No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Perceived quality of care: The influence of the waiting room environment
Abstract
The current study investigated the effect of the physical environment of the waiting room on perceptions of the quality of care of the physician. One hundred forty-seven college students and 58 senior citizens viewed 35 slides of physicians' waiting rooms. Using a visual analog scale, participants rated the perceived quality of care and the environment of each waiting room. The primary hypothesis was that perceived quality of care would be greater for waiting rooms that were nicely furnished, well-lighted, contained artwork, and were warm in appearance versus waiting rooms that had outdated furnishings, were dark, contained no artwork or poor quality reproductions, and were cold in appearance. Factor analyses of the care and environment ratings produced factors consistent with the hypothesis. Additionally, waiting rooms judged to be those of female physicians were rated higher on both perceived quality of care and comfort in the environment.
... These results are in line with previous studies that relate patients' experiences and perceptions with the environment and other constructs such as perceived quality [24,[34][35][36][37][38][39], or patient satisfaction [34][35][36][37][38][39][40][41][42] in health care services, or even in any service [20]. This suggests that there is a direct relationship between these constructs and the therapeutic relationship, as other authors have already partially demonstrated [34]. ...
... These results are in line with previous studies that relate patients' experiences and perceptions with the environment and other constructs such as perceived quality [24,[34][35][36][37][38][39], or patient satisfaction [34][35][36][37][38][39][40][41][42] in health care services, or even in any service [20]. This suggests that there is a direct relationship between these constructs and the therapeutic relationship, as other authors have already partially demonstrated [34]. ...
... These results are in line with previous studies that relate patients' experiences and perceptions with the environment and other constructs such as perceived quality [24,[34][35][36][37][38][39], or patient satisfaction [34][35][36][37][38][39][40][41][42] in health care services, or even in any service [20]. This suggests that there is a direct relationship between these constructs and the therapeutic relationship, as other authors have already partially demonstrated [34]. We believe it would be interesting to explore this mutual influence. ...
Background
Currently, in the scientific literature there is a great interest on the study of strategies to implement patient-centered care. One of the main tools for this is the therapeutic relationship. Some studies suggest that the perception of the environment in which the treatment takes place can influence the perception of its quality, but this is not explored in physical therapy. For all these reasons, the aim of this study was to understand the influence of the environment in which physical therapy treatment takes place on the patients’ perception of the quality of the patient-centered therapeutic relationship in public health centers in Spain.
Methods
A qualitative study analysed thematically using a modified grounded theory approach. Data collection used semistructured interviewing during focus groups.
Results
We conducted four focus groups. The size of the focus groups ranged from six to nine participants. In total, 31 patients participated in these focus groups. Participants described a series of specific experiences and perceptions relating to the environment, which they felt were influential in the establishment of therapeutic patient-centered relationships, including six physical factors (Architectural barriers, Furniture, Use of the computer, Physical space, Ambiet conditions, and Privacy) and six organizational factors (Patient-physical therapist ratio, Treatment interruptions, Social factors, Continuity with the professional, Lack of professional autonomy, and Coordination or communication among team members).
Conclusion
The results of this study highlight environmental factors that affect the quality of the therapeutic patient-centered relationship in physical therapy from the patient’s point of view, and emphasize the need for physical therapists and administrators to underline the need to review these factors and take them into account in their service delivery.
... It has been shown that waiting spaces have the power to quell or exacerbate these feelings of anxiety, and to increase or decrease trust among patients for their healthcare providers [1,3]. As such, the waiting experience significantly contributes to patients' perception of the quality of care they receive [4]. Unfortunately due to limited resources and longer wait times at safety-net hospitals and community clinics [5], the waiting experience is not often prioritized for publicly insured patients. ...
... Well-designed waiting spaces, on the other hand, have been shown to improve perceived quality of care [4,13,14] and medical literacy [15][16][17][18][19], as well as help to alleviate physical pain and emotional stress through the engagement of the senses [20][21][22][23]. As such, innovation around the waiting space has centered around decreasing wait times and/or improving time perception [24][25][26][27], introducing positive distractors such as televisions and artwork [28][29][30][31][32], and improving patient privacy, information transparency, and comfort [33,34]. ...
... As such, innovation around the waiting space has centered around decreasing wait times and/or improving time perception [24][25][26][27], introducing positive distractors such as televisions and artwork [28][29][30][31][32], and improving patient privacy, information transparency, and comfort [33,34]. Designing waiting spaces with the patient at the center helps patients feel valued and increases patient perceptions on quality of healthcare delivery [4]. ...
Objective:
To use architectural mapping to understand how patients and families utilize the waiting space at an outpatient surgery clinic in a safety-net hospital.
Background:
The waiting period is an important component of patient experience and satisfaction. Studies have found that patients value privacy, information transparency and comfort. However, approaches common in the architecture field have rarely been used to investigate interactions between patients and the built environment in a safety-net healthcare setting.
Methods:
This was a prospective observational study in a general surgery outpatient clinic at a safety-net hospital and level 1 trauma center. We used a web-based application generated from the design and architecture industry, to quantitatively track waiting space utilization over 2 months.
Results:
A total of 728 observations were recorded across 5 variables: time, location, chair selection, person/object, and activity. There were 536 (74%) observations involving people and 179 (25%) involving personal items. People most frequently occupied chairs facing the door (43%, n = 211), and least frequently occupied seats in the hallway (5%, n = 23), regardless of the time of their appointment (p-value = 0.92). Most common activities included interacting with personal phone, gazing into space, and talking face to face. Thirteen percent of people brought mobility devices, and 64% of objects were placed on an adjacent chair, indicating the desire for increased personal space.
Conclusion:
Architectural behavioral mapping is an effective information gathering tool to help design waiting space improvement in the safety-net healthcare setting.
... In the third area, Arneill and Devlin (2002) determined that pictures of comfortable and attractive waiting rooms generated a higher perceived quality of care, and Becker and Douglass (2008) identified that more attractive waiting rooms positively correlated with a higher degree of perceived quality, satisfaction, and staff interaction, as well as anxiety reduction. Furthermore, Lee (2011) established that ambient conditions (environmental conditions, visual attractiveness, and furniture) and "serviceability" (wayfinding, convenience, privacy, communication with staff, and cleanliness) had a significant influence on satisfaction with the facility and that serviceability was a significant predictor of perceived service quality and approach behaviors. ...
... Accordingly, researchers included seat comfort in their perception scales assessing the waiting area and identified its relevance for patients (e.g., Cusack et al., 2010;Deitrick et al., 2005;Fornara et al., 2006;Tsai et al., 2007). Furthermore, Arneill and Devlin (2002) suggested that designers and health professionals should consider the accessibility of all waiting room elements. ...
... Literature in healthcare suggests that pleasing surroundings positively affect patients' health and well-being (Caspari et al., 2006). Arneill and Devlin (2002) observed that patients naturally judge the appearance of the waiting room with words such as "ugly" or "warm and pleasant." Furthermore, researchers reveal the effects of attractive facilities on patients' perceptions, evaluations of quality of care, and behaviors (e.g., Arneill & Devlin, 2002;Becker & Douglass, 2008;Fornara et al., 2006;Leather et al., 2003;Nanda et al., 2012). ...
Waiting to receive medical attention is universally present in outpatient health services and, therefore, is a critical experience for service satisfaction. Researchers find that the waiting room physical environment influences users, and it may reduce the adverse effects of waiting. In this study, we used the spatial user experience model (SUE) framework in order to better understand the impact of waiting room features on patient experience. We developed and administered a questionnaire in waiting rooms at two Chilean medical centers. Responses from 563 outpatients and their companions were analyzed through structural equation modeling, concluding that the model is appropriate to describe the SUE in waiting rooms. The dimensions of emotional reaction, spatial appreciation, physical compatibility, and spatial cognition had the most substantial influence on user experience. Furthermore, the user experience showed a strong influence on behavioral intentions desirable by the healthcare industry. Our study provides useful insights to managers and creative teams about the diversity of factors that should be taken into consideration to implement waiting rooms that facilitate positive experiences for patients and visitors.
... The literature on waiting rooms in healthcare environments has primarily focused on either the overall impact of physical attractiveness on patients' perceived quality of care (Arneill & Devlin, 2002; or user's physiological and psychological responses to the presence of passive positive distractions such as aroma, music, interior colors, views to nature, artificial or live plants, and visual art in waiting areas (Beukeboom et al., 2012;Biddiss et al., 2014;Deitrick et al., 2005;Jiang et al., 2017;Nanda et al., 2012;Tsai et al., 2007;Watts et al., 2016). Nevertheless, a recent qualitative study by Vuong (2014) recognized that waiting room characteristics including seating arrangement, privacy, comfort, position of the reception desk, access to information, and a welcoming atmosphere can impact perceived pleasantness by users in outpatient healthcare waiting environments. ...
... Another study by Baker and Cameron (1996) also found that furniture layout in the waiting area and employee visibility in a waiting room can impact end users' affective status and how they evaluate the waiting area. Furthermore, in a study conducted by Arneill and Devlin (2002), 47 college students and 58 citizens evaluated the 35 slides of physicians' waiting rooms and found that perceived quality of care and level of comfort were highly significant for welllit, nicely furnished waiting areas with artwork as compared to poorly lit waiting areas with outdated furnishings and no artwork. Ayas and colleagues (2008) conducted interviews with 88 patients and staff in six primary health centers in Sweden and found that the seating arrangements in the waiting areas along with other design attributes including lighting, color, privacy, and green plants contributed to creating positive affective values such as a feeling of calmness in the waiting areas. ...
... The importance of all factors including seat comfort, seat location, type of seat, visual privacy, auditory privacy, and visibility of the registration area varied across the scenarios with different tasks, while the importance of visual appearance of the seat did not vary significantly. This finding is supported in previous studies that have found subjects to have positive reactions to nicely furnished and attractive waiting environments regardless of the type of task they were engaged in or the waiting phase (Arneill & Devlin, 2002;Becker & Douglass, 2008). ...
Abstract
Objective:
The purpose of this study was to examine the factors impacting seating choices of care partners while conducting common tasks in an outpatient surgical center waiting room.
Background:
Waiting rooms in healthcare environments have been previously studied to understand how factors such as aesthetics, privacy, comfort, and positive distractions impact user perception of quality of care. Although care partners of patients often spend long hours in the surgical waiting rooms, no studies have addressed users’ seat type and location preferences in waiting areas.
Methods:
In this study, 92 participants made seat selections while performing scenario-based tasks in a virtual waiting area. A mixed-methods approach including a survey and semi-structured interviews was utilized to capture participants’ feedback on how certain factors (e.g., visibility, accessibility, privacy, comfort, and aesthetic quality) impacted their choices.
Results:
The optimal seat location and type in the waiting area varied depending on the type of task care partners were engaged in. While being able to sit with their loved one was the most important factor influencing seat selection during patient check-in, seat location was the most important factor in all other scenarios. The importance of factors such as seat comfort, seat type, visual and auditory privacy, and visibility to registration area varied across scenarios. However, the visual appearance of the seating remained equally important across all scenarios.
Conclusions:
The use of different scenarios allowed users to identify their preferences regarding seating within the context of their specific needs at different points in the waiting process.
... The bene ciaries' satisfaction with CBHI services is also signi cantly in uenced by variables related to health care services. Likewise, other studies reported that the bene ciaries' satisfaction was found to be in uenced by the following health service factors: quality of service [57,58], referral service [54], time spent during a visit (waiting time) [48,54], availability of resources (doctors and medicines) [59,60], access to care [48,60], nancial aspects of care (medical cost per family) [55,60], diagnostic services, explanation about the prescribed medicine, the behavior of health personnel toward clients [61], the surrounding or waiting room environment of healthcare facility [57,61], and the recovery by the patient [59]. The trust put into the process of providing services, however, was found to be far behind [62]. ...
