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1. INTRODUCTION
The issue of wayfinding has been repeatedly studied in
relation to hospital facilities due to the level of com-
plexity of the functional and spatial structure of the
facility and the need to optimise the treatment process
for outpatients. Wayfinding system is considered both
in terms of behavioural and physical factors and this
perspective was adopted in many audit tools that are
used by researchers and designers to define the main
indicators that improve the quality of built environ-
ment [1]. To define the main factors influencing the
wayfinding behaviours and signage system question-
naires combined with on-site examinations are used by
researchers [5]. Using user testing approach outlining
key stages such as planning, setup, commissioning and
debriefing could be more effective method of evalua-
tion wayfinding system in the hospitals [7]. To reach
more accurate and efficient results, computer tech-
niques are used i.e. Space Syntax method or other
tools using simulations of users’ behaviour. The
research using the Space Syntax method in relation to
wayfinding has been carried out since 90’s. Already in
1990 Peponis, Zimring and Choi [8] demonstrated
that studies of wayfinding and spatial learning can
benefit from a more rigorous analytic description of
SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM
IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
Weronika MAZURKIEWICZ a, Michał SITEK b
aAssociate Prof. (Dr. Eng. arch.); Gdansk University of Technology, Faculty of Architecture, ul. Narutowicza 11/12,
80-233 Gdansk, Poland
ORCID: 0000-0001-5486-2886
*E-mail address: weronika.mazurkiewicz@pg.edu.pl
bAssociate Prof. (Dr. Eng. arch.); Silesian University of Architecture, Faculty of Architecture, Akademicka 7,
44-100 Gliwice
ORCID: 0000-0001-7348-1923
*E-mail address: michal.sitek@polsl.pl
Received: 4.10.2024; Revised: 26.10.2024; Accepted: 14.12.2024
Abstract
This paper discusses the results of a study of the quality of space in hospital buildings in the context of solutions facilitat-
ing the orientation of patients in the space of the Outpatient Clinic, in the clinic building complex of the National Institute
of Oncology in Gliwice (NIO). By combining qualitative research methods with a syntactic description of the space, the aim
was to record the experiences of users and define objective design guidelines for the new visual identity system. Completed
research walks testing selected patient routes in the clinic space made it possible to identify decision points as nodal spaces
in the wayfinding system. On the other hand, the use of the Space Syntax method allowed the identification of key areas for
signage visibility and orientation in space. The proposed method can be adapted for various types of public buildings, pro-
viding a flexible framework for pre-design research and analysis. Furthermore, the results show the potential of linking
qualitative research methods with simulation-based user participation and digital tools for in-depth pre-design analyses.
Keywords: Accessibility; Healing environment; Method of examining complex buildings; Qualitative research; Space
Syntax; Wayfinding system.
4/2024 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 67
ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT
The Silesian University of Technology No. 4/2024
d o i : 10.2478/ACEE-2024-0029
W. Mazurkiewicz, M. Sitek
building layout and exploration paths that exhibit
their own pattern. In 1991, Neil studied the effect of
floor plan complexity and several types of signage on
wayfinding in a series of buildings on a university
campus. Penn in 2003 reviewed the contribution
made by syntax research to the understanding of
environmental cognition.
It should be underlined that the concept of Space
Syntax concentrates on defining the rules that deter-
mine how users move around and describing the con-
figurations of space in terms of social and cultural
attributes. However, from the point of view of a full
analysis of building spaces, the behavioural patterns
of users are important aspect in defining the wayfind-
ing problems [6]. Typical Space Syntax analyses
incompletely undertake the analysis of spatial fea-
tures in terms of their accessibility, i.e. a range of
behavioural factors that provide the user with knowl-
edge of how to use the space [12]. The results of
research work of Sadek and McCuskey Shepley
shows that Space Syntax method used for healthcare
facility design and research was extended in recent
years to include correlated behavioural and percep-
tual features of the healthcare physical environment
[12]. It was underlined that among the newly devel-
oped spatial methods the tool Place Syntax brings the
Space Syntax description of the cognitive environ-
ment into a combined accessibility analysis model
with the specified content and features. The relation-
ship between wayfinding and spatial configuration
was investigated in terms of parameters used by
pedestrians to find their way in unfamiliar urban
environment [13, 14, 14], in terms of wayfinding in
complex multilevel buildings [16, 17]. To predict user
routes and to investigate the relationships between
the spatial configuration of the hospital areas and the
wayfinding behaviour of patients the axial map and
isovist analysis were used [18]. The results of the
research obtained by combining qualitative methods
with the Space Syntax method indicate effectiveness
in obtaining more detailed data on modification of
the functional layout and accessibility of the various
zones of the hospital [20].
