Unexpected utilization of servicescape dimensions to support customers experiencing vulnerabilities Open Access

Customers experiencing vulnerabilities – that is, customers experiencing states of powerlessness and a loss of personal control – require support to foster their individual agency (Baker et al., 2005; Koppenhafer et al., 2023; Russell-Bennett et al., 2024). Research shows that service providers can support customers through servicescape, defined as physical, social, socially symbolic and natural dimensions of service environments (e.g. An et al., 2023; Bitner, 1992; Rosenbaum and Massiah, 2011). The role of servicescape in supporting customers becomes accentuated in long-term care facilities, in which the residents who tend to experience complex vulnerabilities related to, for example, dementia and physical frailty, stay for an infinite time (Fleming and Purandare, 2010).

The existing body of research on servicescapes for customers experiencing vulnerabilities indicates that the servicescape influences the wellbeing and satisfaction of both the customers and service providers (e.g. Sag et al., 2018; Rosenbaum and Smallwood, 2011; Sweeney et al., 2023). Furthermore, extant studies also indicate that the utilization of servicescapes in surprising ways can support customers experiencing vulnerabilities, since a break from daily routines (Rosenbaum and Smallwood, 2011) and so-called positive distractions may positively influence the wellbeing of individuals experiencing vulnerabilities (e.g. Hole et al., 2025; Suess and Mody, 2018; Ulrich, 1991). However, there is a lack of empirical studies showing how the servicescape dimensions are utilized in this effort. Therefore, this study set out to investigate how customers experiencing vulnerabilities are supported through the unexpected utilization of servicescape dimensions.

The empirical research was conducted in long-term care facilities for older adults. We particularly focus on the temporary unexpected utilization of servicescape dimensions as used by visiting medical clowns. The visits of these professional artists are becoming more common in long-term care facilities for older adults in various countries. Medical clowns use improvisation and various techniques, including dancing, singing and storytelling, to create humorous moments and to establish a personal connection with residents (Warren and Spitzer, 2011). Previous research has shown that visits by medical clowns foster interaction, increase satisfaction and decrease the aggressiveness and anxiety of customers experiencing vulnerabilities (Gruber et al., 2015; Könsgen et al., 2019; Kontos et al., 2016; Rämgård et al., 2016).

This study contributes to the extant research in three ways. First, we contribute to servicescape research (e.g. Bitner, 1992; Rosenbaum and Massiah, 2011) by showing that all the different dimensions of the servicescape can be utilized also in unexpected ways in encounters with customers experiencing vulnerabilities. We particularly emphasize the importance of relationality in this, echoing Espitia et al. (2025), who call for emotional resonance and inclusivity in servicescapes. Second, we also identified different methods of the unexpected utilization of all servicescape dimensions for customers experiencing vulnerabilities. Third, we contribute to the research on customer vulnerability (e.g. Kabadayi et al., 2020; Ouschan et al., 2006) by identifying the ways in which customers experiencing vulnerabilities can be supported through the unexpected utilization of servicescape dimensions.

We begin this article by introducing the existing research on servicescapes, support for customers experiencing vulnerabilities and mitigation of customer vulnerability in healthcare services. The subsequent sections present the empirical research that was conducted, followed by a presentation and elaboration of the findings. The final sections of the article outline the study’s theoretical and managerial implications.

When the term “servicescape” was first used, it referred to a physical environment in which service took place, including the ambient conditions (e.g. temperature, air quality, noise, music and odor), spatial layout and functionality (including equipment and furnishings) and signs, symbols and artifacts (Bitner, 1992). The concept was later expanded to include the social dimensions (e.g. employees, customers, social density and the displayed emotions of others), socially symbolic dimensions (e.g. ethnic signs, symbols, objects and artifacts) and natural dimensions (i.e. natural restorative environments containing the following stimuli: being away, fascination and compatibility) (Rosenbaum and Massiah, 2011; cf. Han, 2007). It is increasingly acknowledged that servicescapes function as dynamic, interrelated systems of dimensions (Espitia et al., 2025).

Examples of empirical studies on servicescape dimensions and customers experiencing vulnerabilities are depicted in Table 1. It shows that through distinct servicescape dimensions, service providers can create diverse benefits – ranging from feelings of safety and security to increased engagement and interaction – or various unintended negative consequences (such as tension and unpleasant emotions) for customers experiencing vulnerabilities.

