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Perceived quality of care: The influence of the waiting room environment

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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that were nicely furnished, well-lighted, contained artwork, and were warm in appearance versus waiting rooms that had outdated furnishings, were dark, contained no artwork or poor quality reproductions, and were cold in appearance.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.

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... 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). ...
Article
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.
... 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). ...
Article
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.
... 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. ...
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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.
... User experience ranges from searching for a healthcare provider to being discharged from such a facility, possibly including even filling out the patient survey at home. According to reviewed theories, lack of distractions, of sense of control, of social support, or of feelings of safety and security can result in negative user experiences that impact overall wellness in healthcare environments, (Olsen & Pershing, 1981;Ulrich, 1991;Davidson, 1994;Devlin, 1992Devlin, , 1995Arneill & Devlin, 2002). ...
Article
In creating a psychologically supportive healthcare facility, the main lobby is an important place to consider because public lobby has the power to comfort visitors whose impressions of the facility both begin and end with the lobby (Bedner, 2013). The user experience in a healthcare facility lobby space is critical because this experience sets expectations for the quality of clinical care (Malkin, 1991, Pangrazio, 2013). However, a limited study has been conducted on users’ wellness experiences in healthcare facility main entry lobbies. Therefore, the purpose of this study is two-fold: 1) to create a user-centered wellness design evaluation criteria for developing and evaluating an existing facility design, or the design of new construction of such facilities; 2) to test and validate a tool for the design of main entry lobby in a healthcare facility using the guidelines and design checklists needed to support a decision-making by the facility designers and administrations. A combination of both quantitative and qualitative research method was used to create a set of wellness design evaluation criteria and a tool for a designing main lobby in a healthcare facility. First, content analysis was conducted on five existing standards and design guidelines of the healthcare facility design. Based on the qualitative research method of content analysis and literature review, five newly developed wellness design goals, including user experience, positive distractions, sense of control, social interaction and safety and security, along with twenty detailed wellness design features were defined. Secondly, the study used an online survey and statistical analysis to determine how participants might perceive the twenty design features. The data was analyzed to identify which design features were important for user’s experience, and how each feature affected their physical well-being, emotional health, and social interaction in a healthcare facility. A total of 299 human subjects who had visited a healthcare facility at least one time during the past 12 months in the United States participated in the online survey. The mean values from the survey results, the importance of the design features, and their impact on physical, emotional, social wellness, were used to create a wellness design evaluation tool. Survey results indicated that infection control, cleanliness and maintenance, and air comfort and freshness were the top three important features of a healthcare facility’s main entry lobby. The survey results also showed the importance of such design features and that the user perceptions of these three wellness categories were correlated. Survey participants’ age group, type of healthcare facility, frequency of visit, and purpose of visit might have had a major impact on the evaluation results. Based on the results, a wellness design evaluation tool with a design checklist was created to support wellness experience of patients, family members, and staffs. The tool was designed to communicate evidence-based and user-centered evaluation criteria among architects, interior designers, and healthcare facility administrations. Although the survey was conducted with a limited number of participants, the study provides some insights with respect to how the general population might perceive the wellness design features in a main entry lobby of a healthcare facility.
... 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. ...
Article
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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.
... 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). Findings from the semi-structured interviews also emphasized the importance of certain features in care partners' seat selections including privacy (availability of secluded areas, visual and auditory privacy), seat quality (comfort and location), accessibility (to power outlets, outdoor spaces, and positive distractions), visibility (to registration desk and surgical suite corridor), proximity (to other people and registration desk), safety, and tasks. ...
Preprint
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. Though 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 observational study, 92 participants made seat selections while performing scenario-based tasks in a virtual waiting area. A multi-method 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.
... well-thumbed and dated magazines) represent the opposite (i.e. poorer quality of care) (Arneill & Devlin, 2002). Examples of the latter style of waiting room give rise to the contention that such spaces might be interpreted as non-places (Augé, 1992(Augé, /1995. ...
... Furnishing may have a direct effect on customers' quality perceptions, excitement levels, and indirectly on their desire to return (Ryu & Han, 2010). Furnishing affects the comfort of customers in a restaurant (Baker, 1987;Bitner, 1992;Arneill & Devlin, 2002) as well as their assessment of the service quality. As noted by Wakefield and Blodgett (1996: 54), comfort becomes very important as "customers remain in the same seat for extended periods of time. ...