An extension of the research in the field is the use of
data available in the form of a digital twin of a BIM-
compliant building and statistical data on ongoing
organisational processes (BIG DATA). Tools that
introduce the ability to analyse the existing state
using VR and AR, and simulations of user behavior
with analysis allow optimisation of waiting time,
movement and rational use of organisational
resources. The goal is to assist users to move more
easily through the spaces available to them, resulting
in greater satisfaction. Simulations implemented with
tools like AnyLogic allow research to be supplement-
ed with analysis and simulations not available in the
Space Syntax method. These are agent-based model-
ing, discrete event modeling and multimethod mod-
eling and system dynamics modeling. They focus on
mathematical simulations supported by ML, DL and
AI machine learning. The crowd behaviours realised
during the simulation allow remodelling the path-
ways in relation to processes and their impact on
organisational efficiency. In particular, these tools
also work well during the identification of informa-
tion needed for wayfinding.
The issue of the efficiency of communication sys-
tems in healthcare facilities is closely linked to the
efficiency of patient handling, especially in the case
of extended outpatient or clinic areas. In many
cases, the outpatient service area is widely dis-
persed in the hospital facility, which makes its logi-
cal organisation difficult and presents the patient
with a challenging task in finding his or her way to
the individual destination points. This undoubtedly
has the effect of lowering the level of control and
thus, according to Ulrich’s environmental theory of
supportive design (1991), this fact becomes a stress
factor [21]. Taking the concept of implementing the
principles of the therapeutic environment as para-
mount in hospital design, all possible measures
should be taken to ensure that patients are as com-
fortable as possible in the treatment process. Our
research adopts the definition of wayfinding as a
system of spatial solutions to assist the patient in
finding the destination point, targeting a sense of
control and using visual, auditory, tactile and olfac-
tory elements. In addition, the system aims to facil-
itate mental mapping by introducing elements that
give individual spaces characteristics of place [1].
In the concept of universal design, the environmen-
tal conditions affect different individuals different-
ly, while the methods using the syntactic models of
the space generalise the integrated data about the
behavioural patterns. These general environmental
aspects of accessibility were studied by using the
Space Syntax methodology in the urban scale [22].
This article presents a case study on wayfinding in
the Outpatient Clinic of the National Cancer
Institute of Gliwice. It is a facility made up of sev-
eral buildings connected by connecting passages.
The main part of the Outpatient Clinic is located on
the first floor. The diagnosed problem relates to the
confusion of patients and problems with getting to
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SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
the doctor’s offices and diagnostic points. The exist-
ing visual identification system lacks precise infor-
mation, and the dispersed medical functions and
the complex structure of the facility make wayfind-
ing difficult. In addition, cancer patients are con-
fronted with a number of dysfunctions that limit
their efficiency, making the level of accessibility of
the space an important factor in the efficiency of
the system. The objective of the conducted research
project was to determine the conditions to optimise
the wayfinding system at the Institute, taking into
account the functional and spatial characteristics of
the facility. On the basis of the collected data, the
main task was to define design guidelines to
improve the visual identity system and the interior
design in the node spaces. The research questions
posed address the following issues:
• What are the essential observed relationships
between the wayfinding system of the outpatient
areas and the patients’ behaviour?
• What are the opportunities and barriers in using
the digital research methods in terms of determin-
ing the accessibility of the wayfinding system?
2. METHODOLOGY
In the presented research a triangulation approach
was used and four different methods were used
(Table 1). The criteria relating to user behaviour,
behavioural limitations and the behavioural charac-
teristics of the space were analysed with regard to
spatial characteristics. On the other hand, to under-
stand the intuitive behaviour of the users and to
define possible modifications of the user paths, a syn-
tactic analysis of space properties was performed for
the current traffic system and for variant spatial
changes. This approach has made it possible to com-
prehensively identify optimal strategies in terms of
wayfinding system.
