Surgery

Synonyms / Other Terms Used

Surgery Department, Surgical Ward, Operation Theater, Operating Theater, Operation

Category

Public Services, Public Facilities, Health Care

Message / Function

To indicate the location of a clinical facility for surgery/surgical care

	Source	Description
1)	Hablamos Juntos	Two surgeons behind operating table with patient, lamp in upper corner
	Hablamos Juntos	Two surgeons behind an operating table with covered patient
	Prado	Human figure with arm streched out, behind operating table with patient, line from arm to patient, lamp in upper corner, cross on table base
2)	Hablamos Juntos	Surgeon behind operating table with covered patient, lamp in upper corner
	D'source	Side view of lying human figure an top of horizontal line, frontal view of human figure in outline behind, two lamps in top corners
	SIS	Upper part of human figure with mask, arm with line touching disk segment at bottom, above ellipse indicating operating light
	Erco	Upper parts of two human figures with mask and surgical hood (surgeons) mostly in outline, working together
	NYCHHC	Frontal view of face covered by mask and surgical hood
	Aku-Johnson	Frontal view of face covered by mask and surgical hood
	Eko Purnomo	Side view of human figure on operating table, two operating lights above
	Kapitzki	Operating light, operating table below
	Kapitzki	Hand in outline, holding scalpel
	CNIS	Plan view of surgical clamp and scalpel in line with each other
	Dumbar-WH	Frontal view of human figure with large stitched wound on the torso

Note: Some of the examples shown above were mirrored horizontally to contrast differences.

Discussion

The examples shown above are a selection of the heterogeneous range of pictograms and symbols available to indicate the location of a clinical facility for surgery/surgical care. While several pictograms show one or two surgeons behind an operating table with a patient, some with one or two operating lights, other concepts focus on the typical appearance of surgeons with mask and surgical hood. A few present the operating environment without persons or just medical instruments used. A rather old pictogram shows a frontal view of a human figure with a large stitched wound on the torso. No single visual stereotype can be identified.

Studies conducted in several countries present research for this referent, but covering only two of the pictogram variants shown above:

The pictogram marked 2) above was part of the test material used in a research project examining the comprehension of 54 universal medical icons (Zender & Cassedy, 2014). The ISO/ANSI Open-ended Comprehension Test was used to find out if this variant is understood just as well in a different culture, and if not, why it does not work. Test results from the United States and Tanzania reveal that this pictogram basically might work well enough, as 83 % of the responses from the American sample could be classified as correct. But in the Tanzanian sample it became evident that this variant failed there, probably also due to a lack of domain knowledge: while 50 % of the respondents with advanced medical literacy answered correctly, none of the typical local patients could guess what this symbol stands for. This example illustrates the importance of collecting additional information besides the meaning of a graphical symbol, when conducting a Comprehension Test.

A research project comparing comprehensibility of healthcare symbols between the United States, South Korea, and Turkey also included the pictogram marked 1) above (Lee et al., 2014). While 92 % of the answers of the U.S. American respondents could be classified as correct, this was the case for 83 % in Turkey and 72 % in South Korea, indicating this pictogram could be superior to the variant examined by Zender & Cassedy (2014). In a further study of way-finding symbols for healthcare facilities in the United Arab Emirates this variant reached a similar comprehension score of 78 % correct in a Comprehension Test carried out with a sample consisting mostly of young and well educated respondents (Hashim et al., 2014).

Recommendations

Due to the fact that data from research is insufficient, we recommend testing using the Comprehensibility Estimation procedure for eliminating poor variants and identifying the best of the set available, followed by a Comprehension Test. These studies should deliver useful data for recommending the best pictogram. Detailed information about the most frequent responses given in each of the response categories of the Comprehension Test should be provided to correctly judge comprehensibility and improve designs. Also information concerning knowledge about this medical specialization should be collected at the end of the test, as studies suggest that many terms used for healthcare facilities are often not understood well by people visiting hospitals or related institutions.

Tests of pictograms of referent Surgery

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

Lee, S., Dazkir, S. S., Paik, H. S., & Coskun, A. (2014). Comprehensibility of universal healthcare symbols for wayfinding in healthcare facilities. Applied Ergonomics, 45(4), 878-885. doi:10.1016/j.apergo.2013.11.003

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