... The bene ciaries' satisfaction with CBHI services is also signi cantly in uenced by variables related to health care services. Likewise, other studies reported that the bene ciaries' satisfaction was found to be in uenced by the following health service factors: quality of service [57,58], referral service [54], time spent during a visit (waiting time) [48,54], availability of resources (doctors and medicines) [59,60], access to care [48,60], nancial aspects of care (medical cost per family) [55,60], diagnostic services, explanation about the prescribed medicine, the behavior of health personnel toward clients [61], the surrounding or waiting room environment of healthcare facility [57,61], and the recovery by the patient [59]. The trust put into the process of providing services, however, was found to be far behind [62]. ...
Background
The viability of community-based health insurance programs depends on beneficiary satisfaction, and healthcare systems evaluate performance through patient reports and ratings to ensure effectiveness and service quality. To our knowledge, Ethiopia lacks national pooled data on the satisfaction of community-based health insurance beneficiaries and related factors; this review aims to address that gap.
Methods
Database searches on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar were conducted on September 1st, 2022. Thirteen studies were chosen for review from the search results. Checklists from the Joan Briggs Institute were used to evaluate the risk of bias for the included studies. The data were extracted using a 2019 Microsoft Excel spreadsheet and analyzed using RevMan-5 software and STATA 17. The odds ratios at p-values less than 0.05 with a 95% confidence interval were used to evaluate the effect estimates.
Results
The pooled satisfaction of beneficiaries with community-based health insurance was found to be 66.0% (95% CI = 0.57–0.76) and was found to be influenced by socio-demographic, health service-related, the scheme’s related factors, and the beneficiaries' knowledge of it. The beneficiary satisfaction levels were highest in the Amhara region, at 69.0% (95% CI = 0.59–0.79), followed by SNNPR at 67.0% (95% CI = 0.40–0.94), Oromia at 63.0% (95% CI = 0.58–0.68), and Addis Ababa at 53.0% (95% CI = 0.45–0.62).
Conclusion
Even though there was a moderate level of satisfaction, there are indications that the quality of health services and the coverage of the entire population lag behind, necessitating greater efforts to achieve universal health coverage.
... From the soft-furnishings in the waiting area, to the artwork adorning the walls, to the physician's framed credentials: as soon as a patient enters the clinical environment he or she is unavoidably seeped in a range of artifacts. To date, a range of studies in social and health psychology demonstrates that these physical environmental factors -or "artifacts" -can influence patients' perceptions about the quality of their care, and, as a result, even their health outcomes (e.g., Arneill and Devlin, 2002;Devlin et al., 2009;Petrilli et al., 2018). In this paper, we propose that artifacts, which have been investigated at some length in psychology, deserve further scrutiny within the burgeoning field of placebo studies. ...
... For instance, Devlin et al. (2009) have conducted a series of studies in the Northeast of the United States suggesting that the physical space where patients spend time can impact perceptions of care. In one study, college students viewed a series of pictures of physician waiting rooms (Arneill and Devlin, 2002). The authors concluded that waiting rooms that were, "nicely furnished, well-lit, contained artwork, and are warm in appearance" (p. ...
Research in social psychology demonstrates that physical environmental factors – or “artifacts” such as provider clothing and office décor – can influence health outcomes. However, the role of artifacts in augmenting or diminishing health outcomes is under-explored in the burgeoning discipline of placebo studies. In this paper, we argue that a careful consideration of artifacts may carry significant potential in informing how placebo effects can be maximized, and nocebo effects minimized in clinical settings. We discuss the potential mechanisms, including classical conditioning, response expectancy, and mindsets, by which artifacts might enhance or diminish these effects. Next, we propose testable hypotheses to investigate how placebo and nocebo effects might be elicited by artifacts in care settings, and conclude by providing innovative research designs to advance this novel research agendum.
... Related studies have confirmed that an exciting and pleasant atmosphere can increase the number of customers and influence customers to stay longer (Yoo, Park, & MacInnis, 1998). Arneill and Devlin (2002) found that symbols or sign cues in the service environment affect personal identity and perceived quality; Bonnin (2006) similarly confirmed that customers are influenced by space and function and that signs and symbols can provide clear cues to guide customers' wearing perceptions. Based on the above relationship between CCI and CEI in the interactive empirical study of existing research, this study proposes the following hypotheses: ...
This study proposes an extension of the interactive ritual chain model that explores the intrinsic construction of the embodied experience and self-identity of Chinese gay tourists visiting Thailand. The expanded elements include stock, tension, loose, and transformation, which can reflect the intrinsic association of the inner interaction framework. An exploratory sequential mixed methodology approach was adopted. It includes the interviews of 16 respondents followed by a questionnaire survey involving 330 respondents. While most previous research subjects and contexts are from Western countries, this study adds a new knowledge framework and empirical basis for the tourism interactions and identity-based tourism of gay tourists in non-Western countries. This study has practical implications for policymakers in gay tourism destinations in Asia, particularly as this study provides a better understanding of the tourism psychology and behavior of Asian gay tourists, which may be useful in guiding tourism recovery policies in gay-friendly destinations in Asia.
... It may be interesting for healthcare professionals and institutions to explore how they can curate clinical environments for patient benefits. For inspiration: nicely furnished, well lit, and decorated waiting rooms have been associated with higher perceived quality of care (Arneill and Devlin, 2002); physicians who don a white coat are rated more favorably by patients (Petrilli et al., 2018); and surgery patients were found to require less analgesia when their hospital room window overlooked trees compared to a wall (Ulrich, 1984). Softening the "sterile" esthetic of the traditional medical environment with plants, paintings, and warmer lighting could alleviate some of the anxiety that patients feel when at the doctor's office (see the "white coat syndrome"), and place patients in a better mindset for ensuing medical care. ...
The randomized controlled trial (RCT) research design assumes that a drug's "specific" effect can be isolated, added, and subtracted from the "nonspecific" effect of context and person. While RCTs are helpful in assessing the added benefit of a novel drug, they tend to obscure the curative potential of extra-pharmacological variables, known as "the placebo effect." Ample empirical evidence suggests that person/context-dependent physical, social, and cultural variables not only add to, but also shape drug effects, making them worth harnessing for patient benefits. Nevertheless, utilizing placebo effects in medicine is challenging due to conceptual and normative obstacles. In this article, we propose a new framework inspired by the field of psychedelic science and its employment of the "set and setting" concept. This framework acknowledges that drug and nondrug factors have an interactive and synergistic relationship. From it, we suggest ways to reintegrate nondrug variables into the biomedical toolbox, to ethically harness the placebo effect for improved clinical care.
... As it was occasionally difficult for the elementary school students to respond to the complex questions, an aerial photograph of their own school exterior areas, and a visual analogue scale (VAS) were provided in the survey. VAS is used as a measuring tool for phenomena in fields where it is difficult to objectively measure (such as feeling or pain) (Cox and Davison, 2005), and previous studies (Arneill andDevlin, 2002, Devlin, 2008) have used the VAS to analyze feelings associated with environments. Fig.1. ...
Visibility is an important factor that affects fear of crime in environments. This study suggests empirical evidence of the relationship between visibility and fear of crime in environments using an automated quantitative analysis method. Spots where children felt fear in exterior areas of elementary schools were aggregated, and their characteristics were analyzed with two visibility dimensions of visual connectivity with no visible distance restrictions and with visible distances restricted. In general, locations with lower levels of visibility reported higher levels of fear of crime. However, where there was very high visibility, fear of crime also increased. In other words, visibility has a dual nature, both increasing and decreasing fear of crime in environments. In addition, the visible distance was a significant element that affects fear of crime. With the assistance of methods and results of this study, designers can plan safer environments and improve existing environments by considering visibility in a systematic and significant manner.
... As it was sometimes difficult for the elementary school students to respond to the questions, a simplified drawing of the third floor, which was the standard floor for all schools, and a visual analogue scale (VAS) were provided. This type of VAS is used as a measuring tool for phenomena in fields where few objective measures are available (Cox and Davison, 2005), and several environmental studies (Arneill andDevlin, 2002, Devlin, 2008) have used the VAS before to analyze feelings associated with environments. In this study, the VAS scores measured the degree of fear of crime. ...
In any given environment, visibility is a critical element that affects fear of crime. This study provides empirical evidence of the effects of visibility on fear of crime within elementary schools using a quantitative analysis. Spots in which children felt fear were identified, and their characteristics were analyzed according to the four visibility dimensions of: visual connectivity and visual integration, each with and without visible distance restrictions. One finding was that fear of crime was high in the areas where visibility was either extremely low or extremely high, resulting in a relationship that can be expressed as a U-shaped graph. In addition, fear of crime was associated with visibility in relation to human behaviors as well as built environments. Finally, the visibility distance was also found to be an important element affecting fear of crime.
... Arneill and Devlin [90] reported that the nice and warm appearance of the physical facility and equipment in the hospital setting influences participants' perception of the quality of care provision. Patients' perceived appraisals of the quality of the medical staff's care, relationships, and privacy were positively related to perceived quality [8]. ...
This study presents architectural designers’ perception of the importance of healthcare environmental criteria in the implementation of user-centered, therapeutic hospital design. Architectural designers with over three years of professional experience (N = 182) in South Korea were surveyed using an empirical questionnaire. The extensive interviews of 15 hospital design experts followed to interpret the survey results and discuss the barriers and suggestions for the successful delivery of therapeutic healthcare design practice. Among the 27 variables selected from the preliminary literature review, factor analyses revealed seven important therapeutic environmental criteria (i.e., management, interior design, spatial quality, service, nature and rest, ambient indoor comfort, and social program and space; χ2 = 1783.088, df = 300, p < 0.001). Analyses of variance revealed the level of importance among these criteria related to respondents’ personal and professional characteristics. Significant differences were found for the variables from the management, interior design, and spatial quality factors in relation to the respondents sex and age. For the successful delivery of therapeutic healthcare design, the design experts highlighted the implementation of evidence-based design practice that integrates local and international knowledge from various hospital users and multi-disciplinary specialists participating in the healthcare design process.
... Previous studies have pointed to the importance of the physical dimensions of the servicescape in shaping hospital visitors' waiting experiences (Arneill and Delvin, 2002;Devlin, 2022;Leather et al., 2003;Nanda et al., 2012). The data in the current study suggested that poor management of the combination of design and layout, ambient conditions and privacy-related factors could lead to dissatisfaction. ...
This study evaluates waiting experiences in a cancer treatment context. It examines the effects of multiple servicescape dimensions, including the design, spatial layout and functionality of the physical surroundings alongside ambient conditions such as lighting and temperature, on visitor satisfaction. The study adopted a case-study strategy in a cancer and haematology clinic at a UK hospital. Scoping discussions with clinical staff, observations of the clinical environment and ‘walk-throughs’ were used to develop a survey to capture visitors’ expectations, perceptions and satisfaction with waiting experiences. Ambient conditions were shown to have a greater impact on satisfaction than the design and layout. Perceptions of wayfinding and privacy features, alone and in combination, were shown to influence satisfaction and dissatisfaction. Improving experiences of privacy and wayfinding can significantly improve overall satisfaction. Better management of these dimensions can help compensate for deficiencies in other areas of the physical servicescape.