The spatial scope of the study included accessible
outpatient areas on the first floor of the Institute
(Fig. 3). In the period from December 2023 to March
2024, volunteers (n=22) were invited to find selected
destination points (i.e., registration, surgeries of doc-
tors). On the basis of guidelines obtained from med-
ical staff, three target points relevant to outpatients
were selected (Fig. 2):
• the Registration of mammography (path W1),
• the Magnetic Resonance MR1 (path W2),
• the Department of Nuclear Medicine (path W3).
A record of the observations was kept on a prepared
form including the basis for the development of cog-
nitive maps with a record of the most important phe-
nomena and problems during each route. The volun-
teers were also asked to list their personal observa-
tions, which were grouped and formed the basis for
adopting the main categories of phenomena and
mapping user behaviour. On the facilities maps, the
main observations made by every participant were
noticed, and then a synthesis of all routes was devel-
oped on a summary plan for each of the three routes
(Fig. 5–7). The result of this study was the determi-
nation of decision points where the need to choose a
further direction of movement occurs, and the analy-
sis of the space in terms of the course of the main
patient routes.
On the basis of the defined phenomena, a tool was
developed to study patients’ behaviour, taking into
account the following groups of issues: the way of
moving around (independently or with the help of
rehabilitation equipment), remembering characteristic
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4/2024 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 69
a
Table 1.
List of research methods used in the project
Research method Main analyse criteria
Exploratory walks
involving volunteers (n=22) •direction and location signs: visibility of signs and their location, legibility of text;
• occurrence of landmarks,
• characteristics of landmarks: legibility and visibility of the existing visual identity system using vol-
unteers’ perception
Exploratory walks
involving patients (n=8)
• characteristic features of the space (landmarks, interior colours, furnishings, graphic elements, views
from the window, etc.).
• legibility and visibility of the existing visual identity system using patient’s perception
Mapping the behaviours • identification of spatial features, user behaviour and phenomena and their location on object pro-
jections, definition of decision points
Space Syntax methodology • checking the visual step depth (Visual step depth) for the selected starting point in the first floor and
analysing building interiors as the visibility graph analysis (VGA)
W. Mazurkiewicz, M. Sitek
elements to facilitate orientation, preferences in
obtaining information about destination points and
legibility and visibility of the existing visual identity
system. This tool was used in in-depth interviews
completed with patients (n=8). Research walks were
conducted with selected patients who visited the
Cancer Institute for the first time and were unfamil-
iar with the facility space. All of the qualitative
method studies carried out formed the basis for
determining conclusions in terms of the behavioural
assessment of the Institute’s space and comparison
with the syntactic space analyses.
The objectives of using the Space Syntax analysis
were to identify key spatial data in wayfinding and to
assess what are the syntactic properties of the
National Cancer Institute in Gliwice responsible for
orientation of patients. Two spatial changes: the exist-
ing situation in Variant A and the circulation change
in Variant B were analyzed in terms of the visual
accessibility of the floor. The analyses were per-
formed with the help of an open-source tool used by
the Space Syntax community: depthmapX (previous-
ly known as Depthmap). The first part of the Space
Syntax analysis that was applied to the selected case
study is to check the Visual step depth for the select-
ed starting point. The visual step depth shows the
number of syntactic steps required to reach every
other space in the graph, starting from the current –
indicated location. The indicated current location has
a step depth of 0. All locations directly visible from it
have a step depth of 1. All locations directly visible
from those at step depth 1 have a step depth of 2, and
so on. The result is a cumulative isovist growing out
of the initial location. The step depth tool, on the
other hand, shows only the depth values for one, indi-
cated location [23].
Another, and one of the main analyses of Space Syntax
methodologies is the Visibility Graph Analysis (VGA).
It was formulated by Turner et al. [24] as an extension
of Benedikt’s work on isovists and changes in visibility
fields [25]. It is a way to quantify the configuration of a
space as regular units, which can then be used to deter-
mine the relationship of that space to the behavior of
the people who occupy it [26]. The VGA shows calcu-
lations of depth values for all locations in the graph
and compares them with each other. The default
attribute shown in depthmapX for VGA analysis is the
number of connections for each location.
