Outpatient spatial layout and wayfinding efficiency: Quantitative assessment and design implications for healthcare operations

Large multifunctional hospitals create complex outpatient environments that reduce spatial legibility, slow patient flow, and compromise care efficiency. This study examines how spatial configuration shapes wayfinding efficiency (WE) and presents the Spatial Layout Assessment for Wayfinding Efficiency (SLAWE), a quantitative framework integrating space-syntax indicators with patient characteristics. Empirical analyses in three tertiary hospitals across four outpatient zones combine space-syntax simulations with an on-site, task-based experiment (50 participants; 600 observations). WE was operationalized using two behavior-sensitive metrics: Hesitation Time Density (decision latency) and Hesitation Count (decision frequency). Coherent, geometrically regular layouts were associated with lower hesitation time, whereas visually complex or weakly differentiated environments showed higher hesitation frequency. Age and education moderated these relations: older adults hesitated longer, while higher educational attainment predicted more efficient navigation. SLAWE links spatial configuration to measurable performance and provides a transferable decision-support tool to diagnose layout inefficiencies, prioritize retrofits, and inform legible, inclusive, and operationally efficient outpatient design.