An interdisciplinary mixed-methods systematic review of multidimensional factors shaping the outpatient waiting...

Patient satisfaction is a central indicator of healthcare quality and a key outcome in outpatient care. The waiting room, as the first point of contact, strongly shapes patients' comfort, expectations, and perceptions of service quality. Yet most existing studies remain confined within single disciplinary domains rather than integrated relationships among them. This lack of cross-disciplinary synthesis limits theoretical understanding and practical guidance. A systematic review is therefore needed to develop a comprehensive framework for improving outpatient experiences and supporting evidence-based design.

A mixed-methods systematic review was conducted following PRISMA 2020 guidelines to identify major research themes and determinants of patient satisfaction in outpatient waiting rooms. Literature was retrieved from Scopus (2010-2024) using a modified PICO framework adapted for environmental and experiential variables. Quantitative bibliometric mapping analyzed keyword co-occurrence and thematic evolution across three periods, complemented by qualitative coding and thematic synthesis to interpret mechanisms and integrate findings.

This review included 125 studies, 113 research articles and 12 reviews (9.6%), with most appearing in medical/clinical outlets (n = 71; 56.8%), alongside contributions from the social sciences, nursing, engineering, psychology, and management. Across 2010-2014, 2015-2019, and 2020-2024, thematic emphasis shifted from service-quality-focused work toward broader patient-experience and built-environment perspectives, reflecting increasing cross-disciplinary integration. Quantitative mapping and the qualitative synthesis consistently organized determinants into five dimensions: physical environment, healthcare service experience, patient characteristics, perceptual environment, and mediating pathways. These results collectively informed the development of an integrated conceptual framework that structures the field around these five dimensions and their dynamic interactions.

This review consolidates dispersed findings into a multidimensional framework explaining how environmental, psychological, and service-related factors interact to shape patient satisfaction. The proposed framework offers a comprehensive basis for future empirical work and provides practical guidance for the holistic design and management of outpatient environments across disciplines.