The use of the two described methods and related
indicators in a hospital can be used to understand
the user behaviour of finding the right access route
to particular zones and offices. Such information
can then be used to test multiple variants of
changes to the designed solutions and compare
results indicating the likelihood of choosing a par-
ticular access route.
For all syntactic analyses of the space described in
this expertise, the following legend (Fig. 1) for the
values of syntactic variables from minimum (the
bluest) to maximum (the reddest) applies. Taking
into account (in the analyzed visibility charts) the
connectivity variable: the higher its value, the more
red the result, and similarly the lower its value, the
more blue the result. The ranges of the variables of
the parameters studied are given in the visualiza-
tion descriptions of each analysis.
The methodology is based mainly on topological fea-
tures of space, firmly rejecting its metric nature. The
research conducted in this field is concerned with the
various relationships that occur between elements in
space.
The method also aims to answer one of the most
important questions related to spatial planning: how
space can be measured. The method proposes three
main types of topological representation of a given
place, each of which is attributed to a different
activity of users in space: movement of users, inter-
action between users, and observation of the sur-
roundings [27].
The 1st floor of the National Cancer Institute was
studied as a key level in the diagnosis and treatment
of outpatients. The following figure (Fig. 2) shows
the floor zoning.
70 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 4/2024
Figure 1.
Legend of the values of syntactic measures
SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
The main entrance to the floor was marked with a red
dot. For visual step depth analyses, this point was
used as the starting point. To organize the model, a
conventional division of the first floor of the National
Institute of Oncology in Gliwice into three main parts
was made (Fig. 3):
• the first part (part I) includes the spaces and
rooms of the Radiotherapy Unit,
• the second part (part II) includes the spaces and
rooms of the Day Chemotherapy Department,
associated with the general outpatient clinic,
• the third part (part III) includes: the spaces of the
Scintigraphy (PET), Nuclear Medicine
Department and Radiology associated with the
building of the so-called Old Oncology, where
some of the rooms of Radiology are located, asso-
ciated with the Directorate of the Institute.
Description of Model 1 and Model 2
To perform Space Syntax analyses, it was necessary to
prepare an appropriate convex space model. It was
decided to prepare and analyse two basic models
(Model 1 and Model 2), as well as two possible changes
made during the variant stage of changes in the layout
of the open spaces of the clinics based on Model 1
(Variant A and Variant B). The Model 1 (Fig. 4) shows
the entire first floor of the National Cancer Institute
divided into open spaces and public spaces for external
users (who are not hospital employees) and closed
rooms. It was prepared in order to select the spaces
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4/2024 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 71
Figure 2.
First floor of the National Institute of Oncology in Gliwice; two variants of the changes made. Variant A and Variant B in Model 1
a
Figure 3.
Diagram of the conventional division of the first floor of the
National Institute of Oncology in Gliwice
W. Mazurkiewicz, M. Sitek
exhibiting the characteristics of the most and least
accessible to outside users. The figure below shows the
prepared Model 1 convex space of the floor.
Model 2 (Fig. 4) covers the entire first floor with all
offices open to users. It was prepared to verify that
the most accessible spaces are developed in a way
that allows the most efficient use of them. The figure
below shows the prepared Model 2 convex space of
the department.
3. RESULTS
The following categories of results were obtained on
the basis of the completed research process:
a.spatial features determining orientation in the
building,
b.features of the existing visual identity system,
c. factors determining users’ behaviour.
The complexity of the communication layout and the
lack of clear functional zones is one of the most sig-
nificant factors contributing to confusion in hospitals.
The peculiarities of the Institute's buildings linked by
connectors and the haphazard arrangement of func-
tions make mental mapping and route memorisation
difficult. The results of the walks with the volunteers
indicate the location of sites lacking information and
the absence of landmarks, which determined the
decision points. However, a comprehensive analysis
of the space, combining qualitative methods with
simulation methods using digital tools, yielded a com-
prehensive analysis of the features that determine
orientation in space.
