.. (1.1.13W!‘ 1rd. .m. 33‘ . ‘0. 33%; flaiufin u: .. $.03 rd. W66: .31.. dumijaumugz ... .1... i x 1‘21 ‘ . [55.3 {it x . .. I? . .1. . than... . ‘ at” x. . 33.1.! “'1‘“: ,. :11: t . immune: 3.1 .1. .. .31.... Si x (.1 l .7225. in}: This is to certify that the thesis entitled USERS’ PRIORITIES: ACTIVITIES AND ENVIRONMENTAL FACTORS IN THE HOSPITAL OUTPATIENT WAITING ROOM presented by Jamie C. MoLelland has been accepted towards fulfillment of the requirements for the MA. degree in Human Environment & Design filmw iZ/L (yajor Professor’s Signature AM 2 b . W _, . Date MSU is an Affirmative Action/Equal Opportunity Institution LIBRARY Michigan State University PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. MAY BE RECALLED with earlier due date if requested. DATE DUE DATE DUE DATE DUE 6/01 c:/CIRC/DateDue.p65-p.15 USERS’ PRIORITIES: ACTIVITIES AND ENVIRONMENTAL FACTORS IN THE HOSPITAL OUTPATIENT WAITING ROOM By Jamie C. McLelland A THESIS Submitted to Michigan State University In partial fulfillment of the requirement for the degree of MASTER OF ARTS College of Human Ecology Department of Human Environment and Design 2004 ABSTRACT USERS’ PRIORITIES: ACTIVITIES AND ENVIRONMENTAL FACTORS IN THE HOSPITAL OUTPATIENT WAITING ROOM By Jamie C. McLelland The purpose of this study is to identify user preferred activities and priorities and levels of user satisfaction within the environmental factors including: temperature, lighting, noise, furniture and equipment, location/access, view and privacy, to develop design considerations for the hospital outpatient waiting room. The study of the outpatient hospital waiting rooms used questionnaires administered to 154 participants in two waiting rooms in Sparrow Health System. Data were analyzed using both descriptive and inferential statistics. The results of this study found the following: 1) reading was the most preferred activity among waiting room users, 2) patients and companions prefer the same activities while waiting in the waiting room, 3) waiting room users found many of the environmental factors to be of equally high importance, including temperature, location, access, noise, lighting, furniture and equipment, 4) users were most satisfied with the location and accessibility, temperature and lighting of the waiting rooms. This study also discusses the implications of the results which could be beneficial to professionals including: interior designers, facilities managers, healthcare providers and educators. Dedication This thesis is dedicated to all my loved ones that are crazy enough to put up with and take care of me, no matter what it takes. I could not have made it without you, thank you. iii Acknowledgements I wish to thank the following faculty in the college of Human Ecology who served as my graduate committee. Without their valuable input, guidance and time this project would not have been possible. Nam-Kyu Park, Ph.D., Interior Design and Facilities Management, Assistant Professor David Lawrence, Ph.D., Interior Design and Facilities Management, Assistant Professor Sally Helvenston, Ph.D., Apparel and Textiles, Chairperson and Associate Professor I also wish to thank Judy L. Foley, Director of Patient and Guest Services at Sparrow Health Systems, for leading my investigation at Sparrow Health Systems and Dennis Gilliland, Ph.D., Professor of Statistics and Probability at Michigan State University for giving meaning to raw data. iv Table of Contents List of Tables ................................................................................. vii List of Figures ................................................................................ viii Chapter I Introduction ................................................................................... 1 Statement of the Problem ........................................................... 1 Purpose of the Study ................................................................. 5 Research Hypotheses ................................................................. 5 Limitations .......................................................................... 7 Assumptions .......................................................................... 8 Operational Definitions ............................................................. 8 Chapter II Review of Literature ........................................................................ 12 Introduction .......................................................................... 12 Healthcare Facilities and Waiting Room Design ................................ 12 Environmental Factors .............................................................. 15 User Behavior ....................................................................... 17 Conclusion ........................................................................... 20 Chapter III Methods ......................................................................................... 21 Sample ................................................................................ 21 The Hospital Facility and Two Waiting Rooms ................................. 23 Waiting Room A: MRI/ X-Ray .................................................... 23 Waiting Room B: Diagnostic Center ............................................. 26 Instrumentation ....................................................................... 28 DataCollection 29 Data Analysis ......................................................................... 30 Chapter IV Results .......................................................................................... 32 Sample Characteristics .............................................................. 32 Waiting Room Characteristics ..................................................... 35 Reliability of Measures ............................................................. 38 Hypotheses Findings ................................................................ 4O Chapter V Discussion and Conclusion ............................................................... 59 Discussion ............................................................................ 59 Conclusion ........................................................................... 67 Implications .......................................................................... 69 Future Research ...................................................................... 73 Appendices ...................................................................................... 75 A. UCHRIS Approval Letter ....................................................... 76 B. Consent Form 78 C. Questionnaire ........................................................................ 80 D. Write-in Comments ................................................................ 86 References ..................................................................................... 91 vi Table 10 11 12 13 14 List of Tables Demographic Profile of Respondents .......................................... Profile of Respondents: Time and Stress ..................................... Temperature and Relative Humidity during Time of Data Collection Sound and Illuminance During Time of Data Collection ................... Pearson Correlation Coefficient for Users’ Satisfaction with Environmental Factors .................................................. Mean and SD of Users’ Preferred Activities and Ranking by Mean ...... Results of Paired T-test of Users’ Preferred Activities ...................... Preferred activities: Patient verses Companion .............................. Mean and SD for the Importance of Environmental Factors by Users and Ranking by Mean ....................................................... Results of Paired T-test of Importance of Environmental Factors by Users ...................................................................... Importance Of Environmental Factors by Users According to Room Mean and SD of Users’ Satisfaction with Environment Factors and Ranking by Mean ....................................................... Results of Paired T-test of Users’ Satisfaction with Environment Factors .................................................................... Users’ Satisfaction with Environmental Factors According to Room vii Page 34 35 36 38 43 47 49 55 List of Figures Figure Page 1 Floor Plan of Waiting Room A ................................................ 25 2 Floor Plan of Waiting Room B ................................................ 27 3 Box Plot of Users’ Preferred Activity ........................................ 42 4 Box plot of Users’ Preferred Activity According to User Type ........... 45 5 Box Plot of Importance of Environmental Factors by Users ............... 48 6 Box Plot of Importance of Environmental Factors by Users According to Room ..................................................................... 5 l 7 Box Plot of Users’ Satisfaction with Environmental Factors .............. 54 8 Box Plot Of Users’ Satisfaction with Environmental Factors According to Room .................................................................. 