Past research reveals the complex interaction between servicescape design and customer vulnerability and shows that servicescapes can create, exacerbate or alleviate the vulnerability experienced by customers. First, when servicescapes fail to foster a nurturing and respectful atmosphere, vulnerabilities experienced by customers may arise or increase due to feelings of being dehumanized and unvalued. This was shown, for example, in studies highlighting a dignified and respectful care environment during childbirth (Bohren et al., 2015; Mwasha et al., 2023) and during transgender persons’ encounters with healthcare professionals (Carlström et al., 2021).

Furthermore, servicescapes that fail to adequately address safety concerns may create experiences of vulnerability among customers (Maher et al., 2022). In addition, services that foster feelings of captivity can intensify the vulnerability experienced by customers, as customers may experience a scarcity of choice, resulting in a reduced capacity for agency and a heightened dependency on service providers (Furrer et al., 2021). In addition, customers who enter the servicescape with differing conditions (such as developmental disabilities, blindness, deafness or physical disabilities) may be more sensitive to particular environmental cues, which can further result in increased experiences of vulnerability when interacting with servicescapes that do not cater to their particular needs (Rosenbaum et al., 2017).

The majority of research on servicescapes views them as stable, established spaces with fixed processes (Bitner, 1992; Rosenbaum and Massiah, 2011) and many studies on servicescapes for customers experiencing vulnerabilities focus on secure environments (such as hospitals and long-term care facilities) and, thus, also further emphasize the stability and predictability of servicescape dimensions (e.g. An et al., 2023; Leino et al., 2023). However, it has been noted that in these servicescapes, intricate dynamics are created by busyness, overcrowding and lack of privacy, which may lead to heightened levels of anxiety and distress among customers (Hung et al., 2017; Yap et al., 2022). The dynamism and instability of the servicescape dimensions have also been recognized by Kuppelwieser, Spielmann and Vega (2023), who studied crisis servicescapes, and noted that due to the uncertainties involved, these scapes are not always designed with established processes.

Furthermore, through the dimensions of servicescapes, service providers may create positive distractions for customers. The benefits of positive distractions in healthcare environments have been acknowledged (e.g. McCaul and Malott, 1984; Suess and Mody, 2018), since they provide positive emotions and calm behavior, and allow customers experiencing vulnerabilities to focus on something other than their own and the surrounding individuals’ conditions (Hathorn and Nanda, 2008; Iyendo et al., 2016; Pati and Nanda, 2011; Ulrich, 1991). Additionally, servicescapes that provide feelings of being somewhere unique (being away) can foster restorative opportunities for customers experiencing vulnerabilities (Dubost, 2025; Rosenbaum and Smallwood, 2011).

Customers experiencing vulnerabilities often benefit from tailored support that addresses their particular challenges (e.g. Valentin et al., 2025; Van den Berg et al., 2025). Kabadayi et al. (2020) note that this kind of support maximizes their wellbeing outcomes, which may lead to better physical health, longevity and mitigation of the detrimental effects of chronic illnesses (Diener and Chan, 2011; Ryff, 2014). In healthcare, wellbeing has been seen to include the subjective evaluation of the emotional, physical, social, financial and spiritual domains of life (Kabadayi et al., 2020).

Following Kabadayi et al.’s (2020) conceptualization of older adult care experiences, we see that support for customers experiencing vulnerabilities can be divided into empowerment, engagement, connection and dignity (see also Gressel et al., 2020; Koppenhafer et al., 2023). Individual-level empowerment refers to the process and consequences of efforts to exercise influence and control over the choices that have an impact on one’s life, including actions to achieve control and perceptions of personal control (Perkins and Zimmerman, 1995; Shearer, 2004). Empowerment seems to be particularly important for customers experiencing states of powerlessness (Baker et al., 2005; Koppenhafer et al., 2023); hence, it has been an important goal in transformative consumer research (e.g. Crockett et al., 2013; Mick et al., 2012).

Engagement can be characterized as the deliberate application of effort combined with emotional involvement or commitment (Lequerica and Kortte, 2010). It can be fostered through meaningful activities that require communication and the detection of the unique needs of each customer experiencing vulnerabilities (Coulter and Ellins, 2007; Kabadayi et al., 2020).

