In past studies, wayfinding between different floors was a common challenge for visitors ^[1][2][3][18,19,54]. From the experimental results, rwesearchers  found that most participants would preferentially rely on hanging-style signs on the ceiling to find directions and search for and read more informative signs. It was more difficult to find tasks that needed to move between floors. There needed to be a clear sign informing the target of the location of the floor. Otherwise, visitors would not easily go upstairs to find it. During the wayfinding process, if the target information was not seen on the sign, the participant would wander the corridor repeatedly or return to the lobby. Some participants might reason independently to look for other related subjects, resulting in a complete deviation from the correct route. Therefore, the hanging signs in the lobby and the central corridor should play the main role of guiding visitors. The signs on the walls could complement and compensate for the shortcomings of the hanging signs. Participants looked at the sign and expected the next sign with the information they needed, and incoherent information led to confusion or return.

Due to the hospital’s lack of signs for floor instructions, participants generally found it challenging to go from the first to the second floor to find the target. Unless the sign with the target location was on the second floor, they did not quickly go upstairs but repeatedly wandered on the first floor to search, increasing their negative emotions when finding the way.

The main purpose of information architecture is findability ^[4][55]. However, the term is designed with its origins in the rise of the Internet and extended to the user experience. However, it largely corresponds to the paths, edges, districts, nodes, and landmarks in Kevin Lynch’s The Image of the City ^[5][6]. Since the NTUH West Campus is a Baroque building and a completely symmetrical structure, the concept of “landmark” is not applicable in this indoor environment. However, the lobby is very different from the rest of the building, and most visitors can find it without relying on signs. However, the number of signs with information about the location of other exits in the hospital is small, such as the Jingfu Passage linking the West Campus to the East Campus, which is not easy to find. However, to exit to the East Campus, most participants must go back and forth to find various corridors and signs for information. Therefore, the sign system in the hospital still needs to add signs and smaller specific exits to assist with wayfinding.

Currently, the classification method of information on the hanging-style sign is difficult for unfamiliar visitors to understand. They were even misled by the two classification titles of ward and outpatient. This is not in line with the “labeling system” in the information architecture that should consider viewers’ manner or mental model ^[4][55]. The auxiliary icon was interspersed with text information without rules, which interfered with the user’s reading flow. It is necessary to arrange the information content neatly and regularly; otherwise, it is easy to ignore the information. The meanings of directional arrows must also be unified to avoid misunderstandings. Currently, the walls of the circulation corridor of the hospital are full of signs of various styles and sizes and too many kinds of presentation methods. Too much repetitive information and the lack of consistency will make the visitors question and be confused about finding their way, reducing trust in this sign system ^[6][56]. Therefore, it is necessary to unify the design specifications to make and decide the location of the installation.

The experimental results show that the essential wayfinding ability of the participants in the pretest affected the task performance in some tasks. High-ability people are more likely to reach task goals faster and may generate less anxiety during the task. Still, similar results were not found in the posttest. ResWearchers speculate that this may be due to the optimization of the sign system so that people of both high and low ability can better reach their destination in the hospital. In terms of experience with FPV 3D games, it was found in both experiments that although all participants moved at an equal rate during the simulated wayfinding, in some cases, those with no game experience still took more time to reach the task targets than those with game experience. Therefore, in a virtual environment, the participant’s “experience with/without 3D games” is more likely to impact experimental performance than “essential wayfinding ability”.

The advantage of this study is that the experimental process did not affect the hospital’s operation, and it can control the variation and scope of the experimental field and save a lot of time and physical strength for testing. Participants conducted the task in the first-person view, giving researchers a clearer idea of what they were looking at. However, there are still some limitations in this experimental method, that is, the influence of the “crowd” on feelings and wayfinding behavior. In addition, this study was conducted on a desktop screen display, which is relatively narrow compared to walking in the real field, and it is easy to ignore the scenery on both sides; in particular, the corridor of NTUH West Campus has many pillars and arches, which easily cause blind spots. In addition, due to the long experimental time during the pilot test, a small number of people reported dizziness during the process of going up and down the stairs, and the way of climbing the stairs was changed to touching the specified icon and then being teleported upstairs so that the number of participants who reported dizziness was greatly reduced. If participants are inexperienced with 3D games, they can reduce the mouse sensitivity beforehand to avoid dizziness caused by uncomfortable operations. Although there are many parts to pay attention to when using a virtual environment as an experimental method, it still has many advantages for related wayfinding research in medical institutions because it can easily change the environment and verify the design effectiveness without affecting the hospital’s operation. This presents the benefit of the “digital twin” concept ^[7][8][9][35,36,38].