57 viii Chapter I: Introduction Statement of Problem Almost 1.7 trillion dollars were spent on healthcare in the year 2003 alone and healthcare costs continue to the rise (Appleby, 2004). In addition, a great deal of construction and growth is expected, in the near future, of the healthcare environment (Hospital Construction, 2002). With baby boomers placing greater demands and higher expectations on healthcare (Capital Spending in Healthcare, 2004; Levin, 2002), hospitals are finding outpatient healthcare to be a highly cost efficient method of treating patients. This all leads to the fact that further research could be used to optimize within outpatient healthcare. This study of hospital outpatient waiting rooms and the users’ perception Of the environment should aid in creating environments that promote positive user attitudes within the hospital waiting room. A patient is sitting and waiting, staring into space, watching the people come and go, hoping that their name is the next to be called. Waiting for a doctor’s appointment in the hospital waiting room is probably not the most pleasant thing they have done with their day. The wait does not have to be long, in order for it to be uncomfortable. So, this time they have brought a friend or family member to wait with them. Together they both try to fight off the boredom and anxiety. However, everyone seems to be able to hear their conversation and the looming awkwardness quickly silences the two of them. Now the patient and their companion sit staring at others in the room who seem equally irritated that every five minutes feels like an hour as the stress of the appointment builds. Along with boredom, dissatisfaction with conditions, such as temperature or lighting, in the environment itself can also affect the users’ disposition. However, the hospital outpatient waiting room is not always this unpleasant. Some waiting rooms are very relaxing and comfortable. So what makes one waiting room more stressful than another? The hospital outpatient waiting room intended for patients who will not be staying over night, and will be waiting a shorter period time for an appointment in which a medical examination, treatment or consultation will take place (Deasy, 1985). Some appointments may be booked in advance; others are reserved for walk-in patients. In general, the average waiting time can range depending on the individual waiting rooms. Furthermore, the design of the waiting room may vary in layout, in interior elements it contains, and in activities it supports. The patient is the first and most obvious user of the waiting room. However, the patient may bring a companion who could possibly be a family member or friend. A patient may decide to bring more than one companion. These companions should also be considered as users Of the waiting room and therefore incorporated into considerations for the waiting room design. The patients’ companions help in many ways such as a means of comfort, encouragement, support and entertainment, which potentially can help reduce stress (Schilling, L., Scatena, L., Steiner, J., Albertson, G., Lin, C., Cyran, L., Ware, L. & Anderson, R., 2002). Companions are important users to consider due to the fact that they may spend more time in the waiting room than the patient. Often companions’ opinions are later considered by patients when assessing quality of healthcare (Tansik and Routhieaux, 1999). The function of the hospital outpatient waiting room should be considered. Support for user activities should be provided within the space while the patient and the companion are waiting. For this type of environment there is a lack of research on which activities are preferred by the users. Furthermore, activities preferred may have indicated design implications. For example, if it was found that users prefer to do paperwork while waiting, designers may try to accommodate this activity by providing many task chairs at small tables and task lighting. On the other hand, if watching television is preferred, the design of the waiting room may include lounge chairs oriented toward televisions, and low levels of light may be more appropriate. Giving researchers a clearer understanding of which studies should be given higher priority. There is also a lack of research of environmental priorities and needs of the user within a hospital outpatient waiting room. Through research, interior designers and other professionals will be able to have a clearer understanding of which environmental factors to focus upon within the design of hospital outpatient waiting rooms. For example, if it is found that privacy is more important to users than the furniture used in a waiting room, designers may spend more time determining which waiting room layout will provide the type of privacy users require, rather than what type of furniture to specify. Along with understanding which environmental factor is of the highest priority, it is also important to find out users’ perception of the current waiting room’s environmental factors. In the past, it has been found that users are more likely to rate an environmental factor as a higher priority, when not satisfied with that factor within the current environment that they are in. Therefore, deficiencies within the waiting room may be found to influence the feelings toward importance of given factors 03amenkopf and Roth, 1980). It is therefore important to measure and record these factors when conducting environmental research. Currently, due to the lack of research on environmental factors and user activities within the waiting room environment, users’ expectations, goals and satisfaction levels may not be met. This will then, potentially, lead to further stress for the user, who may already be finding themselves in a stressful situation. Stress, which if not prevented, may lead users to respond physiologically and or psychologically; enacting coping mechanisms to deal with the poor conditions. This study may provide information for designers of waiting rooms that will aid in creating designs and waiting room environments that suit users’ preferences and help accomplish behavior goals. In doing so, the waiting room environment should induce less stress to the user. Many healthcare facilities conduct patient satisfaction surveys. These, sometimes nonscientific studies consist of questionnaires which generally cover a number of topics ranging from cleanliness to how well the patients were treated by the staff, to time they spent waiting in the waiting room (Strasser & Davis, 1991). Hospital patient satisfaction surveys are generally tools to assist in continuous service quality improvements. These surveys are, for the most part, very specific to the hospital in question, and unfortunately, cannot be generalized for other establishments. Designers may also conduct Post Occupancy Evaluation or similar studies, in which a specific area within a healthcare facility, after it has been designed, built and put to use, is studied. These studies help identify any successes or shortcomings within the built environment in question. These studies can generally be very useful for future modifications of that explicit space, but overall can be hard to generalize for other similar spaces, because they are so specific. The findings of this type of study may not apply to other waiting rooms. Kaplan (1983) found this to be true for many designed environments. He noted that previous studies focused on an environment and level of compatibility with its users, relative to that specific use only. Kaplan suggested that research should focus on common environmental qualities that users require from a space in general, making it applicable to other similar environments. Purpose of Study The main purpose of this study was to identify user preferred activities and environmental priorities and needs in order to develop design guidelines for the hospital outpatient waiting room. The objectives of this study were: 1. To identify users’ preferred activities within the hospital outpatient waiting room. 2. To identify and compare the preferred activities between patients and companions within the hospital outpatient waiting room. 3. To identify users’ perceptions of importance in environmental factors within the hospital outpatient waiting room. 4. To identify and access satisfaction levels of users in relation to environmental factors within the hospital outpatient waiting room. 5. To develop design recommendations for the hospital outpatient waiting room. Research Hypotheses In order to accomplish the objectives of this study the following research hypotheses were tested: Hypothesis 1. While waiting in the hospital outpatient waiting room, the users most preferred activity will be: a. Watching television. b. Sitting and looking at things. c. Listening to music. (1. Talking. e. Thinking, praying or meditating. f. Writing or doing paperwork. g. Working on the computer h. Reading. i. Eating] drinking. j. Sleeping. k. Playing games. Hypothesis 2. Preferences of users’ activities will be different between patients and companions in the hospital outpatient waiting room. Hypothesis 3. Users will find the most important environmental factor in hospital outpatient waiting rooms to be: a. Temperature. b. Lighting. c. Noise. (1. Equipment and furniture. e. Location] access. f. View. g. Privacy. Hypothesis 4. The environmental factor that users are the most satisfied with in the hospital outpatient waiting room will be: a. b. Limitations Temperature. Lighting. Noise. Equipment and furniture. Location/ access. View. Privacy. The following are some limitations of this study: 1. 2. 3. 4. Although age, culture and other personal background were not the focus of this study, they may have an affect on users’ preferred activities and perceptions of the environmental factors and should be considered in future studies. This sample was limited to the users who were waiting in the outpatient waiting room in a local hospital of Lansing, Michigan. This study was limited to two different waiting room layouts. However, there are many different types and layouts of waiting rooms within a hospital. For the respondent in the waiting room, their past experiences in the waiting room environment may be a variable that could impact the Assumptions preferred activities and perception of the environmental factors, but past experiences is not a focus of this study. Stress and health conditions of the users may affect users experience and response at the time of data collection. This study was limited to asking primarily close ended questions about eleven activities and seven environmental factors through use of a questionnaire. The following assumptions were made in respect to this study: 1. Respondents were not required to participate in the study, increasing subjects’ motivation to complete the questionnaire thoughtfully and accurately. 