Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-26T18:11:11.290Z Has data issue: false hasContentIssue false

Impact of the hospital built environment on treatment satisfaction of psychiatric in-patients

Published online by Cambridge University Press:  22 October 2020

Nikolina Jovanović*
Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, UK
Elisabetta Miglietta
Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
Anja Podlesek
Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
Adam Malekzadeh
Centre for Transport Studies (CTS), Department of Civil, Environmental & Geomatic Engineering, University College London, London, UK
Antonio Lasalvia
Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy UOC Psichiatria, Azienda Ospedaliera Universitaria Intergrata di Verona, Verona, Italy
Justin Campbell
Institute of Global Health, University College London, UK
Stefan Priebe
Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, UK
Author for correspondence: Nikolina Jovanovic, E-mail:



A hospital built environment can affect patients’ treatment satisfaction, which is, in turn, associated with crucial clinical outcomes. However, little research has explored which elements are specifically important for psychiatric in-patients. This study aims to identify which elements of the hospital environment are associated with higher patient satisfaction with psychiatric in-patient care.


The study was conducted in Italy and the United Kingdom. Data was collected through hospital visits and patient interviews. All hospitals were assessed for general characteristics, aspects specific to psychiatry (patient safety, mixed/single-sex wards, smoking on/off wards), and quality of hospital environment. Patients’ treatment satisfaction was assessed using the Client Assessment of Treatment Scale (CAT). Multi-level modelling was used to explore the role of environment in predicting the CAT scores adjusted for age, gender, education, diagnosis, and formal status.


The study included 18 psychiatric hospitals (7 in Italy and 11 in the United Kingdom) and 2130 patients. Healthcare systems in these countries share key characteristics (e.g. National Health Service, care organised on a geographical basis) and differ in policy regulation and governance. Two elements were associated with higher patient treatment satisfaction: being hospitalised on a mixed-sex ward (p = 0.003) and the availability of rooms to meet family off wards (p = 0.020).


As hospitals are among the most expensive facilities to build, their design should be guided by research evidence. Two design features can potentially improve patient satisfaction: family rooms off wards and mixed-sex wards. This evidence should be considered when designing or renovating psychiatric facilities.