Based on the pretest results, rethisearchers study formulates the basic sign system design principles. ReseasrchersWe readjust the information presentation, classification, and layout of all hanging-style signs and various types of wall signs in the experimental environment and propose a new sign system. The information on the hanging sign is changed to outpatient, medical, laboratory, and ward services according to the type of function provided. Based on the Gestalt principles ^[10][57] and synthesizing the study results, rwesearchers  make three recommendations: (1) Important hospital administrative services and outpatient departments must be presented. (2) The information on the sign is processed consistently to avoid interruptions in reading, and the layout is based on the principle of not affecting the columnar format. (3) Services on the same floor should be prioritized in order.

Repetitive information is removed from the wall, and each corridor is marked with its corridor code and directions. Stairs and elevators are also equipped with a sign system with columnar format floor space information, which follows the exact specifications of the overall sign system. At the same time, adding a color classification system to the above design can positively impact the wayfinding behavior of visitors.

The results of the posttest show that the new sign system is better than the existing sign system in the performance of many tasks, which shows that the basic design principles set are conducive to visitors finding destination information in the hospital sign system. People can make correct wayfinding decisions through the guidance of the sign, which helps to find the target faster and significantly reduces the negative emotions generated during wayfinding. In addition, rwesearchers h have also found that when there is perfect sign guidance in a medical facility, people of high or low ability can smoothly follow the sign guidance in the hospital to reach their destination, so the wayfinding behavior tends to be consistent.

Through the design verification of the posttest, the following design points and suggestions are summarized in this study for reference in future medical institution marking systems:

• Hanging-style sign design

The information on the signs on important circulation corridors should include essential administrative services and outpatient departments in the hospital. The information between the signs should be presented consistently, and the direction arrows should be used uniformly and standardized because of visual consistency; the viewer’s accessibility in reading information will be improved ^[11][12][58,59]. The diagonal upper arrows can be emphasized by adding floor or staircase icons if they mean upper and lower floors. In addition, in the posttest, rwesearchers a also found that some participants could not find their direction for a while after going upstairs, so a hanging sign could be added to indicate the staircase on the second floor. The auxiliary icons on the sign should not be interspersed with principal text information, and stairs, exits, or parking lots can be added as needed to assist visitors in finding their way.

Information can be classified according to the type of function provided, such as outpatient, medical, laboratory, and ward services. According to proximity and common region in Gestalt principles ^[10][57], the same type of information can be placed in the same block, and the order is not affected by the principle of column reading. The layout of the sign system is uniformly arranged in this order for easy access so that the user can quickly find the target information.

For the wall, the use of many repetitive signs should be avoided, and all signs should be designed with the exact specifications of the overall sign system. Each staircase and elevator should provide complete and precise floor information regarding floor guidance. In the posttest, the task performance of going upstairs to find the Dermatology Clinic and the Jingfu Passage is still low. So, the wall near the entrance can be modified to contain the floor map and spatial system information of the entire hospital to improve the wayfinding efficiency of visitors.

Since medical facilities will gradually add new services and facilities over time, or the location of departments will be adjusted, it is possible to pay more attention to the use of types that can be easily changed in the sign system so that flexible adjustments can be made at any time. In addition, an overall wayfinding sign and a color-coded four-color description were added at the lobby entrance and used in conjunction with the West Campus map colors. Madson and Goodwin’s ^[13][60] research has demonstrated that color coding systems positively impact wayfinding, which can amplify the impact of color coding and improve wayfinding performance.