3.1. Results of qualitative research
In the first stage, a diagnosis of the communication
space was performed. As a result of this stage, deci-
sion points, characteristic elements of the space and
flaws in the visual identification system were indicat-
ed (Fig. 5). The collected results were supported by
observation of their own behaviour, grouped into
separate categories and marked on behaviour maps
(Figs. 6-7). This was the stage of recording the events
and behaviours of volunteers as they travelled the
selected routes. In particular, the results indicate that
one of the main spatial issues causing orientation
problems in the facility is the level of complexity of
the functions, the ambiguity of the existing visual
identification system and the different route options
to the destination points.
The following behavioural maps are a sample record
of events and observations that determine the effi-
ciency of volunteers’ movement in the Institute
space. The locations of the density of markings for
each category of events were interpreted as the loca-
tions of decision points that require design interven-
tions. This mainly refers to places of traffic diversion,
where visual identification was insufficient. In order
to deepen the results the categories of incidents were
assigned to particular methods (Table 2; Q – qualita-
tive methods and S – syntactic methods).
In order to obtain a more detailed analysis of the
phenomena, in-depth interviews were conducted with
selected patients (n = 8), which helped to clarify the
key categories of space description that determine
patients’ difficulties in wayfinding and orientation.
The study identified preferred ways to get to the
Institute, elements that help to navigate the facility,
remembering distinctive elements to facilitate
orientation, and preferences for obtaining information
72 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 4/2024
Figure 4.
Left: Model 1 – Branch divided into closed and open spaces (accessible to external users). Open spaces filled with paint.
Right: Model 2 – All offices open and accessible to users
SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
about destination points. On the other hand, the cat-
egories assigned to the simulation study were
analysed using the Space Syntax method.
One of the main findings overlapping between the
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Figure 6.
Example results of users’ behaviour mapping for the patient route to mammography registration (W1)
Figure 5.
The indicated decision points. Left: waiting room. Right: main hall by the patient lifts
a
W. Mazurkiewicz, M. Sitek
74 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 4/2024
Criteria of analysis Characteristics of the indicated features of the space Proposed methods
of further research
A. spatial features determining orientation in the building
A1. Legibility of the communication layout illegibility of the communication layout, numerous staircases that are
not distinguished in the communication space
S
A2. Characteristic elements in the space
(landmarks)
few landmarks to help remember routes, Q
A3. Visual accessibility of the destination/
decision point
insufficient differentiation of the target points in the communication
space (no colour codes, no characteristic elements of the equipment)
S
A4. Zoning of the functional areas in the
building, difference in areas and buildings
at the site
No clear functional zones, no colour codes applied consistently,
Excessive colour elements without a coherent system
Q/S
A5. Number of changes in direction along
each route
multiple changes of direction S
A6. Location of vertical communication Failure to distinguish the location of staircases in the communication
space
S
B. features of the existing visual identity system
B1. Visibility of visual identification system Location of signage in areas not visible from the initial decision point Q/S
B2. Legibility of the signage system Directional signage located under the ceiling is not always legible Q
B3. Characteristic signs in the circular area Individual landmarks, e.g., fishes, pots of greenery, murals with
nature motives
Q
C. behavioural factors
C1. Overloading of distractors and obscur-
ing elements
Too much information posted, information posted is misleading (no
update of information posted)
Q
C2. Cognitive bariers Unintelligible names of medical functions Q
Explanation: Q – qualitative research; S – simulation research
Figure 7.
Results of users’ behaviour mapping for the patient route to Nuclear Medicine Department (W3)
Table 2.
Main results of research walks
SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
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Figure 8.
Survey results regarding the criteria of analysis according to the age groups
Figure 9.
The obtained data were analysed and grouped according to the specific of each factor (as it is presented in Table 3)
a
W. Mazurkiewicz, M. Sitek
two methods is that patients focus most of their
attention on other users of space in a hospital space
lacking unambiguous information for orientation in
space. This conclusion indicates that patients obtain
information from staff or other patients. An assess-
ment of the readability and comprehension of sig-
nage, was confirmed in in-depth interviews, accord-
ing to the age groups and the declared level of stress
(Fig. 8, 9).
The collected results indicate fundamental problems
with existing visual identity system, mainly related to
the age of the patients (34.5% of the respondents
were 60 and over). Additionally, the declared level of
stress can certainly affect the ability to interpret
information from the environment, although this has
not been studied in depth. The verification of the
other criteria using the syntactic method comple-
mented the diagnosis of existing problems in terms of
spatial morphology.