Original Article
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Andrade, C., Lima, M. L., Fornara, F., & Bonaiuto, M. (2012). Users’ views of hospital environmental quality: validation of the perceived hospital environment quality indicators (PHEQIs). Journal of Environmental Psychology, 32, 97111. Scholar
Bird, V., Giacco, D., Nicaise, P., Pfennig, A., Lasalvia, A., Welbel, M., & Priebe, S. (2018). In-patient treatment in functional and sectorised care: patient satisfaction and length of stay. The British Journal of Psychiatry, 212, 8187. doi: 10.1192/bjp.2017.20.CrossRefGoogle ScholarPubMed
Bonnes, M., & Secchiaroli, G. (1995). Environmental psychology. A psycho-social introduction. London: Sage.CrossRefGoogle Scholar
Bowers, L., Whittington, R., Parkin, D., Curtis, S., Bhui, K., Hackney, D., … Flood, C. The city 128 study of observation and outcomes on acute psychiatric wards. National Co-ordinating Centre for the National Institute for Health Research Service Delivery and Organisation Programme (NCCSDO), 2006. Retrieved from: Scholar
Burnham, K. P., Anderson, D. R., & Huyvaert, K. P. (2011). AIC Model selection and multimodel inference in behavioral ecology: some background, observations, and comparisons. Behavioral Ecology and Sociobiology, 65, 2335. Scholar
Chue, P. (2006). The relationship between patient satisfaction and treatment outcomes in schizophrenia. Journal of Psychopharmacology, 20, 3856. doi: 10.1177/1359786806071246.CrossRefGoogle Scholar
Curtis, S., Gesler, W., Priebe, S., & Francis, S. (2009). New spaces of inpatient in-patient care for people with mental illness: a complex ‘rebirth’ of the clinic? Health & Place, 15, 340348. doi: 10.1016/j.healthplace.2008.06.007.CrossRefGoogle Scholar
de Girolamo, G., Barbato, A., Bracco, R., Gaddini, A., Miglio, R., Morosini, P., … Dell'Aqua, G. (2007). Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy. British Journal of Psychiatry, 191, 170177. ScholarPubMed
Elf, M., Nordin, S., Wijk, H., & Mckee, K. J. (2017). A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare. Journal of Advanced Nursing, 73, 27962816. doi: 10.1111/jan.13281.CrossRefGoogle ScholarPubMed
Enders, C. K., & Tofighi, D. (2007). Centering predictor variables in cross-sectional multi-level models: a new look at an old issue. Psychological Methods, 12, 121138. doi: 10.1037/1082-989X.12.2.121.CrossRefGoogle Scholar
Evans, G. W. (2003). The built environment and mental health. Journal of Urban Health, 80, 536555. doi: 10.1093/jurban/jtg063.CrossRefGoogle ScholarPubMed
Fornara, F. (2005). Users’ evaluative responses to spatio-physical humanization: the case of hospital environments. In: Martens, B & Keul, AG (eds) Designing social innovation: Planning, building, evaluating pp 231240. Göttingen, Germany: Hogrefe.Google Scholar
Fornara, F., Bonaiuto, M., & Bonnes, M. (2006). Perceived hospital environment quality indicators: A study of orthopaedic units. Journal of Environmental Psychology, 26, 321334. Scholar
Giacco, D., Bird, V. J., McCrone, P., Lorant, V., Nicaise, P., Pfennig, A., … Priebe, S. (2015). Specialised teams or personal continuity across in-patient and outpatient mental healthcare? Study protocol for a natural experiment. BMJ Open, 5, e008996. doi: 10.1136/bmjopen-2015-008996.CrossRefGoogle ScholarPubMed
Harris, P. B., McBride, G., Ross, C., & Curtis, L. (2002). A place to heal: environmental sources of satisfaction among hospital patients. Journal of Applied Social Psychology, 32, 12761299. Scholar
Isobel, S., Foster, K., & Edwards, C. (2015). Developing family rooms in mental health in-patient units: an exploratory descriptive study. BMC Health Service Research, 15, 238. doi: 10.1186/s12913-015-0914-0.CrossRefGoogle Scholar
Johansson, I. M., Skärsäter, I., & Danielson, E. (2007). Encounters in a locked psychiatric ward environment. Journal of Psychiatric Mental Health Nursing, 14, 366372. Scholar
Jovanović, N., Campbell, J., & Priebe, S. (2019). How to design psychiatric facilities to foster positive social interaction – a systematic review. European Psychiatry, 60, 4962. doi: 10.1016/j.eurpsy.2019.04.005.CrossRefGoogle ScholarPubMed
Kuosmanen, L., Hätönen, H., Jyrkinen, A. R., Katajisto, , & Välimäki, M. (2006). Patient satisfaction with psychiatric inpatient care. Journal of Advanced Nursing, 55, 655663. doi: 10.1111/j.1365-2648.2006.03957.x.CrossRefGoogle ScholarPubMed
Leavey, G., Papageorgiou, A., & Papadopoulos, C. (2006). Patient and staff perspectives on single-sex accommodation. Journal of Health Management, 8, 7990. Scholar
