‘Inclusivity Washing’ in Wayfinding Design: The Confusion Between Universal Design and Inclusive Design

Inclusivity, is a an absolute human right

A few years ago, a court in Australia reprimanded a brand-new hospital following a lawsuit from a blind patient who kept getting lost. This resulted in a court order requiring the hospital to make several modifications to the building.

The judge found that the man with his visual impairment was discriminated against and stated that the hospital’s poor design caused the patient with the visual impairment to frequently get lost as an outpatient.

The question is how the judge was able to assess this, or was it that the hospital could not convincingly demonstrate that they had made efforts to make the building more accessible for people with visual impairments? Probably the latter, because there is no standard for inclusive design.

But, when is your design truly inclusive? What is inclusive for one group can even be exclusive for another group. One of the comments in this lawsuit was: “There’s a lot of natural light and polished surfaces everywhere; it was very disorienting for the person.” Ironically today, we are designing hospitals more and more based on evidence-based design (EBD), and it just so happens that EBD tells us that more daylight contributes to the well-being of the patient.

This immediately demonstrates the tension between Universal Design and Inclusive Design.

Universal Design, Design for All, Inclusive Design

“Universal Design” can be interchangeably used with “Design for All” is defined as:

“The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design”
(Connell et al., 1997).

Later, it was added that the group should be as large as reasonably possible for the sake of inclusivity. However, the United Nations’ Convention on the Rights of Persons with Disabilities claims these rights to be absolute and unconditional.

Shipley (2014) states that:

‘Inclusive Design‘ is not a fixed set of design criteria, but a constantly evolving philosophy. The goal of creating beautiful and functional environments that can be used equally by everyone, irrespective of age, gender, or disability, requires that the design process must be constantly expanding to accommodate a diverse range of users, as we develop a greater understanding of their requirements, desires, and expectations.

This suggests that the judge in the court case was not able to measure the outcome against a specific standard but probably assumed that the hospital could not demonstrate that it had actively considered inclusivity.

We can therefore conclude that a solution to a problem designed according to the Universal Design (Design for All) principle can (unintentionally) exclude a significant number of minority groups.

Does this make Universal Design bad?

Absolutely not! Universal Design is crucial for expanding the group that can benefit from a single solution to its maximum potential.

Universal Design involves a meticulous process aimed at accommodating the largest possible user group. This sometimes means making decisions that might not fully cater to a small minority if it benefits a slightly larger one.

For those few who are excluded, alternative solutions are developed, just as specific solutions are created for various minority groups. The combination of all these tailored solutions results in a more inclusive overall design.

In short, there isn’t one all-encompassing inclusive solution. Claiming so would imply completeness, which is never the case

‘Inclusivity Washing’ in Wayfinding Design

The term ‘Wayfinding’ has become somewhat of a catch-all phrase, often misused to describe merely designing signs or physical elements with arrows. However, true Wayfinding Design encompasses far more than just the visual design of signs. It involves creating a comprehensive system where information design is paramount. This means strategically determining what information to present, when and where to present it, and to whom, across various touchpoints. The ultimate goal is to effectively support individuals as effectively as possible in the complex tasks related to both directed and undirected wayfinding.

Inclusive Wayfinding Design in healthcare settings is an ongoing process, beginning with the goal of creating solutions that serve the largest possible group (Universal Design). At this stage, many research questions remain unanswered. Only after addressing these can we identify additional solutions necessary to fully support minority groups within the entire system for equitable accessibility. Without this thorough approach, we risk ending up with a disjointed collection of features hastily labeled as “inclusive.” In our field, the term Inclusive Design is often used indiscriminately, leading to ‘inclusivity washing’ and diluting the true essence of inclusivity in wayfinding design

Moving Forward

Navigating through hospitals can be classified as directed aided wayfinding (Wiener et al., 2009), where individuals have a specific goal and are supported by tools to reach their destination. Research indicates that tools supporting egocentric navigation, or those that help individuals complete their path, are most effective. This journey is complex, spanning from home to the appointment and possibly a follow-up visit. Essentially, this involves applying the Universal Design principle to ‘Patient Journey Design’, which first addresses the needs of the largest possible group. Subsequently, we design Patient Journeys for minority groups to enhance the inclusivity of the entire Wayfinding System.

When designing for inclusivity in healthcare settings and asserting that the wayfinding design promotes inclusivity, it means more than just making existing elements more accessible. It involves creating comprehensive solutions that enhance the inclusivity of the entire system. Designers should therefore explain the specific Patient Journeys or partial solutions they have developed for minority groups, such as individuals with visual impairments, physical disabilities, or neurodiversity. This approach demonstrates a true commitment to promoting inclusivity throughout the entire system.

For instance:

Incorporating braille into a hospital directory sign enhances its accessibility for individuals with visual impairments, yet this alone does not render the entire wayfinding system inclusively designed.

A hospital might provide a navigation app specifically for individuals with visual impairments, but this solution on its own is not genuinely inclusive. Most people are unlikely to download an app solely to navigate to an appointment, with the possible exception of those with visual impairments who may value the increased autonomy. However, the low download rates for such apps suggest that even this group’s willingness is limited. Consequently, a significant portion of the population is excluded, resulting in a poor return on investment.

Similarly, merely indicating the locations of elevators on hospital signs does not make the wayfinding design inclusive for individuals with physical disabilities, nor does it ensure the inclusivity of the entire system.

So again, demonstrate why your design is inclusive by showing that it covers the entire Patient Journey for a minority group. If it doesn’t, then your Wayfinding Design is not inclusive.

This is not a shame because it is incredibly difficult. In fact, it is already challenging enough for most designers to come up with a good Universal Wayfinding Design in hospitals, even for people without disabilities, let alone for people with disabilities.