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This paper aims to examine the perceptions of customers towards restaurant servicescapes and to find out the influential role of restaurant servicescapes in customer loyalty. Therefore, a survey was conducted at three restaurants in the context of servicescapes in Safranbolu, Turkey. Respondents were interviewed at the end of their meal and asked to complete a scoresheet that consisted of 35 servicescape factors. Using data collected from 327 guests, it was found that the guests' perception of the restaurant servicescape influences their loyalty. Results indicate that both direct/indirect external servicescape influences and physical environment: external presentation had the highest scores that positively affect the loyalty of customers.
... Por otra parte, el tener una mejor valoración del ambiente conlleva una mejor valoración de la calidad de la atención, conforme a los resultados obtenidos entre los CPI de la sala pediátrica en comparación con los CPI de las salas oncológicas de cáncer de mama y urología, evidencia que se ha identificado en algunas ocasiones en investigaciones realizadas en salas con calidad enriquecida, es decir, en donde se cuenta con diversas facilidades para el confort de sus usuarios, así como que en ambientes con calidad empobrecida (cuando no se cuenta con condiciones mínimas de comodidad e inclusive de atención de necesidades básicas como puede ser el acceso a sanitarios lim- pios) el impacto se ve reflejado en una peor evaluación de la calidad de la atención, de acuerdo con lo reportado por diversos investigadores (Arneill & Devlin, 2002;Evans & McCoy, 1998;Leather, Beale, Santos, Watts, & Lee, 2003). En este contexto, a pesar de las diferencias significativas entre las tres salas, la carga es muy relevante en las tres muestras de cuidadores primarios informales por lo que es de gran importancia que los programas de intervención para los cuidadores primarios deben establecerse como un proceso de atención integrado en el sistema de salud, coadyuvando en la obtención y mantenimiento de interacciones de apoyo social, sentimientos de dominio e interacciones positivas, sin descuidar la atención que se da a los pacientes (Vázquez et al., 2015). ...
Article
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Factores ambientales y estrés en salas de espera: comparación en cuidadores primarios informales de pacientes con Cáncer Environmental factors and stress in waiting rooms: comparison in informal primary caregivers of patients with Cancer Con objeto de identificar las relaciones del estrés, las condiciones ambientales y la carga en cuidadores primarios informales (CPI) sobre la valoración de la calidad de la atención durante su permanencia se evaluaron en tres salas de espera de hospitales especializados en el tratamiento del cáncer. A 448 CPI de pacientes con cáncer de mama, de próstata y pediátrico se les aplicó una batería de pruebas: Carga del Cuidador, Escala de Estrés Ambiental, Escala de Estrés Psicológico, Escala de Evaluación Ambiental y Escala de Calidad de la Atención. Para identificar la influencia de las condiciones am-bientales (funcionalidad, privacidad, señalización y ruido percibido), del estrés (estrés y activación) y de la carga del cuidador (impacto del cuidador, relaciones interpersonales y expectativas del cuidador) durante su estancia en las salas de espera, se obtuvo un modelo de regresión múltiple que identifica el grado de influencia de las variables de la evaluación ambiental y del nivel de activación en la calidad de la atención de las instituciones para el cuidado de la atención oncológica. Además se obtuvieron las diferencias significativas de los promedios obtenidos entre los tres grupos de usuarios conforme a los diferentes factores evaluados. Se destaca la importancia del ambiente hospitalario que apoya las nece-sidades de los cuidadores y sus repercusiones sobre el cuidado y atención de sus pacientes con cáncer.
... 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. ...
Thesis
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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.
... 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). ...
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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.
... 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. ...
Article
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.
... 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. ...
Preprint
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.
... 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. ...
Article
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
... There is extended literature referring to health and hospital quality in particular, the bulk of which deals with patient satisfaction (e.g., [6][7][8][9][10][11]). Another crucial area of study deals with perceived quality from patient care [12], in the majority dealing from specific care conditions, situations or practices [13,14] or from the health care personnel [15][16][17][18], or from specific attributes that constitute health care quality [19,20]. Lastly, a quite large number deal with hospital service quality perceptions (e.g., [21][22][23][24][25][26]). As regards the Greek context, while a number deal with patient satisfaction [27][28][29][30] few academic papers have been found dealing with patients' perceptions of hospital quality [31][32][33][34]. ...