3.2. Spatial analysis using the Space Syntax method
The results of the syntactic method research verify
previous indications regarding spatial layout and its
accessibility. For Model 1, the visual step depth from
the indicated starting point was analyzed. In both
cases (Model 1 and Model 2), depth values were cal-
culated for all locations on the graph (VGA analysis)
and compared with each other. The first part of the
Space Syntax analysis is to check the visual step depth
(Visual step depth) for the selected starting point. In
the following analysis (Fig. 10), the starting point was
established at the location of the main staircase and
elevators in Part No. II (Fig. 3.). In the diagram
below (Fig. 10), the red isovist 3600 (with a depth
of 1) is the visibility field drawn on the surface
bounded by obstacles, as seen from the starting point
(whose syntactic depth=0). The orange isovist has a
depth of visibility steps of 2, yellow 3, green 4, blue 5,
dark blue 6. The analysis shows that the part of the
space where the administration is located is farthest
from the starting point.
The following VGA analyses for both models (Fig. 10
and Fig. 11) show in red the best-accessible places
and in blue the most isolated from others throughout
the model.
76 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 4/2024
Table 3.
Wayfinding experiences indicated by patients and staff (in terms of criteria included in Table 2)
Criteria of analysis Meaning of the indicated space features Behavioural interpretation
A. spatial features determining orientation in the building
A2. Characteristic elements in
the space (landmarks)
Confusing movement to destination, asking people/staff for direc-
tions
Stress, sense of confusion,
A4. Zoning of the functional
areas in the building, difference
in areas and buildings at the site
Unconscious movement to destination, difficult finding the desired
location,
The embarrassment of having
to ask staff for directions
B. features of the existing visual identity system
B1. Visibility of visual identifica-
tion system
Location of signage in areas not visible from the initial decision
point, difficult to find the right sign
Visual and cognitive barriers
B2. Legibility of the signage sys-
tem
Directional signage located under the ceiling is not always legible,
too little signage to see from a distance, and incomprehensible
names of the locations
Visual barriers
B3. Characteristic signs in the
circular area
Individual landmarks, e.g. fishes, pots of greenery, green steps Difficulties in building the
mental maps
C. behavioural factors
C1. Overloading of distractors
and obscuring elements
Older patients have indicated confusion with many information
and inconsistent nomenclature
Confusion, stress
C2. Cognitive bariers Unintelligible names of medical functions Confusion
Figure 10.
Visual step depth for the starting point
SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
The result of the VGA analysis of Model 1 (Fig. 11)
shows how accessible each individual model space is
in relation to the entire model. It can be clearly
observed that the longest corridor connecting Part I,
Part II and Part III (See Fig. 4) is the most accessible
to users due to its syntactic properties. Additionally,
the radiation therapy facility and the administrative
part show characteristics of good accessibility.
However, the functional space of diagnostic imaging
is difficult to access and isolate. The staircases in the
diagram are shown as isolated (difficult to access);
however, it should be assumed that they are natural
places that concentrate users due to their function of
combining floor accessibility vertically. The result of
the VGA for Model 2 analysis (Fig. 12) allows us to
draw similar conclusions to the result shown in
Fig. 11. Each of the offices and administrative rooms
are isolated, and the corridors are the best accessible
spaces of the ward. However, due to the purpose of
the expertise, the proposed changes will be shown on
Model 1. After performing the first Space Syntax
analyses, it was decided to analyze two spatial
changes. This step after the analysis was to test two
variants of spatial changes (variant A and Variant B).
The following illustration shows the changes imple-
mented consisting of:
• closure of one corridor (Variant A),
• closure of one corridor and a part including the
radiotherapy facility (Variant B).
Variant A
The introduction of Variant A consists of closing one
internal corridor connecting Part II and Part III. in
order to reduce the number of alternative accesses
from one place to another. The following illustration
(Fig. 13) shows a model with Variant A introduced.
The introduction of Variant A in Model 1 appears to
be beneficial for the legibility of the layout. The space
of the longest corridor appears to be crucial in the
whole system because it connects the three parts of
the cancer institute. Analysis of the visibility graph
shows that after the introduction of Variant A, this
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a
4/2024 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 77
Figure 11.
