Assessing Spatial User Experience for Design Guidelines: A Comparative Study of Outpatient Waiting Rooms With Conventional Versus Modern Features

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Assessing Spatial User Experience for Design Guidelines: A Comparative Study of Outpatient Waiting Rooms With Conventional Versus Modern Features

Abstract

Objectives: Identify waiting room design features that are most appreciated by outpatients and their companions in conventional and modern waiting rooms. Evaluate if end users evaluate the environment differently from experts and in what aspects. Provide evidence-based design guidelines that orient designers and healthcare managers. Background: Built environments are relevant in patients' evaluation of overall healthcare service. For outpatients, waiting frequently consumes the largest amount of time; thus, waiting room interior design has great potential to enhance their experience. Methods: This study compares perceptions of two types of waiting rooms-conventional and modern-based on the spatial user experience model. In the first stage of the study, we compared user evaluations of conventional waiting rooms and modern waiting rooms with respect to the eight spatial user experience model dimensions using multigroup structural equation modeling. In the second stage, an expert ergonomist and two professional interior designers assessed both types of waiting rooms. Results: Results showed that modern waiting rooms were perceived to be significantly better in all spatial user experience dimensions. We also found experts' evaluations were overall consistent with users' perceptions. Discrepancies were only found in temperature perception, signage evaluation, and spatial appreciation. Conclusions: Participants valued modern style waiting room features such as good quality signage, use of armchairs and sofas, a controlled environment, and decoration. We suggest involving end users in the design process to respond to their needs and promote a positive experience. Finally, we provide easy-to-adopt design guidelines to improve patients' waiting room experience.

Tangible elements such as built environments are relevant for the patient's evaluation of overall healthcare service. Consequently, healthcare providers are increasingly interested in improving their facilities to deliver high-quality service and foster positive experiences.

In outpatient services, waiting usually consumes the greatest amount of time. The experience of it plays a critical role in outpatient satisfaction and patients' perception of care quality. Although there is vast literature exploring strategies to decrease waiting time, this goal is not always achieved, and outpatients often experience delays to get specialist care. In this scenario, enhancing the physical environment can be a concrete alternative strategy to improve the waiting experience for patients and visitors.

In recent decades, practitioners have applied an evidence-based design approach to improve healthcare environments. The Center for Health Design defines evidence-based design as "the process of basing decisions about the built environment on credible research to achieve the best possible outcomes." Research that shows the effects of waiting room environments on outpatient experience is limited, however, and it can be challenging for designers to define the diverse waiting room features based on evidence.

The latest contributions to this subject mainly address the positive impacts of environmental elements such as daylight, scents, interactive media and aquarium, vegetation, images of natural landscapes, and music and nature sounds on patients' and visitors' anxiety levels. There are also studies exploring comfort perceptions in the waiting room based on seat features such as stability and capacity to support users of different ages and sizes and the introduction of Feng Shui principles, which aim to achieve the environment energy balance and users' harmony with their surroundings.

While anxiety and comfort are important aspects of the user experience, they are only a part of it. According to the spatial user experience model, the user experience in physical settings is a holistic phenomenon influenced by ergonomic and affective dimensions. In turn, the user experience influences behavioral responses. Aiming to provide a comprehensive understanding of the user experience in waiting rooms, in our previous work, we designed a questionnaire based on the spatial user experience model and distributed it in waiting rooms at two medical centers. Structural equation modeling analysis results showed a significant impact of several factors on the user experience dimension: emotional reaction, physical compatibility, spatial appreciation, and spatial cognition. We also found that the user experience strongly influences patients' behavioral intentions, such as willingness to recommend and return.

The user experience in outpatient waiting rooms is simultaneously influenced by various factors, including emotions, physical comfort, spatial appreciation, and spatial cognition. In turn, the user experience impacts behavioral responses.

Our prior work gathered data from two medical centers with waiting rooms that differ in functional and aesthetic features. However, differences between the participants' spatial user experience perceptions in each scenario were not addressed. There have been previous studies in the literature that compared patient perceptions of interior design features in different types of waiting rooms. Leather et al. found that "nouveau" waiting areas or those with a user-oriented design, with open-plan reception area, color coordination, fabric-upholstered seats, wall-mounted fixtures, plants, and nature photography were related to better perceptions of the environment, higher satisfaction scores, and lower self-reported stress compared to "traditional" ones (i.e., regular waiting areas of outpatient clinics in United Kingdom, with square plan, enclosed reception area, no color coordination, plastic-covered seats, and no music or television). Fornara et al. identified that patients and visitors evaluated significantly better the most "humanized environments," defined as environments that respond to patients' necessities and promote their wellbeing. These results were mostly congruent with experts' evaluations of spatial humanization in the facilities under study, suggesting that hospital design improvements could potentially promote greater patient satisfaction with the environment. Finally, Andrade et al. found that outpatients evaluated "newer facilities (in the sense of recently built or renovated buildings versus buildings from the early twentieth century)

significantly higher in terms of environmental quality, which was consistent with the expert evaluation of the settings."

Although these works identified highly valued features, they did not consider all aspects involved in the SUE model or evaluate each dimension thoroughly. Additionally, study results rarely translated into specific design recommendations, which could be an obstacle to their application in practice. Finally, they offered no discussion about the aspects in which experts and visitors agreed and disagreed.

Discovering the SUE dimensions that have higher evaluations in the two types of waiting rooms from our previous study could contribute interesting insights to waiting room design literature and for design practice. In the present study, we apply the label "conventional waiting rooms" to the waiting areas in the first medical center, whose design type is one frequently implemented in local health centers: it includes plastic chairs, wooden reception desks, and no decorative elements. In turn, we call "modern waiting rooms" the waiting room design found in the second medical center, which has distinctive modern design features, such as overall neutral tone with accent color elements in furniture and art, furniture with clean lines, details of chrome and glass, use of art as decor, and use of decorative wall panels. Detailed features of each waiting room type are defined in Table One and Figures Two through Four. Previous literature suggests that modern waiting rooms could have higher user evaluations, given that they are in a recently remodeled building, and they share "nouveau" and "humanized" waiting room features, offering a more user-centered waiting space.

The purpose of the present study is to add the knowledge base on waiting room research by identifying the design features most appreciated in conventional and modern waiting rooms according to the multidimensional SUE model and provide easy-to-apply EBD guidelines. We also aim to explore the congruence between actual users and expert evaluations identifying similarities, discrepancies, and aspects toward which users show greater tolerance in order to better understand their priorities and needs. We expect our study findings can help designers and healthcare facility managers create waiting rooms that promote positive experiences.