2026 articles

Wayfinding in Healthcare

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the Sept-Oct 2026 issue of Healthcare Hygiene magazine.

Wayfinding is an important part of patient safety and quality in healthcare facilities. It is often treated as a convenience issue, but the ability to find the correct entrance, department, or treatment area can affect timely access to care, patient stress, staff workload, and the overall care experience. Healthcare organizations should treat wayfinding as a quality priority because navigation barriers can delay care, interrupt staff responsibilities, and create added challenges for patients with disabilities or limited English proficiency (Devlin, 2014). This paper presents the argument that wayfinding is an important component of patient safety and quality of care and that healthcare organizations must address navigation barriers through inclusive design, clear communication, patient involvement, and coordinated systems rather than relying on signage alone.

The healthcare environment can be difficult to navigate regardless of a person’s background or abilities. Common problems include hard to read signs, complicated building layouts, several entrances and exits, and directions that assume a person is already familiar with the facility. Patients may also be trying to understand unfamiliar medical terms while moving through long corridors, elevators, and multiple departments. These conditions can be especially challenging for older adults and people with visual, mobility, or cognitive limitations. Language differences may create another barrier and increase the need for personal assistance. Morag et al. (2024) emphasized that hospital wayfinding systems must account for different needs and abilities rather than relying on one approach for every patient.
Poor wayfinding also affects healthcare operations. In a survey of 301 hospital staff members, employees reported spending an average of approximately 30 minutes each week helping others find their destinations. Staff also described distraction, frustration, and incivility connected with navigation problems (Jamshidi et al., 2025). These findings do not prove that poor wayfinding directly causes patient harm, but they show how navigation problems consume staff time and pull attention away from primary responsibilities. Patients who arrive late or miss an appointment may also experience interruptions in the continuity of their care.

Improvement efforts should examine the complete patient journey, beginning before the patient arrives and continuing until the patient leaves the facility. Appointment instructions should clearly explain parking, the correct entrance, check in locations, elevators, and directions to the specific clinical area. Once inside the facility, signs should use consistent terms, readable lettering, recognizable symbols, and visible landmarks. Devlin (2014) explained that signage is only one part of wayfinding. Building layout, visual access, landmarks, maps, and staff communication must work together as one system.

Digital tools may strengthen this system, but they should not replace accessible signs or personal assistance. Mobile directions, kiosks, and electronic maps may help some patients, while others may have limited access to technology or difficulty using it. Morag and Pintelon (2021) found that hospital leaders considered issues such as cost, user trust, privacy, system performance, and the needs of different users when evaluating digital wayfinding. A combined approach gives patients more than one way to reach their destination and reduces dependence on a single technology.

Wayfinding should also be included in quality improvement activities. Patient surveys and focus groups can ask whether people found parking, entrances, elevators, and clinical departments without assistance. Patients with disabilities and people who speak different languages should be included in testing proposed changes. Sahoo et al. (2024) demonstrated that wayfinding signage can be implemented and evaluated as a quality improvement initiative. Useful measures may include late arrivals associated with navigation, requests for directions, staff time spent providing assistance, time needed to reach common destinations, and patient reported ease of navigation.

Conclusion
Clear wayfinding will not solve every access or scheduling problem, but it removes a barrier that healthcare organizations can identify and improve. When patients can reach the right location with less confusion, they experience less stress and are better positioned to receive care on time. Staff members can also spend less time giving directions and more time on their assigned responsibilities. For these reasons, wayfinding should be recognized as part of patient safety, accessibility, and organizational quality rather than as a minor facility concern.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.
 
