Comfortable seating. A building that conveys dignity. Meaningful privacy. These may seem like baseline expectations in healthcare, but not all buildings have them, and research from Providence and NBBJ shows they are powerful drivers of patient satisfaction.
That’s because these environmental cues do more than shape first impressions. They influence how patients engage in their care. And when people feel respected and secure, they are more likely to trust providers, share critical information and follow treatment plans, directly improving health outcomes.
This research, called Design for Belonging, focuses on ambient belonging, the environmental cues that influence whether patients feel welcome or excluded.
To generate the insights, Providence and NBBJ studied six emergency departments in Oregon, collecting 1,656 patient surveys alongside seven focus groups. Together, these methods reveal a clear correlation between building design, environmental conditions and patient satisfaction, as measured through Press Ganey and HCAHPS surveys.
The Design for Belonging Initiative
A person should have privacy when discussing medical issues. Everyone can hear everything. It was embarrassing."
— Patient Survey Response
The doors are so far from parking. I’m handicapped and find it very difficult to access the walk-in clinic when sick."
— Patient Survey Response
Top Design Interventions that Improve Patient Satisfaction
The survey evaluates healthcare facilities across four human needs—comfort, safety, connection and acceptance—linking design performance directly to patient experience.
One key finding is the three priorities patients find most critical to the arrival experience: clear visibility of the emergency department, an intuitive path from parking and a weather-protected entrance. The study shows that experiences during arrival, check-in and waiting strongly shape overall perceptions of care, illustrating how early design cues build trust and satisfaction.
Among the six EDs studied, facilities scoring lowest in essentials like warmth, seating and privacy received the poorest experience ratings, while higher belonging scores consistently correlated with higher patient satisfaction.
The following design interventions are consistently correlated with improved satisfaction, both during arrival and once inside the building:
Clear, Protected Entrances Healthcare buildings with clear, easily accessible and weather-protected entrances see higher satisfaction scores, especially among patients with disabilities and older adults.
Culturally Reflective Artwork and Graphics: When artwork reflects local or cultural identities, patients feel more seen and respected, elevating ratings tied to dignity and inclusion.
Temperature Control and Seating Variety Locations that provide adequate seating and temperature control report higher ratings for comfort and safety, reinforcing the importance of physical comfort as a foundation for satisfaction.
Privacy at Check-In Adding partitions, spacing, or visual shielding at registration desks increases perceived respect and reduces stress for patients during intake.
Differentiated Waiting Areas Clinics and hospitals that offer sub-zones with varied lighting, acoustics and privacy levels allow patients to choose their preferred environment—leading to greater comfort and calm.
Space for Companions: Providing seating and accommodation for loved ones reinforces feelings of support and belonging, correlating with higher satisfaction.
Patients’ perception of their environment affects their level of engagement in their care and quality outcomes.”
— Jessica Monego, MSN BSN RN NE-BC Director of Nursing, Providence Portland
Emergency Department
Multilingual, Legible Signage Sites that improved wayfinding clarity—particularly through multilingual signage—reduce anxiety and improve satisfaction scores across diverse patient groups.
Together, the findings show that meeting basic needs is foundational to satisfaction.
Once these basics are in place, signals of respect and inclusion—such as multilingual signage, culturally relevant artwork and space for companions—emerge as meaningful differentiators in how patients perceive care.
Across sites, stronger environmental quality consistently aligns with higher belonging scores, higher patient satisfaction and fewer adverse incidents, including “Left Without Being Seen” and “Code Gray” events.
Taken together, the data reinforces a clear conclusion: design is not peripheral to care, but a measurable contributor to trust, safety and outcomes.
Warmth
Seating
Privacy
Basic Needs Met
The findings from Providence and NBBJ align with lessons from other healthcare projects:
When Belonging Goes Beyond Baseline
Belonging is Community
Seattle Children's Odessa Brown Children's Clinic Reflecting a long-standing commitment to whole-family, culturally grounded care, this children's clinic is designed for and with the community. Large, flexible waiting areas accommodate families of all sizes, while artwork celebrates neighborhood identity and creates a sense of welcome.
Belonging is Joy UCSF Stad Center For children and families facing pain treatment, palliative care and physical therapy, the center embodies joy and choice, aligning with the insight that comfort and control improve satisfaction. Protective waiting nooks provide respite, while a digital waterfall and uplifting graphics infuse the care journey with play.
Belonging is Connection OHSU Inpatient Addition Designed to meet the growing need for care in the Portland and Southwest Washington State, the project highlights connection to place through nature and artwork, echoing the data showing that inclusive, familiar visuals elevate belonging and engagement.
Design That Drives Patient Satisfaction and Outcomes
Creating spaces that signal safety, dignity and respect is not about surface aesthetics—it is about measurable impact. Across six emergency departments, higher belonging scores consistently correlate with higher patient satisfaction and lower stress-related incidents. These findings confirm that inclusive design is a strategic investment in trust, engagement and operational performance. Lauren Cole is system director of design strategy at Providence Health (Renton, WA).
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A clear view of ED front door
Easy access from parking to building
Entrance protected from weather
Exterior lighting
Security officer
Access to a wheelchair
Signage in my language
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Top survey factors that influence satisfaction during the arrival experience.