Message areas:
As a first step, all the major facilities where a symbol was necessary, were identified and classified according to their potential for representing in the iconic, indexical and the arbitrary categories.

This involved visits to various hospitals, photographic documentation of all the facilities along with the users, observing and following the users navigating through the hospital spaces, taking down notes and making sketches, keeping track of the different interactions the users have with the hospital environment and talking to the users about their difficulties and asking them to narrate their experiences.

Variations:
In order to generate possible solutions pertaining to each message area, three methods were employed.

from users:

First, the users (patients, visitors and hospital staff) themselves were requested to propose solutions. Their perceptions were quite helpful in conceptualising especially the indexical category of representations. They were interviewed and asked to narrate their experiences with the aim of finding out what association they had regarding a particular message area. Key words associated to the message areas described by the users were documented. These were then visualised into possible visual representations by the designer.

from designers:

Secondly, brainstorming creativity sessions were held involving designers and visual artists in order to generate solutions mainly for the iconic and arbitrary category of representation.

from existing solutions:

Thirdly, existing international solutions were documented. This procedure resulted in the accumulation of a large number of alternatives for each message area.

Evaluation by the people:

The next stage consisted in going back to the users for an evaluation. Without volunteering any information, the users were shown the complete set of possible solutions for each message area and asked to mention what these represented and to identify the ones which gave them sufficient clues towards identification. When the results were tabulated, it was discovered that out of the whole set of possible solutions a few were semantically considered more appropriate then the rest. These few were then passed on to the next phase of the process.

Ergonomic and system attributes:

Following this was the pragmatic phase where ergonomic studies were done on aspects like visual distances, amount of relative blackness perceived, minimum thickness of lines, and the required enlargements. Decisions at a macro level in the semantic and syntactic domain were formulated across message areas so that it became a convention to be used in all symbols for a given environment (e.g.; the patient in black and the hospital staff in white, the roundness of form, the character of border, etc.)

Redrawing of symbols:

In the light of all these studies and evaluations, the symbols were redrawn incorporating ergonomic features and established standards, and then made to syntactically match with each other. The designer's task was to work them over and refine them so that they were graphically more compatible with each other.

Re-evaluation by designer:

Next the designer evaluated the symbols for ease of recognition and for syntactic compatibility.

Redrawing of the symbols:

The symbols were corrected and redrawn.

Operation test on site: