This study aims to investigate how hospital environmental stimuli influence inpatients' pleasure, trust in physicians and behavioral intentions (revisit and recommendation) in a large public–private partnership (PPP) city hospital in Türkiye. Drawing on the stimulus–organism–response (SOR) framework, the study conceptualizes hospital environmental stimuli as a multidimensional service environment comprising physical, functional and interpersonal cues experienced during hospitalization. The study specifically examines whether these environmental perceptions shape behavioral intentions directly and indirectly through pleasure and trust in physicians.
This cross-sectional study was conducted between August 2021 and March 2022 with 404 adult inpatients from the obstetrics and gynecology and physical therapy and rehabilitation units of Ankara Bilkent City Hospital. Relationships among environmental stimuli, pleasure, trust in physicians and behavioral intentions were analyzed. Scale validity and reliability were assessed using exploratory and confirmatory factor analyses, and structural equation modeling tested direct and mediating effects within the SOR framework.
Hospital environmental stimuli advanced technology, safety, ambience, layout and accessibility and physician and/or nurse care had significant direct effects on pleasure, trust in physicians and behavioral intentions. Pleasure and trust partially mediated the relationship between environmental stimuli and behavioral intentions, indicating that emotional and cognitive responses are critical pathways shaping patient behavior.
Several limitations of this study should be acknowledged. First, the sample consisted only of inpatients from the Gynecology and Obstetrics Hospital and the Physical Therapy and Rehabilitation Hospital of Ankara Bilkent City Hospital because survey permission was granted only for these units. Consequently, the findings may not reflect the experiences of patients treated in other departments. Second, purposive sampling was employed, which may have introduced selection bias and limited the representativeness of the sample. Third, the study was conducted in a single city hospital in Türkiye, limiting the generalizability of the findings to other city hospitals, healthcare organizations or different national contexts.
Given the relatively novel nature of city hospitals, healthcare managers and policymakers need a clearer understanding of how environmental stimuli shape patients' perceptions of service quality, emotional responses, trust in physicians and behavioral intentions. The findings suggest that investments in hospital environments should extend beyond functional infrastructure to include patient-centered design features that enhance comfort, accessibility, safety and overall service experience. By improving these environmental dimensions, hospital administrators can strengthen patients' trust in physicians, increase perceived service quality and encourage favorable behavioral intentions, such as positive word-of-mouth and revisit intentions. These findings provide practical guidance for managers and policymakers seeking to optimize patient experience and improve the effectiveness of large-scale healthcare facilities.
This study contributes to the literature by testing an established SOR-based framework in the organizationally distinctive context of a PPP city hospital in Türkiye, where evidence on patient experience mechanisms remains limited. Its value lies in demonstrating that hospital environmental stimuli are linked not only to behavioral intentions directly but also indirectly through inpatients' pleasure and trust in physicians, thereby offering an empirically grounded explanation of patient responses in a complex hospital setting.