... For example, Grondin et al. [93] reported that altered eye contact in VCP may not be as detrimental as previously believed for the perception of empathy from a psychotherapist. Several practical questions remain unanswered, and these could have an impact on the contexts in which our results could be generalized, such as how to ensure that patients are in an adequate environment for psychotherapy (i.e., no distracting stimuli, secured confidentiality), which software options really make a significant contribution to an optimal experience (e.g., using the picture-in-picture option [94]), or which factors contribute to patients being ready to start their psychotherapy session (e.g., regaining composure in a waiting room before a session [95]). The past experiences of patients and psychotherapists using videoconference also merit study, as attraction to novelty and previous negative experiences with the technology may influence the impact of VCP [96]. ...
Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027.
... Bitner et al. (1990Bitner et al. ( , 1992 was the first to suggest that a customer's perceived service environment influences customer-service interaction quality. Wu and Liang (2009) suggested a pleasant ambient environment presents the value of the customer experience and is necessary for customer satisfaction, while Harris and Ezeh (2008) and Arneill and Devlin (2002) found that symbolic or sign cues in the service environment affect customer loyalty and the perceived quality of service, for example, Aromatic scents in the front lobby can make check-in guests feel at ease and comfortable, thus building loyalty to the hotel's services. Regarding hotel customer-client interactions, the research has explored the interaction concept definition, classification, effects, and theoretical derivation, among which customer-client interaction classification is the most noteworthy. ...
Host-guest interactions in boutique hotels can improve guest satisfaction and word-of-mouth communication, as well as contribute to the sustainable development of the brand image of boutique hotels. However, existing studies have less research on the micro-sociological perspective of interaction in boutique hotels, and this issue needs to be further discussed. This study adopts grounded theory and fuzzy set qualitative comparative analysis (FsQCA)respectively, exploring the multiple paths and combinatorial relationships of the intrinsic influence of multiple factors on the host-guest interaction of boutique hotels from a holistic perspective, taking a typical boutique hotel in an ethnic minority region in China as an example. The results show that the intrinsic model of the host-guest interaction ritual of boutique hotels consists of two paths of interactive ritual preparation, elements , and results, the successful ritual path can lead to the interaction of the host-guest to generate brand symbolic cognition and group ethnic cultural identity, and the failed ritual path fails to form the collective ritual of host-guest interaction and brand image cognition, subsequently, there are four antecedent combinations that can realize the common influence of the interactive ritual of boutique hotels and combinatorial relationships, and these antecedent combinations are classified as behavior-intention dominant, interaction-satisfaction dominant, cultural interaction dominant, and behavior-satisfaction-cultural perception dominant. This study innovates the research perspective of micro-sociology of boutique hotels, identifying the key factors and multiple paths of successful host-guest interaction rituals, and expands the application of host-guest interaction theory to provide an empirical basis for the effectiveness transformation and brand value enhancement of existing boutique hotel host-guest interaction rituals.
... In a medical space, both software (the interaction between doctors and patients) and hardware (service equipment and space design) will convey, replicate, and expose the values of the medical system to the patients [35]. Most patients' attitudes toward medical quality are defined by their experience [36,37]. Relevant studies have also pointed out that medical service experience has a significant impact on the quality of doctor-patient relationships and patient loyalty [22,23]. ...
The demand for health care has increased with the development of global technology and the rise of public health awareness, and smart service systems have also been introduced to medical care to relieve the pressure on hospital staff. However, the survey found that patients’ willingness to use smart services at the time of consultation has not improved. The main research purpose of this study was to understand the willingness of patients from various groups to use smart medical service systems and to explore the influencing factors on patients’ use of smart service systems in hospitals through the technology acceptance model. This study distributed questionnaires in the outpatient area of National Taiwan University Hospital Yunlin Branch, and a total of 202 valid questionnaires were obtained. After related research and regression analysis, it was found that patients paid more attention to the benefits and convenience brought by smart services. If patients believed that smart services were trustworthy and beneficial to themselves, their usage intention and attitude would be positive. The results of this study are summarized by the following four points: (1) Designed according to the cultural conditions of different regions; (2) think about design from the patient’s perspective; (3) strengthen the explanation and promotion of smart services; and (4) add humanized care and design. This study could be used as a reference for hospitals to improve their service quality and systems in the future.
... For centuries, patient waiting times (WT) have been a persistent issue in the healthcare industry. [13][14][15][16][17][18] Long patient WT can be caused by many factors and would affect the quality of care in hospitals. 19 Arneill and Devlin 17 concluded that the physical environment of the waiting room has an impact on the overall quality of care. ...
Long patient waiting time is one of the major problems in the healthcare system and it would decrease patient satisfaction. Previous studies usually investigated how to improve the treatment flow in order to reduce patient waiting time or length of stay. The studies on blood collection counters have received less attention. Therefore, the objective of this study is to reduce the patient waiting time at outpatient clinics for metabolism and nephrology outpatients. A discrete-event simulation is used to analyze the four different strategies for blood collection counter resource allocation. Through analyzing four different strategic settings, the experimental results revealed that the maximum number of patients waiting before the outpatient clinics was reduced from 41 to 33 (20%); the maximum patient waiti-ng time at the outpatient clinics was decreased from 201.6 minutes to 83 minutes (59%). In this study, we found that adjusting the settings of blood collection counters would be beneficial. Assigning one exclusive blood collection counter from 8 to 10 am is the most suitable option with the least impact on the operational process for hospital staff. The results provide managerial insight regarding the cost-effective strategy selection for the hospital operational strategy.
... Most of these factors are determined before physicians start to practice and are unlikely to change. Second, consultation quality is a multidimensional notion that involves both technical (objective) and nontechnical (nonobjective) aspects of care (see Haddad et al., 2000;Arneill and Devlin, 2002;Levine et al., 2012). Consequently, patients' views on the quality of a physician's consultation seem to be a better proxy for evaluating quality of care than purely technical physician measures of quality. ...
During the last 30 years in France, concerns about healthcare access have grown as physician fees have increased threefold. In this paper, we developed an innovative structural framework to provide new insights into free-billing physician pricing behavior. We test our theoretical framework using a unique geolocalized database covering more than 4,000 private practitioners in three specializations (ophthalmology, gynecology and pediatrics). Our main findings highlight a low price competition environment driven by local imitative pricing between physicians, which increases with competition density. This evidence in the context of growing spatial concentration and an increasing share of free-billing physicians calls for new policies to limit additional fees.
... Understanding the factors affecting patient satisfaction is the key to improving patient care and satisfaction. There are three categories of factors [9], including non-modifiable predictors, modifiable predictors, and environmental determinants [10]. The non-modifiable predictors include better subjective health [11,12], better functional status [13], or a lower pain level [14], which are associated with higher satisfaction. ...
Objective
Patient-physician communication affects cancer patients' satisfaction, health outcomes, and reimbursement for physician services. Our objective is to use machine learning to comprehensively examine the association between patient satisfaction and physician factors in clinical consultations about cancer prognosis and pain.
Methods
We used data from audio-recorded, transcribed communications between physicians and standardized patients (SPs). We analyzed the data using logistic regression (LR) and random forests (RF).
Results
The LR models suggested that lower patient satisfaction was associated with more in-depth prognosis discussion; and higher patient satisfaction was associated with a greater extent of shared decision making, patient being black, and doctor being young. Conversely, the RF models suggested the opposite association with the same set of variables.
Conclusion
Somewhat contradicting results from distinct machine learning models suggested possible confounding factors (hidden variables) in prognosis discussion, shared decision-making, and doctor age, on the modeling of patient satisfaction. Practitioners should not make inferences with one single data-modeling method and enlarge the study cohort to help deal with population heterogeneity.
Innovation
Comparing diverse machine learning models (both parametric and non-parametric types) and carefully applying variable selection methods prior to regression modeling, can enrich the examination of physician factors in characterizing patient-physician communication outcomes.
... ej., un entorno deteriorado, desordenado o funcionalmente pobre) que pueden ser interpretadas por los usuarios como señales de la calidad de la atención sanitaria (Ortega-Andeane & Estrada-Rodríguez, 2010;Ortega-Andeane et al., 2005). Sin embargo, si el centro comunica que el personal se preocupa Procesos psicoambientales del hospital 6 por la apariencia física del centro y que su diseño responde a las necesidades del paciente, el paciente entra en el centro con una imagen positiva sobre la atención sanitaria (Arnell & Devlin, 2002). La importancia del aspecto físico es evidente en la valoración global del hospital, siendo las características físicas aquellas que predicen la satisfacción con el mismo: el diseño interior, la privacidad que ofrece, la limpieza o el mantenimiento y la arquitectura del edificio (Harris, et al., 2002). ...
A pesar del auge del movimiento por la humanización del ambiente sanitario, la implementación de mejoras en el diseño que reduzcan los efectos negativos del entorno hospitalario no se ha llevado a cabo de forma generalizada. Se revisan las aportaciones de la investigación psico-ambiental sobre las implicaciones psicosociales del diseño en la salud y bienestar de los usuarios en las áreas de eficiencia de la atención sanitaria, compromiso de los pacientes, interacción social, orientación espacial y estrés ambiental. También se realizan recomendaciones para el diseño del espacio atendiendo a su doble función como lugar de permanencia para el paciente y lugar de trabajo para el personal. Finalmente, se discute la amplificación de los efectos negativos del entorno hospitalario durante la situación de pandemia provocada por el COVID-19. Esta revisión es una guía básica de los efectos del ambiente hospitalario para profesionales del sector con el objetivo de mejorar la atención sanitaria.
Abstract
Despite the popularity of the humanization movement in healthcare environments, the implementation of design changes for reducing the negative effects of hospital environments has not been carry it out systematically. This review offers the contributions of the psycho-environmental research about the psycho-social implications of the design for users’ health and wellbeing in the areas of health care, patient’s compromise, social interaction, spatial orientation, and environmental stress. It also proposes recommendations for the spatial design regarding the double function as patient care space and workplace for staff members. Finally, the amplification of the hospital’s negative effects during the COVID-19 pandemic situation is discussed. This review is a basic guide of the hospital environmental effects for the professionals to improve healthcare
... While generally considered a detrimental habit, overthinking is often also an unavoidably yield by circumstances and situations such as waiting for a flight at the airport gate, hanging around before an exam, or while in an hospital waiting room. It has been proven that the quality of the time spent in a waiting room also affect the perceived quality of the awaited service, especially in healthcarerelated contests [3]. The latter are also often positively or negatively affected by the perceived quality of service that, in the second case, could also tamper with the therapeutic efficacy of the treatments (e.g. for psychological counseling or and psychotherapy [9]). ...
Stress and anxiety are part of the human mental process which is often unavoidably yield by circumstances and situations such as waiting for a flight at the airport gate, hanging around before an exam, or while in an hospital waiting room. In this work we devise a decision system for a robotic aroma diffusion device designed to lessen stress and anxiety-related behaviors. The robot is intended as designed for deployments in closed environments that resembles the aspect and structure of a waiting room with different chairs where people sit and wait. The robot can be remotely driven by means of an artificial intelligence based on Radial Basis Function Neural Networks classifiers. The latter is responsible to recognize when stress or anxiety levels are arising so that the diffusion of specific aromas could relax the bystanders. We make use of thermal images to infer the level of stress by means of an ad hoc feature extraction approach. The system is prone to future improvements such as the refinement of the classification process also by means of accurate psychometric studies that could be based on standardized tests or derivatives.
... While generally considered a detrimental habit, overthinking is often also an unavoidably yield by circumstances and situations such as waiting for a flight at the airport gate, hanging around before an exam, or while in an hospital waiting room. It has been proven that the quality of the time spent in a waiting room also affect the perceived quality of the awaited service, especially in healthcarerelated contests [3]. The latter are also often positively or negatively affected by the perceived quality of service that, in the second case, could also tamper with the therapeutic efficacy of the treatments (e.g. for psychological counseling or and psychotherapy [9]). ...