References:
Devlin, A. S. (2014). Wayfinding in healthcare facilities: Contributions from environmental psychology. Behavioral Sciences, 4(4), 423–436. https://doi.org/10.3390/bs4040423
Jamshidi, S., Hashemi, S., & Tran, D.-M. T. (2025). Costs and effects of ineffective wayfinding in US hospitals: A survey of hospital staff. HERD: Health Environments Research & Design Journal, 18(2), 259–275. https://doi.org/10.1177/19375867251317240
Morag, I., & Pintelon, L. (2021). Digital wayfinding systems in hospitals: A qualitative evaluation based on managerial perceptions and considerations before and after implementation. Applied Ergonomics, 90, 103260. https://doi.org/10.1016/j.apergo.2020.103260
Morag, I., Sonmez, V., Van Puyvelde, A., & Pintelon, L. (2024). Improving wayfinding in hospitals for people with diverse needs and abilities: An exploratory approach based on multi-criteria decision making. Applied Ergonomics, 114, 104149. https://doi.org/10.1016/j.apergo.2023.104149
Sahoo, B., Pillai, J. S. K., Md, S., & Sahoo, M. C. (2024). Implementation of wayfinding signage in public hospitals and its evaluation towards quality improvement. Cureus, 16(7), e65435. https://doi.org/10.7759/cureus.65435

Why Leaders Ought to Have One Finger on the Pulse of Operations

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the July-August 2026 issue of Healthcare Hygiene magazine.

Quality dashboards, incident reports, accreditation findings, and performance measures are common metrics to assess patient safety. Although these tools are significant, they mostly give information concerning events that are already happening. They assist leaders in understanding trends and outcomes, although they do not necessarily reveal the circumstances that could lead to future damage. This is why healthcare leaders need to be active in day-to-day operations and have real-time visibility into what is going on across their organizations.

One of the best strategies to meet this objective is executive and leadership rounding. Leadership rounding is a process in which leaders frequently visit clinical and operational areas, assess workflows, speak with employees, and hear employees’ concerns (Murray, 2024). Instead of relying on reports, leaders have a first-hand understanding of the actual situation of patient care as it unfolds. With this presence, leaders can recognize risks, barriers, and weaknesses before they escalate into serious patient safety events.

Frontline employees tend to be the first to identify possible safety issues. They witness communication lapses, workflow bottlenecks, equipment issues, staffing issues, and process workarounds daily. Nonetheless, such issues do not necessarily appear in formal reporting systems. Through effective discussions during rounding, leaders may make observations that would otherwise be invisible. Most importantly, they show that employee voices are heard and that safety issues will be considered.

Being a good rounding leader involves more than just asking whether everything is okay. Leaders should also be capable of listening so as to understand rather than react. They are supposed to ask open-ended questions, encourage truthful feedback, and ask questions to understand the challenges staff face in their day-to-day operations. Leaders can better understand the determinants of patient safety and quality outcomes when they are curious and humble during the rounding process.

In addition to risk identification, executive rounding enhances trust in the organization. Employees will feel freer to communicate openly in the presence of leaders who are visible, friendly, and regularly present. This trust fosters psychological safety, which is fundamental to reporting concerns, discussing errors, and identifying ways to improve. Consequently, it allows organizations to more easily identify problems and develop more effective solutions.

The presence of leadership also fosters a culture of accountability and continuous improvement. Leaders can demonstrate that patient safety is a collective responsibility by regularly reviewing operations and addressing raised issues (Mazrouei, 2025). The employees understand that leadership is determined not only by performance measures but also by awareness of the circumstances under which they promote performance.

Ultimately, patient safety cannot be sustained through metrics alone. Quality dashboards and reports remain significant, but active leadership should be involved. Executive rounding, direct observation, and meaningful interaction with staff help leaders stay on the pulse of operations, enabling them to detect risks, enhance safety culture, and protect patients from harm before adverse events occur.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References

Mazrouei, M. A. (2025). Leading for Safety: The Role of Leadership in Promoting Organizational Safety Culture in Abu Dhabi’s Government Sector. https://doi.org/10.2139/ssrn.5439074

Murray, J. (2024). Leader Rounding for High Reliability and Improved Patient Safety. Federal Practitioner, 41(1). https://doi.org/10.12788/fp.0444

Healthcare Communication and Patient Safety

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the May-June 2026 issue of Healthcare Hygiene magazine.

