This research examined the usability and effectiveness of wayfinding in multiple large, complex, multi-building hospitals. The initial research explored three large hospitals’ touchscreen wayfinding interfaces. Errors and issues consistently observed were organized and developed into heuristics and design recommendations. In phase two, a promising mobile application was chosen and both a heuristic analysis and an onsite test of effectiveness were conducted by four researchers. Though the application met many requirements and solved many issues from phase one, it did not meet the expectation of real time navigation. For phase three we chose an app that provided real time navigation and conducted a usability test onsite. Results indicate that this problem is multi-faceted and wayfinding solutions must consider the other available aids in the environment. Incorporation of user centered design principles and requiring the evaluations of users in the development of wayfinding aids are needed. Beyond usability, the key learning is that the wayfinding systems cannot be created in a vacuum, rather the interfaces, the placement of the wayfinding system and the environment of the hospital must be considered. The wayfinding kiosk or app information should complement the environmental information such as color coding, landmarks, room and elevator labeling and signage.