... The visual interpretation of the furnishing that customers convey will ultimately provide the overall assessment of the service encounter (Arneill & Devlin 2002). Evaluations of furnishings also include issues of personal space and crowding. ...
While numerous published works have extensively examined servicescape models and its linkage to loyalty, not many have systematically examined the influence of demographic factors specifically on servicescape in the context of department stores. The purpose of this study is to examine whether servicescape of department stores have specific influence on six demographic characteristics (age, gender, income, race, education and occupation). A mall intercept method was conducted by administering 560 questionnaires across 5 regions in Malaysia. The results indicate that age and income are strongly associated with servicescape (differences in perception as well as experiences on servicescape), while gender, race, occupation, education and occupation are not. Additionally, it was found that older consumers possess different motives on servicescape implications compared to the younger consumers. The results indicated that patrons to department stores have different perception on servicescapes especially among the high income and younger age groups. The findings will enable retailers to understand the implications of customers’ experiential values and personality in line with the demographic characteristics affecting the servicescape offerings. This could lead to better servicescape development strategies to create unique in-store environments to enhance shopping experiences and therefore, result in more satisfied shoppers.
... On what matters within the "facilities and services" domain, having a comfortable and clean waiting room mattered most in the decision-making. Previous studies postulated that an attractive and clean environment were associated with the perception of gaining high standards of services and care, thus motivating parents to seek care for their child's illness from such facilities (Arneill & Devlin, 2002;Becker & Douglass, 2008;Tieche et al., 2016). Convenience was another crucial factor rated by parents when seeking child health care services (Nicholson et al., 2020). ...
Introduction
In today’s highly demanding health care industry, paediatricians realise the need to focus on what matters to parents as a means to improve their service quality and health care delivery. This study aimed to identify which key choice elements were important for parents when choosing a paediatric general practice service for their children. It also examined the difference of how parental socioeconomic status influenced these key choice elements.
Methods
An analytical cross-sectional study was conducted at two urban paediatric general practice centres in Malaysia, where parents are at liberty to choose their children’s health care provider. Parents who brought their child to seek treatment at the clinics were invited to participate following an informed consent. A self-administered questionnaire was devised from the literature and a focus group discussion. A 5-point Likert scale was applied to 25 elements that were organised into 5 major domains: “consultations”, “facilities and services”, “fees and charges”, “social media engagement”, and “doctor’s appearance”.
Results
Out of 424 questionnaires administered, 387 were completed (91.3% response rate). Families value the provision of “facilities and services” as well as the interaction with health care professionals during “consultation”. Effective communication via social media engagement was highly desired even beyond office visits. In exchange, parents appeared to tolerate some inconvenience and costlier consultations but still appreciate transparent charges. While certain ratings of key elements varied across income level, parents with higher educational level had more desire for shared decision making.
Conclusion
The extent to which key elements were important for parents when choosing a paediatric general practice service appeared to be influenced by their educational and income level. Linking the right drivers to best practices is a key component of effective management strategy in the health care practice.
... In a study in the US (N = 205) into the influence of the waiting room environment on the perceived quality of care, many comments from patients indicated a preference for waiting rooms that contain "lots to read and look at." That may help them pass the time and distract them from worrying too much about the health issue for which they are in the waiting room [10]. This conclusion is underscored in another US study (N = 320). ...
Presenting attractive and useful health education materials in waiting rooms can help improve an organization’s health literacy responsiveness. However, it is unclear to what extent patients may be interested in health education materials, such as brochures. We conducted a three-week field study in waiting rooms of three primary care centers in Groningen. Three versions of a brochure on doctor-patient communication were randomly distributed, 2250 in total. One version contained six short photo stories, another version was non-narrative but contained comparable photos, and the third version was a traditional brochure. Each day we counted how many brochures were taken. We also asked patients (N = 471) to participate in a brief interview. Patients who consented (N = 390) were asked if they had noticed the brochure. If yes (N = 135), they were asked why they had or had not browsed the brochure, and why they had or had not taken it. Interview responses were categorized by two authors. Only 2.9% of the brochures were taken; no significant association with brochure version was found. Analysis of the interview data showed that the version with the photo narrative was noticed significantly more often than the non-narrative version or the traditional version. These results suggest that designing attractive and comprehensible health materials is not enough. Healthcare organizations should also create effective strategies to reach their target population.
... The healthcare professionals also reported that they had made many improvements to their practice facilities related to patients' physical comfort and privacy, based on the PCC improvement program content. Previous studies have revealed the importance of the waiting room physical environment in primary care for the quality of care and patients' satisfaction with care [26]. Indeed, in this study, patients' survey responses indicated that the GP practice improvements improved their experiences. ...
Background
The present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, coordination of care, continuity and transition, emotional support, and family and friends). This study characterizes the interventions implemented in practice as part of the PCC improvement program and describes the experiences of healthcare professionals and patients with the resulting PCC delivery.
Methods
This study employed a mixed-methods design. Semi-structured interviews were conducted with nine general practitioners and nurse practitioners from seven primary care practices in Noord-Brabant, the Netherlands, that participated in the program (which included interventions and workshops). The qualitative interview data were examined using thematic analysis. A longitudinal survey was conducted with 138 patients with multimorbidity from these practices to assess perceived improvements in PCC and its underlying dimensions. Paired sample t tests were performed to compare survey responses obtained at a 1-year interval corresponding to program implementation.
Results
The PCC improvement program is described, and themes necessary for PCC improvement according to healthcare professionals were generated [e.g. Aligning information to patients’ needs and backgrounds, adapting a coaching role]. PCC experiences of patients with multimorbidity improved significantly during the year in which the PCC interventions were implemented ( t = 2.66, p = 0.005).
Conclusion
This study revealed how primary PCC can be improved for patients with multimorbidity. It emphasizes the importance of investing in PCC improvement programs to tailor care delivery to heterogenous patients with multimorbidity with diverse care needs. This study generates new perspectives on care delivery and highlights opportunities for its improvement according to the eight dimensions of PCC for patients with multimorbidity in a primary care setting.
... Beyond Fenko and Loock's study [196], the multisensory design of the waiting room environment is undoubtedly important, given that people may end-up spending a lot of time here, experiencing elevated levels of anxiety and/or stress [206,230]. While the environment might well be designed to reduce stress/anxiety, another role for sensory design here could, of course, be used to help reduce the perceived duration of the wait too [231], though Fenko and Loock [196] found no influence of their environmental manipulations on this particular aspect of their participants' ratings. ...
A large and growing body of empirical research now demonstrates the positive impact that music and other auditory stimuli (such as nature soundscapes) can have across the entire spectrum of the healthcare ecosystem. From the point of entry and onward to the operating room/theatre, in the peri-operational environment, patient wards, and medical waiting rooms, music affects all of those who hear it: Patients, their families, surgeons, caregivers, and hospital staff alike. In the age of the “experience economy,” where patients are considered both guests and consumers, private healthcare is increasingly starting to focus on customer satisfaction, and its impact on both financial performance and (not unrelated) health outcomes. In this review, we summarize the latest evidence concerning the impact of music, soundscapes, and noise, on medical outcomes and healthcare provision. We highlight the importance of the auditory (and, ultimately, the multisensory) environment, not only for health and well-being, but also in terms of improving patient satisfaction and managing costs.KEYWORDS: MUSIC; MEDICINE; ATMOSPHERICS; SOUNDSCAPES
... such as perceived quality [34], patient satisfaction [35][36][37][38], or clinical outcomes [39][40][41]. We were unable to find studies that directly relate the environment to the therapeutic relationship, however, as shown above, these three indicators are related to this construct. ...
Currently, in the scientific literature there is a great interest on the study of strategies to implement patient-centered care. One of the main tools for this is the therapeutic relationship. Some studies suggest that the perception of the environment in which the physical therapy treatment takes place can influence the perception of its quality. A qualitative study using focus groups was performed. Two researchers conducted the focus groups, using a topic guide with predetermined questions. The focus group discussions were audio-recorded, transcribed verbatim and analyzed thematically using a modified grounded theory approach. The setting was three hospitals and six public health centers located in Spain. The inclusion criteria were patients who had received a minimum of 15 physical therapy sessions and with no communication impairments. Thirty-one participants in four focus groups. Participants described a series of specific experiences relating to the environment, which they felt were influential in the establishment of therapeutic patient-centered relationships, including eight physical factors and five organizational factors. The results of this study highlight environmental factors that affect the quality of the therapeutic patient-centered relationship in physical therapy and emphasize the need for physical therapists and administrators to rethink the situation and propose strategies for improvement.
... The literature relevant to healthcare waiting rooms can be traced through the continuing development of many different concepts examined in, for example, general studies of design in public places (Setola & Borgianni, 2016) and research of specialized healthcare practice, including on mental health facilities (Chrysikou, 2014) and children's hospitals (McLaughlan et al., 2019). Design treatments or features of waiting rooms that may reduce the stress of patients include attractiveness of the interiors (Arneill & Devlin, 2002;Leather et al., 2003), plants as a positive distraction (Beukeboom et al., 2012), the transparency of the waiting space (Jiang et al., 2016), and interactive media in pediatric settings (Biddiss et al., 2013). In the literature that informs evidencebased design, research that measures the effects of cultural difference for various user groups of healthcare environments is limited. ...
The theory of supportive design influences healthcare facility design but is under-researched for different cultural groups. This mixed-methods study compared two Indigenous sample populations in Australia to examine the effect of the physical environment in public hospitals and clinics on Indigenous people’s perceptions and experiences of waiting for care. Quantitative survey data ( n = 602) measured perceptions of relevant design attributes using paired images in a screen-based survey. Semi-structured interviews ( n = 55) identified concerns about the physical healthcare environment including waiting rooms. Ceiling heights, seating arrangements and views to the outside were significant showing commonalities between perceptions of the two populations. The interviews revealed that cultural and social constructs, including privacy, fear, shame, and racism, were significant and that people’s perceptions were influenced by colonization and independent of location. Our study highlights the importance of a cross-cultural approach to supportive design interventions for spatial and symbolic treatments of waiting areas.
... Against this backdrop, the importance of the hospital environment has been researched in a variety of ways. For example, Arneill and Devlin (2002) demonstrate that perceived quality of care is higher in spaces deemed more palatable to patients (well furnished, light and containing artwork) and Schreuder et al. (2016) illustrate that patients' self-reported wellbeing is most likely to be influenced by spatial comfort, safety and security, and autonomy. Indeed, hospital spaces have been shown to have a negative impact on the quality of care provided (Melo, 2018) as well as reducing the ability of nurses to optimally care for multiple patients when private rooms are used (Donetto et al., 2017). ...
Improving the patient experience is widely recognised as an important goal in the delivery of high-quality healthcare. This study contributes to this goal with a particular focus on the role of the material hospital environment for patients being treated for cancer. Extending the burgeoning literature utilising materialist theoretical approaches in social science and medicine, we report on qualitative data with 18 participants who had received cancer treatment from one UK hospital. Our analysis offers a typology of ways in which the material hospital environment is affective: through patients' direct intra-actions with nonhuman materiality; through providing shared spaces within which human-human assemblages are actualised; and through being the material component of the practices of treatment. Within each process in this typology, the analysis highlights how the affective feeling states which play a critical role in patient wellbeing are in many ways contingent, fluid and context-sensitive. Amidst ambitions to improve the patient experience, these findings underline the significance of materialities of care and offer a broad explanatory typology with analytic and practical potential for healthcare staff, patient groups, architects and designers.