The provision of quality care not only needs clinical expertise but also the interplay between clinicians and patients in the bedside setting. Bedside communication manner has been a misperceived soft skill, but it is directly involved in patient outcomes and safety. Effective, sensitive, and respectful communications will enable the patient to comprehend their conditions, adhere to the treatment regimen, and feel safe. According to Anshasi and Almayasi (2024), bedside communication is even more important in the context of modern healthcare systems, where complexity and speed are rising. This paper states that bedside communication is a core part of patient safety, and it should be viewed as a quantifiable and correctable part of clinical practice to enhance patient outcomes.

Bedside communication is one of the critical patient safety components, as it pre-establishes the appropriate information communication between healthcare providers and patients. Patients have higher chances of understanding and adhering to their treatment plans when clinicians can discuss with them what is wrong with them, what to administer, and how. Additionally, communication enables patients to inquire and give information about the symptoms and enables the providers to make the correct decisions. Safe and effective care cannot be done without bedside communication, which is mandatory and not optional.

Lack of effective communication can result in very serious consequences, and such consequences might comprise medical errors and lateness in interventions. The inability of a healthcare provider to communicate effectively can lead to a failure to comprehend or even not receive the essential information. To illustrate this, a physician may give unclear information about the dosage of a medication, and a nurse or a patient can take it incorrectly. Poor communication between shifts, on the same note, can result in unaddressed or untimely symptoms (Howick et al., 2024). These may be caused by assumptions, lack of clarity, and not checking the information. Consequently, the patients can be harmed, which would not have happened with improved communication practices.

Poor bedside communication is also caused by systemic problems in healthcare settings. Lack of time may compel providers to hurry up in their interactions and prevent any meaningful dialogue. Moreover, hierarchal relationships may hinder open communication, particularly when the nurse or junior staff of an organization feels powerless to challenge the decision of senior physicians. This disconnection of collaboration may result in a situation where errors are not challenged (Alder, 2026). Moreover, overworking and burnout lower the quality of interactions with patients, and communication becomes less efficient. Such systemic issues raise concerns about organizational change that emphasizes communication as a component of patient safety.

Considering these threats, bedside manner must be regarded as a quantifiable and enforcing part of clinical performance. Standardized communication protocols, including checklists and training in patient-centered communication, can be adopted in healthcare institutions (Ahmed et al., 2025). Communication skills should be part of a performance evaluation, and effectiveness should be determined through feedback by patients. By making providers accountable, organizations can guarantee a regular focus on communication.

Bedside communication is an essential aspect of patient safety that is not about mere politeness. Any delay in communication can lead to serious adverse consequences, and the obstacles on the systemic level will not allow the interactions to be successful. Bedside communication should thus be recognized as a significant clinical skill in healthcare systems, and standards should be placed on it to promote effective, explicit, and empathetic communication to improve patient safety and outcomes.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References
Ahmed, W. E., Fakhry, S. F., & Mohamed Badran, F. M. (2025). Bedside handover training and its effects on nurses’ knowledge and compliance. BMC Nursing. https://doi.org/10.1186/s12912-025-04075-9
Alder, S. (2026, January 2). Effects of Poor Communication in Healthcare – 2026 Update. The HIPAA Journal. https://www.hipaajournal.com/effects-of-poor-communication-in-healthcare/
Anshasi, H., & Almayasi, Z. A. (2024). Perceptions of Patients and Nurses about Bedside Nursing Handover: A Qualitative Systematic Review and Meta-Synthesis. Nursing Research and Practice, 2024(1), 1–18. https://doi.org/10.1155/2024/3208747
Howick, J., Weston, A. B., Solomon, J., Nockels, K., Bostock, J., & Keshtkar, L. (2024). How does communication affect patient safety? Protocol for a systematic review and logic model. BMJ Open, 14(5), 1–8. https://doi.org/10.1136/bmjopen-2024-085312

Patient Safety Failures in Healthcare

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the March-April 2026 issue of Healthcare Hygiene magazine.