... Because of the asymmetry of information between providers and patients in the healthcare market, patients do not have full knowledge about what constitutes good quality; in this case, they may not be fully aware of the recommended components of clinical assessment for their child. 47 This study had several strengths. First, the availability of exact spatial location data of the SPA health facilities and all EAs for the MICS from the 2008 Malawi census data provided a unique opportunity to examine health http://bmjopen.bmj.com/ ...
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Objective Increasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation is often inconsistent and quality of care can be poor. We assessed whether poor quality of sick child healthcare in Malawi is associated with low utilisation of sick child healthcare. Design We measured two elements of quality of sick child healthcare: facility structural readiness and process of care using data from the 2013 Malawi Service Provision Assessment. Overall quality was defined as the average of these metrics. We extracted demographic data from the 2013–2014 Malawi Multiple Indicator Cluster Survey and linked households to nearby facilities using geocodes. We used logistic regression to examine the association of facility quality with utilisation of formal health services for children under 5 years of age suffering diarrhoea, fever or cough/acute respiratory illness, controlling for demographic and socioeconomic characteristics. We conducted sensitivity analyses (SAs), modifying the travel distance and population—facility matching criteria. Setting and population 568 facilities were linked with 9701 children with recent illness symptoms in Malawi, of whom 69% had been brought to a health facility. Results Overall, facilities showed gaps in structural quality (62% readiness) and major deficiencies in process quality (33%), for an overall quality score of 48%. Better facility quality was associated with higher odds of utilisation of sick child healthcare services (adjusted ORs (AOR): 1.66, 95% CI: 1.04 to 2.63), as was structural quality alone (AOR: 1.33, 95% CI: 0.95 to 1.87). SAs supported the main finding. Conclusion Although Malawi’s health facilities for curative child care are widely available, quality and utilisation of sick child healthcare services are in short supply. Improving facility quality may provide a way to encourage higher utilisation of healthcare, thereby decreasing preventable childhood morbidity and mortality.
... These "hard facilities" (Ulrich et al., 1991) usually work against the process of healing. Increasing interests in and efforts to improve healthcare facility users' experiences led to implementations of design research that have studied diverse user groups to explore the role of the environment in the healing process (Arneill and Devlin, 2002;Fottler et al., 2000). Consequently, there is a growing acknowledgement that the design of the physical healthcare environments can affect patient medical outcomes and care quality (Ulrich, 1984;Ulrich et al., 2010). ...
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Given that we live in a time within a growing competitive healthcare market, the customer experience and healing opportunities are on top of the priority list. However, little attention has been dedicated on how to merge the disciplines of architecture, healthcare and management to create healthcare environments to enhance the customer experience and the healing process. The goal of this paper is to explore how design can foster customer-perceived intimacy within a healthcare context to achieve enhanced customer outcomes, such as customer well-being. Understanding the importance of customer- perceived intimacy is paramount, as customers are constantly exposed to intimate situations. The study suggest that there is potential for such situations to be wrought with problems involving complexities associated with human cognition, emotions, physiological responses, and behaviors. A literature review is undertaken to highlight the antecedents and the short-term and long-term outcomes of customer- perceived intimacy. As a result, the paper provides a conceptual framework that raises many questions that need to be answered. In doing so, a solid foundation for future inquiry has been laid.
... 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). ...
Article
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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.
... 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]. ...
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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. ...
Article
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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. ...
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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.
... In this regard, it has been suggested that neuro-aesthetics can provide a source of pleasure in the healthcare environment (Nanda, Pati, & McCurry, 2009). The placement of furniture, even without modifying the architectural configuration, also has this capacity (Arneill & Devlin, 2002). ...
Article
The implementation of environmental satisfaction sources in the design of a health centre is a means to achieve stress reduction. The present work analyses the effect that these sources have on the stress reduction of patients' companions in a paediatric service. A two-phase study was carried out. During the first phase, 120 participants assessed 20 waiting rooms in situ in order to select the environmental sources with the greatest effect. During the second phase, the stress levels of 26 participants were measured in four simulated waiting rooms that combined the selected sources from the first phase. A multisensory simulation was carried out through a virtual reality experiment with visual, auditory and olfactory elements, and stress levels were measured at the psychological and neurophysiological levels. Results suggest that a combination of environmental satisfaction sources creates an important synergistic effect at the psychological and neurophysiological levels and underlines the importance of auditory and olfactory stimuli. Conclusions may be of interest to designers and managers of healthcare facilities.