... De elementer i rummet, der refererede til hospitalsverdenen, blev fjernet og erstattet med elementer, der bidrog positivt til rummet som helhed. Indretningen og redskaber til de øvrige funktioner skulle indarbejdes, således at de berigede rummet som helhed og ikke blev forstyrrende elementer, fx udstyr til fysiske øvelser og av-udstyr i forbindelse med undervisning (Arneill, Devlin 2002 Kunstvaerker blev haengt op på vaeggene, nøje udvalgt og tilpasset rummet Det røde saftevand i plastkander blev skiftet ud med isvand i glaskarafler. Rullebordet med te og kaffe og plastickopper blev skiftet ud med et "rigtigt" bord, hvor te, kaffe og frugt var placeret sammen med porcelaenskopper og smukke skåle. ...
Background: Hospital space has significance for human healing processes. The physical
environment can have both positive and negative impact on the interaction between patients, relatives and staff. Objective: a) to obtain knowledge of the interaction between space and people in two very different contexts, B) to test methods which combine qualitative data with quantitative data, and c) to contribute to the future development of methods in "real settings".
Method: Two studies on different ways of combining qualitative and quantitative tools.
Study 1: Case study in two intensive care units. It was investigated how the space supported or prevented ' interaction of the relatives with the patient. The intervention consisted of 6
interviews and 33 systematic observations over a period of three months, and photo
documentation. Results: Architectural knowledge was generated in relation to three main
themes: a. space for seclusion, b. distance and proximity, and c. machines.
Study 2: Randomized experiment in a multidisciplinary pain center. Three hypotheses were tested: a) room decor affects the interaction and thus the psychotherapeutic group therapy, b) the meaning of space for the interaction could be measured on the effect of treatment and c) the experimental room was perceived as more comfortable and secure than the control room. 66 test persons participated. Group A (treatment groups, n=18) received treatment in a general hospital room (room A), group B (treatment groups, n=19) received treatment in a specially adapted space (space B) and group V (n =29) was on the waiting list for treatment. Treatments lasted five months and consisted of 10 sessions in groups. Treatment effect was measured before and after in relation to quality of life : Short Form 36 ( SF36 -v2 ), WHO Quality of Life Scale (WHOQOL - Bref) , Becks Depression Inventory (BDI -II), and in relation to pain with Roland - Morris questionnaire (RMQ) , Pain Catastrophizing Scale (PCS) and the McGill pain questionnaire (MPQ). Interaction level in the group was measured with Group Clima questionnaire (GCQ) in week 2, 6 and 10.
Space was assessed with Semantic Environmental Assessment (SMB) after treatment periods. Test participants were blinded. The therapists were not. The six therapists were interviewed
individually and afterwards in a group. Result: Room B was perceived as significantly more comfortable and secure than room A. There was no significant difference between group climates in the two rooms. There was no significant difference in efficacy of treatment. The therapists preferred room B for their therapy. They described the room as a tool.
Overall results: The studies shed light on the different interactions in different spaces. The
combination of qualitative and quantitative methods worked well in the context of research on hospital architecture and afforded knowledge to research the "real settings". Conclusion: The space is important for interaction. When space is considered as a tool for health care staff it makes the space visible and has potential for future development of the hospital's physical environment, care and research methods where qualitative and quantitative methods are combined.
Contexte et objectifs. L’enquête nationale de satisfaction e-Satis, par la Haute Autorité de santé, donne la parole aux patients, en les laissant s’exprimer librement à la fin du questionnaire. Aucune analyse régulière des commentaires n’étant effectuée au centre hospitalier universitaire de Clermont-Ferrand, la question de sa faisabilité s’est posée. L’objectif principal de cette étude est l’analyse des thématiques de ces commentaires en les comparant aux thématiques des plaintes reçues. Méthode. Nous avons réalisé une analyse descriptive des thématiques retrouvées dans les verbatims issus d’e-Satis grâce à une triangulation et à la modification d’un thésaurus existant, jusqu’à saturation des thématiques. Nous avons ensuite regroupé les différentes thématiques selon leurs sens en commun. Nous avons comparé statistiquement les thématiques retrouvées dans le questionnaire e-Satis et celles des plaintes. Résultats. 542 patients ont laissé au moins un commentaire (63,7% des patients ayant rempli le questionnaire). Une remarque positive sur deux concerne la satisfaction vis-à-vis du personnel (sans préciser lequel). Le thème négatif le plus fréquent (34,6% des remarques négatives) concerne le déroulement de la prise en charge. Nous avons pu identifier de nombreux thèmes plus précis. Les thématiques des plaintes sont réparties différemment de manière significative. Discussion et conclusion. Cette étude permet d’identifier de nombreux axes d’amélioration pour la satisfaction du patient et confirme que les commentaires libres sont complémentaires aux plaintes. Les ressources nécessaires à un tel travail régulier restent difficiles à assumer individuellement par établissement et pourraient être aidées par un logiciel auto-apprenant.
As two of the most stressful professions, doctors and nurses work intensively in direct contact with patients. However, there has been little research into their perception of and satisfaction with healthcare interiors. To fill this gap in the literature, this study evaluated the working, resting, and dining spaces of healthcare staff in terms of control. Specifically, privacy, boundary and territory, and environmental control were analyzed in four state hospitals as case studies. Following a literature review, observations, semi-structured interviews, and surveys were conducted with doctors and nurses from the four hospitals in 2017. The findings showed that controlling privacy, boundaries, and environmental control elements like natural and artificial lighting, noise and odour were important for the participants. This indicates a need to ensure privacy and boundaries more effectively through separate spaces and furniture while noise and odour should also be given more attention.
The transformation of today’s society generates an increase in users’ needs in terms of use, with impact on the physical, cognitive and psychological well-being for the greatest number of people. In addition, different scientific studies demonstrate that the physical environment can influence people behavior, performance and well-being. For this reason, ‘Design for All’ strategy was defined as the design for human diversity, inclusion and equality by the EIDD-Design for All Europe. This strategy is based on the concept that good design enables and bad design disables all people regardless their age, gender, culture, abilities or disabilities. The article addresses Design for All in relation to the built environment, focusing on healthcare facilities to clearly describe how to enhance different users’ benefits and positive outcomes such as usability, well-being and social inclusion. The current study provides both a theoretical background and practical information to integrate Design for All within the design process and solutions of the architectural field by means of a descriptive approach. In particular, two case studies of healthcare facilities (hospitals and therapeutic gardens) were analyzed to highlight how Design for All can be integrated to achieve more inclusive and healthier environment.
Objective:
The study examined perceived control in the context of the outpatient waiting room to further understand the extent to which patients want to exercise control in that environment. Background: In Ulrich's theory of supportive design, research shows more evidence for positive distraction and social support than for perceived control; its role in outpatient settings has not been examined.
Method:
This between-subjects experimental design, in which participants read a written scenario varying the number of patients waiting (1 or 5) and the control available (no information provided, personal controls, and room controls), examined the effect of those variables on stress, satisfaction with the environment, extent of perceived control, and participants' schema of who should control the environment of the waiting room.
Results:
Having individual controls available in the waiting room favorably impacted the perception of the environment but did not significantly impact stress. The data show that people likely have a schema of appropriate behavior in a doctor's waiting room, which does not encourage manipulation of environmental elements.
Conclusions:
In the doctor's office waiting room, having individual controls, such as on-off knobs on table lamps next to each chair, can improve evaluation of the environment and increase people's perception of control.
Though place attachment has been widely studied for a variety of settings, little attention has been devoted to place attachment in the workplace, particularly in healthcare environments. The objective of this research is to test the relationship between Secure workplace attachment and work engagement through the mediating effect of the work environment, in both spatial-physical and social-relational terms. A self-report questionnaire was completed by 150 health personnel of different hospitals. Results show that a more Secure workplace attachment is associated with a higher level of work engagement, and such relationship is mediated positively by the perception of environmental comfort and negatively by the feeling of having difficult relationships with patients. These findings suggest the importance of addressing health workers’ place attachment in the hospital setting, with specific reference to the physical and social environment in which the healthcare is delivered, in order to increase their positive involvement toward their job activity.
Adopting an evidence-based approach, this book uses two state-of-the-art experimental studies to explore nature’s therapeutic benefits in healthcare environments, emphasizing how windows and transparent spaces can strengthen people–nature interactions. High-quality, supportive, and patient-centred healthcare environments are a key priority for healthcare designers worldwide, with ageing populations creating a demand for remodeled and updated facilities. The first study demonstrates individual psychophysiological responses, moods, and preferences in simulated hospital waiting areas with different levels of visual access to nature through windows, while the second experiment uses cutting-edge immersive virtual reality techniques to explore how gardens and nature views impact people’s spatial cognition, wayfinding behaviors, and experience when navigating hospitals. Through these studies and discussions drawing on architectural theory, the book highlights the important benefits of having access to nature from hospital interiors. This concise volume will appeal to academics and designers interested in therapeutic landscapes and healthcare architecture.
Background: Locations, by creating a sense of comfort and peace or sorrow and distress have a great effect on self-confidence, personality, and personal health. Paying attention to the perceptual indicators of environmental quality can lead to sustainable changes in architectural designs. The aim of this study is to identify perceptual indicators of the environmental quality in medical centers and use these indicators to evaluate the physical-spatial qualities of those centers. The study environment was one the private hospitals in Yazd.
Methods: This was a cross-sectional study conducted in 2022 in a private hospital in Yazd. The statistical population includes patients, visitors, carers and staff. 73 users from the pediatric care and hospitalization ward and 47 users from the outpatient ward were selected as the statistical sample through convenience sampling. The data collection tool was a researcher-made questionnaire consisting of 27 questions with 5 Likert scale options and 5 demographic questions, the validity of which was approved by 10 experts in the field of architecture and psychology. The reliability of the questionnaire was also confirmed by Cronbach's alpha test with a value of 0.75. Questions included 3 dimensions of perceptual indicators regarding the quality of hospital environment. 2 dimensions evaluated the physical aspects of the hospital exterior and interior space of the wards and 1 dimension evaluated social aspects. For statistical analysis, descriptive methods (frequency, mean, etc.) and SPSS 26 software were employed.
Results: The outcome of the percentages obtained regarding the dimension of physical-spatial aspects of the hospital's external spaces, pediatric care and hospitalization ward, the outpatient ward and the socio-functional aspects of hospital spaces, were obtained as + 25, + 38.38, + 44.73, and +36 % respectively.
Conclusion: Based on the results, the outcome of the percentages obtained for the dimensions of the physical-spatial aspects of the hospital's external spaces, pediatric care and hospitalization ward, the outpatient ward and the socio-functional aspects of hospital spaces indicated the favorable status of the dimension from the users' point of view.
Objective
This study investigates preference for five different seating arrangements (e.g., rows, clusters) in a doctor’s office waiting room, whether these reduce stress and improve judgments of medical care, and how such choices may have changed over the pandemic (2013 vs. 2021).
Background
What is called the doctor’s office layout, with chairs lining the perimeter of the waiting room, is criticized by designers, yet little empirical evidence exists to support that assessment.
Method
Data collected in 2013 and 2021 used sketches of five different seating arrangements; people saw just one of these. The study examined the effect of time and seating arrangement on anxiety, need for privacy, situational awareness, evaluation of the environment, and perception of the doctor.