Major adverse events tend to be preceded by minor incidents of missteps, which are disregarded and gradually lead to the collapse of patient safety. These small hygiene violations do not seem dangerous on their own. Nonetheless, Kirwan et al. (2025) indicate that they serve as early warning signs that there is a drift in the system. When companies condone such minor failures, they give variability a chance to flourish. It does not actually pose danger as the error on its own but the tolerance of the mistake. The tolerance influences, in the course of time, expectations and minimizes vigilance. The safety erosion of patient safety is slow at the beginning, and it becomes faster when the review of the small signals is neglected instead of doing it as it should be.

Defining the ‘Small Miss
’Every little deviation from the set hygiene or safety measures is what is termed a small miss. Some of them involve reducing the time required to disinfect patients, not taking a hand hygiene opportunity during a busy shift, and not recording it until the conclusion of the day. Others are a lack of labeling a specimen immediately or complete completion of a checklist. Such actions are hardly deliberate negligence. Rather, they are temporal reactions to time awaiting or workflow disruptions. Employees tend to think that the risk is not much, as the deviation seems to be minor. Nevertheless, every shortcut brings deviation to systems that are to be precise. The presence of even small inconsistencies threatens to make the processes of infection prevention and patient protection weak.

Psychology of Rationalization
Healthcare settings are highly affected by operational pressures. Cognitive overload comes as a result of high patient flow, nursing staff shortages, and continuous interruption (Neumann and Purdy, 2023). In this situation, professionals are engaged in doing the tasks that are seemingly urgent. It probably seems reasonable to shorten a cleaning step or postpone documentation in a specific moment. Employees tend to convince themselves that the diversion is a one-time affair or that it is harmless. When faced with these pressures time after time, then the rationalization is facilitated. The thing that used to be uncomfortable starts to become normal. The expectations are slightly changed, and the bar of acceptable performance is lowered. This process of mental adaptation lessens the risk of responsiveness and increases minor deviations.

System Drift and Cultural Effect
System drift starts when one tolerates minor deviation. This makes processes less predictable, as there is inconsistent application of standards. Diversity gets more and more, and protections become weaker. When the leadership reactions are not consistent, the staff members get divided messages regarding priorities. Formal policies are overtaken by informal norms with time. Observation is used to teach new employees behavior instead of written procedures. This cultural drift transforms what is acceptable in the organization. With the erosion of standards, there are increased chances of greater failures. It renders the system weak since it is no longer running on a disciplined basis.

Micro-Corrections
Normalization of deviation is prevented by the leaders playing a critical role. Micro-correction strategies entail prompt, respectful feedback in case of minor errors. Chughtai et al. (2023) also claim that as standards are reinforced in real-time coaching, the coaches do not blame the employees. The apparent leadership presence is an indication that details are important. Feedback loops work in short to allow staff to know what is wanted. Reinforcement leads to accountability and trust. Timely responses by leaders ensure reliability of the systems. Making corrections as soon as possible leads to the small deviations being corrected before they become a norm.

Conclusion
High-reliability organizations react to alarm signs. They consider small hygienic overlooks as indications that attention should be given to the room. Strict attention to detail helps to maintain patient safety, and early intervention helps to keep the situation under control. Typically, the initial step in the process of patient protection is the correction of the initial minor error.
 
References
Chughtai, M. S., Syed, F., Naseer, S., & Chinchilla, N. (2023). Role of adaptive leadership in learning organizations to boost organizational innovations with change self-efficacy. Current Psychology, 1(20), 1–20. NCBI. https://doi.org/10.1007/s12144-023-04669-z
Kirwan, M., Egan, E., & Matthews, A. (2025). Missed Nursing Care Infection Prevention and Control Practices in Acute Hospitals in Ireland During the COVID‐19 Pandemic. International Journal of Nursing Practice, 31(5). https://doi.org/10.1111/ijn.70062
Neumann, W. P., & Purdy, N. (2023). The better work, better care framework: 7 strategies for sustainable healthcare system process improvement. Health Systems, 12(4), 1–17. https://doi.org/10.1080/20476965.2023.2198580

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

Handling Healthcare Personnel Behavior-Related Deviance to Uphold Patient Safety and Quality

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the Jan-Feb 2026 issue of Healthcare Hygiene magazine.

Patient safety and quality of care are primary topics of contemporary healthcare systems, as they have a direct impact on patient outcomes, organizational performance, and the trust of the population. Despite technological progress and intellectual standards of care, patient safety incidents are still taking place in terrifying proportions. Such incidents are mostly blamed on human error, but Tariq, et al. (2024) have proved that the root cause is the failure of systems. The normalization of deviance is one of the most alarming failures in the system because over time the unsafe practices develop into a routine. This article presents the argument that deviance is a normal state of affairs in patient safety and quality of care and that deviance can only be dealt with through strong leadership, psychological safety, and well-designed systems, but none through enforcement of policies.

The events associated with patient safety involve medication errors, patient falls, healthcare-associated infections, and delays in the diagnosis. These happenings are very infrequent since one person does not succeed; rather, they come out of complex arrangements in which minute variances compound without being noticed. When such deviations do not cause immediate harm, then normalization of deviance emerges. Employees might start to consider unsafe practices as normal due to the lack of any negative consequences in the previous instances (Wright, 2023). Eventually, standards are compromised, and unsafe habits become institutionalized in clinical practice.

Clinical settings that demand high levels of pressure are highly open to normalization of deviance. The problem of staffing, a high workload, and the necessity to spend more time on productivity promote shortcuts and workarounds. Sometimes staff can rush to work and overlook safety checks or even disregard protocols to accomplish work fast. Unless leaders act on these acts, they become normal. New workers tend to acquire unsafe behaviors through observation of old workers, a fact that perpetuates the issue among crews and divisions.

Unsafe practices are enabled by several conditions in an organization. The lack of leadership visibility conveys a message that safety is not a priority. Leaders are no longer present in clinical areas and therefore have not been able to assess risks and assist staff. Psychological safety is of importance as well. The fear of being blamed or punished does not make employees report about any mistakes or near misses. The lack of the proper system design aggravates the situation (Wright, 2023). Inefficient workflows, insufficient staffing, and unreliable technology complicate adherence of clinicians to safe practices regularly.

The effect of the normalization of deviance on patient safety and quality of care is harsh. It adds variability in care processes and the exposure to potential harm that can be avoided. Patient quality is compromised, expenses escalate, and employee morale goes down (Sedlar, et al., 2023). Distrust in the healthcare organization is destroyed with the course of time. The following impacts demonstrate the urgency of prevention-based measures.

To deal with the normalizing of deviance, there is a need to enforce policies and procedures. The change of ingrained behavior cannot be done with policies alone. There is a need to have visible and active leadership to guarantee safety expectations. Top management should be able to hear lower-level employees and take action on safety issues. The psychological safety should be provided to make the staff feel free to speak. To promote safe practice, system design must lessen complexity and workload. Constant monitoring can determine unsafe drift in time.

Normalization of deviance is a silent yet powerful risk to the quality and safety of the patients in the healthcare environment. It takes more than rules and policies to prevent the unsafe practices from turning into the standard operations. In order to facilitate safe care, healthcare institutions should encourage visible leadership, psychological safety, and systems. An efficient and proactive safety culture is a key to attaining sustainable patient-focused quality-based care.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References:

Sedlar N, et al. (2023). A qualitative systematic review on the application of the normalization of deviance phenomenon within high-risk industries. J Safety Research. 84, 290-305. https://doi.org/10.1016/j.jsr.2022.11.005

Tariq RA, et al. (2024). Medication Dispensing Errors and Prevention. NIH.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519065/

Wright I. (2023). Normalization of Deviance Is Contrary to the Principles of High Reliability. AORN Journal. 117(4), 231–238. https://doi.org/10.1002/aorn.13894