VGA analysis of model 1 connectivity parameter (min. 15 –
max. 2163)
Figure 12.
VGA analysis of model 2. Connectivity parameter
(min. 6 – max. 2208)
Figure 13.
Variant A in Model 1: One corridor closed to users
Figure 14.
VGA analysis for Variant A in model 1. Connectivity para-
meter (min 4 – max 629)
W. Mazurkiewicz, M. Sitek
space is the best accessible space, and at each inter-
section with another corridor, it shows accessibility
enhancement properties. The visual step depth analy-
sis for the starting point (Fig. 15) also confirms the
validity of Variant A. The isovist with a depth of 2
(orange) covers all the most important communica-
tion spaces connecting all three parts. This means
that each orange space is in the same visual depth of
2 (from the starting point).
Variant B
The introduction of Variation B in Model 1 consists
of an additional (compared to Variation A) closure of
the transition from the space covering daytime
chemotherapy to the space of the radiation therapy
facility. This part of the analysis is to see how the vis-
ibility graph for each part will change. Figure 16
below shows the separation of the right and left parts
in Variant B.
Analysis of the visibility diagram of Part I (Fig.16)
and Parts II and III (Fig.17) shows a significant
weakening of the accessibility of the corridor lead-
ing from Part I to Part II of the building. The analy-
sis of Part III (Fig. 16) shows a strengthening of the
accessibility of the corridor serving the administra-
tive part, which is not advisable in the context of
finding patient access routes to the various spaces of
the oncology institute. Visual step depth analyses
78 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 4/2024
Figure 16.
Variant B in Model 1. Separate the two zones (right and left) by adding one door and closing one corridor in the section leading to the
diagnostic imaging space to outside users
Figure 17.
VGA analysis for variant B in model 1 – part I. Connectivity
parameter (min. 26 – max. 1635)
Figure 15.
Visual step depth – comparison of the situation before and after the Variant A
SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
(Fig. 18 and Fig. 19) also show that closing the pas-
sage between Parts I and II and III will disrupt the
logical process of finding passage in both parts. For
Part I, the red isovist with a depth of 1 (from the exit
point of the staircase) does not lead to the offices
but only indicates a corridor, which in this case loses
its value. In Parts II and III, the orange isovist actu-
ally covers only the passageways in Part II without
leading to Part III. Such a change would disrupt the
logic of wayfinding between Parts II and III. The
analyses carried out allow for a more accurate
assessment of the possible consequences of the spa-
tial changes made to the building.
4. DISCUSSION
In assessing the behavioural quality of the space, the
role of factors related to the perception of the visual
identity system was pointed out, which was used in
the development of research criteria for the patient
research stage. These included: Visibility of visual
identification system, Legibility of the signage sys-
tem, Characteristic signs in the circular area.
Analogous to the criteria identified in the research
condition, the importance of stress level, difficulty in
finding their way and uncertainty in moving around
were pointed out as crucial factors for patients' ori-
entation in space. On the other hand, analysis of the
location of directional signage was possible in both
qualitative research and Space Syntax, based on
VGA analysis. The use of the Space Syntax method
provided the opportunity for mathematical analysis
of space with simultaneous variation of functional
changes. This allowed us to analyse possible direc-
tions of functional changes and location of key func-
tions. On the other hand, this method did not allow
to evaluate the accessibility aspects of communica-
tion layout of the building (lack of variants of routes
taking into account the change of floors). The
research assumed a focus on patient needs and capa-
bilities as a key starting point. This translated into
combining qualitative research techniques to record
user perception and behaviour with syntactic analyses
to map accessibility and linkages of key functions.
This provided the basis for formulating design guide-
lines for the visual identity system strategy for the
buildings of the Institute of Oncology in Gliwice.
The presented Space Syntax analyses shows that:
• To make it easier to find the paths of access routes
to the individual spaces of the National Institute of
Oncology in Gliwice, the spatial accessibility of the
corridor connecting all parts of the building should
be strengthened by closing an alternative route
leading from space II to space III.
• separating parts of the floor covering functions that
could theoretically operate independently (space I
from spaces II and III) will negatively influence the
ease of finding the main corridor and the route
from space II to space III.
• With the separation of part I from parts II and III,
A R C H I T E C T U R E
4/2024 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 79
Figure 18.