... 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). ...
Article
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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]). ...
Conference Paper
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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. ...
Article
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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). ...
Article
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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.
Article
Background: People with self harm and suicidal ideation are increasingly presenting emergency departments, resulting in significant economic impacts, increasing pressure on triage processes, and often poor outcomes and experiences. The emerging field of evidence-based design seeks to improve healthcare outcomes through considered design of the built environments delivering healthcare services. Methods: This scoping review aimed to (1) identify the current body of literature which examined the design of emergency departments for people with self harm and suicidal ideation, and (2) identify the ways in which the built environment could increase the efficacy of therapeutic efforts through improving service user outcomes and experiences. Results: Design strategies from the literature are collated and discussed. This review also developed a thematic network of key themes in the literature, to guide future evidence-based design researchers addressing the design of the built environment with the provision of care for people with self harm and suicidal ideation specifically in emergency departments. Conclusions: Future research directions, limitations of the field and potential methodologies to address these limitations are presented, including clear definition of participant groups and settings, co-design processes engaging the service user voice alongside other stakeholders, and collaborative interdisciplinary research partnerships.
Article
Objective: To quantify differences in patient expectations of healthscape (e.g., interior environment) across Western medicine (WM) and Traditional Chinese Medicine (TCM) paradigms. Data sources/study setting: Primary survey data comprise 469 Taiwanese consumers. National insurance coverage of both TCM and WM is an ideal setting to test for differences in healthscape expectations. Study design: Respondents report their recent experience as either exclusive users of TCM, exclusive WM, neither, or dual usage (both TCM and WM), and are randomly assigned to one of two surveys (identical except one refers to WM contexts, the other TCM) to rate the importance of 28 healthscape factors derived from previous studies. Data collection/extraction methods: Multivariate analysis of variance is used to test the research hypotheses. Principal findings: Dual users accept some differences across paradigms. In contrast, exclusive WM users apply their existing WM expectations to TCM contexts, raising the possibility of dissatisfaction and low adoption. Conclusions: A person's experience with TCM is related to acceptance of healthscape differences. Medical service providers of TCM, and by extension complementary and alternative medicine, should devise strategies to ease initial visitation by exclusive WM users. Healthscape designs need not be modeled closely on a WM standard, as dual users accept differences.
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Antimicrobial resistance and the adaptation of microbial life to antibiotics are recognised as a major healthcare challenge. Whereas most social science engagement with antimicrobial resistance has focussed on aspects of ‘behaviour’ (prescribing, antibiotic usage, patient ‘compliance’, etc.), this article instead explores antimicrobial resistance in the context of building design and healthcare architecture, focussing on the layout, design and ritual practices of three cystic fibrosis outpatient clinics. Cystic fibrosis is a life-threatening multi-system genetic condition, often characterised by frequent respiratory infections and antibiotic treatment. Preventing antimicrobial resistance and cross-infection in cystic fibrosis increasingly depends on the spatiotemporal isolation of both people and pathogens. Our research aims to bring to the fore the role of the built environment exploring how containment and segregation are varyingly performed in interaction with material design, focussing on three core themes. These include, first, aspects of flow, movement and the spatiotemporal choreography of cystic fibrosis care. Second, the management of waiting and the materiality of the waiting room is a recurrent concern in our fieldwork. Finally, we take up the question of air, the intangibility of airborne risks and their material mitigation in the cystic fibrosis clinic.
Chapter
De omgevingspsychologie houdt zich bezig met het bestuderen van de interactie tussen mensen en hun omgeving. Daarbij besteedt zij onder meer aandacht aan de vraag in welke mate een omgeving tegemoetkomt aan de behoeften van de gebruikers. Speciale aandacht wordt daarbij besteed aan eventuele ‘misfits’. Een misfit is de omstandigheid waarin de omgeving een groter beroep doet op gebruikers dan in het licht van hun aanpassingsvermogen gevraagd kan worden. Het denken in misfits is interessant in de context van het stress-sensitief werken. De aandacht in het sociaal domein voor een effectieve inrichting van bijvoorbeeld ontmoetingsruimten is nu nog beperkt. Dat is een gemis omdat onderzoeken in onder meer de zorg en op werkvloeren laten zien dat beperkte aanpassingen grote effecten kunnen hebben. In dit hoofdstuk wordt kort stil gestaan bij de initiatieven die er al wel zijn in het sociaal domein. In aanvulling daarop wordt er ter inspiratie uitgebreider verslag gedaan van inzichten in de zorg en werkvloeren, met als doel het sociaal domein aan te zetten tot meer aandacht voor de inrichting van ontmoetingsruimten.
