EDGE Philadelphia

Hospitals can be tough to navigate, especially for immigrants who speak little or no English.

So students at four colleges have designed a series of navigation symbols-from a large white tooth to show dental services, to a head with gears inside depicting mental health services-as a way to help guide immigrants through the daunting mazes of hospital hallways and buildings.

The students’ creations resemble the geometric designs representing a person in a wheelchair for handicapped services and the figures of a man and a woman for male and female restrooms, and are part of an effort to create standardized signs for all health care settings.

The design students attend the University of Cincinnati and Kent State University in Ohio, California Polytechnic State University and Iowa State University.

Professional designers also have created symbols, including a teddy bear with a cross in its center for pediatrics and a symbol showing test tubes and a microscope for laboratories.

About 75 of the students’ creations will be tested this year through surveys of various language groups in Cincinnati, Kent and Ames, Iowa. As many as 15 of those along with 28 professionally designed symbols will be tested for effectiveness at four health facilities around the country.

"We believe universal health care symbols can be as effective as the universally recognized symbols developed for transportation and parks," said Yolanda Partida," director of Hablamos Juntos at the UCSF Fresno Center for Medical Education, the group leading the project.

As hospitals have grown more complex with added destinations, earlier navigation tools like colored lines on floors don’t work as well, and meeting federal requirements for signs in patients’ languages is increasingly difficult.

"Communication is becoming more of a challenge as immigrant and migrant populations grow even in rural areas, and more hospitals are having to develop formal language assistance programs," said Fred Hobby, president and CEO of the Institute for Diversity in Health Management, an American Hospital Association affiliate.

A 2008 Pew Research Center report projected that nearly 19 percent of Americans will be immigrants in 2050, compared with 12 percent in 2005.

Doralinda Soto, 30, came to Cincinnati from San Marcos, Guatemala. She thinks the symbols would be a big help.

"I had problems in hospitals when my children were born," Soto said through an interpreter. "I couldn’t always understand and I ended up in the wrong places."

UC student Paige Farwick’s design for a mental health symbol depicts a head with gears inside.

"That was a difficult one, but it’s cool to think that your design may end up an icon in hospitals everywhere," said Farwick, 22, of Cincinnati.

While a few hospitals have navigation systems, health and design leaders say they have seen nothing consistent that all health care environments could adopt.

"It’s too expensive and time-consuming for facilities to try to do this all themselves," said Leslie Gallery-Dilworth, CEO of the Society for Environmental Graphic Design. The group is partnering in the project funded by the Robert Wood Johnson Foundation, which funds projects for improving health and health care.

It also costs facilities time and money when patients can’t find their way and have to stop staff to ask directions or are late for appointments, slowing down services and reducing the number of patients served.

Hobby is optimistic that the symbols will test successfully but says the challenges will be in creating symbols that can be understood by everyone and getting hospitals to adopt them.

Grady Health Systems in Atlanta, where patient languages have multiplied to 170, has tested some of the symbols and adopted some, including a figure in a chair reading a magazine for waiting areas.

"We’d run out of wall space if we tried to put translations for even the top five or six languages on every sign," said Grady architectural project manager George C. Smith. "We have had very positive feedback, and we plan to add more of the symbols wherever possible."