Results
There was no significant impact of the seating arrangement on any of the dependent variables, but ratings were higher for situational awareness, need for privacy, evaluation of the environment, and aspects related to the physician in 2021. In addition, seating preferences favored end, not middle seats, and chair selections with the chair back to a wall.
Conclusion
In this study, no evidence exists that the doctor’s office layout is less preferred than four other seating arrangements, but seat choice shows people prefer end seats (not middle seats) across arrangements. The doctor’s office layout may offer a supportive familiarity to people; also, given the percentage of people who visit the doctor unaccompanied, layouts designed to encourage social interaction may not always be appropriate.
The main threat to health is no longer infectious diseases but instead chronic and degenerative diseases closely related to lifestyle factors, particularly stress, so the services that relieve physical and mental fatigue are becoming prevalent, these environments involve different situations, space constraints, and user needs. Indeed, the service items of a stress relief space meet diverse needs and purposes.
In this paper, we propose that the service concept can be the key driver of service design decisions at all levels of planning. First, we define the service concept and how it drives design decisions for stress relief services. Second, we convergence the service conceptual framework is useful at the operational level during service design planning by user satisfaction, particularly in determining appropriate performance measures for evaluating service design. Third, service space limitation, is used to show the usefulness of applying the service concept in designing and enhancing service satisfaction.
The waiting rooms and areas of general practice (GP) health facilities are places that nearly all of us will find ourselves in but the waiting experience is under-explored. What happens to our sense of self when we move between the outside world where we are citizens and these spaces where we become patients-in-waiting? I begin with what has been written about waiting in general and in health waiting areas in particular. I then discuss a photo-documentation study of twenty-two GP waiting rooms in Edinburgh, Scotland and explore the questions that arise from the resultant images. Examples are presented that illustrate the unique place of the waiting room in the patient journey between the outside world and the encounter with their doctor. Examples are given of both calm-inducing and unsettling elements. Potentially disempowering processes are identified occasioned by the waiting experience and the issue of the transition in sense of self is raised. I conclude by pointing to other waiting areas and places where such dynamics and processes might be more acute.
Purpose:
This study aimed at the identification of perceptional environment properties in hospital public spaces that can affect salutogenic components and patients' overall satisfaction and suggested a conceptual framework.
Design/methodology/approach:
A systematic review focused on specific steps to clarify the impact of public spaces' environmental quality on patients' satisfaction through the salutogenic approach. Searches were conducted in five databases and four scientific journals.
Findings:
Five perceptional environment components of hospital public spaces: physical–psychological comfort, visibility, accessibility, legibility and relationability can be related to three indicators of salutogenic approach: manageability, perception and meaning and can be evaluated in patients' overall satisfaction: desire to use hospital again, to recommend the hospital to others, to prefer hospital to other healthcare environments and to trust in the hospital.
Originality/value:
Despite studies on healthcare environments, there is a lack of research on the salutogenic approach in hospital public spaces. Therefore, this paper focuses on the environmental quality in public spaces as an influence on patients' satisfaction with the salutogenic perspective to create a health-promoting environment.
Objective
This study fills the gap in literature by examining the design elements preferred in psychotherapy waiting rooms.
Background
Studies have examined waiting rooms in hospitals and doctors’ offices, but there is little published literature on waiting rooms in psychotherapy offices. Waiting rooms in psychotherapy offices may affect clients’ perceived quality of care and their comfort level.
Method
Psychotherapists in Connecticut and Rhode Island were interviewed and agreed to have the waiting rooms (20 in total) of their practices photographed. Then, in a within-subjects design, 250 participants (225 retained for analyses) from MTurk answered questions about the quality of care and comfort in the environment expected in those 20 waiting rooms.
Results
Factor analytic results showed that waiting rooms that were welcoming and comfortable as well as large and spacious rated higher for the quality of care and comfort in the environment anticipated by the participant; those that were cramped and crowded rated lower. Few therapists reported any design education about counseling environments and none about the waiting room.
Conclusion
Information from this study can guide the design of psychotherapy waiting rooms and enhance healthcare experience.
Objectives
This study examines the physical environment in the outpatient waiting area and its effects on overall satisfaction, experience, perceived waiting time, and behavior.
Background
Waiting can be a frustrating experience for patients. Previous studies on waiting areas in hospitals have been rooted mainly in the Western cultural context, and research focusing on the impact of the physical environment on the waiting experience with the denser patient concentration in China is important.
Methods
Physical environment measurements, observations, and questionnaire surveys were employed.
Results
The actual lighting intensity and sound level did not meet the national standards. Sound level and satisfaction with the size of the waiting area, signage system, and visual art on the wall were significant predictors ( R ² = .463, p = .000) for overall satisfaction. Experiences related to the size of the waiting area, seating, signage system, and restrooms were significant predictors ( R ² = .373, p = .000) of overall waiting experience. The experience related to the acoustic environment (β = −.184, p = .006) had a significant relationship with perceived waiting time. The increase in participants’ behaviors of looking out of a window and the decrease in looking at other people, looking around, dozing, and looking at a wall might result from a substantial increase in lighting and the availability of a nature view from the window.
Conclusions
The effect of the physical setting of waiting areas may positively impact patient satisfaction, waiting experience, perceived waiting time, and behavior, which has implications for patient-centered design.
Waiting for health care services have impact on people from several perspectives. First of all, seen from patients' point of view, due to psychologically and physically burden short waiting times are an indication of quality. Second, seen from health care systems' point of view, short waiting times can be a competitive advantage for health care providers. Finally, short-waiting times can contribute to a more effective system applied in health care. In this chapter, the impact of waiting times of patients are analyzed on all three levels based on quantitative and qualitative study carried out by the authors as well as on the foregoing literature review. The situation of patients and their requirements are shown, strategies to reduce waiting times are presented by also considering the role of information and communication technologies, and several relevant questions raised are answered.
The chapter investigates the dynamic of encounters between staff and patients in two case studies on hospital organisation, taking special account of the emotional and psychological aspects associated with practices in the use of organisational space. By drawing on two empirical cases set in different hospital contexts (the waiting rooms of two outpatients wards and an emergency unit), analysis is made of two examples of practices which represent express violations of the rules on the use of space by patients and their relatives. Violations that could be analysed as demand of engagement - by patients and relatives - in the process of care. In these empirical cases the governance defensive reaction strategies used by hospital staff in their interaction with waiting patients is shown in light of the rules that define the behaviour acceptable for patients and relatives. The study is based on a qualitative methodological approach using the techniques of observation and in-depth interviews with hospital staff, patients and relatives.
Heuristic evaluation is a valid and widely accepted method for evaluating system usability. Findings from such evaluations provide valuable insight concerning which system elements should be targeted in future design iterations for improved functionality and user experience. This paper details a heuristic evaluation, utilizing Nielsen’s Heuristics and Shneiderman’s Golden Rules of Interface Design, of an inpatient environmental control unit used at the VA Spinal Cord Injuries and Disorders (SCI/D) Centers nationwide. Results identified a number of usability issues inherent to the currently deployed interface at varying levels of severity. Design recommendations for addressing these significant issues in future iterations of this system are provided in an effort to foster independence and enhance quality of life in veterans with spinal cord injuries and disorders.
Hospital waiting time is an important issue for improving patient satisfaction. The problem is described as the necessity of shortening not only “direct waiting time” a physical quantity, but also “sensory waiting time,” so that patients spend the same amount of time without frustration and do not feel waiting times to be overlong. It is thus necessary to devise ways to reduce the subjective feeling of waiting. This study is an exploratory/preliminary study focusing on how patients wait based on the mother’s attending experience of a medical graduate who is aware of the issue of waiting time. A patient journey map and a mental model of attitudes toward waiting time in hospitals and feelings when waiting are created. It is suggested that the user experience (UX) will be improved by providing more sufficient services using the “time” and “space (place)” in the hospital.
Do consumers become stingy tippers in inclement weather? Prior literature suggests that such weather induces negative moods, which in turn leads to stingy tipping. In this paper, on the basis of New York City taxi tipping data merged with corresponding real-time weather data, we provide different perspectives on weather-induced mood effects that take into account ambient environments provided by indoor services under inclement weather. In addition, we show that reciprocity effects triggered by taxi drivers’ extra efforts in rainy or snowy weather conditions contribute to eliciting generous taxi tipping. In our investigation, precipitation and whether extreme temperature conditions are present or not are analysed after controlling for speed, fare amount for a trip, borough, taxi vendor company, and driver fixed effects. The implications are discussed in relation to weather-driven reciprocity effects and relativism of weather-driven mood effects on generosity.
This paper considers an under-examined space in primary health care – the reception area/waiting room. This space can be challenging to negotiate, particularly for those who experience social marginalisation. We begin by situating the significance of the ‘entry into the health care setting’ in the patient journey in terms of time as well as space. Through an analysis of interview and focus group data gathered in a New Zealand study, we highlight ways that patients view these spaces as firmly bounded and confronting. In reflecting on the data, we then identify the potential for these spaces to be more permeable. We conclude that this spatio-temporal context need not be one of constraint. Rather, there are ways in which the boundaries of this space can be potentially enabling to those required to pause in the process of enacting patienthood.
Psychophysiological approaches to studying leisure use physiological measures to assess stress, attention, emotions, and other responses. These methods are discussed from the standpoint of their capabilities, advantages, and limitations for leisure research. Emphasis is given to the use of psychophysiological approaches for investigating stress reducing consequences of leisure experiences in natural environments. Although findings are limited, results suggest that recuperation from stress occurs faster and more completely during passive exposures to natural rather than urban environments. Psychophysiological methods can identify consequences of leisure that may be outside the conscious awareness of participants and hence may not be identified by verbal methods.
The provision of high quality medical care and the insurance of patient satisfaction depend in part upon the ability and willingness of physicians to establish rapport with their patients and to develop effective physician-patient communication. In this study, patients' overall satisfaction with their physicians' care was assessed in relation to their perceptions of their physicians' (1) proficiency at communicating and listening to details of the illness and medical treatment, (2) capability of providing affective care, and (3) technical competence. Perceptions of physician behaviors were measured by a questionnaire administered to 329 patients of 54 residents in a family practice center. The relationship between the perceptions of patients and their satisfaction with medical care was examined both for the entire sample and among groups of patients with differing demographic characteristics. Results indicate an important link between patients' perceptions of socioemotional aspects of the physician-patient relationship and their reported satisfaction with medical care. Noticeable differences were found to exist in the importance that patients with different demographic characteristics placed on various aspects of their physicians' conduct.
In order (1) to study the relationship between complexity and preference for slides of the physical environment and (2) to
test the hypothesis that the content of slides (in particular, whether nature or urban) will influence preference, independent
of the rated complexity, 88 Ss were asked to rate 56 slides, both for preference and for complexity. Based on dimensional
analyses, a nature and an urban dimension were identified. Three major results were obtained: (1) Nature scenes were greatly
preferred to urban scenes (p < .001). (2) Complexity predicted preference within the nature domain (r = .69) and within the
urban domain (r = .78). (3) Complexity did not account for the preference for nature over urban slides; the greatly preferred
nature slides were, in fact, judged on the average less complex than the urban slides. The possibility is raised that the
domain-specific character of the preference/complexity relationship found in this study may be general; that is, it may not
be a special property of environmentally generated arrays.
