplify the
process of wayfinding, allowing the user to access essential information about their
location while navigating freely through the environment. Hospitals are now investing
in interactive navigation systems, such as mobile applications, to complement traditional
©Springer Nature Switzerland AG 2020
N. J. Lightner and J. Kalra (Eds.): AHFE 2019, AISC 957, pp. 89–96, 2020.
https://doi.org/10.1007/978-3-030-20451-8_9
wayfinding aids. But, if a wayfinding aid does not provide the support expected, users
will likely abandon the technology [4]. Wayfinding mobile applications should be easy
to use, effective, accessible, and intuitive. If patients and visitors do not find an appli-
cation effective for their intended purpose, there may be economic loss for the medical
care facilities that invest in an ultimately rejected technology [5].
The first phase of this research examined the usability and effectiveness of inter-
active, touchscreen, wayfinding kiosks in three large hospitals [6]. Participants were
recruited onsite from each of these hospitals and asked to complete various tasks using
the wayfinding display in their hospital. There were five tasks developed by the
researchers that included basic navigation to destinations within the hospital, com-
prehension of orientation in the environment, accessing help, locating relevant infor-
mation utilizing the search function, and navigating through the hospital based on the
route and directions provided. SUS scores collected and averaged across participants
indicated that each interface was perceived by users to be below average in terms of
usability. Consistent issues observed were documented and used to draw implications
and develop recommendations for future designs. Results from this research indicated
that basic heuristics were often overlooked, such as classifying information according
to user expectations, including a universal search, minimizing unnecessary on-screen
information, adhering to platform standards, presenting visual aids effectively, and
orienting navigation information effectively.
In the second phase of research which is the focus of this paper, we have explored
several mobile wayfinding applications designed for large multi-building hospital
complexes. Evaluating the current apps can help establish guidelines for future
wayfinding application designs. Researchers decided to focus on one of these mobile
applications for a heuristic analysis. In this type of evaluation, multiple researchers
assess whether or not an interface design adheres to certain heuristics, or guidelines,
that should be followed for optimal usability [7,8]. This method provides a simplified
benchmark by which to examine interface design and offers varied perspectives to
identify usability issues. After prioritizing the criticality of these errors, researchers
develop recommendations to be implemented in the next iteration of the design. Given
that the standard set of heuristics were established by Nielsen and Molich in the
nineties, it has been suggested that they may be too general to evaluate the usability of
designs intended for mobile devices and therefore design-specific heuristics are rec-
ommended [9]. For this reason, we began by developing our own set of heuristics,
influenced by our prior research, to evaluate this specific wayfinding application.
Ideally, user-centered design would be incorporated in the development phases, rather
than solely using retrospective judgement [5], however we believe evaluating current
systems can help establish guidelines for future designs and fill the gap in the current
literature about the usability and design of mobile wayfinding applications.
2 Method
Four researchers were selected and briefed on the purpose of this current phase of
research surrounding the mobile wayfinding application. A review of the previous
research on touchscreen kiosks from phase one was done in order to highlight issues
90 C. Harper et al.
identified with wayfinding systems. Following the review, a set of heuristics (Table 1)
were established to measure the usability and effectiveness of the mobile wayfinding
system. Twenty heuristics were created comprising six general categories: language,
effectiveness of wayfinding instructions, consistency between the environment and
application, interface interaction, accessibility and cognitive workload. In order to fully
assess these heuristics, the application was examined on site in the hospital. Each
researcher used an iOS device to individually conduct a heuristic analysis, taking note
of usability issues, documenting impressions of the layout and features of the interface,
and capturing screenshots of the application. Additionally, the researchers used the
application to navigate to a destination, to evaluate effectiveness and compare the
signage, icons, labeling and color coding of the application to the environment. After
the evaluations, a debrief was held to discuss the findings, identify usability issues and
suggest recommendations for improvement.
3 Results
The first phase of this research examined the usability of interactive, wayfinding,
touchscreen kiosks in large complex hospitals. Phase two focused on the use of a
mobile application which solved some of the issues found in the initial research. For
instance, being able to bring the instructions with you solved the problem of cognitive
workload. In phase one, users were required to remember a set of directions given to
them by the system. Individuals often missed pages of instructions by leaving the kiosk
before realizing that all of the instructions were not visible. An accessibility issue
observed in phase one and solved by the mobile app was the difficulty of attempting to
use a kiosk from a wheelchair. It is beneficial that this application can be used remotely,
making the instructions accessible for anyone, including people with disabilities.
Finally, information inside the application complemented other wayfinding aids, such
as the colors, landmarks and signage used in the environment. Having the system
match the environment is useful because it helps individuals identify other surrounding
cues, making the wayfinding process more efficient. Though the mobile app solved
some of the issues from phase one, it did not include a universal search feature, provide
instructions on how to access help from a human or provide location-based navigation.
Following the heuristic evaluation, and categorization of the usability issues, we pro-
vided recommendations to improve mobile applications, as detailed below.
Inclusion of a Universal Search. In our previous research on interactive wayfinding
kiosks, we found that a search option was often only available within specific cate-
gories on the screen. For example, in one task when participants were asked to find the
landmark called
Art Gallery, some incorrectly chose the menu option Food, Shops and Services.
