Problem Identification and definition

Initial problem identification was an industry led activity which took place during a meeting that marked the end of a project in which the University of Salford and Salford Royal NHS Foundation Trust had collaborated for over a year. Here the problems challenging the hospital were described in a way that made it apparent that the organisation was having difficulty in communicating wayfinding information to its visitors. Researchers from the university took the opportunity to communicate the perceived appropriateness of the tri-partite conception of knowledge flows as an evaluative and sensitisation tool with regards to managing the problems of wayfinding.

The benefits of a more efficient wayfinding system were briefly highlighted and discussed. Those representing the hospital’s Redevelopment Team indicated their keenness to engage with any efforts that would lead to an improvement in the hospital’s existing wayfinding system from the outset. This timely occurrence made two things possible: 1) an immediate and convenient opportunity to do an in-depth study in order to establish whether more suitable way of communicating wayfinding information could be suggested whilst gaining an understanding into the behaviour of wayfinders, and 2) smooth and continuous access to the setting for the purpose of demonstrating and evaluating proposed design solutions.

The initial description of the nature of wayfinding problems at Salford Royal hospital supported by the author's pre-existing knowledge of the persistent nature of wayfinding

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problems in NHS hospitals, gained from her experience as a nurse, patient and visitor, prompted the author to turn her own experiences into topics of inquiry. Thus, in the interim period, the author took the opportunity to engage in the retrospective exercise of self reflecting on her own wayfinding experience prior to commencing this research. By turning her own experiences into topics of inquiry, she aimed to gain a better understanding of the nature of wayfinding problems in general.

The technique of ‘armchair research’ (Francis and Hester 2004) using the method of self- reflection was adopted for this purpose. According to Francis and Hester (2004)

‘...all of us, as members of society, possess knowledge and competences that we bring to bear to understand the situations, events, objects and persons that we encounter in and as comprising our daily lives. This knowledge and these competencies are normally taken for granted- we rely upon them but do not typically reflect upon them. Yet these phenomena are fundamental to social life; without them we would not be able to understand other, nor they us. Self-reflection then, is a method of bringing into focus this taken for granted domain. By reflecting on upon our own understanding, we can begin to examine and appreciate the accomplished nature of social phenomena, and analyse the methods in and through which ordinary life is done’ (p.52)

Guided by the fundamental thinking highlighted above, the author reflected on specific incidences where as: a nurse she had to stop her usual nursing duties in order to give instructions to lost visitors; and as patient and visitor she had needed the help of others in finding the way around complex NHS settings. In addition, the author spent approximately five hours at the hospital which is the subject of her self-reflection in order to gain a firsthand account of how other visitors found their way around this complex setting. The opportunity was also used to assess how wayfinding information is communicated. This time other techniques including ethnographic interviews, participant observation, direct observation and the analysis of documents and photographs of hospital artefacts were used. A detailed report of these experiences is offered in Chapter four under section 4.2. In this phase a paper presented at a postgraduate conference marked the initial efforts at communicating the importance of the research to an academic audience.

The third phase of the study was the busiest of all. In the months that followed the initial meeting between Salford Royal hospital and Salford University two more meetings were held prior to in-depth ethnographic fieldwork. The purpose of the first meeting was to supply the researchers with more details on the internal and external layout of the site and problematic

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areas to focus on. Literature and other wayfinding aids used to support the existing wayfinding system (e.g. leaflets with maps representing internal routes, official guidelines on how to realise effective wayfinding in NHS estates etc) were also supplied. One of these was Miller and Lewis’ (2005) document which is criticised for its lack of transparency in the literature review Chapter. The project manager was amused by the claims that the guidelines were designed for busy people like her. Whilst she acknowledged the value of the advice contained in this document, she made it clear that she found it most difficult to follow due to layout and small print.

In the second meeting, the researcher was introduced to several stakeholders (e.g. other members of the Redevelopment team at Salford Royal hospital, Balfour Beatty (the builders) and Ryders HKS (the architects). Here the role of the researcher was explained as was the expected outcome from the involvement of the university: a report detailing the good and bad aspects of the existing wayfinding system containing suggestions for improvement (see Appendix 3) and, depending on the impact of the report, possible continuous involvement.

The intensive ethnographic fieldwork that followed spread over a period of eleven weeks from 13 October 2008 to 31 December 2008. The fieldwork was conducted to conform to demands of the unique adequacy criteria (see Chapter four). Adhering to the demands of the unique adequacy approach during data collection made the job of capturing the problem’s complexity less problematic. This, backed by a simultaneous review of literature on wayfinding (see Chapter three), led to a more refined and deeper understanding of the breadth of the problems of wayfinding not only at Salford Royal hospital but elsewhere in the UK and around the world. Data was collected in ten separate visits the objective of each visit being to find a specific department e.g. dermatology, radiology, maternity, outpatients department etc. chosen at random and previously unknown to the researcher. In undertaking these journeys, the researcher was a visitor to the hospital who was unfamiliar with the hospital lay-out. As such, she was in an analogous position to any other visitor to the setting, whether patient, visitor, or new staff member.

In addition, the researcher observed how people made sense of the hospital environment and was also able to reflect on her own experience of navigating the environment as this was her first time through. These direct observation methods were supplemented by conversations with other visitors to the hospital and with members of staff and hospital voluntary workers.

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The eye witness experience of how other visitors to the setting made sense of the environment in finding their way proved a rich source of data which surveys, interviews or other methods would have missed. Photographs were also taken. Following the data collection phase it was possible to identify and classify both helpful and unhelpful aspects of the wayfinding system at Salford Royal hospital as seen by the wayfinders (see report in Appendix 3).

Attempts at answering the question of what a better artefact would accomplish, posed by Peffers et al (2006) led to a clear identification of the need to develop design solutions that would ensure effective and efficient wayfinding in old and complex environments such as that of Salford Royal hospital. The benefits of an effective and efficient wayfinding system or strategy were first discussed during the initial meetings held between the researchers and their hospital partners. However, following the review of wayfinding literature and in-depth fieldwork at Salford Royal hospital the benefits were confirmed and re-emphasised. It became clear that a good design solution would accomplish improved physical health of the wayfinder and the fiscal health of the organisation in question. Evidence from the review of literature indicate that improving the operating costs of an organisation while adding value for patients and members of the public can be achieved through:

1. Reducing the amount of time wasted by highly trained and expensive medical operatives, in giving directions to members of the public (e.g. Arthur and Passini 1992)

2. Facilitating better time-keeping by patients visiting hospital departments, contributing to greater efficiency in the use of resources and consequent cost- savings (e.g. Huelat 2007)

3. Reducing the levels of stress and anxiety, accompanied by frustration, anger, elevated blood pressure and feelings of inadequacy, which in turn have a negative effect on health outcomes (Arthur and Passini 1992).

4. Encouraging better attendance by patients at repeat appointments with medical professional, contributing to better health outcomes (e.g. Carpman and Grant 2002)

5. Encouraging more frequent visits to the hospital by those coming to see their hospitalized relatives, contributing to speedy recovery (e.g. Huelat 2007) 6. Improving the overall patient flows and patient experience (e.g. Huelat 2007).

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through the review of literature on wayfinding and intensive-ethnographic work. These activities led to an in-depth knowledge of the state of the problem and the importance of its solution (Peffers et al. 2008). The next section focuses on the design and development stage which according to Peffers et al. (2008: 55) needs resources such as knowledge of ‘theory that can be brought to bear in a solution’