2. Similar waiting room conditions exist to which the findings may be applied. 3. The outpatient waiting rooms used in this study were assumed to be representative of typical outpatient waiting room in a hospital. 4. The instrument used to collect data, a self-questionnaire, accurately measured the opinions of the respondents about the activities preferred and the environmental factors. Operational Definitions Activity The act a patient or patient companion may choose to take part in while waiting in the waiting room will be referred to as an activity. For the purpose of this study, eleven classifications of activities have been identified through observation and literature review. They are as follows: watching television, sitting and looking at things, listening to music, talking, thinking/ praying] meditating, writing] doing paperwork, reading, eating] drinking, sleeping and playing games (Tivorsak, Britto, Klostermann, Nebrig & Slap, 2004). Environmental factors The individual characteristics of the waiting room as a built setting are referred to as environmental factors. This study will explain the importance of environmental factors to users (also referred to as EFI) and users’ satisfaction with environmental factors (also referred to as EFS). Through literature review and observation seven dimensions of environmental factors were identified (Farrenkopf & Roth, 1980). For this study of the hospital outpatient waiting rooms, environmental factors used were the following: 1. Equipment and Furniture: the items in a waiting room that are used to carry out a purpose. For this study, equipment may be television, vending machines and computers. Furniture is considered being almost essential for any activity to take place. Tables and chairs are two types of furniture commonly used in the waiting room (Pile, 1995) 2. Lighting: the appearance, source and characteristics of the light within the hospital outpatient waiting room measured by units of illuminance called footcandles (Dechiara, J., Panero, J., Zelnik, M., 2001). 3. Location] Access: the proximity of the waiting room in relation to the reception area, the bathroom, or patient treatment! examination rooms. 4. Noise: any sound that can be heard with in the waiting room. Possible sources of noise within the waiting room may include voices, television or music. Sound is measured in decibels (dB) (Dechiara, J. et al, 2001). 5. Privacy: the access that a patient or patient companion has to others in the waiting room. This includes visual, auditory and physical access. Privacy, for this study’s purpose, is also closely related to crowding and personal space (Gifford, 1997). 6. Temperature: the relative heat or coldness of the hospital outpatient waiting room measured in degrees of Fahrenheit. 7. View: the scene or something to observe from inside or looking out of the waiting room. For the purpose of this study, view as an environmental factor, is something that the outpatient or patient’s companion is capable of seeing, for instance the outside landscape Observed through a window. Hospital Outpatient Waiting Room The area used by patients and people accompanying patients while they wait for a scheduled or walk-in doctor’s appointment, which could be for a variety of medical reasons, is referred to as the hospital outpatient waiting room. The waiting room can vary 10 in size and layout. The waiting period is short term, in which user may be waiting anywhere from minutes to hours (Deasy, 1985). Outpatient and Companion Any person receiving treatment at a hospital without being admitted as a patient is referred to as an outpatient. All patients referred to in this study are outpatients waiting in the hospital waiting room to be treated. A person who accompanies an outpatient during the time spent in the hospital waiting room is referred to as a patient companion. Outpatients and companions are the two user types which were studied in the waiting room. Perception A mental impression that a person develops about an object, item, or group of things, is a perception. For the purpose of this study, perception refers to the mental impression of importance developed by patient or patient companion in relevance to the hospital waiting room’s environmental factors. Satisfaction The degree to which a patient or patient’s companion is able to accomplish a self determined goal is referred to as satisfaction. For this study, environmental factors and the waiting room are the two variables which were researched in relation to patient and patient companion satisfaction. 11 Chapter II: Review of Literature Introduction This chapter discusses studies that have taken place prior to the completion of this research pertaining to: healthcare facility and waiting room design, environmental factors, user behavior, and the overall relationship between the user and design. Healthcare Facilities and Waiting Room Design There are many studies on hospital healthcare, and a number of studies pertaining to the healthcare facility itself. An article entitled, Design based on the Evidence, by Levin (2002), the Vice-President of the Center of Health Design explains that like medicine, design should be evidence based, listing: 1) Access, 2) Control, 3) Positive Distraction, 4) Social Support, 5) Environmental stressors as the five areas important to healthcare design research. All of these areas of research may be applied to the design of the waiting room and are touched on in one way or another in this study. The following are relevant studies pertaining to healthcare facility design, addressing issues that affect both the facilities and their users. A study, by PricewaterhouseCooper (Hospital Construction 2002), surveyed more than 650 people including top health care executives, health plans, physician groups, medical vendors, and employers and health government officials. In this study, it was concluded among other things that hospitals need to start reassessing their old buildings before they start building new ones. The study indicated that newly constructed hospitals need to pay attention to issues not previously addressed, such as privacy, flexibility and zoning. Furthermore, it is being recognized that patients’ families must be taken into greater consideration, incorporating larger waiting rooms into hospitals when 12 constructing or renovating. These changes in healthcare are thought to be important in order to improve the quality of care and increase retention of professional staff. Additionally, in a qualitative study by Jacqueline Azzarto (1994), it was found that both patients and staff work better in family-like settings. This was determined after observing an inner-city community health center. Another study, by Ulrich (1984), matching similar type patients, found the} when patients are given a view of trees and landscaping, they are likely to have a quicker recovery time and use less pain reliever, as Opposed to patients who view a brick wall. Most hospitals do their own research through Patient Satisfaction Surveys. This may be one reason why there is very little research on waiting rooms that has been published. Although the studies seem to work well for the hospital in which they were conducted, it often cannot be used by others outside that facility. Furthermore, much of this research is used to identify operational or procedural problems that may exist within a specific area, rather than looking at overall environmental features. As such, the studies are of little use for a designer working on a new facility. The following are studies of ' ._ _ elements of the waiting room environment which have been published. A study by Ameill and Devlin (2002) found that a positive appearance within a waiting room is important when trying to give the feel of quality of care being provided. In this study, updated furniture, quality lighting, and enhanced aesthetics incorporating art work was used to give a positive perception of the environment. The study showed that the waiting rooms for female physicians where perceived to have a higher quality environment. The female physicians were also perceived as providing a better quality of care. Pruyn and Smidts (1998) studied the effects of the aesthetics and distraction within 13 the waiting environment in the marketing and service realm. They concluded that the aesthetics of the environment had more of a positive effect than shortening the time of waiting. In one study by Tivosak et al (2004), adolescents’ attitudes and preferences towards the waiting room were explored. The study sampled 54 adolescents ranging in age from 11 to 19 years of age. The participants were separated into focus groups where they were asked to talk about how they would design the doctor’s office. One topic that was repeatedly expressed was the quality of the waiting experience. The waiting rooms were not only lacking attractiveness, but subjects also found that waiting times were too long. More importantly, subjects felt that it was not the lack of activities that was the problem but rather the lack of interesting activities, entertainment or distractions while waiting that lead to dissatisfaction and boredom. Research by Tansik and Routhieaux (1999) was designed to determine if slow relaxing music in the surgery waiting room helped reduce stress and anxiety for people waiting for patients in surgery, and if that music would give a better perception of the hospital’s quality of service. Through use of a questionnaire, this study found that people did, in fact, perceive reduced stress and increased