Although every hospital complex is different, the follow basic issues usually need to be considered during the development of a comprehensive wayfinding plan:

1. ADA Directional Signs: the biggest cost issue is usually converson to 3" caps on all corridor signs mounted above 80". The tactile/braille signs for permament rooms are achievable with many of the new modular sign systems, but the large lettering size for the corridor signs usually requires editing the names of the departments, which requires client discussion. A new rule being considered by the Justice Department may allow 2" cap lettering if the sign can be approached within 15 feet by the observer; this will substantially help with message congestion on overhead signs.

2. ADA Elevators: all cabs must be fitted with tactile floor numbers on door jambs and floor and function tactile/braille indicators for all buttons. Identifing the routes to accessible entrances and elevators is an important requirement.

3. ADA-Related Programs: visual paging systems is the current topic in most public buildings and it looks at alternate-channel communication methods to deal with partial hearing loss, cognitive difficulties and text-telephones for the deaf. New symbols are required by ADA to mark these functions.

4. Evacuation Maps: a typical large-committee issue; hospital should have a standing committee which can deal with this important safety issue; not regulated by ADA, but rather by the Uniform Fire Code and hospital accreditation requirements.

5. Areas of Rescure Assistance: with a higher level of people in wheelchairs or with mobility limitation, code-designated areas within stairwells or corridors must be marked.

6. Directory Map Artwork: clients are now asking for more control of the changeability of most directories; some new output technology is available now which allows lower cost map artwork; not regulated by ADA.

7. Electronic Kiosks & Directories: several manufacturers offer menu-driven databases listing staff, departments, and maps on how to get there; evaluate the number of people who will need to access the maps at the same time and consider the cost of having several of this type of directory in the hospital; sometimes standard artwork is more cost effective.

8. Terminology: due to the long terms currently used to describe most medical specialities, this issue usually involves considerable client/committee discussion; grouping several similar functions under one term can help.

9. Multiple Entrances/Functions: expansion projects often create more "front doors" to be explained; patient information brochures might be needed and a reconsideration of which entrance actually wants to be the "main" one; it is easiest to direct patients to multiple entrances if they are associated with a certain function.

10. Parking Signage & Remote Lots: usually a challenge, due to walking distance being unrelated to the main entry; pathway signage is often needed; unobstructable marking of van-accessible stalls and auto-accessible stalls is required; need to determine number of accessible stalls required and their best location.

11. Lighting: general illumination levels affect sign legibility more in hospitals because the main directional system is rarely internally illuminated; coordination with the energy code, architectural and budget concerns is required.

12. Identity and Logo Development: it is not uncommon to reexamine the hospital's existing logo during a thorough wayfinding study, particularly if the hospital has several facilities or is part of a larger healthcare network. Care must be taken to not lose community recognition of the existing logo, while improving the image of the hospital.

13. Art Programs: sculpture, artwork, spaces to hold impromtu theater, and other artistic enhancements of the hospital environment can be used as visual and auditory reference points in a good wayfinding program.

14. Staff Training: staff involvment during the design phase and training sessions after will improve wayfinding by bringing the building and how it is operated into harmony. People are an essential key in wayfinding.