Many hospitals have developed over a number of years in a piecemeal fashion. This has resulted in complex environments made up of long and confusing corridor systems with bends, turns, and confusing signs. Such settings challenge and frustrate those who visit them. The importance of wayfinding to building use, costs and safety and the growth in terms of theories, principles, guidelines, and methodologies over the years does not appear to have made an impact on wayfinding performance in complex hospitals. Thus, there remains a need to find more effective wayfinding solutions to the problems that continue to occur in complex hospitals. This research aims at improving methods for developing wayfinding systems and strategies in old and complex hospital environments. The study adopts a design science research approach informed by uniquely adequate observations of how wayfinders make sense of wayfinding information embedded in the complex built environments they have to navigate. The approach includes an extensive review of literature on wayfinding supported by that of the fields of knowledge management, design (architectural and industrial), and production and operations management. The research brings together the disciplines of design and knowledge management to sensitise designers to the varied needs and knowledge levels of wayfinders when designing wayfinding systems. Drawing on findings from both the review of literature and extensive ethnographic fieldwork the research has produced prescriptive and evaluative wayfinding frameworks to aid the design of effective and efficient wayfinding systems and strategies. The outcome of successfully applying the design science research approach to researching the problems of wayfinding and mapping the approach research process with the unique adequacy approach is the Wayfinding Conceptual framework. It represents a methodological contribution, aimed at helping to mitigate the problem of relevance often associated with academic management research.