Social connection can be defined as feeling close to others (Lee et al., 2001), and the connection provided by the social environment and interpersonal interactions can give people a sense of being nurtured and supported (Kabadayi et al., 2020). This is important, particularly for people living in long-term care facilities; loneliness and social isolation are often prevalent among people living in these facilities, and they have been demonstrated to be linked to various psychosocial difficulties (e.g. low self-esteem), mental health problems (e.g. anxiety) and physical health issues (e.g. poorer immune functioning) (Crewdson, 2016; Heinrich and Gullone, 2006; Quan et al., 2020).

To be respected by others and to maintain one’s sense of self-worth is what is meant by dignity (Kabadayi et al., 2020). According to the definition provided by the Royal College of Nursing (2008), “Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals” (p. 8). Customers experiencing vulnerabilities need to feel that they and their needs, autonomy and privacy are acknowledged, and they should be treated as individuals, not as depersonalized members of a group of vulnerable customers (Kabadayi et al., 2020; Mann, 1998; Russell-Bennett et al., 2024).

Servicescapes can adopt particular spatial and temporal design tactics that support consumers experiencing vulnerabilities and enable consumer transformations (Gopaldas et al., 2022); however, these tactics typically require the capability to memorize service incidents (cf. Duerden et al., 2018). Thus, in the context of long-term care facilities where people are living with dementia, it is relevant to study how certain short-term events (in our case, the unexpected utilization of servicescape dimensions) can provide experiences of empowerment, engagement, connection and dignity. Even though these experiences may be just momentary for these residents, they can still be important at that specific moment (Dowlen and Keady, 2023) and also reflect on their moods and quality of life (Cho, 2018).

Past research has shown that mitigating customer vulnerability in healthcare requires a multifaceted approach, including both long-term development efforts and short-term interventions. Development efforts may contain, for example, the initiation of tailored services that consider the unique vulnerabilities experienced by customers with certain health conditions (Hare et al., 2013), the promotion of healthcare practices that support customer participation (Junaid et al., 2024) or better management of customer experiences throughout their healthcare journey (McColl-Kennedy et al., 2017; Sudbury-Riley et al., 2024).

Short-term interventions aimed at mitigating customer vulnerability in healthcare services entail a range of interventions designed to improve access to care and address specific needs. Interventions aimed at improving access through increased approachability, availability and the affordability of care services have been proposed to be associated with a reduction in both hospitalization and emergency department admissions (Khanassov et al., 2016). It is worth noting that even short-term interventions connected to healthcare services may serve to set the stage for beneficial long-term impacts (e.g. Gao et al., 2023; Yamaguchi et al., 2006).

The role of customers in mitigating vulnerability in healthcare services ranges from passive recipients to active co-creators. On the one hand, service providers take the entire responsibility of addressing vulnerability and providing tailored services according to the needs of vulnerable customers experiencing vulnerabilities (cf. Foucault, 1994), whereas, on the other hand, these customers actively initiate and cocreate service experiences (McColl-Kennedy et al., 2012). It is increasingly acknowledged that cocreation between customers and service providers is essential in addressing individual needs and empowering customers experiencing vulnerabilities (e.g. Moretta Tartaglione et al., 2018; Sharma et al., 2017). However, particularly regarding these customers, the active measures undertaken by service providers remain crucial in fostering an environment that encourages and facilitates such cocreation, thus increasing agency and independence (Carlini et al., 2024; Grech et al., 2025).

Long-term care facilities face particular challenges in mitigating the vulnerability of residents, many of whom are older adults with complex health needs. Many residents have dementia, characterized by cognitive decline, behavioral changes and functional impairments (WHO, 2025). Thus, communication with these residents may be limited, which can further increase the vulnerability that they experience. Furthermore, rapid changes in their conditions require service providers to adapt their communication and care strategies in real time (Rees et al., 2023). To address these challenges, in long-term care facilities for older adults, servicescapes are commonly built to support a sense of security, foster safe routines and convey the feeling of predictability for customers experiencing vulnerabilities (Leino et al., 2023; Sandberg et al., 2022).

Art-based interventions have emerged as promising methods for mitigating vulnerability in the healthcare context. For example, art therapy and the provision of art-based experiences have been shown to empower individuals experiencing vulnerabilities to express themselves and to connect with each other (Law et al., 2023; Worsley et al., 2022). Furthermore, these interventions may relieve anxiety and offer opportunities for individualized care (Moss, 2025).