relaxation when music was played, as opposed to no music. However, the music did not make an impact on the user’s evaluation of the quality of the hospital’s service. Furthermore, this study gives a reminder that there are other customers in a hospital other than the patient. The patients’ companions’ opinions are also important. This customer, possibly a family member or friend of the patient, may be paying the medical bills and returning for other services. It 14 was noted that companions are often under less stress and are able to better evaluate the hospital environment (T ansik and Routhieaux, 1999). In a study by Schilling et al. (2002), the presence and importance of the patients’ companions in the waiting room, as well as in the examination room was analyzed. The study found that this group of users were useful not only for transportation, but also as a source of emotional support and companionship. Findings showed that both physicians and patients agreed that companions are helpful during the visit. Hence, it is important to get feedback on the waiting room environment from companions, as well as patients. Environmental Factors When designing a space it is important to identify needs and priorities of the user for the space. Although there are limited studies available on the waiting room environment in general, there are quite a few on the office environment. In a study, by Farrenkopf and Roth (1980), users were interviewed and asked to rank office environment dimensions (or environmental factors) by order of importance and also identify satisfaction levels. The dimensions identified in the study where presented in an eight-item environmental priorities rank-order list and included: 1) space, 2) location/access to people and resources, 3) aesthetics, 4) privacy and quiet, 5) heating/ ventilation/air conditioning (HVAC), 6) lighting, 7) equipment and furniture, 8) windows and view. These eight environmental dimensions were determined in previous studies. The study, of 71 faculty members, found privacy to be one of the most important dimensions of the office environment, second only to location. The study further concluded that the more inadequate the office (in relation to environmental factors), the higher the users rated importance of the environmental factor. 15 In a study by Archea (1977), the relationship between the physical environment and privacy was explored. The study found that in order to maintain or attain a behavior (in relation to privacy) one must have control over the physical environment. Archea expresses that the physical environment is an independent variable that must be addressed when accessing issues of privacy. Archea concludes that the environment must be accurately studied and documented with the same level of intensity as that used to measure user behavior in order to understand the relationship between the two. Sundstrom, Town, Brown, Forrnan, McGee (1982) found that a person’s perception of privacy depended upon the type of activity and control over their contact with others. In this study a questionnaire, completed by 154 office employees, was used to determine factors that affected perceptions of privacy. Based on a seven point scale, participants rated job complexity, job satisfaction, satisfaction with workspace, privacy, proximity, crowding, noise, distraction, and pleasant place. Along with the questionnaire, participants’ offices were assessed to establish space characteristics such as square footage and amount of enclosure. The results found that the amount of physical enclosure a participant had in their workspace related directly to how they rated privacy. In another office environment study, Sundstrom, Herbert, & Brown (1982) used a questionnaire to find employee’s satisfaction levels with communication, distraction and privacy in the open-plan office environment. The study found, among other things, that although visual privacy presented a problem in achieving satisfaction, noise also played a very compelling negative role; it explained that without this, confidentiality in conversation is lost. Researchers concluded that acoustics is an important factor when designing for privacy within office environments. 16 These studies concentrate largely on the relationship that exists between the environmental factors (in this case privacy), the user and the environment. These studies would not be important, if Farrenkopf and Roth (1980) had not proven the importance of privacy to the user in the first place. It is for this reason a study is necessary to find out what environmental factors are important to waiting room users. User Behavior There are many views on the combined factors of the environment, the user, and behavior and their relationships. The following are past studies, models and theories used to develop this study. Zimring (1981) explored, “several areas where the designed environment interacts with important behavior processes, and consider[ed] these interactions from perspective of stress imposed on the individual,” (p. 145). He viewed the designed environment as an environment in which the physical elements interact with individual goals and needs. Furthermore, Zimring found stress to be a result of interactions of person and environment in which the individual’s needs and the environmental attributes do not fit. Zimring found that in order to create a fit, the environment’s design must be conducive to the individual’s social, cognitive and behavior goals. Overall, the findings of Zimring support the idea that it is important for the design of the environment to fit with goals of the individual users in order to avoid stress. Kaplan (1983) proposed a new approach for researchers when studying user and environment relationship which would aid in the understanding and creating of environments that are appropriate for people. He had found that previous studies focused on an environment and level of compatibility with its users, relative to that specific 17 location only. Kaplan suggested that research should focus on finding common environmental qualities that users require from that type of space in general, making it applicable to similar environment’s designs. Furthermore, focus should be placed on, “behavior that is either required or actively discouraged in a particular setting,” (p.313). Overall, the important aspect to keep in mind while researching would be to figure out the characteristics that people want and need from a type of environment, rather than what they get from one specific environment. Based on the connection of the environment (the physical setting) and individuals, environmental psychology aims to improve building design in order to improve the relationship between the building and its users. This study, of the outpatient waiting room activities and environmental factors, references theories from environmental psychology in attempts to better understand the waiting room environment and strengthen its relationship with the users. This is a relatively different and new type of interior environment to be studied, due to the fact that the user is in the room for a relatively short amount of time, yet the environment could potentially cause stress to the user. Theory and models, as a source for guidance of research and practice, provide a framework for understanding the sometimes difficult behavior and environment relationship and its problems. The following are theories and models referenced in this study. Opportunity Structure Model This study references the Opportunity Structure Model. This model assumes that the environment should be used to accomplish goals (Gifford, 1997). The behavior that the user of the waiting room chooses is based on many inputs. Social-culture background, expectations, emotions, goals and the setting itself will direct the user behavior (Gifford, 18 1997). It is important to understand the users’ goals and intentions, in order to be able to support user behavior and well-being in a positive manner. This study, also, recognized that it is not purely the environmental factors which affect a person’s response to an environment. Many factors such as age, sex, social-culture, personality, and perceptions may all affect a person’s responses to the environment factors (Gifford, 1997). This is why it is important to understand in what activities a user of a waiting room may want to participate. Behavior-Setting Theory One of the theories this research references is the theory of the environment and behavior and environmental psychology known as the Behavior- Setting Theory (Gifford, 1997). This theory is based on the concept that there are consistent patterns of behavior which correspond to a given setting. One assumed behavior pattern which may be found within a waiting room is seat selection. It is because of the Behavior-Setting theory that this study looks to further understand which behaviors correspond with the waiting room. This study looked to see not only what the user commonly does, but what the preferred behavior is, so that future waiting room environments may accommodate that behavior. Stimulation Theory Another of the theories this research references is the theory of the environment and behavior and environmental psychology known as the Stimulation Theory (Gifford, 1997). This theory is based on the idea that the physical environment is the supplier of sensory information, such as light and sound, which is fundamental to our wellbeing. Other theoretical models relate to Stimulation theory, which examines the effects of over and under stimulation. It is because of this theory that this study looks to further 19 understand the environmental factors. By studying the users’ satisfaction levels of the environmental factors, this study will begin to develop an understanding of what conditions are acceptable to users. Conclusion