Different conceptual perspectives converge to predict that if individuals are stressed, an encounter with most unthreatening natural environments will have a stress reducing or restorative influence, whereas many urban environments will hamper recuperation. Hypotheses regarding emotional, attentional and physiological aspects of stress reducing influences of nature are derived from a psycho-evolutionary theory. To investigate these hypotheses, 120 subjects first viewed a stressful movie, and then were exposed to color/sound videotapes of one of six different natural and urban settings. Data concerning stress recovery during the environmental presentations were obtained from self-ratings of affective states and a battery of physiological measures: heart period, muscle tension, skin conductance and pulse transit time, a non-invasive measure that correlates with systolic blood pressure. Findings from the physiological and verbal measures converged to indicate that recovery was faster and more complete when subjects were exposed to natural rather than urban environments. The pattern of physiological findings raised the possibility that responses to nature had a salient parasympathetic nervous system component; however, there was no evidence of pronounced parasympathetic involvement in responses to the urban settings. There were directional differences in cardiac responses to the natural vs urban settings, suggesting that attention/intake was higher during the natural exposures. However, both the stressor film and the nature settings elicited high levels of involuntary or automatic attention, which contradicts the notion that restorative influences of nature stem from involuntary attention or fascination. Findings were consistent with the predictions of the psycho-evolutionary theory that restorative influences of nature involve a shift towards a more positively-toned emotional state, positive changes in physiological activity levels, and that these changes are accompanied by sustained attention/intake. Content differences in terms of natural vs human-made properties appeared decisive in accounting for the differences in recuperation and perceptual intake.
Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined
to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three
surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays,
received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in
similar rooms with windows facing a brick building wall.
Larrabee's model of quality proposes a relationship between quality and value. This study tested the relationship by identifying predictors of patient-perceived quality for nursing care. Data were obtained from interviews and records of 199 adult patients. Candidate predictors of patient-perceived quality included patient goal achievement, nurse-perceived quality, and nurse goal achievement. Candidate predictors also included seven demographic, seven financial, six illness, and six hospital variables. Predictors of both patient-perceived quality global and patient-perceived quality total were pain severity on exit interview, clinic referral, unit, and patient goal achievement. Medicare nonrecipient was a predictor of patient-perceived quality global. Worry score on admission was a predictor of patient-perceived quality total. The results support the relationship between quality and value and between quality and beneficence postulated by Larrabee's model of quality. Additional investigation of these relationships in other populations and using other operationalizations of the model concepts is needed to provide further support for the model. This model is potentially useful for investigating quality in diverse cultures because the operationalization of the model concepts can be designed to reflect local, regional, or national values.
This study was carried out in the framework of a wider research project concerning the degree of patient satisfaction with the various types of primary health care. We have studied the relationship among the gender of the doctor, the gender of the patient and the type of primary health care center involved. In 1 type of primary care center (health centers) the medical staff work as a team, whereas in the other (ambulatory care services), the doctor works alone. The survey was conducted among 86 doctors and 860 patients from urban areas in Andalusia, Spain. The degree of patient satisfaction was tested on Likert scales. Both male and female patients attended by female doctors were more satisfied than those attended by male doctors (P < 0.005). Both male and female patients were attended in equal proportions by both male and female doctors (P > 0.20). Overall patient satisfaction values were not affected by the patient's gender (P > 0.40). In comparing overall satisfaction among patients according with the doctor's gender and type of primary health care center, there was a greater degree of satisfaction with female doctors working in health centers (P < 0.01) and no difference existed in ambulatory care services in this area.
To summarize briefly, key general points in this presentation include the following: To promote wellness, healthcare facilities should be designed to support patients in coping with stress. As general compass points for designers, scientific research suggests that healthcare environments will support coping with stress and promote wellness if they are designed to foster: 1. Sense of control; 2. Access to social support; 3. Access to positive distractions, and lack of exposure to negative distractions; A growing amount of scientific evidence suggests that nature elements or views can be effective as stress-reducing, positive distractions that promote wellness in healthcare environments. In considering the needs of different types of users of healthcare facilities--patients, visitors, staff--it should be kept in mind that these groups sometimes have conflicting needs or orientations with respect to control, social support, and positive distractions. It is important for designers to recognize such differing orientations as potential sources of conflict and stress in health facilities (Schumaker and Pequegnat, 1989). For instance, a receptionist in a waiting area may understandably wish to control the programs on a television that he or she is continuously exposed to; however, patients in the waiting area may experience some stress if they cannot select the programs or elect to turn off the television. Some staff may prefer bright, arousing art for corridors and patient rooms where they spend much of their time; however, for many patients, such art may increase rather than reduce stress. A difficult but important challenge for designers is to be sensitive to such group differences in orientations, and try to assess the gains or losses for one group vis-a-vis the other in attempting to achieve the goal of psychologically supportive design. Designers should also consider programs or strategies that combine or mesh different stress-reducing components. For example, it seems possible that a program enabling patients to select at least some of their wall art or pictures would foster both control and access to positive distraction. As another example, the theory outlined in this paper suggests that an "artist-in-residence" program, wherein an artist with a caring, supportive disposition would work with patients, might foster social support in addition to control and access to positive distraction. Running through this presentation is the conviction that scientific research can be useful in informing the intuition, sensitivity, and creativity of designers, and thereby can help to create psychologically supportive healthcare environments.(ABSTRACT TRUNCATED AT 400 WORDS)
The development of empirical research concerning the perception and evaluation of landscape quality has been hampered by the difficulties of presenting adequate samples of landscape views to large samples of respondents. Consequently, there has been extensive use of photographic displays as a substitute for on-site environmental survey. There is, however, relatively little evidence for the validity of such surrogates. The paper reviews the results of previous studies and reports a case study which provides further evidence for the validity and effectiveness of photographs in representing landscapes.
The aim of the present study was to develop a theoretical understanding of quality of care from a patient perspective, using a grounded theory approach. Thirty-five interviews were conducted with a sample of 20 adult hospitalized patients (mean age: 60 years) in a clinic for infectious diseases. Data were analysed according to the constant comparative method. A model was formulated according to which quality of care can be understood in the light of two conditions, the resource structure of the care organization and the patient's preferences. The resource structure of the care organization consists of person-related and physical- and administrative environmental qualities. The patient's preferences have a rational and a human aspect. Within this framework, patients' perceptions of quality of care may be considered from four dimensions: the medical-technical competence of the caregivers; the physical-technical conditions of the care organization; the degree of identity-orientation in the attitudes and actions of the caregivers and the socio-cultural atmosphere of the care organization. The model is discussed in relation to existing theories in the field.
Environmental improvements including new day hall furniture, plants, wallpaper and paint, and brighter lighting were carried out on four wards of a 40-year old state psychiatric facility. Staff on these wards rated environmental variables pre- and post renovation; behavioral mapping data for both patients and staff were also collected on one of those wards pre- and post renovation. Results indicate significant pre-post improvements in the ratings of day hall furnishings and plants. Significant main effects for ward were found in a number of environmental variables, reflecting the less demanding nature of the patient population and greater administrative support on these wards. Behavioral data showed a significant decrease in patient stereotypy and a preference for more private seating areas in the day hall following renovation.
An empirical investigation focused on person-window transactions in the physical medicine and rehabilitation environment. Attributes of windows, view, daylight, and spaces perceived as insufficient in these respects were studied in six hospitals. Preference, environmental documentation, and behaviorsassociated with windows and windowless rooms were the subject of a two-part interview and questionnaire. The respondent group numbered 250 persons. Nonmetric multidimensional scaling (MDS) was utilized, yielding an array of 21 cognitive dimensions. From evaluations of 56 photographs that sampled a broad spectrum of spaces ranging from highly windowed to windowless, 8 visual dimensions were identified; and 13 nonvisual dimensions distilled from 89 written response items were identified that addressed degree of satisfaction and associated behaviors. Among the findings, ideal window and view conditions frequently contrasted the actual conditions in one's hospital setting; informative views of urban life and nature beyond the hospital, accessible from one's typical viewing angle and position within the room, were desired; minimally windowed rooms wereequated with architecturally windowless spaces, and window-view substitutes in windowless rooms were distinguished from similar rooms without such compensatory measures. Implications for hospital planning and design are discussed.
This study was carried out in the framework of a wider research project concerning the degree of patient satisfaction with the various types of primary health care. We have studied the relationship among the gender of the doctor, the gender of the patient and the type of primary health care center involved. In 1 type of primary care center (health centers) the medical staff work as a team, whereas in the other (ambulatory care services), the doctor works alone. The survey was conducted among 86 doctors and 860 patients from urban areas in Andalusia, Spain. The degree of patient satisfaction was tested on Likert scales. Both male and female patients attended by female doctors were more satisfied than those attended by male doctors (P < 0.005). Both male and female patients were attended in equal proportions by both male and female doctors (P > 0.20). Overall patient satisfaction values were not affected by the patient's gender (P > 0.40). In comparing overall satisfaction among patients according with the doctor's gender and type of primary health care center, there was a greater degree of satisfaction with female doctors working in health centers (P < 0.01) and no difference existed in ambulatory care services in this area.
Compared 137 staff and 100 inpatient responses to windows, views, and associated factors in hospitals. Data were gathered through the use of drawings, photographs, behavioral observation, and a 2-phase questionnaire. Patients were more negatively affected by poorly windowed rooms compared to staff. Paralyzed, immobile, visually impaired patients, and non-White patients were susceptible, particularly with respect to being more than 10 ft from a window for relatively long periods each day, as were those in rooms with screens obstructing part or all of the view. Staff persons who worked more than 40 hrs/wk, those who worked in occupational and physical therapy, or who commuted to work were associated with lessened well-being. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Compared 30 medical patients in a progressive care hospital unit with 30 similarly diagnosed patients in a traditional unit in the same hospital by use of behavioral observations and interviews, to determine if the progressive care unit affected perceptions of confinement, depression or anxiety, boredom, and pleasantness. The progressive care unit treated Ss, who were nonacutely ill, in a less hospitallike environment that contained daybeds, a dining room, patient pantry, and lounges. The comparison unit admitted the normal range of acutely and nonacutely ill surgical Ss into a traditional hospital environment lacking the amenities present in the progressive care unit. The results show that the Ss in the progressive care unit, in comparison with the Ss on the traditional floor, felt less confined, rated their environment as more pleasant and cheerful, were more positive, and used more noninstitutional associations in describing their environment; they felt that the hospital environment affected them in a more positive way. Progressive care Ss also exhibited more mobile, more social, and less passive behaviors than the comparison group. No significant differences were found in Ss' ratings of their nursing care, perceptions of boredom, slow passage of time, and depression originating from exposure to acutely ill neighbors. The positive impact of the unit on patient behaviors and perceptions is attributed to the increased behavioral choice provided by the deinstitutional spaces in the unit and the energizing effect which these spaces had on patient activity levels. (20 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study investigated the effects of relatively minor design modifications in one wing of a local hospital on the organizational climate of the institution and the behavior of various user groups. Results showed that the changes had positive effects for patients and staff members on mood and morale and on the perceived quality of health care, while visitors reacted negatively to the modifications. Use of the more public areas of the experimental ward increased as a result of the alterations, especially in the evenings when more visitors were present. The positive effects occasionally spread to other wards as well.
Psychosocial stress due to the experience of hospitalization can be quantified using the Hospital Stress Rating Scale. Each patient is asked to identify, from a list of 49 events often experienced by hospitalized persons, those events which he/she personally has experienced since coming to the hospital. Each event has a stress score attached to it, which indicates the amount of stress generally caused by that event relative to the other events on the scale, as judged by a large number of hospital patients. A stress score can therefore be calculated for each patient by summing the scores for those events he/she has identified. In addition, the items on the scale are clustered into nine different hospital stress factors, representing specific dimensions of psychosocial stress associated with hospitalization. Therefore, nine-factor stress scores can be calculated for each patient by summing the stress scores for all items within each factor separately. The purpose of this paper is to examine the effects of the nine hospital stress factors on changes in blood pressure, heart rate and stroke volume during the course of hospitalization. Data were analyzed separately for different groups classified by type of patient (medical or surgical) and seriousness of illness. Our results indicated positive correlation between hospital stress and changes in heart rate for patients with minor illnesses, both medical and surgical. For medical patients with serious illnesses, both systolic and diastolic blood pressure changes correlated positively with hospital stress. Finally, among surgical patients with serious illnesses, we found negative correlation between hospital stress and changes in stroke volume.