They would then use the search function within that category to obtain the information
they sought –in this case the Art Gallery. However, because the Art Gallery is a
landmark, rather than a destination within Food, Shops and Services, they were unable
to find the information using the search feature. This prompted us to develop a search
heuristic for the wayfinding application, since a universal search would enable users to
Designing Hospital Wayfinding Systems, Touchscreen Kiosks 91
search for diverse data [10], such as doctors, buildings, room numbers, etc., regardless
of where you are in the interface. This application contains several comprehensive lists
of items (Fig. 1) that require users to scroll extensively through the options. Due to the
lack of a universal search option, users are often unable to easily find information they
seek, which may lead to frustration. There should be a search feature that allows
individuals to search for distinct things particular to each person. It should also be
easily discoverable and usable, enabling a more efficient system.
Table 1. Final heuristics for analysis.
Is the terminology for laymen or medical professionals?
Does the interface respond as expected (touch, navigation, familiar elements)
Are the systems accessible for people in wheelchairs?
Is there a universal search?
Can you easily get directions to locations?
Can you correctly use the instructions to navigate?
Are the directions oriented to match their location in the hospital?
Can users tell when they have the full set of directions? Are there timing issues or hidden next button
issues?
Is it clear where you are in the system, how to get back, how to proceed?
Is there information overload and confusion of important elements in the directions?
Is there an overload of verbal instructions?
Is there too much information to remember?
Does the color coding match the hospital?
Do the naming conventions match hospital labeling? (rooms, elevators, signs)
Do they use landmarks in the instructions?
Is there good signage in the environment?
Are there multiple helpful signs in the environment?
Is there help?
Is there a culture of helpfulness from the staff?
If there is an error, is it easy to recover from?
92 C. Harper et al.
Option to Locate a Help Desk. A recommendation from the first phase of this
research was to continue to provide a culture of helpfulness in the hospital environ-
ments. If participants were unsuccessful at using the interactive system, they generally
indicated that they would seek assistance from a hospital employee. In this application,
there wasn’t an option to search for or guide the user to a help desk nearby, which
violated one of the heuristics during evaluation. Providing an option to locate a “Help
Desk”would be ideal for patients and visitors who are lost and would like assistance
from a human staff member. Ideally patients would never need to ask for help but
having an option to identify where help desks are would increase the application’s
wayfinding effectiveness.
Providing a Map for Visual Aid with Appropriate Orientation. When Campus
Directions was selected within the application, users were prompted to select a “From”
and “To”location (Fig. 2), similar to the mental model of obtaining directions in other
common navigation applications. The output provided is a list of instructions with
symbols, buttons and icons that match the environment of the hospital. Providing a map
of the directions that users are required to travel in order to get to their destination
would enhance the effectiveness of the list of instructions. This map should also be
oriented appropriately so that users are not confused on which direction they should go.
The layout of the maps at each hospital should match the environment in which it is
located, giving participants the expected orientation to avoid confusion [11]. This
would require allowing different orientations based on physical location of the device
in the environment.
Fig. 1. This is a comprehensive list that individuals are presented whenever they are selecting
locations within the hospital. The user must scroll through this list to find their desired location.
Designing Hospital Wayfinding Systems, Touchscreen Kiosks 93
4 Discussion
In this paper, we reported issues associated with a mobile wayfinding application
designed for one large medical-care facility. Our primary goal was to learn from this
application and offer recommendations for the iteration of current and development of
future wayfinding applications, to enhance their effectiveness in real-world environ-
ments. Creating our own set of heuristics allowed us to identify multiple issues with the
wayfinding app that could (Fig. 3) cause individuals frustrations and/or confusion.
People visiting hospitals who experience the frustration of a poor interface or receive
confusing or incomplete directions from a wayfinding system experience increased
stress [12]. Users that experience many obstacles may abandon the technology and
search for another source of information. With the amount of money invested in
wayfinding systems, the importance of usability should be at the forefront of designers’
minds throughout entire process of system design [13].
Interfaces, such as the wayfinding application described, should allow first time
users to identify the information needed quickly and effectively. In order to achieve
this, wayfinding apps should be designed to reduce cognitive overload, as well as the
time it takes to navigate to a specific destination, by implementing intuitive interaction
techniques and features consistent with additional wayfinding cues [14]. Wayfinding
applications that exist or are currently being developed should consider the environ-
ment of the hospital during the design phase. Information inside the application should
complement the environmental information such as color coding, landmarks, room and
Fig. 2. A list of instructions is provided to the user once they have selected a “From”and “To”
location. These directions help the user navigate through the hospital to reach their destination.
94 C. Harper et al.
elevator labeling and signage, which this application did well. The key user-centered
design principles we recommend to be helpful in wayfinding interfaces are: including a
universal search option, including an option to locate help desks in the hospital and
providing a map for visual aid with appropriate orientation. These general wayfinding
application guidelines should be considered for all types of interface aids including
interactive touch displays and static maps.
Future work and Limitations. Though we took the approach of developing heuristics
specific to the interface design we were evaluating, there is the possibility of missing
some heuristics or identifying issues that may only have a minor or negligible impact.
Ideally, a heuristic analysis should be part of an iterative design process that includes
user testing. We found that the wayfinding application did solve some of the issues
found in phase one with the touchscreen kiosk usability testing. As the application is
mobile, cognitive overload from a huge set of instructions, overlooking screens of
instructions, not being accessible to wheelchair users and the interface elements not
responding as expected were solved. However, while the navigation elements of the
application responded as expected, it did not provide real time orientation or mapping
for navigation. With the advance of GPS technology, expectations have changed [15].
The ideal wayfinding application would provide real time location and direction. Our
next step will be identifying an application with this functionality and testing the
usability and effectiveness as a wayfinding aid.
Fig. 3. Several environmental cues that are consistent with other wayfinding aids help guide
users to their intended destinations.
Designing Hospital Wayfinding Systems, Touchscreen Kiosks 95
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