Throughout the literature review a strong relationship can be found between the user and the environment. Although there is much research to be found on healthcare facilities, the hospital outpatient waiting room is an area that has received very little attention. This writer contends that the environment should be conducive to the user, and therefore understanding the user’s behavior, goals and intention should help to develop a positive relationship between the two. Users’ activities and environmental factors are two areas which have been studied in other environments such as children’s waiting rooms and offices in order to help understand and create a constructive relation; that example is followed here. 20 Chapter III: Methods Sample The quantitative study was conducted using data reported from a questionnaire completed by 154 patients and companions who were randomly selected while in the waiting rooms and who agreed to participate. To help control for the many possible extraneous independent variables, including types of medical treatments, waiting times, locations, interaction between nurses, doctors and patients which could affect the result of the study, measurements for this study were performed in two separate outpatient waiting rooms in Sparrow Health System, during the same time period. The two waiting rooms were chosen due to some of their similarities. The two waiting rooms used in the study both provided a range of services which varied from annual check ups that could be not very stressful to other treatments that were more severe and could be very stressful. Furthermore, they both served a variety of patients of all different ages. Lastly, both waiting rooms provided for the same types of activities and were relatively close in square footage. Furthermore, the two waiting rooms were also chosen due to some Of their differences. Waiting room B was built within the last couple of years, where as Waiting A is a considerably older. Furthermore, the two waiting rooms had differences in some of their design features that can be closely related back to a few of this study’s environmental factors. For example, the lighting is very different between the two rooms. The difference in this environmental factor may influence the users’ responses. Therefore by using two waiting rooms with different lighting, a greater understanding of the relationship between the users’ answers and the environment they were in during the time of responding may be developed. 21 The target population consisted of hospital outpatients and companions waiting in hospital outpatient waiting rooms in Sparrow Health System in Lansing, Michigan. The researcher randomly chose the two outpatient waiting rooms from Sparrow hospitals. Any person that was either a patient or patient companion, and at least eighteen years of age, was permitted to complete the survey, regardless of gender, income or occupational status. Prior to administration of the questionnaire, Approval was received by Michigan State University’s University Committee on Research Involving Human Subjects and Sparrow Health System Institutional Research Review Committee. These two organizations were developed to protect the rights of human subjects. In order to obtain these approvals the cover letter, purpose and methods of study as well as the contents of the questionnaire were reviewed by each group. The finalized questionnaire was distributed to participants accompanied by a cover letter of consent endorsed with the Sparrow Health Systems Institutional Research Review Committee approval stamp and date. Both the consent letter and the researcher distributing the questionnaires explained the purpose of the survey. They also explained that all responses are confidential and that participation in the questionnaire was voluntary. Furthermore, it was made clear that refusal to participate in the survey or certain questions would not result in any penalty. The recipients by signing and dating the consent form, completing and returning the questionnaire were deemed to agree to participate in the study. Participants were not paid or given any other form of compensation for completing the survey. 22 The Hospital Facility and Two Waiting Rooms The two waiting rooms used in this study were part of the Sparrow Health System. The Sparrow Health System, established in 1896, currently has in excess of six thousand employees, who work together to provide healthcare for the mid-Michigan area. Sparrow Health System is located in Ingham County, and the capital city of Michigan, Lansing. Lansing, with a population of 119,128, as of year 2000, consists of approximately 48 percent males and 52 percent females. The population consists approximately Of 61 percent White non-Hispanic, 22 percent Black, and 10 percent Hispanic (Lansing, Michigan, 2004). Sparrow hospital serves both inpatient and outpatient hospital-based care. Receiving accreditation by the Joint Commission on Accreditation of Healthcare Organizations, Sparrow hospital consists of primary and specialty care facilities, as well as a number of other services and facilities (Sparrow Health Systems, 2004). Waiting Room A: MRI/X-Ray Waiting Room A is located in the Sparrow Hospital’s Main building on the ground level. Both MRI and X-ray outpatients and patients’ companions share this room. Serving two different departments, the waiting room had two separate reception windows adjacent to each other. The patients stand at a small counter and talk to the receptionist through a half open window. Some patients had to fill out paperwork given to them by the receptionist. Clipboards were used for support while writing. The X-Ray department is open twenty—four hours a day, every day of the week. The MRI department opens twenty four hours a day Tuesday through Saturday, 6am to midnight Sunday and Monday. The waiting room serves walk-in patients, patients waiting for appointments, 23 and persons waiting to pick up x-rays. Patients consisted of both adults and children. The waiting room is approximately 335 square feet. This waiting room had light cream- colored walls and medium and dark tone carpet. The room contains both chairs with and without arms, two side tables and a magazine rack. A television was on in the corner of the room. There is no natural light in the room. The major light source comes from florescent light recessed into the ceiling, and reflected through baffled openings; fixtures were located next to the walls around half of the waiting room. There are also four recessed incandescent lights, two located near the reception windows, and one above each of the two entryways. In general, the average lighting for the waiting room is 13.8 footcandles. See Figure 1 Floor Plan of Waiting Room A for further room details. 24 Hallway to Examination Rooms 1‘ 1945i" i * Entry ‘T 4 _ I I I . ' I 9. II— c 5: Reception -— Waiting Area Area h j I l f _.l_... a... _. Hallway Figure 1. Waiting roomA N? 35,, Scale: No Scale a. Typical chair without b. Typical chair with mm c. Television: A.F.F. = 68" (1. Trash receptacle e. Table f. Magazin' e rack g. MRI Reception h. X-Ray/ Radiology Recepn'on 25 Waiting Room B: Diagnostic Center This waiting room is located in the Sparrow Professional building, which is located directly south across Michigan Avenue from the main hospital building on the ground floor. This waiting room opens Monday through Friday, 7am to 7:30 pm. Patients consisted of both adults and children. Waiting Room B is approximately 350 square feet. The waiting room serves walk-in patients and patients waiting for appointments for services including: Diagnostic center, Infusion center, Laboratory, Mammography, Pre operative testing, Pulmonary Function and Radiology/ X-Ray. The reception area of this waiting room has four reception counters, separated by small-half wall partitions, in which patients could talk while sitting at the counter. Receptionists collected information from the patients and entered it directly into the computer system. This waiting room had light cream-colored walls and medium and dark tone carpet. The room contained both chairs with and without arms, a table and a magazine rack. A television was on in the corner of the room, it also had a VCR but this was not on. The primary light source for the room was the natural light coming from the entry and the interior windows near the entry. There are also nine incandescent recessed lights through out the waiting room. In general, the average lighting for the waiting room varies quite a bit depending on the weather and the time of day. See Figure 2 Floor Plan of Waiting Room B for further room details. 26 Figure 2: Waiting room B ScalerNoScele 232634" ’//////////// WWfl/W/WWW/fl/fl/flfl/flflflm/flflfl/fl/ lit-Iii ‘ 31'. WaitingArea . —I ._l '== I=.D.’:_JEI. \-—» \\\\\\\\\\\\\\\\\\\\\\\\'\\\\\\\\\\\\ fi‘ 858? /... fi— \\\\\\ 27 \\\\\\\\\\\\\‘ \\\\\>\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\‘ L Instrumentation A questionnaire was developed in order to assess the patient and patient’s companion’s preferences of activities while in the waiting room, as well as, their priorities of environmental factors and degree of satisfaction. The questionnaire can be found in Appendix A. The first section of the questionnaire contained demographic questions relating to the characteristics of the participant. The questions included: age, gender, whether they were a patient or a patient’s companion, race, frequency and time spent in the waiting room and stress levels. The second section pertained to activity preferences of the participant in the waiting room. Questions were developed by the researcher based on previous similar studies Of activity preferences in different fields (Konrad, Kashlak, Yoshioka, Waryszak & Toren, 2001; Sherwood, Story, Neumark-Sztainer, Adkins & Davis, 2003). The seven- point Likert type scale was the primary format for this section of the questionnaire, along with rank order questions. Individual categories of activities were based on research observation and behavior studies of waiting rooms as well as previous studies found in the literature review (Tivorsak et al., 2004). The third section pertained to the participants’ preferences of environmental attributes and overall satisfaction with the waiting room. Environmental Factors and methods chosen for the questionnaire were developed by the researcher based on information found in the literature (Farrenkofp & Roth, 1980; Sherwood, et al., 2003; Tansik & Routhieaux, 1999). 