We used qualitative approach to study how customers experiencing vulnerabilities are supported through the unexpected utilization of servicescape dimensions. Empirical data was collected in long-term care facilities for older adults because they can be seen as servicescapes in which support for customers experiencing vulnerabilities is constantly needed (e.g. Schoberer et al., 2016), in which the servicescape is typically built to support predictability and daily routines (e.g. Sandberg et al., 2022), and, consequently, in which the utilization of servicescape dimensions tends to be rather conventional and ordinary. Long-term care facilities provide service environments with round-the-clock care to people who require help with daily tasks because of complicated medical needs and increased vulnerability (Sanford et al., 2015).

The studied servicescapes were located in three long-term care facilities for older adults in a city in southern Finland. The chosen facilities varied in terms of location, size, features of the unit and ownership (see Table 2), but they were rather comparable in terms of the characteristics of the residents (the majority of the residents had dementia).

We focused on the unexpected utilization of servicescape dimensions as used by visiting medical clowns in these long-term care facilities. Medical clowns as an intervention stress the deviation from the ordinary, expected routines in servicescape, making also the potential impact more visible. Medical clowns (also called clown doctors) are specially trained professional artists who work in a wide range of healthcare settings and provide interventions to improve the overall environment and healthcare experience and to help the healthcare delivery. They use improvisational music, movement and theater techniques to interact with customers (Warren, 2008). Although improvisation always requires co-creation with customers, medical clowns are in the lead in these encounters: They use knowledge of residents’ abilities, previous history and interests to create tailored interactions with each resident (Warren and Spitzer, 2011).

In all, there were four medical clowns, called here as Mirthful Martha, Snappy Scout, Troy Tuneful and Cattie Cherry (pseudonyms). They worked in pairs and a clown pair visited each long-term care facility once a week for ten weeks (from 2022 to 2023), spending approximately 5 h in each facility per visit. The clown pair visited residents in their private rooms and circulated around the common areas of the facilities with the goal of interacting with each resident.

We sought and obtained a supporting ethical statement from our university’s Research Ethics Committee because the study involved individuals experiencing vulnerabilities. Residents or their family members (in cases where obtaining the residents’ written consent was not possible) signed the consent forms for observation and video recording. Even if the resident made a positive decision concerning participation, this comprehension of involvement was assessed and determined before observation. It was emphasized that the residents’ participation was entirely voluntary, that their privacy would be respected and that they could withdraw at any time without it negatively impacting their care or treatment.

Observation (making notes in notebooks and video recording) was regarded as a suitable method for data gathering since it enabled us to collect data on the servicescape from a first-hand perspective and to capture real-time utilization of servicescape dimensions. Additionally, a significant number of residents struggled with verbal expressions and communication challenges, and we estimated that less than 5 of the 34 informants would have been able to provide comprehensive and credible interview data. Residents’ family members were only in rare occasions present in the facilities during the clowns’ visit and, thus, were not interviewed.

Two researchers spent five days observing medical clowns visits to each facility. These observations were spread out equally over the course of ten weeks. The observations of the encounters between the medical clowns and the residents took place in the residents’ private rooms, in shared spaces and in the hallways. The encounters were captured on video camera and documented in field notes by the researchers. We observed residents’ reactions to the clowns’ behavior and activities and made notes about their interaction and participation. The residents paid little attention to the researchers or cameras since they were mostly interested about the clowns.

The resulting data set includes 82 video recordings (totaling 8 h and 10 min) and 153 pages (41,240 words) of field notes. The data collected concerning each resident is shown in Table 3. It shows that the nature and amount of data varied greatly between residents. This was because the conditions of residents varied and because some residents preferred to spend all their days in the dining room (which allowed us to collect lots of field notes but limited the possibilities for video recording because in shared spaces there were also residents who did not participate in our research).

The structured data analysis started after all field notes were reviewed and all video recordings were viewed. The video recordings, which included medical clowns utilizing servicescape in unexpected ways, were annotated and partially transcribed. After this, a loose analytical framework was established. It included the dimensions of the servicescape, their utilization in unexpected ways, and the related support for customers experiencing vulnerabilities.

