Hospital

Synonyms / Other Terms Used

Clinic, Sanatorium, Infirmary

Category

Public Services, Public Facilities, Health Care

Message / Function

For notice in general and to indicate the location of a hospital

	Source	Description
	Icograda	Side view of empty bed with large cross above to indicate medical care
1)	ÖNORM A 3011	Side view of empty bed with cross above to indicate medical care
	Tern	Side view of empty bed with red cross above to indicate medical care
	CNIS	Human figure in bed with cross above to indicate medical care
	ISO 7001	Human figure in bed with cross above to indicate medical care
	Erco	Human figure in bed with cross above to indicate medical care
	Bolivia	Side view of mattress with pillow and cover, cross above to indicate medical care
2)	UN 1968	View of empty bed on blue ground with red cross in top right corner
	Aragón	View of empty bed on blue ground with red cross in top right corner
	SVI	View of empty bed on blue ground with red cross in top right corner
A)	Icograda	Front view of bed with human figure symbolized by a circle plus cross on foot end of bed to indicate medical care
	Icograda	Bird's eye view of human figure in bed with cross to indicate medical care
	Kapitzki	Side view of empty bed with cross above inside building
	ON Testdesign	View of building with red cross on wall to indicate medical care
	MH NY	View of building with cross on wall to indicate medical care
	StVO D	Red cross to indicate medical care, inverted 'V' above
	Eco-Mo Foundation	View of building with cross on wall to indicate medical care
	Icograda	View of building with cross and letter H on wall
	Braunstein & McLaren	View of building with cross on wall, upper part of human figure with mask and headdress
	Icograda	Upper part of human figure with stethoscope and headlamp
	Braunstein & McLaren	Stethoscope
	Icograda	Side view of empty hospital bed with IV bag on a pole connected to IV line
	González	Head with typical nurse accessories, hand in front and finger over mouth area
	Icograda	Front view of head with page boy or bob like hair cut and traditional nurse uniform cap
B)	Icograda	Upper part of human figure with arm sling
	Icograda	Front view of human figure with bandaged leg and axillary crutch
	ARIB	Greek cross in outline of shield
C)	Dreyfuss	White cross on black disk
	SEGD	White cross on dark background
	ICRC	Red cross to indicate medical care
3)	UN 1968	White letter H on blue ground
	NST Portugal	White letter H on blue ground
	OCHA	Blue letter H on white ground
	SADC	White letter H on red ground, inside white circle

Discussion

The examples shown above are only a small selection from the wide range of pictograms and symbols for the referent Hospital and the related terms Clinic, Sanatorium, Infirmary that can be found in publications and guiding systems worldwide. Some even are supposed to cover more general terms like Health Services and Health Center. There are several general concepts and a multitude of visualizations. It seems there is no real single stereotype to express this message.

Studies from several countries present research covering many pictogram variants in use to indicate the location of a hospital:

In a comparison of fifteen variants based on an Appropriateness Ranking Test conducted in Austria (Brugger, 1977 a), pictograms showing a bed with a cross above were seen as more appropriate than the variants typically used for indicating First Aid, e.g. displaying a hand with a bandaged finger. The letter H on blue ground - traffic sign E, 13a found in the 20. Convention on Road Signs and Signals - was placed second in the ranking results, while images displaying just a red cross or a white cross on green background were judged as less appropriate. Of the three top ranked variants subsequently tested for comprehension in another Austrian sample (Brugger, 1977 b, labeled 1) to 3) in the table above), applying strict scoring the UN traffic sign symbol 2) performed best with 66 % correct responses. Applying lenient scoring the two pictograms displaying a bed with a cross above - marked with 1) and 2) - reached more than 90 % answers classified as correct, but results for variant 3) did not improve with 56 % correct answers.

In the context of the Icograda student project and the ISO test series 1979/80 (Easterby & Graydon, 1981 a) more than fourty pictogram variants intended for the message were examined using the Appropriateness Ranking method. Three pictograms of the set judged as most appropriate subsequently were selected for further research on basis of a Comprehension Test (Easterby & Graydon, 1981 b, graphic symbols marked A) to C) in the table above). Doubts concerning category assignments for responses like First Aid, Emergency Service etc. led to several versions of categorization. When only answers implying full hospital facilities were regarded as correct, the Icograda pictogram A) was understood best with 72.9 % correct answers, while variants B) and C) only reached 31.0 % and 20.2 % correct responses. No context information was offered in this large scale study with more than 1200 respondents, which was conducted in six countries.

