Applied Ergonomics 114 (2024) 104149 0003-6870/© 2023 Elsevier Ltd. All rights reserved. Improving wayfnding in hospitals for people with diverse needs and abilities: An exploratory approach based on multi-criteria decision making Ido Morag a, * , Volkan Sonmez b , Astrid Van Puyvelde c , Liliane Pintelon c a Shenkar College of Engineering and Design, School of Industrial Engineering and Management, Ramat Gan, 52526, Israel b Hacettepe University, Department of Industrial Engineering, Ankara, 06800, Turkey c Katholieke Universiteit Leuven, Centre for Industrial Management/Traffc & Infrastructure/Dept. of Mechanical Engineering, Celestijnenlaan 300A, Hevelee, 3001, Leuven, Belgium A R T I C L E INFO Keywords: Wayfnding in hospitals People with diverse needs and abilities Architectural features that affect spatial orientation and wayfnding behaviors Multi-criteria decision-making Inclusive wayfnding systems Minimizing disorientation and confusion ABSTRACT Hospital wayfnding systems that are based solely on signage do not provide adequate solutions for wayfnding needs, especially for users with impairments. Moreover, the interaction between user characteristics and the inner space of the building also determines wayfnding effciency. The aims of this study, therefore, were to identify architectural features that affect spatial orientation and wayfnding behaviors; demonstrate the imple- mentation of a multi-criteria decision-making (MCDM) approach for improving wayfnding in a diverse range of users; and produce a set of quantitative values (i.e., weights) for each selected architectural feature, based on the individual’s preferences. Doing so could enable the formulating of practical design guidelines for hospital buildings, tailored to the needs and abilities of the users, to minimize disorientation and confusion – as demonstrated in this paper through a case study. The MCDM approach was chosen as it is based on observations whereby wayfnding resembles a continuous decision-making process, throughout which, users continuously select those architectural features that they perceive as having the greatest wayfnding value. 1. Introduction The term wayfnding refers to the coordinated and goal-directed movements of an individual while traversing through the environment (Montello and Sas, 2006). Wayfnding employs a range of cognitive processes, such as perception, memory, and problem-solving, and relies on the provision of successive communication cues, such as visual, audible, tactile, and olfactory elements. When performing indoor way- fnding, users usually draw on locally available information, such as maps and signs, that when combined could be defned as a wayfnding system. This system may also include implicit information from the surrounding architecture, including landmarks/points of reference and interior design features (Passini et al., 2000). 1.1. Wayfnding in hospitals Wayfnding is particularly challenging in hospitals, one of the most complex indoor setting environments that members of the public are likely to navigate (Morag and Pintelon, 2021). The wayfnding complexity of hospitals stems from two related factors. First, the design and layout of hospitals serve a wide range of users, including patients, visitors, and hospital staff (Morag and Gopher, 2006). Moreover, each group of users has numerous different needs and capabilities (Lee et al., 2014; Rey-Galindo et al., 2020). Hence, successful wayfnding is dependent on navigational cues that are benefcial for such user di- versity (Morag et al., 2016). This is particularly important in the light of the recent and anticipated demographic changes in user populations. For example, in the U.S., the elderly population is expected to increase from 16% of the population (54 million people) in 2019 to 21% by 2040 (Administration for Community Living, 2021). Since aging has been linked to decreased spatial cognition and learning capacity, reduced visual acuity, and narrowing of the visual feld, future users are likely to be less adept at navigating within new and even known environments, while exhibiting great diffculty learning new routes (Bates and Wolbers, 2014; Figueiredo et al., 2022). Similarly, in terms of general disability, the number of people with disabilities in the U.S. is predicted to increase from 60.1 million in 2021 to 80.8 million in 2040 (Centers for Disease Control and Prevention, 2022), which will also increase the proportion * Corresponding author. E-mail addresses: Ido-ilit@013.net.il (I. Morag), volkansz@hacettepe.edu.tr (V. Sonmez), astrid.vanpuyvelde@kuleuven.be (A. Van Puyvelde), liliane.pintelon@ kuleuven.be (L. Pintelon). Contents lists available at ScienceDirect Applied Ergonomics journal homepage: www.elsevier.com/locate/apergo https://doi.org/10.1016/j.apergo.2023.104149 Received 17 April 2023; Received in revised form 13 September 2023; Accepted 4 October 2023