Developing a patient satisfaction model in hospitals based on an evidence-based design (EBD) approach

Despite their essential role in providing medical care and saving lives, most hospitals have inadvertently created environments that are often uncomfortable and unpleasant for patients and staff. Patients who are in a vulnerable physical and mental state are often forced to spend their sick days in spaces that lack warmth, comfort, and a sense of calm. Similarly, employees such as doctors, nurses, and other medical personnel are often expected to perform their demanding tasks in stressful and poorly designed environments that do not support their physical and mental health. The main reason for this is the neglect of fundamental human-centered concepts during the architectural design and construction processes of hospitals and healthcare facilities. Given the principle that the desirability of any architectural space is largely determined by the satisfaction of its users; in the case of hospitals, user satisfaction includes patients and staff who interact with the built environment on a daily basis. An individual's satisfaction with a particular environment depends on the extent to which that space meets their personal, social, emotional, and functional needs. When these needs are ignored or inadequately addressed, users experience discomfort, stress, and a general sense of dissatisfaction that can directly impact patient recovery and staff job performance. Several interrelated factors contribute to the negative experiences commonly associated with hospital environments:
The first and perhaps most fundamental issue is the overemphasis on the technological aspects of hospitals during the design process. In most cases, architectural planning is influenced by priorities for treatment modalities, the placement of medical equipment, and the organization of clinical relationships between functional spaces. While these are undoubtedly important, the resulting environments often feel sterile, impersonal, and intimidating, leaving little room for emotional comfort or human connection. The second major issue is the passive role assigned to patients in the hospital environment. Patients are often seen as objects of treatment, not as active participants in their own recovery journey. This passivity limits their sense of control and autonomy, which in turn increases anxiety and reduces the effectiveness of the recovery process. Hospital spatial design rarely empowers patients or gives them the opportunity to positively interact with their surroundings. The third reason for the poor state of many hospital spaces is the existence of fixed, outdated ideas about what a hospital should look and feel like. Decision-makers, policymakers, and designers often rely on traditional, inflexible mental models that resist change, innovation, and adaptation to modern scientific findings about environmental psychology and healing design. This stagnation perpetuates environments that are functional but emotionally and psychologically indifferent. The fourth and final major reason is the lack of attention to staff well-being and the critical link between staff satisfaction and patient outcomes. The quality of life and health of medical staff directly impacts the quality of care they provide. Stressful and uninspiring environments can lead to fatigue, burnout, and reduced efficiency among staff, which ultimately impacts patient experiences and recovery. Therefore, if a hospital fails to support the well-being of its staff, it cannot be considered truly healing.
In recent decades, as healthcare systems increasingly focus on patient safety, well-being, and speed of recovery, a new architectural approach called evidence-based design (EBD) has emerged. This approach, rooted in empirical research and scientific observation, has gained widespread attention among architects, planners, and healthcare professionals. Evidence-based design involves making design decisions based on credible evidence from studies and data on how the built environment affects health outcomes, stress levels, and overall satisfaction. The main objective of the present research is to explore and promote the use of evidence-based approaches in hospital design, placing the patient at the center of all architectural and functional considerations. This study seeks to demonstrate how the application of EBD principles can improve hospital environments, increase patient satisfaction, accelerate recovery, and create efficient and purposeful healthcare spaces. By focusing on evidence-based design solutions, this research hopes to bridge the gap between clinical practice and human experience. Evidence-based design encourages the creation of hospital environments that not only meet the technical requirements of treatment, but also support family presence and participation, promote psychological well-being, and enhance the performance and resilience of healthcare workers. In addition, evidence-based design aims to improve work productivity, treatment outcomes, economic performance, and overall patient satisfaction, making it an integrated approach that benefits all stakeholders in the healthcare system.
The research methodology of this study follows an analytical-descriptive framework that combines field observations and library studies. Data were also collected through questionnaires distributed to 289 hospitalized patients in four major hospitals in Tehran: Imam Khomeini, Gandhi, Bahman, and Kasra. The collected data were analyzed using ASPECT and SPSS version 26 software programs, which enabled the researcher to identify measurable relationships between environmental qualities and user satisfaction. By analyzing this information, this study provides practical and theoretical ideas for improving hospital design.
Based on the statistical analysis, it can be concluded with 99% confidence that there is a significant difference between the mean performance of the healing environment components among the four hospitals studied. Based on the calculated means, Gandhi Hospital showed the best performance, reflecting its more human-centered and evidence-based design practices. In contrast, Imam Khomeini Hospital showed the lowest performance, likely due to its outdated design model and lack of focus on environmental quality. Bahman Hospital and Kasra Hospital ranked second and third, respectively, with moderate but significant success in implementing healing design aspects. These findings confirm that hospital environments have a direct and measurable impact on patients’ perceptions, recovery experiences, and emotional well-being. They also demonstrate the tangible benefits of integrating evidence-based design principles into healthcare architecture. Ultimately, this study emphasizes that creating a healing hospital is not simply a matter of adding aesthetic elements or cutting-edge medical technology—it requires a holistic understanding of the human experience in space. Through thoughtful, evidence-based, and empathetic design, hospitals can become environments that heal not only the body, but also the mind and spirit.