28 Data Collection Environmental Conditions, including room temperature, relative humidity, sound and illumination levels were recorded for the hospital outpatient waiting rooms on the day the questionnaire was distributed. A Box Car Pro 4.3 Program was used along with HOBO loggers to measure the temperature and relative humidity. A Mannix sound level meter was used to measure sound. A Sylvania light meter was used to measure the illuminance levels. At this time, floor plans were drafted to demonstrate room dimensions and fumiture/equipment arrangement. The questionnaire was administered to all of the users in the two selected waiting rooms at Sparrow hospital. Overall, participants took approximately 15 minutes to complete the self-adrninistrated questionnaire. The questionnaires were distributed and collected while participants were in the waiting rooms. The questionnaires were distributed in six different time blocks, each consisting of approximately four and half hours. Each day consisted of two time blocks, categorized as either a morning or evening period. The data collection procedures are described below. A researcher, wearing a nametag, identified herself and distributed the questionnaires along with pens to waiting room users who agreed to participate. After handing the questionnaire to a voluntary participant, the researcher explained the consent form, voluntary participation and that a signature was needed on the consent form in order to complete the questionnaire. The researcher stayed in the room after distributing the questionnaires to answer any questions that the participants had. The consent letter also told the subjects to place the consent form in one box and the questionnaire in another box in order to ensure confidentiality. The consent letter box was labeled 29 “Consent letters.” The other box was labeled “Waiting Room Survey.” The two collection boxes were prominently placed by each other in the waiting room. Copies of blank consent forms were available, if a participant would like to have one. Although, the two boxes were present for participant to place their questionnaire in upon completion, the majority of the participants handed their and consent form and questionnaire back to the researcher when finished. When this happened the researcher placed them in the correct boxes. Data Analysis During the time of data collection 229 questionnaires were distributed. After all questionnaires were collected back from the participants, they were reviewed for level of completion and validity. Questionnaires with 13 or more incomplete answers were discarded. Furthermore, any questionnaires in which it appeared that the participant did not consider questions seriously were also discarded. For example, questionnaires with the same answer selected for the entire questionnaire, or those who suggested activities such as “oil wrestling” and “drinking beer” as alterative preferred activities were discarded. Therefore, 154 participants’ questionnaires were used to analyze the objectives of this study. All data collected from the questionnaire were tabulated, coded, and statistically analyzed in a manner designed to identify a list of evaluative criteria. Frequencies, percentages and measures of central tendency were calculated for the characteristics of the respondents and their preferences of the activities, importance and satisfaction of environmental factors for the hospital outpatient waiting room environments. 30 To analyze the statistical significance of preferred activity a paired t-test was used. To find out possible statistical significance of preferred activity between the two different user types (outpatients and companions) a two sample t-test was used. To analyze the statistical significance of users’ responses to importance of environmental factors a paired t-test was used. A two sample t-test was used to analyze the statistical significance of the importance of the environmental factors between the two waiting rooms. To find the statistical significance of the satisfaction with environmental factors a paired t-test was used. T o analyze the statistical significance of the users satisfaction with environmental factors between the two waiting rooms a two sample t-test was used. P- values equal to or less than 0.05 are considered to show a statistical difference. The more stringent p-value of equal or less than 0.01 was also indicated because of the use of multiple comparisons. (See Appendix C, questions 15 through 22.) Furthermore, a Pearson Correlation Coefficient was used to calculate correlation between similarly phrased questions of satisfaction with environmental factors to determine the statistical significance and consistency in user responses to temperature, light, noise, equipment/ furniture, privacy and view. 31 Chapter IV: Results Shunde(]uuuwnniuum As seen in Table 1 Demographic Profile of Respondents, the sample consisting of two Sparrow Hospital waiting rooms users (N = 154), 59.01% (n = 91) were patients and 40.91% (n = 63) were companions. Both females (62.33%, n = 96) and males (37.66%, n = 58) participated in the study. Although, over half of the sample was between the ages of thirty and fifty-nine years of age (64.23%, n = 97), the sample also included user ages 18 to 29 (13.91%, n = 21), and age 60 to 100 (21.85%, n = 33). The majority of the sample was Caucasian/ Non-Hispanic (82.24%, n = 125). Other races included within the sample were 7.89% African American/ Non-Hispanic (n = 12), 3.29% Hispanic (n: 5), and the remaining 6.58% consisted of Mexican American, American Indian, Asian American and others that were not included in these first six categories. Out of ninety-one patients, more than half of the patients did not bring a companion with them (65.93%, n = 60). Patients Often only brought one companion with them (72.41%, n = 21). The companion generally was a family member of the patient (87.30%, n = 55). Participants spent on average less than fifteen minutes (mean = 11.17, n = 143) filling out the questionnaire. The average time participants expected to wait was just under forty-five minutes (mean = 40.97, n: 141). Participants reported experiencing mostly medium to low amounts of stress while in the waiting room (mean = 5.272, n = 154). 32 Table 1 Demographic Profile of Respondents Sample Characteristics n N* Count Percentage (%) Gender 154 0 Male 58 37.66 Female 96 62.33 Age (years) 151 3 18 — 29 21 13.91 30 — 39 24 15.89 40 — 49 46 30.46 50 — 59 27 17.88 60 — 69 15 9.93 70 - 100 18 11.92 Race 152 2 Caucasian Non-Hispanic 125 82.24 Hispanic 5 3.29 African American Non-Hispanic 12 7.89 Mexican American 2 1.32 American Indian 1 0.66 Asian American 2 1.32 Other 5 3.29 33 (table continues) Table 1 (continued). Sample Characteristics n N * Count Percentage (%) User Type 154 0 Patient 91 59.09 Patient Companion 63 40.91 Patient brought a companion 91 63 Yes 3 1 34.07 N o 60 65.93 Number of people patient brought 91 63 None 62 68.13 1 21 23.08 2 5 5.49 3 2 2.20 more than 3 1 1.10 Companion relationship to patient 163 91 Family Member 55 87.30 Friend 4 6.35 Other 4 6.35 34 Table 2 Profile of Respondents: Time and Stress Sample Characteristics n N* Mean SD Time Spent Waiting Actual 143 11 1 1.17 minutes 14.55 User’s Expectation of 141 13 40.97 minutes 64.65 Stress* 154 0 5.272 1.796 *Calculated on 7 point likert scale (7 = Hardly any stress, 1 = Very stressed) Waiting Room Characteristics General data were collected from the waiting rooms, in order to make conclusions from the sample’s answers. Data such as room temperature, relative humidity, sound and levels of illumination were recorded by the reseacher. Both waiting rooms maintained, on average, a temperature of approximately seventy-two degrees Fahrenheit with an average humidity of approximately forty-two percent. See Table 3 Temperature and Relative Humidity during Time of Data Collection for recorded data of temperature and relative humidity of the two waiting rooms. 35 Table 3 Temperature and Relative Humidity during Time of Data Collection Day/ Room Temperature (° F) Relative Humidity (%) Minimum Maximum Mean Minimum Maximum Mean Monday Room A 71.77 72.46 72.15 41.1 44.3 43.4 Room B 70.39 72.46 71.55 36.8 42.0 39.52 Tuesday Room A 72.46 72.46 72.46 42.8 44.3 43.4 Room B 72.46 73.15 72.98 40.6 46.7 44.0 Wednesday Room A 71.77 72.46 72.12 41.5 43.3 42.5 Room B 71.77 72.46 72.29 39.0 44.0 41.1 Sound levels often varied between the two waiting rooms. Waiting Room A had a tendency to be quieter, with an overall mean of 57.4 decibels, during time surveying was taking place in the room. Waiting Room B had an overall mean of 62.1 decibels. Higher levels in Waiting Room B may be partly attributed to the large open entryway into the main lobby compared to the smaller entryways with doors in Waiting Room A. The overall mean for the sound levels for both rooms is 59.8 decibels. Forty to fifty decibels is considered to be a moderate sound sensation level, whereas sixty to eighty is considered to be loud. With forty decibels being equivalent to face to face conversation, and eighty decibel equivalent to a very loud cocktail party (Dechiara, et al., 2001). See 36 Table 4 Sound and Illuminance during Time of Data Collection for minimums, maximums and means of sound levels during time of surveying. There was also a great deal of difference in the levels of illumination found in the two waiting rooms. Waiting Room A averaged about 13.8 footcandles in the space. Without any source of natural light, Waiting Room A lighting remained the same. However, this was not the case for Waiting Room B, which had a great deal of natural light depending on the type of weather and time of day. Levels of illumination varied anywhere from 15 to 80 footcandles during the time of surveying. Twenty footcandles are recommend as a minimum, for a general office reception area, however this is for users who have fairly good eye sight (Dechiara, et al., 2001). Both waiting rooms seemed to have a variety of levels of lighting throughout the room. See Table 4 Sound and Illuminance during Time of Data Collection for recorded minimums, maximums and means levels of illumination recorded during time of surveying. 