Article
Background Waiting areas in healthcare settings play an important role in reassuring or potentially further distressing service users. The effects of the designed environment on mental health service users specifically are regarded by health professionals as having a considerable influence on treatment outcomes, experiences, and perceptions of care. Purpose The purpose of this article is to explore service user and practicing therapist perspectives of waiting areas in mental health service settings and how the design of these spaces affects anxiety levels, comfort, therapeutic relationships, outcomes, and perceptions of care. Methods The methodology for this exploratory phenomenological study was developed in order to preserve the integrity of participant voices in the essences of experiences, during explorations of their encounters with therapeutic waiting areas. Fieldwork undertaken by the author involved a series of focused in-depth interviews with service users of mental health services and practicing therapists, counselors, and psychologists. Results Key themes identified through data analysis include (1) space acting as symbolism, (2) interpersonal relations which are threatening, and (3) sensory modulation. Design implications in relation to each theme are presented. Conclusions This study uncovered a set of findings in relation to symbolic content inferred by spatial design aspects and the ways in which design can afford, or mitigate, development of interpersonal agencies, psychological safety, and negative stigmas. Future transdisciplinary research directions are suggested, including (1) examination of other relationships, beyond the service user–therapist dyad, which may influence waiting area experiences and (2) examination of the applicability of design suggestions to different contexts.
Article
Agency problems are a defining characteristic of health care markets. We present the results from a field experiment in the market for dental care: A test patient who does not need treatment is sent to 180 dentists to receive treatment recommendations. In the experiment, we vary the socio-economic status (SES) of the patient and whether a second opinion signal is sent. Furthermore, measures of market, practice and dentist characteristics are collected. We observe an overtreatment recommendation rate of 28% and a striking heterogeneity in treatment recommendations. Furthermore, we find significantly less overtreatment recommendations for patients with higher SES compared to lower SES for standard visits, suggesting a complex role of patients’ SES. Competition intensity, measured by dentist density, does not have a significant influence on overtreatment. Dentists with shorter waiting times are more likely to propose unnecessary treatment.
Article
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.
Article
As privilege-dependent organizations, U.S. public schools have an interest in catering to higher-SES White families. But, what happens when privileged families’ interests conflict with schools’ stated goals? Focusing on the case of homework, and drawing insights from organizational theory, cultural capital theory, and research on parent involvement in schools, I examine how schools’ dependence on higher-SES White families influences their enforcement of rules. Using a longitudinal, ethnographic study of one socioeconomically diverse public elementary school, I find that teachers wanted to enforce homework rules, but they worried doing so would lead to conflict with the higher-SES White “helicopter” parents, on whom they relied most for support. Thus, teachers selectively enforced rules, using evidence of “helicopter” parenting to determine which students “deserved” leeway and lenience. Those decisions, in turn, contributed to inequalities in teachers’ punishment and evaluation of students. Broadly, these findings suggest privilege-dependence leads schools to appease privileged families, even when those actions contradict the school’s stated goals. These findings also challenge standard policy assumptions about parent involvement and homework, and they suggest policies aimed at reducing the power of privilege are necessary for lessening inequalities in school.
Article
Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area. To help address this gap, we present evidence that highlights the pivotal role of evidence-based architectural design in service users’ experience of mental health services. We propose six important design principles to enhance the care of mental health service users. Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, we outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience. In this Personal View, we argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels.
Article
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.
Article
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.
Chapter
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.
Article
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.
Chapter
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.
Chapter
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.
Article
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.
Article
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.
Article
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.
Article
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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)
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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.
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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.
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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.
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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.
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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.
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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)
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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)
Article
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.
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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.
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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.
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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.
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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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
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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.
Article
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.
Article
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.
Article
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