Is literacy the largest accessibility problem in Australia’s hospitals?

In our role as the leading hospital wayfinders we speak directly with a lot of hospital directors. And when we say a lot, we mean it. 

Most of them are concerned about accessibility, specifically, mobility and issues associated with an ageing population. But there’s an underlying accessibility concern that many aren’t even aware of. And they need to be.

Visitors who enter their facilities won’t be able to find their way around due to one fundamental issue: millions of visitors can’t read the wayfinding in their facilities. Close to 8 million Australians are currently affected by this problem. We think that it is an urgent issue that demands immediate action from the health community.

That’s why we do the work we do in the manner we do it. We think that everyone has the right to feel safe and that their experience matters. We want to create wayfinding systems that work for all, not just some. And we have the tools and skills to help Australian hospitals to provide the best experience possible for everyone who enters their doors, regardless of their literacy level.

We just have to get them to listen.

Australia’s literacy rate is a complex issue

We regularly meet with hospital leaders about the issues they are experiencing with their wayfinding. They’re coming to us with the same wayfinding issues we encounter all the time. People are getting lost at similar junctures. Patients and visitors are running late to appointments. Spaces don’t feel intuitive and work against natural traffic flows, as opposed to with them. 

But the literacy issue is one that has caused us a great deal of concern lately. We’ve tried to raise it with many hospital directors around the country, but our concerns have mostly fallen on deaf ears.

That’s because determining Australia’s literacy rate isn’t as simple as separating the population into those who can read and write and those who cannot. It’s a complex issue that involves levels of literacy and what each means for someone’s ability to fully participate in society. 

According to a 2012 survey of adult skills conducted nationwide, Australia scored fifth out of all other participating countries for literacy coming in after Japan, Finland, the Netherlands and Sweden. We didn’t do as well on the numeracy front coming in 14th, but at least we beat the UK (17th) and the USA (21st). 

For those who work in areas that interact with the breadth of the general population (e.g. hospitals), it’s important to understand that a low level of literacy is not the same thing as being illiterate. Being ‘illiterate’ means someone has an inability to read or write. A low level of literacy is slightly different as it relates to someone’s ability to read, write and understand a range of information. This ability is categorised according to levels that summarise what a person with a particular score can do. There are six proficiency levels for literacy and numeracy (Levels 1 through 5 plus below Level 1) and four for problem solving in technology-rich environments (Levels 1 through 3 plus below Level 1).

Using these levels as indicators, the OECD survey showed that only 17% of adults attained the two highest levels of proficiency in literacy (Level 4 or 5), meaning they had a strong comprehension of written information. Meanwhile, 39% showed proficiency at Level 3 in literacy similar, meaning they could understand and respond appropriately to dense or lengthy texts and make appropriate inferences using knowledge text structures.

Shockingly, this meant that 40–50% of adults in Australia had literacy levels below the international standard required for participation in work, education and society. This assessment is supported by the Australian Bureau of Statistics (ABS), which determined that around 44% or 7.8 million Australian adults don’t have the literacy skills needed for everyday life. This means that nearly half of the adult population may struggle to comprehend information that goes beyond brief texts on familiar topics, especially if it isn't presented in an easy-to-understand or accessible way. 

For those of us who work squarely in a field that centres on comprehension, this high percentage of those with a lower literacy is something we need to pay attention to. Especially as we go to design wayfinding systems that need to be understood quickly and easily by everyone who enters a hospital environment.

How wayfinders can help with Australia’s literacy issue

There’s numerous reasons why many Australians have low literacy, including learning difficulties, learning preferences, social circumstances and cultural background. 

In typical government fashion, there is a lengthy parliamentary inquiry underway to look into how to improve adult literacy in Australia. But we’re more interested in formulating strategies that work now. That’s why we’re pushing hospitals to take a look at their wayfinding with the literacy challenge front of mind.

We suggest that the solution lies not only in helping to improve adults’ literacy long-term, but by making services more accessible starting today. This means we need to create and prioritise systems that reduce unnecessary hurdles and meet users at the literacy level they are now.

At ID-LAB, we have worked with forward-thinking hospital directors to integrate wayfinding systems that are simple, logical and intuitive. We champion simple, coded systems that can work across most large and complex facilities. We recommend them because they are easier to recognise for those with a lower literacy level. They are flexible, expandable and multilingual. 

Finally, they allow for future proofing. As codes are not linked with a particular service name, they can accommodate more than one service depending on a changing need, location or time. For example, it’s easier to tell someone to head to Ward 7B as opposed to the Podiatric versus the Paediatric Ward. With codes, the potential for error is diminished, while the opportunity for success is enhanced. 

As wayfinders on these hospital projects designed to last generations, we have to implement strategies to contend with Australia’s literacy issue now, and into the future.