In several other research projects each just focused on a single graphical symbol for Hospital:

The pictogram variant labeled as Eco-Mo Foundation proved to be well comprehensible with a comprehension score of 90.3 in a Japanese study to propose domestically unified graphical symbols based on scientific methods (Eco-Mo Foundation, 2001).

Al-Rousan & Umar (2021) examined comprehensibility of traffic signs among drivers in the Emirate of Abu Dhabi, where the UN-Hospital sign displaying a white latin letter H on blue ground was correctly recognized by 79 % of the respondents, even though this latin letter is not an element of the local Arabic script. When examined in black and white, in a study of way-finding symbols for healthcare facilities conducted in the United Arab Emirates, this letter based variant was not so well understood with a score of 62 % correct among mostly young and well educated respondents (Hashim et al., 2014).

When Fiori (2008) examined a map symbol displaying a red cross, 91.6 % of the respondents answered correctly regarding the broader message Hospital / First Aid. This study was conducted in Brazil.

A white cross on dark background, shown as SEGD in the table above, intended for the very general referent Health Services, was reviewed by Zender & Cassedy (2014). Results from a Comprehension Test conducted in rural Tanzania and the United States of America reveal that this symbol elicited sufficient associations with Health Services in the USA, but not in Tanzania, where numerous answers referring to church or religion indicate a differing message.

Based on the findings available it can be summarized:

Symbols just based on a cross have a more general meaning than just Hospital, Clinic, or Sanatorium and are therefore not specific enough for conveying the intended message. Furthermore the symbol of a red cross is an official protective symbol of the International Red Cross and Red Crescent Movement. According to the Geneva Conventions and other international laws, the use of this and similar symbols is reserved for official agencies of the International Red Cross and Red Crescent, and as a protective emblem for medical personnel and facilities in combat situations. Use by any other person or organization is illegal, and may lead to prosecution.
The UN-Hospital traffic sign displaying a white latin letter H on blue ground, or similar variants based on the letter H, may be well understood by trained persons like drivers, but this cannot be expected from the general public.
Pictograms showing medical personnel or instruments are judged as more or less inappropriate.
Renderings of a human figure with arm in sling or hands with bandaged fingers are primarily associated with First Aid.
Pictograms displaying a building with a cross (or a corresponding symbol appropriate to the culture of the using country) on the wall, or similar concepts like the German traffic sign labeled StVO D, possibly might be sufficiently comprehensible.
Pictogram variants showing a bed with a cross either above or on the bed, or a corresponding symbol appropriate to the culture of the using country, probably are suited best to indicate the location of a hospital.

Recommendations

ÖNORM A 3011 Hospital

Based on the test results known, we recommend the use of a pictogram showing a bed from the side with a cross above to indicate medical care.

The cross to indicate medical care may be substituted with another symbol appropriate to the culture of the using country.

Tests of pictograms and symbols of referent Hospital

Al-Rousan, T.M. & Umar, A.A. (2021): Assessment of Traffic Sign Comprehension Levels among Drivers in the Emirate of Abu Dhabi, UAE. Infrastructures 2021, 6, 122. https://doi.org/10.3390/infrastructures6090122

Brugger, Ch. (1977 a): Abschlußbericht über den Reihungstest. Report to the Austrian Standards Institute, Vienna, 1977-07-27.

Brugger, Ch. (1977 b): Abschlußbericht über den Erkennungstest. Report to the Austrian Standards Institute, Vienna, 1977-10-04.

Easterby, R.S. & Graydon, I.R. (1981 a): Evaluation of Public Information Symbols: ISO Test: 1979/80 Series. Part I: Appropriateness Ranking Tests. AP Report 99, Applied Psychology Department, University of Aston in Birmingham, January 1981.

Easterby, R.S. & Graydon, I.R. (1981 b): Evaluation of Public Information Symbols: ISO 1979/80 Test Series. Part II: Comprehension/Recognition Tests. AP Report 100, Applied Psychology Department, University of Aston in Birmingham, January 1981.

Eco-Mo Foundation (2001): Test data of public information symbols in Japan - Procedure for the testing of public information symbols by the Study Committee. ISO: ISO/TC 145/SC 1 N 329.

Fiori, S. R. (2008): Mapas para o turismo e a interatividade - proposta teórica e prática. Tese de Doutorado - Depto. de Geografia, FFLCH-USP.

Hashim, M. J., Alkaabi, M. S., & Bharwani, S. (2014): Interpretation of way-finding healthcare symbols by a multicultural population: navigation signage design for global health. Applied ergonomics, 45(3), 503–509. https://doi.org/10.1016/j.apergo.2013.07.002

Zender, M., & Cassedy, A.E. (2014): (Mis)understanding: Icon Comprehension in Different Cultural Contexts. Visible Language, 48, 69.