Major dimensions of consumer perceptions regarding physicians and medical care services were identified using factor analysis of survey data, as follows: accessibility, availability of family doctors, availability of hospitals/specialists, completeness of facilities, continuity of care, and physician conduct (art and technical aspects of quality). Scores for these dimensions and multivariate statistical methods were used to predict general satisfaction ratings for a cross section of adults and for groups differing in age, education, health status, and sex. Physician conduct was clearly the most important factor in relation to general satisfaction with care for the total sample and for all groups studied. Other factors also were important, suggesting that more than one interpretation of general satisfaction scores should be considered when consumer satisfaction surveys are used to support the planning of educational programs in medicine and the delivery of services.
Quality in health care has two critical components: quality in practice and quality in perception. The first involves meeting your own or some other set of standards; the second, meeting your customers' expectations. Neither of these essentials will, by itself, carry a hospital far. This article examines the extent to which customer perception is important in understanding the concept of quality in health care.
Patients' preferences for physicians of a particular sex tend to skew sex distributions of clinical populations in training and practice settings. A study was developed to explore these preferences and potential reasons for them. Of 185 adult patients surveyed at four family practice residency clinics, 45% expressed a preference for sex of physician; 43% of women and 12% of men preferred a female physician, while 31% of men and 9% of women preferred a male physician. Patients who stated no overall preference often expressed one in specific clinical situations, eg, anal or genital examinations. Patients who preferred female physicians reported humane behaviors as more characteristic of female physicians, and those who preferred male physicians reported humane behaviors as more characteristic of men; patients who had no overall sex preference did not sex stereotype physicians on these behaviors (F = 59.34, P less than .01). Patients who preferred male physicians reported technical competence behaviors as more characteristic of male physicians; others did not sex stereotype physicians on these behaviors (F = 15.4, P less than .01). Patients rated humaneness and comprehensiveness as being of high priority, but no relationship was found between priorities for aspects of care and preferences for sex of physician. Areas for future investigation include assessing preferences in other populations and exploring sex differences in physician behavior during office encounters and correlating these differences with patient satisfaction.
As patient satisfaction has been demonstrated to influence certain health-related behaviors (e.g., compliance with medical regimens and use of medical services), research has attempted to identify its key determinants. Although the influence of patient characteristics often has been studied, attention has been focused on sociodemographic characteristics (e.g., age and sex) rather than attitudinal or situational factors (e.g., confidence in the medical care system and feelings of internal control) that may predispose one toward satisfaction with care received. Data to test the relative importance of these types of determinants were collected in a general household survey of 400 persons. The patient satisfaction scale developed and tested by Roghmann and his colleagues using nonmetric multidimensional scaling was used. Multiple regression analysis was performed on the data. Results show that certain predispositional factors (confidence in the community's medical care system, having a regular source of care, and being satisfied with life in general) are more important predictors of patient satisfaction than patient's age, sex, race, educational attainment, or income.
A Before and After Look at How Refurbishing Affects Staff and Patient Perceptions of the Psychosocial Treatment Environment.
The incidence of postoperative delirium in 50 consecutive surgical patients treated for at least 72 hours in an intensive care unit without windows was compared to 50 similar patients in an intensive care unit possessing windows. Over twice as many episodes of organic delirium were seen in the intensive care unit without windows, and among those patients with abnormal hemoglobin or blood urea nitrogen levels, the incidence of delirium was almost three times greater in the windowless unit. Age, type of surgical procedure, average temperature elevation following surgery, surgical staff, nursing care, or socioeconomic class of the patients had no effect on the incidence of delirium. It is concluded that the presence of windows is highly desirable in the intensive care unit for the prevention of sensory deprivation.
The authors describe the redesign and evaluation of a 30-bed psychiatric unit. The design approach was user oriented, employing a psychoenvironmental model that postulates an interaction between the physical environment and the psychotherapeutic milieu. Objective and subjective instruments demonstrated that environmental redesign based on this model correlated with behavioral changes in clinically desirable directions. These changes also correlated with reduced psychopathology and might have been facilitated by "social organizers," design solutions that encourage social interaction focused on ward activities.
In this paper, factors thought to explain consumer satisfaction with physician provided services are analyzed in causally ordered models using cross-sectional and longitudinal data. Categories of variables employed are prior satisfaction, characteristics of the health delivery system, interim utilization of services, and characteristics of the consumer. The study group is government employees enrolled in either a prepaid group or a fee-for-service plan. In both path analyses, the hypothesized orderings are partially supported. Notably, interim utilization of health services is not statistically significant in accounting for consumer satisfaction. As posited, much of the explained variance in current satisfaction is due to prior satisfaction, assessment of the availability of services and having or not having a personal physician. Revised models are suggested. Results are discussed in view of the current state of the literature and practical implications.
The aim of the present study was to develop a theoretical understanding of quality of care from a patient perspective, using a grounded theory approach. Thirty-five interviews were conducted with a sample of 20 adult hospitalized patients (mean age: 60 years) in a clinic for infectious diseases. Data were analysed according to the constant comparative method. A model was formulated according to which quality of care can be understood in the light of two conditions, the resource structure of the care organization and the patient's preferences. The resource structure of the care organization consists of person-related and physical- and administrative environmental qualities. The patient's preferences have a rational and a human aspect. Within this framework, patients' perceptions of quality of care may be considered from four dimensions: the medical-technical competence of the caregivers; the physical-technical conditions of the care organization; the degree of identity-orientation in the attitudes and actions of the caregivers and the socio-cultural atmosphere of the care organization. The model is discussed in relation to existing theories in the field.
This study was undertaken to describe patient and physician sociodemographic characteristics that might be associated with the patient's perception of the quality of care rendered by his or her physician. A random telephone survey of 685 adult Kentucky residents showed that self-health assessment correlated positively, while patient education correlated negatively, with perceived quality of care. Perceived physician origin was related to the respondent's perceptions of quality of care, with native-born physicians perceived as supplying higher quality of care than their foreign-born counterparts. Cultural and communication issues might explain differences in perceived quality of care.
The Planetree Model Hospital Project at Pacific Presbyterian Medical Center in San Francisco uses a patient-centered philosophy to incorporate the patient as a partner in the care process. This article describes the Planetree unit and discusses two aspects of the program--training patients to be partners and increasing nurse satisfaction. Such programs have the potential for improving the health outcomes of patients and aiding hospitals by assuring quality of care with greater patient participation, by improving public relations, and by promoting staff satisfaction.
This paper presents a framework and summarizes evidence bearing on the role that the physical environment plays in the prevention and reduction of psychological and social problems encountered by patients in acute care and psychiatric institutions. Factors that are considered important to preventive strategies include issues such as the spatial layout and design of hospital environments, privacy problems, personal control and independence, information interventions, hospital social relationships, and levels of environmental stimulation. Two case studies are utilized to illustrate these issues within the context of both acute care and psychiatric facilities in a large municipal hospital. Greatest emphasis is placed on the use of the physical environment in the promotion of primary and secondary prevention within tertiary care settings.
Planetree, a nonprofit organization, was founded in 1978 to provide the public with health and medical information and to improve the quality of patient care. Planetree's 13-bed model medical/surgical unit, located in San Francisco's Pacific Presbyterian Medical Center, opened in July 1985. Its goal is to humanize patient care--to encourage patient and family involvement, personalize the patient-nurse interaction, create an optimal healing environment, provide nutritious and palatable food, maximize communication between professionals and patients, and include arts and entertainment in the healing process. Part One of this article (see Healthcare Forum, May/June 1986) described the unit's departures from the traditional hospital environment, changes in nursing practices, physician involvement, and cost effectiveness.
The idea of the patient as partner incorporates a perspective that involves the patient in the care experience for explicit and important purposes. This article includes discussions of patient contributions; quality of care; cost implications; patient and provider satisfaction; and marketing, facilitation, and evaluation of a program that is designed to involve the patient in the care experience.
Psychiatric ward renovation: Sta¡ per-ception and patient behavior. Environment and Beha-vior
- A S Devlin
Devlin, A. S. (1992). Psychiatric ward renovation: Sta¡ per-ception and patient behavior. Environment and Beha-vior, 24, 66^84.
Design that cares: Planning health facilities for patients and visitors Chicago: American Hospital Association. Cooperative care tied to quicker recovery Decem-ber)
- J R Carpman
- M A Grant
Carpman, J. R. & Grant, M. A. (1993). Design that cares: Planning health facilities for patients and visitors (2nd ed.) Chicago: American Hospital Association. Cooperative care tied to quicker recovery (1985, Decem-ber). Hospitals, 59^60. Corey, L. J., Wallace, M. A., Harris, S. H. & Casey, B. (1986).
Progress report: An in-vestigation to determine whether the built environment a¡ects patients' medical outcomes The Center for Health Design Use of photographs as an environ-mental presentation medium in landscape studies
- H R Rubin
- A J Owens
Rubin, H. R. & Owens, A. J. (1996). Progress report: An in-vestigation to determine whether the built environment a¡ects patients' medical outcomes. Martinez, CA: The Center for Health Design, Inc. Shuttleworth, S. (1980). Use of photographs as an environ-mental presentation medium in landscape studies. Journal of Environmental Management, 11, 61^76.
Staff, patients, and visitors: Responses to hospital unit enhancements
- Devlin
Devlin, A. S. (1995). Sta¡, patients, and visitors: Re-sponses to hospital unit enhancements. In J. Nasar, P. Grannis & K. Hanyu (Eds), Proceedings of the 26th Annual Conference of the Environmental Design Re-search Association (pp. 75^80). Oklahoma City, OK: EDRA.
Sex of phy-sician: Patients' preferences and stereotypes Consumer satisfaction with physician provided services: A panel study
- K Fennema
- D L Meyer
- N Owen
Fennema, K., Meyer, D. L. & Owen, N. (1990). Sex of phy-sician: Patients' preferences and stereotypes. Journal of Family Practice, 30, 441^446. Gray, L. C. (1980). Consumer satisfaction with physician provided services: A panel study. Social Science and Medicine, 14a, 65^71.
Stress recovery dur-ing exposure to natural and urban environments Pa-tients and personnel speak (Publication No 527)
- R S Ulrich
- R F Simons
- B D Losito
- E Fiorito
- M A Miles
- M Zelson
Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A. & Zelson, M. (1991). Stress recovery dur-ing exposure to natural and urban environments. Journal of Environmental Psychology, 11, 201^230. U.S. Public Health Service, Nursing Division. (1964). Pa-tients and personnel speak (Publication No 527). Wa-shington, DC: U.S. Government Printing O⁄ce.
What's wrong with self-reported measures in environment and behavior research?
- Evans
Evans, G. (1995). What's wrong with self-reported measures in environment and behavior research? In A. D. Sei-del (Ed.), Banking on Design? Proceedings of the 25th Annual Conference of the Environmental Design Re-search Association (pp. 83^91). Oklahoma City, OK: EDRA.
The gap between design and healing
- Lemprecht
Ceiling design in the hospital rehabilitation environment: The patient's perspective
- Barrington
The Planetree model hospital project: An example of the patient as partner
- Martin