Long, C. G., Langford, V., Clay, R., Craig, L., & Hollin, C. R. (2011). Architectural change and the effects on the perceptions of the ward environment in a medium secure unit for women. Journal of Forensic Practice, 13, 205212. Scholar
MacAllister, L., Zimring, C., & Ryherd, E. (2016). Environmental variables that influence patient satisfaction: a review of the literature. Health Environments Research & Design Journal, 10, 155169. doi: 10.1177/1937586716660825.CrossRefGoogle ScholarPubMed
Mbeah-Bankas, H. (2013). Service delivery board final report on family-friendly services project. East London NHS Foundation Trust.Google Scholar
Mezey, G., Hassell, Y., & Bartlett, A. (2005). Safety of women in mixed-sex and single-sex medium secure units: staff and patient perceptions. British Journal of Psychiatry, 187, 579582. ScholarPubMed
Miglietta, E., Belessiotis-Richards, C., Ruggeri, M., & Priebe, S. (2018). Scales for assessing patient satisfaction with mental health care: a systematic review. Journal of Psychiatric Research, 100:3346. doi: 10.1016/j.jpsychires.2018.02.014.CrossRefGoogle ScholarPubMed
O'Brien, L., Anand, M., Brady, P., & Gillies, D. (2011a). Children visiting parents in inpatient psychiatric facilities: perspectives of parents, carers, and children. International Journal of Mental Health Nursing, 20, 137143. doi: 10.1111/j.1447-0349.2010.00718.x.CrossRefGoogle Scholar
O'Brien, L., Brady, P., Anand, M., & Gillies, D. (2011b). Children of parents with a mental illness visiting psychiatric settings: perspectives of staff. International Journal of Mental Health Nursing, 20, 358363. doi: 10.1111/j.1447-0349.2011.00740.x.CrossRefGoogle Scholar
Owen, S. (2008). Children of parents with a mental illness: Systems change in Australia report. Stepney: Australian Infant Child Adolescent and Family Mental Health Association.Google Scholar
Priebe, S., Barnicot, K., McCabe, R., Kiejna, A., Nawka, P., Raboch, J., … Kallert, T. (2011). Patients’ subjective initial response and the outcome of in-patient and day hospital treatment. European Psychiatry, 26, 408413. doi: 10.1016/j.eurpsy.2010.03.009.CrossRefGoogle Scholar
Priebe, S., Gruyters, T., Heinze, M., Hoffmann, C., & Jäkel, A. (1995). Subjektive Evaluationskriterien in der psychiatrischen Versorgung – Erhebungsmethoden für Forschung und Praxis [Subjective criteria for evaluation of psychiatric care – methods for assessment in research and routine care]. Psychiatrische Praxis, 22, 140144.Google Scholar
Priebe, S., Katsakou, C., Amos, T., Leese, M., Morriss, R., Rose, D., … Yeeles, K. (2009). Patients’ views and readmissions 1 year after involuntary hospitalisation. British Journal of Psychiatry, 194, 4954. doi: 10.1192/bjp.bp.108.052266.CrossRefGoogle ScholarPubMed
Radcliffe, J., & Smith, R. (2007). Acute in-patient psychiatry: how patients spend their time on acute psychiatric wards. Psychiatric Bullettin, 31, 167170. Scholar
Remnik, Y., Melamed, Y., Swartz, M., Elizur, A., & Barak, Y. (2004). Patients’ satisfaction with psychiatric inpatient care. Israel Journal of Psychiatry and Related Sciences, 41, 208212.Google ScholarPubMed
Richardson, M., Katsakou, C., Torres-Gonzalez, F., Onchev, G., Kallert, T., & Priebe, S. (2011). Factorial validity and measurement equivalence of the client assessment of treatment scale for psychiatric in-patient care – a study in three European countries. Psychiatry Research, 188, 156160. doi: 10.1016/j.psychres.2011.01.020.CrossRefGoogle Scholar
Royal College of Psychiatrists (2002). Patients as parents: addressing the needs, including safety, of children whose parents have mental illness. London: College Report.Google Scholar
Thomas, S. P., Shattell, M., & Martin, T. (2002). What's therapeutic about the therapeutic milieu? Archives of Psychiatric Nursing, 16, 99107. doi: 10.1053/apnu.2002.32945.CrossRefGoogle ScholarPubMed
Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H. B., Choi, Y. S., … Joseph, A. (2008). A review of the research literature on evidence-based healthcare design. Health Environments Research & Design Journal 1, 61125. doi: 10.1177/193758670800100306.CrossRefGoogle ScholarPubMed
Wood, V. J., Curtis, S. E., Gesler, W., Spencer, I. H., Close, H. J., Mason, J., & Reilly, J. G. (2013). Creating ‘therapeutic landscapes’ for mental health carers in in-patient settings: a dynamic perspective on permeability and inclusivity. Social Science & Medicine, 91, 122129. doi: 10.1016/j.socscimed.2012.09.045.CrossRefGoogle Scholar