37 Table 4 Sound and Illuminance During Time of Data Collection Day/ Room Sound (dB) Illuminance (fc) Minimum Maximum Mean Minimum Maximum Mean Monday Room A 42.3 78.2 58.2 3 29 13.8 Room B 43.1 83.3 59.9 28 78 43.3 Tuesday Room A Low 81.8 52.1 3 29 13.8 Room B 45.5 82.1 63.2 15 42 26.7 Wednesday Room A 44.2 88.4 62.0 3 29 13.8 Room B 43.0 81.8 63.2 28 80 43.9 Reliability of Measures Reliability of measurement was not an issue for this study due to the fact that preexisting methods of measuring were used. A check of reliability of raw data entry was done in which ten questionnaires were picked at random using Minitab. Questionnaires 104, 53, 70, 91, 39, 61, 17, 113, 16 and 99 were chosen and reexamined to evaluate the reliability of raw data input. Through reexamination no errors were found. In addition, a Pearson Correlation Coefficient Test was used to examine the reliability of the participant’s answers to satisfaction with environmental factors. The correlation was based on participants’ answers to the question: “How do you feel about 38 the following conditions of the waiting room,” for each environmental factor. The first time the question was asked participants chose answers from a 7 point Likert scale based on, “Very Dissatisfied” to “Very Satisfied.” In the next section, participants were asked the same question but they must chose an answer from a 7 point Likert scale based on, “Inadequate” to “Adequate.” Correlations were all significant and achieved statistically significant positive correlation. Therefore, reliability of participant responses was consistent. See Table 5 Pearson Correlation Coefficient for User’s Satisfaction with Environmental Factors for calculated values. Table 5 Pearson Correlation Coefi‘icient for User’s Satisfaction with Environmental Factors** Environmental Factor Correlation P-value Temperature 0.456 0000* Lighting 0.404 0000* Noise 0.596 0000* Equipment] Furniture 0.467 0000* Privacy: Auditory Distraction 0.401 0000* View 0.728 0000* * P-value 5 0.01 **Table based on questions 15 through 22 of Questionnaire. Answers were based on a 7 point Likert scale: 7 = Very Satisfied to 1 = Very Dissatisfied, 2) 7 point Likert scale: 7 = Adequate to 1: Inadequate, (See Appendix C.) 39 Hypotheses Findings The following are the results based on respondents’ answers from the questionnaire. The data collected is presented according to the hypothesis for which the questions were intended to test. Hypothesis 1. While waiting in the hospital outpatient waiting room, the users most preferred activity will be: a. b. j. k. Watching television. Sitting and looking at things. Listening to music. Talking. Thinking, praying or meditating. Writing or doing paperwork. Working on the computer Reading. Eating/ drinking. Sleeping. Playing games. When participants were asked, “If given the choice to do any of the following activities which would you prefer to do while waiting in the hospital outpatient waiting room?” they were able to choose from a seven point likert scale which ranged from one representing “strongly dislike” to seven representing “strongly like”. All of the activities receive a minimum value of one and a maximum value of seven, although “Reading’s” minimum of one was an outlier. “Reading” (M = 6) received the highest median of all 40 activities. “Sitting and looking at things”, “Writingl. doing paperwork”, “Working on the computer”, “Eating/ drinking”, “Sleeping” and “Playing games” all shared the lowest median (M = 4). See Figure 4 Box plot of Users’ Preferred Activities for box plot of all ranges, medians, first and third quadrants and outliers of participant responses. The central box for each activity represents the first and third quadrants, with the bottom line of the box being the first quartile, the 25th percentile, and the top line being the third quartile, the 75th percentile. The line centered in most boxes represents the median which is the central distribution, the 50th percentile. If the median can not be seen in the center, then it lies either on the first or third quartile. Medians are also identified in the text, for easy identification. The lines that extend from the boxes represent the responses outside the first and third quartiles. The asterisks represent outliers, responses that fall outside the interquartile range by a multiple of 1.5 (Moore and McCabe, 2003). 41 User Activity Preference 7- 0" l [her Response 2» a a - N 1 ~ ‘16 e°° 956°” éc’ . 9Q . Qg $9 (6‘9 4S6? - g 25 9 . Q Q Q," .‘é‘ &- '\Q 9 '\° «e $0 (965’ a??? (65¢ a)??? (96‘ Figure 3. Box Plot of Users’ Preferred Activity Based on participant responses, ranks were given to activities according to the calculated mean of user activity preference. “Reading” (mean = 5.894) received the highest ranking. “Playing games” (mean = 3.473) received the lowest ranking. See Table 6 Mean and SD of Users’ Preferred Activities and Ranking by Mean for all activities’ ranks, means and standard deviations. 42 Table 6 Mean and SD of Users ’ Preferred Activities and Ranking by Mean Rank Activity Mean SD 1 Reading 5.894 1.223 2 Listening to Music 5.067 1.450 3 Watching Television 4.889 1.704 4 Thinking/ Praying! Meditating 4.841 1.646 5 Talking 4.632 1.543 6 Sitting and Looking at Things 4.253 1.737 7 Eating/ Drinking 4.134 1.815 8 Writing/ Doing Paperwork 4.087 1.741 9 Sleeping 3.770 1.785 10 Computer 3.581 1.881 1 1 Games 3.473 1.896 Calculated from 7 point scale (7 = strongly like, 1 = strongly dislike) In order to further understand the respondents’ preferences, a paired t-test was used to distinguish extent of difference between means. “Reading” (p-value = 0.00) achieved the lowest p-values when compared to all other activities. Therefore, this study finds hypothesis lg to be true, hypotheses la, 1b, 1c, 1d, 1e, 1f, 1h, 1i and lj were rejected. See Table 7 Results from Paired T-Test of Users’ Preferred Activities for the p- values comparing all activities. Numbers labeling the table are the rankings of factors found in Table 6. 43 Table 7 Results from Paired T-Test of Users’ Preferred Activities *** l 2 3 4 5 6 7 8 9 10 11 _ 000* 000* 000* 000* 000* 000* 000* 000* 000* 000* __ 0.23 0.15 000* 000* 000* 000* 000* 000* 000* _ 0.83 0.16 000* 000* 000* 000* 000* 000* _ 0.21 000* 000* 000* 000* 000* 000* _ 003* 000* 001* 000* 000* 000* __ 0.54 0.46 000* 000* 000* 7 . _ 0.92 0.03** 000* 000* 8 _ 0.09 000* 000* 9 _ 0.39 0.12 10 _ 0.57 11 _— * P-value _<_ 0.01 ** P-value g 0.05 *** Numbers representing activities by preference ranking: 1 = Reading, 2 = Listening to Music, 3 = Watching television, 4 = Thinking] Praying] Meditating, 5 = Talking, 6 = Sitting and Looking at Things, 7 = Eating] Drinking, 8 = Writing] Doing Paperwork, 9 = Sleeping, 10 = Computer, 11 = Games User’s were asked, “Are there other activities that you would like to do while waiting in the hospital outpatient waiting room? Please list if any.” The written responses to this question can be found in Appendix D. Hypothesis 2. Preferences of users’ activities will be different between patients and companions in the hospital outpatient waiting room. Responses to the question, “If given the choice to do any of the following activities, which would you prefer to do while waiting in the hospital outpatient waiting room,” when separated into two groups according to user type, did not indicate significant difference between patient and companion activity preferences. See Figure 4 Box Plot of Users’ Preferred Activities According to User Type for box plots of all ranges, medians, first and third quadrants and outliers for both patients’ and patient companions’ responses. Patient Preferences According to User Type 21 *l l" U! L l Lber Response .h I J I I I I l l l l‘ _ i‘: II. x ll u... H :4 4t 4t <1: 44 w 4t 44 {t 4 RP .~t> \ e a «’5 4‘“ $3” of $59 Q? 945’ (.9 \Oé\ $9 {9 4° \6) User: 1 = patient, 2 = patient companion Figure 4. Box plot of Users’ Preferred Activities According to User Type 45 Based on the means, a rank for each activity for both patient and companion was established. The rank order for patients varied from that of the companions. Four of the activities including: "Thinking/ praying] meditating”, “Watching television”, “Eating/ drinking”, and “Writing/ doing paperwork” were not ranked the same for the patients as they were for companions. The rest of the activity preferences remain in the same order. Using a two sample t-test, p-values were calculated comparing patients and companions’ activity preference. All p-values calculated were above 0.05. Therefore, hypothesis 2 was rejected, finding patient and companion preferences to be similar. See Table 8 Preferred Activities: Patients verses Companions for all recorded means, standard deviations and p- values of preferred activities when comparing patients and companions. 