Hello, 
Thank you so much for posting this article. People might want to look at the Health Literacy Study Circle+ Guides on line at www.ncsall.net or www.hsph.harvard.edu/healthliteracy.
 One of them focuses on Access to Health Care and Navigation Skills. We have several versions of an adult education 'field trip' to a local hospital. 

Here is one:
Activity: Field Trip to a Local Hospital, 
Time: 2 hours

1)	Getting to the Hospital: ~20 minutes
Travel to the hospital together. As you approach the hospital ask participants consider where and how to enter. Here are some questions: 
§	How do we know which way to go? 
§	What is helpful or confusing about available signs? 
§	How do we decide where the main entrance of the hospital is located?

Once you have reached the main entrance, take a few minutes to discuss students’ observations as a group. You should remain outside if you can form a circle without being in the way. 


2)	The Hospital Lobby: 30 minutes

Assignment
Enter the main entrance of the hospital. Find a reasonable meeting place. You may be able to sit in the lobby. 

Next, give the students their first assignment and agree to meet in the designated place within 15 minutes. Ask the students to walk about alone to explore the lobby and  notice the many different options they have for finding their way around. Encourage them to return in 10 minutes to share their observations. 

Follow-up Discussion
After students have had time to make these observations, bring the group back together, and find a place sit down and discuss students’ observations

§	Is there an information or welcome desk? Are there signs or symbols indicating that it is the information desk? 	Is there someone there to answer questions?
§	Is there a map of the hospital?  Is it on the wall?  Are there hand-held maps to take with you?  Is the map easy to read?  What makes it easy or hard to read?
§	Are there other signs in the lobby?  Are they helpful?  Do they use words that are easy to understand?
§	Does the lobby feel welcoming?  Why or why not?  
§	What do the people in the lobby look like?  Do they seem willing to help?

3)	Completing A Navigation Task: 30 minutes 

Make a plan to meet in the coffee shop or cafeteria at a specified time * leaving about ½ hour for the exercise. 
Have students form pairs. Assign each pair a destination in the hospital such as: 1) medical records, 2) asthma center, 3) MRI, 4) Registration, 5)Billing.  6) Pharmacy. 

Ask students to talk to each other about the following before they walk around: 
§	How do they usually go about finding their way? Do they ask other people for directions? Do they consult a map?

Next, ask each pair to do the following:
§	If you want to turn left or right, explain why. Point out any tools or signs you use to make your decision. 
§	Talk about things you notice along the way. 
§	Explain how you know when you have reached your destination. 
§	Point out any signs or people who let you know.  

Finally, ask the pairs to talk about their feelings as they walk back to the meeting place. 

4)	Meeting in Cafeteria: 40 minutes
Have everyone come together as a large group and have a discussion about their experiences both finding their destination and visiting the hospital overall.  The discussion might focus on the following:
	How do you feel?
	What was easy about this exercise?
	What was hard?
	What was most interesting?
	What should the hospital change to make things easier?

5) Possible follow up
Ask the class to work together to write a letter to the head of the hospital to describe what they did and what they learned. Include any suggestions from the group. . 
 


Rima E. Rudd, ScD, MSPH
Department of Society, Human Development & Health
Harvard School of Public Health
677 Huntington Avenue
Boston MA 02115
Phone: 617 432 1135
fax:     617 432 3123
web:    www.hsph.harvard.edu/healthliteracy
www.hsph.harvard.edu/sisterstogether