The physical facilities in which healthcare services are performed play an important role in the healing process. Evidence-based design in healthcare is a developing field of study that holds great promise for benefiting key stakeholders: patients, families, physicians, and nurses, as well as other healthcare staff and organizations. In this paper, the authors present and discuss a conceptual framework intended to capture the current domain of evidence-based design in healthcare. In this framework, the built environment is represented by nine design variable categories: audio environment, visual environment, safety enhancement, wayfinding system, sustainability, patient room, family support spaces, staff support spaces, and physician support spaces. Furthermore, a series of matrices is presented that indicates knowledge gaps concerning the relationship between specific healthcare facility design variable categories and participant and organizational outcomes. From this analysis, the authors identify fertile research opportunities from the perspectives of key stakeholders.

We incorporated the views of patients to develop a comprehensive set of ideal physician behaviors. Telephone interviews were conducted in 2001 and 2002 with a random sample of 192 patients who were seen in 14 different medical specialties of Mayo Clinic in Scottsdale, Ariz, and Mayo Clinic in Rochester, Minn. Interviews focused on the physician-patient relationship and lasted between 20 and 50 minutes. Patients were asked to describe their best and worst experiences with a physician in the Mayo Clinic system and to give specifics of the encounter. The interviewers independently generated and validated 7 ideal behavioral themes that emerged from the interview transcripts. The ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Ways that physicians can incorporate clues to the 7 ideal physician behaviors to create positive relationships with patients are suggested.

Although studies have provided evidence that characteristics of the physical environment (servicescape) affect employees' attitudes (e.g., job satisfaction), these studies were limited in the scope of the characteristics they examined. Furthermore, they did not delineate the processes through which (a) the servicescape affects the attitudes and (b) the attitudes generate outcomes beneficial to service firms. Specifically, this research considered the effects of three elements of the servicescape (pleasantness, safety, and convenience) upon service workers' job stress and job satisfaction and, subsequently, their commitment to the organization and referral intentions. The authors developed a model to embody these processes and tested this model by conducting a quasi-experiment with longitudinal data from nurses working in a hospital that added a new wing to its existing facility. Their analysis of responses from the nurses supports the model, and they suggest implications for service firms in managing the servicescape.

The research presented here extends the traditional theoretical model of service failure and service recovery to the online shopping environment by investigating the moderating role of cumulative online purchasing experience. Using a multigroup structural equation modeling approach to assess differences across two groups with low and high levels of online purchasing experience, the study provides empirical support that cumulative online purchasing experience moderates several key attitudinal and behavioral outcomes of the service failure/recovery encounter. Specifically, in the group with less online purchasing experience, the perceived fairness of the remedy offered by the seller has a greater impact on post-recovery satisfaction. Further, if dissatisfied following a service failure encounter, the group with low levels of purchasing experience is more likely to engage in negative word of mouth. Finally, post-recovery satisfaction is more predictive of repurchase intentions in the highly experienced group than the less experienced group.

PURPOSEThe patient-physician relationship is the cornerstone of health care service delivery. The objectives of this study were to assess the contribution of relationship commitment along with trust to patient-physician relationships and to evaluate the association of commitment and trust with adherence to medical advice and healthy eating behaviors. METHODSTo test the proposed model, we developed a questionnaire that included both existing scales and a scale constructed specifi cally for the study; the questions addressed trust, commitment, adherence to physicians' medical recommendations, and healthy eating behavior. The questionnaire was given to adult patients in the waiting rooms of 4 large clinics in central Texas.RESULTS A total of 1,008 patients returned questionnaires; 869 patients' questionnaires were complete and used in the analysis. A 3-stage least squares analysis that tested a system of 4 equations which included relationship commitment yielded a systemwide R 2 of 0.71 that was 0.09 higher than a system of equations excluding relationship commitment. Trust and commitment were positively associated with adherence (P <.001 and P = .02, respectively). We also found positive relationships between adherence and commitment and between trust and commitment (P <.001 for each). Adherence and commitment were both associated with healthy eating behavior as well (P <.001 for each).CONCLUSIONS Patients' trust in their physician and commitment to the relationship offer a more complete understanding of the patient-physician relationship. In addition, trust and commitment favorably infl uence patients' health behaviors.