VGA analysis for variant B in model 1 – part II and III.
Connectivity parameter (min. 15 – max. 1605)
Figure 19.
Visual step depth for variant B – part I
Figure 20.
Visual step depth for variant B – part II and III
a
W. Mazurkiewicz, M. Sitek
the accessibility of the administrative part in the old
oncology will be reinforced (which is not advisable
in view of the objective of improving the accessibil-
ity of other spaces).
The following diagram (Fig. 21) presents a proposal
for a model process for analysing complex buildings
in terms of wayfinding. It takes into account both the
course of the various phases of the research and the
possibility of using this process in didactics for archi-
tecture majors. Although the process takes into
account analytical and simulation methods using dig-
ital tools (Level 2), the key starting point is the diag-
nosis of the building's problems in the context of user
perception (Level 1). The full conception of an effec-
tive research process requires the use of simulation
tools (Level 3) to test user flow. The Table 4 illus-
trates the results detected using individual research
tools and techniques.
5. SUMMARY
The proposed method for examining complex build-
ings focuses on conducting multicriteria analyses of
complex spaces in public utility buildings. It assumes,
among other things, the use of the syntax of space in
the presented method to obtain the legibility of the
transportation system recognised by means of a
mathematical model of space. The mathematical
model makes it possible to study the existing or
designed functional layout and the consequences of
possible spatial changes. Syntactic parameters indi-
cate the number of changes in the direction of move-
ment in the system, which makes it possible to
analyse its level of complication and test possible
solutions to improve movement between designated
points. The described method, which is used for pre-
design research for a specific type of object, can be
adapted and utilized for pre-design research for vari-
ous types of objects. This can include different fields
such as architecture, engineering, visual identifica-
tion design, or scientific research.
80 ARCHITECTURE CIVIL ENGINEERING ENVIRONMENT 4/2024
Table 4.
The identified key issues for planning the research on wayfinding systems in hospitals
Main architectural components of wayfinding system Exploratory walks
Detected results
Space Syntax
Detected results
Complementary
simulation method
legibility of the communication layout * * *
Characteristic elements in the space (landmarks) * *
Visual accessibility of the destination/ decision point * * *
Zoning of the functional areas in the building, difference in
areas and buildings at the site * *
Visibility of visual identification system * *
Legibility of the signage system * *
Number of changes in direction along each route * *
Overloading of distractors and obscuring elements * *
Characteristic points and functions in the circular area * *
Figure 21.
A diagram of the process of examining the space of complex buildings in terms of wayfinding systems
SPATIAL AND BEHAVIOURAL COGNITION OF WAYFINDING SYSTEM IN HOSPITAL BUILDINGS IN TERMS OF ONCOLOGY PATIENTS’ COMFORT
Furthermore, the framework of the method serves as
a valuable tool fostering skills in pre-design research,
data analysis, users’ behaviour interpretation, prob-
lem solving and decision-making across disciplines.
Imparting the knowledge and ability to use modern
simulation techniques to understand the relationship
between space and the users’ behaviour and process-
es in it is crucial in view of the need to improve the
quality of the products offered, which are buildings
and urban spaces. The construction principle of the
method is shown in a diagram (Fig. 21), which allows
the tool to be applied to other types of complex pub-
lic buildings. The scheme of the developed method
indicates the possibility of moving at level three to
the stage of simulations based on data collected in
earlier phases. Once the problem has been diag-
nosed, the tools available to researchers allow, in suc-
cessive iterations, to test in the form of simulations
the behaviour of users of space, divided into groups
of customer and service providers. The goal is to opti-
mise not only the accessibility of the space but also
the distances and relationships between key function-
al zones. Level 3 activity will be performed based on
the analysis of processes carried out over time and
based on available human, equipment and spatial
resources. The goal is to increase patient/customer
satisfaction (LoS) and rationalise organizational
activities.
A key element is flexibility and the ability to tailor the
method to specific needs and contexts. By identifying
core concepts and processes and adapting them to
different thematic areas, it is possible to utilize this
method in a wide range of research applications.
ACKNOWLEDGMENTS
The authors would like to thank the volunteers
involved in the research – students of the Faculty of
Architecture at the Silesian University of Technology
–for their commitment and assistance in carrying out
the research.
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