46 Table 8 Preferred Activities: Patient verses Companion Patient Companion Activity Mean SD Rank Mean SD Rank P—value Reading 5.741 1.311 1 6.091 1.077 1 0.074 Listening to Music 5.186 1.410 2 4.906 1.498 2 0.248 Watching Television 4.942 1.738 3 4.821 1.669 4 0.663 Think] Pray/ Meditate 4.849 1.523 4 4.831 1.808 3 0.948 Talking 4.558 1.576 5 4.727 1.504 5 0.502 Sitting] Look at things 4.119 1.624 6 4.435 1.878 6 0.289 Write] Do Paperwork 3.976 1.704 7 4.231 1.792 8 0.381 Eating] Drinking 3.930 1.858 8 4.413 1.729 7 0.105 Sleeping 3.667 1.897 9 3.906 1.630 9 0.411 Computer 3.500 1.883 10 3.694 1.887 10 0.539 Games 3.477 1.908 1 1 3.469 1.894 1 1 0.980 Hypothesis 3. Users will find the most important environmental factor in hospital outpatient waiting rooms to be: a. Temperature. b. Lighting. c. Noise. (1. Equipment and furniture. e. Location] access. 47 f. View. g. Privacy. When asked,” In general, how important do you feel the following environmental factors are within the hospital outpatient waiting room,” participants were able to choose from a seven point scale, one being very unimportant to seven being very important. “View” (M = 4) was the only environmental factor that did not achieve a median of six. See Figure 5 Box Plot of Importance of Environmental Factors by Users for box plot of all ranges, medians, first and third quadrants and outliers. Users' Perception of Inportance of Environmental Factors in Waiting Roorrs 7- 6-4 U1 I [Ber Response 4? 3_ l 2 _ 1 * * *r 9e )6 @‘Q’ e9” 69‘” «Six ex°° $6 443” K - § W Q? g\ \ QQ’ \v «9 . 52% \\9 «\Q ((3 é‘N «3X Figure 5. Box Plot of Importance of Environmental Factors by Users Based on participant responses, ranks were given to environmental factors according to the calculated mean of users’ perception of importance. “Temperature” 48 (mean = 5.649) received the highest ranking. “View” (mean = 4.377) received the lowest ranking. See Table 9 Mean and SD of Importance of Environmental Factors by Users and Ranking by Mean for all of the environmental factors’ ranks, means and standard deviations. Table 9 Mean and SD of Importance of Environmental Factors by Users and Ranking by Mean Rank Environmental Factors Mean SD 1 Temperature 5.649 1.770 2 Location] access 5.597 1.743 3 Noise 5.591 1.647 4 Lighting 5.575 1.657 5 Equipment and furniture 5.455 1.669 6 Privacy 5.253 1.667 7 View 4.377 1.879 Calculated from 7 point scale (7 = strongly like, 1 = strongly dislike) A paired t-test was used to further understand the respondents’ perceptions of importance and to distinguish the extent of difference between means. “Privacy” had a p- value less than equal 0.01 when compare to all other environmental factors except “Equipment and furniture”. “View” had a p-value less than equal 0.01 when compared to all other environmental factors. Therefore, “Temperature”, “Location/ access”, “Noise”, “Lighting” and “Equipment and furniture” were all found to be equally important with no statistically significant difference between the five factors. The hypotheses 3a through 3g 49 were rejected, finding none of the environmental factors to be more important than the others. See Table 10 Results from Paired T-Test of Importance of Environmental Factors by Users for the p-values found when comparing all environmental factors’ means. Numbers labeling the table are the rankings of factors found on Table 9. Table 10 Results from Paired T—Test of Importance of Environmental Factors by Users *** l 2 3 4 6 7 l _ 0.63 0.58 0.1 1 0.06 000* 000* 2 __ 0.95 0.84 0.12 000* 000* 3 _ 0.83 0.22 001* 000* 4 _ 0.16 001* 000* 5 _ 0.07 000* 6 _ 000* 7 __ * P-value g 0.01 ** P—value g 0.05 *** Numbers representing environmental factors by importance ranking: 1 = Temperature, 2 = Location] Access, 3 = Noise, 4 = Lighting, 5 = Equipment and Furniture, 6 = Privacy, 7 = View The data Of users’ perception of importance was also separated into groups: Waiting Room A and Waiting Room B. This was done to look for differences in responses due to the condition and environment of the waiting room. “Privacy” (A: M = 5, B: M = 6) and “View” (A: M = 4, B: M = 4.5) seemed to be the only two factors which 50 have different medians between the two rooms. See Figure 6 Box Plot of Importance of Environmental Factors by Users According to Room for box plot of ranges, medians, first and third quartile, and outliers. Importance of Environmental Factors to Waiting Room Users According to Room 7" '1, 6- u 2 5- I x r. 3. B 21 1 at it it re at x- x- re it as at Room V» Q) P ‘b v ‘2) R <2> v ‘6 Y Q) P ‘b '9‘ c9” 6"” (.08 8"" rod 46’ x ’0 x «I <80 ‘8” ’8 e e‘ Figure 6. Box Plot of Importance of Environmental Factors by Users According to Room Although there are differences between the two responses from the two rooms, it is minimal. Means were calculated for each factor for each room. Ranks were then assigned to the factors according to the mean. “Temperature” (A: mean = 5.513, B: mean = 5.782) was ranked number one in both rooms for having the highest mean. “View” (A: mean = 4.184, B: mean = 4.564) received the lowest rank, of seven, for both rooms. Responses for both rooms seemed very similar other than “Noise” and “Lighting” which have switched ranks. P-values were calculated from a two sample t-test using the factors 51 means for each factor. No statistical difference was found. See Table 11 Importance of Environmental Factors by Users According to Room for a complete list of means, standard deviations, ranks and p-values between the two rooms’ means for each factors importance. Table 11 Users ’ Perception Environmental Factors Importance According to Room Waiting Room A Waiting Room B Environmental Factor Mean SD Mean SD Rank P—value Temperature 5.513 1.829 5.782 1.711 1 0.348 Location 5.487 1.815 5.705 1.676 2 0.440 Noise 5.487 1.724 5.692 1.573 4 0.441 Lighting 5.447 1.708 5.701 1.606 3 0.345 Equipment] Furniture 5.382 L743 5.526 1.601 5 0.594 Privacy 5.079 1.655 5.423 1.671 6 0.201 View 4.184 1.958 4.564 1.792 7 0.211 Hypothesis 4. The environmental factor that users are the most satisfied with in the hospital outpatient waiting room will be: a. Temperature. b. Lighting. c. Noise. (1. Equipment and furniture. 52 e. Location] access. f. View. g. Privacy. When participants were asked, “How do feel about the following conditions of the waiting room,” user chose a response from a seven point likert scale ranging for one, “Very Dissatisfied,” to seven “Very Satisfied,” for each of the seven environmental factors. All answers ranged from one to seven, other than “Location/ access” which received a minimum value of two. “Temperature” (M = 6), lighting (M = 6), “Location and Access” (M = 6) all achieved the highest median, equaling six. “View” (M = 4) received the lowest median of all the factors. See Figure 7 Box Plot of Users’ Satisfaction with Environmental Factors for a box plot indicating median, first and third quadrants, range and outliers. 53 Users' Satisfaciton with Environmental- Factors in Waiting Rooms 7" l 6- i 5- % I I: 4- -—4 ".2 g 3" ’5 * x. 2- *- * it- 1- it- it (8' Q9 6, 6‘ CQ 6 {A "b 059% 9‘9\ 4’0 b (Fro 9&9! 6“? (<39 <8 SQ 6:" ‘9 ‘5‘ «e «a 03 <3" <3" Figure 7. Box Plot of Users’ Satisfaction with Environmental Factors Based on participant responses, ranks were given to environmental factors according to the calculated mean of users’ satisfaction. “Location/ access” (mean = 5.675) received the highest ranking. “View” (mean = 4.370) received the lowest ranking. See Table 12 Mean and SD of Users’ Satisfaction with Environment Factors and Ranking by Mean for all of the environmental factors’ ranks, means and standard deviations calculated. 54 Table 12 Mean and SD of Users ’ Satisfaction with Environment Factors and Ranking by Mean Rank Environmental Factors Mean SD Location] access 5.675 1.102 Temperature 5.591 1.245 Lighting 5.556 1.224 Equipment and furniture 4.916 1.499 Noise 4.708 1.567 Privacy 4.630 1.517 View 4.370 1.649 Calculated from 7 point scale (7 = strongly like, 1 = strongly dislike) The paired t-test was used to further understand the respondents’ satisfaction with the environmental factors and to distinguish the extent of difference between means. “Location/ access”, “Temperature” and “Lighting” are ranked the highest Of the environmental factors but when compared none of the p-values are statistically different. Therefore, hypothesis 4a - g were rejected, due to the fact that users did not find one individual environmental factor that they were most satisfied with. See Table 13 Results of Paired T—Test of Users’ Satisfaction with Environmental Factors for the p-values when comparing all environmental factors means. Numbers labeling the table are the rankings of factors found on the Table 12. 55 Table 13 Results from Paired T—Test of Users’ Satisfaction with Environment Factors *** l 2 3 4 5 6 7 1 _ 0.42 0.26 000* 000* 000* 000* 2 _ 0.51 000* 000* 000* 000* 3 _ 000* 000* 000* 000* 4 _ 0.12 001* 000* 5 _ 0.53 0.03** 6 _ 0.03** 7 _— * P-value 5 0.01 ** P-value 5 0.05 *** Numbers representing environmental factors by satisfaction ranking: 1 = Location] Access, 2 = Temperature, 3 = Lighting, 4 = Equipment and Furniture, 5 = Noise, 6 = Privacy, 7 = View The data of users’ satisfaction responses were also separated into two groups: Waiting Room A and Waiting Room B. This was done to identify differences in responses due to the variations in the waiting rooms’ environment. Satisfaction levels remained the same between the two rooms for “Temperature” and “Lighting”. All other factors seemed to vary between the rooms. See Figure 8 Box Plot of Users’ Satisfaction with Environmental Factors According to Room for box plot of all ranges, medians, first and third quartile, and outliers. 56 Users' Satisfaciton with Environmental Factors According to Room 7- ’ I 4" I I 3‘ ‘K is ‘K- * * Z-l as it It I Q) U'IO‘ User Response 1- as as as fil—T I I I I I I I I I I I Room v Q) v Q; is <2; v <22 v Q) v~