The data analysis utilized both deduction and induction. We started deductively by using the established division of servicescape dimensions (e.g. Bitner, 1992; Rosenbaum and Massiah, 2011) and the support categorization of Kabadayi et al. (2020). This helped us detect the dimensions and the main categories of support. However, as we wanted to scrutinize the unexpected ways of the utilization of the servicescape dimensions and the distinct types of support, we classified the subcategories inductively, thereby allowing novel interpretations to arise from the data.

Based on the nuanced observations on residents’ reactions to the clowns’ behavior, we also made interpretations on the support received by the residents. We observed residents’ gestures and behaviors in addition to their vocal expressions, paying close attention to any changes, always considering the unique characteristics of the individual in question. For instance, we noted if an anxious, hyperactive resident calmed down and seemed to relax, or if a motionless, expressionless resident suddenly smiled subtly.

Although the first author started the analysis, it was modified and validated by the three other researchers who had all taken part in the data collection and, consequently, in the preliminary stage of data analysis during observations. In all, six iteration cycles were required for the data analysis. The researcher team’s co-created understanding is displayed in the following findings section, in which pseudonymized quotations are utilized to support the analysis.

Medical clowns used versatile dimensions of the servicescape in the encounters with the residents of the long-term care facilities. Regarding the physical dimension medical clowns, for example, paid attention to the temperature (as ambient condition) and made exaggerated efforts to either cool down or warm up the residents. The residents welcomed these attempts and seemed to enjoy the attention from the clowns. The clowns also often used improvised or ready-made music (singing, playing an instrument or playing music from sound reproducers) in the encounters with the residents. The spatial layout and functionality were also sometimes used: clowns ran and marched in the long corridors and used the big dining rooms and lounge areas as their playing fields. Furthermore, when the residents noted that the clowns were not capable of using spatial elements (such as doors) properly, they were seemingly amused. The same amusement was noticed regarding the improper use of artifacts (such as chairs). Sometimes, the clowns carried bags containing different artifacts (such as balls or magic coloring books) that they used when communicating with the residents. The most often-used artifact was a toy dog, which was treated as a real, living creature.

Since interaction with residents is the cornerstone of the behavior of medical clowns, it is natural that social dimension was emphasized in the encounters. However, in addition to the interaction between a clown and a resident, clowns also created and supported interactions among the residents. Socially symbolic dimension was not particularly accentuated in our data, but since our data collection took place around Independence Day, and since many residents had experienced Second World War, the clowns highlighted their achievements, which seemed to create pride among residents.

Even though the clowns worked indoors, natural dimension was often also highlighted. The residents were eager to know about the weather outside, and the clowns responded to their queries by highlighting the current weather elements, making sounds of raindrops, imitating the sound of wind and exaggerating the feelings of hot weather by mimicking feelings caused by scorching sunshine and heat. They also spent time looking out of the windows with the residents and, in a vivid manner, discussed the animals and trees they saw outside.

In sum, this section displays the variety of servicescape dimensions utilized by medical clowns. The next section discusses how the servicescape dimensions were used and thus clarifies the unexpected utilization of these dimensions in more detail.

The dimensions of the servicescape were used in multiple ways. In the data analysis, we inductively detected different methods that could be grouped into five main categories of methods: drawing residents’ attention to a particular dimension of the servicescape, transforming the space into something else, transforming the resident into something else, transforming an object into a living being and unconventional utilization of the dimensions of the servicescape (see Table 4).

When medical clowns drew residents’ attention to a certain servicescape dimension, they often either emphasized problems with the dimension (such as a clown getting stuck in a doorway) or vociferously admired the beauty of the dimension:

When the clowns wanted to emphasize a servicescape dimension, they also used an empty picture frame, which they occasionally carried with them. They either placed the frame between the resident and the clown, or they placed the frame around a certain element of servicescape (such as a vase filled with roses) and admired “the painting” together with the resident.

A typical way of unexpected utilization of servicescape dimensions was to fictitiously change a servicescape dimension (space, resident, object) into something else. With this approach, only imagination sets the boundaries. Examples of the transformation of the space into something else included turning the corridor into basketball court, dancehall and lecture room; turning the dining room into an Argentine tango room, discotheque and Ewing family home (from the Dallas TV series); and turning the resident’s room into a dancing room, skiing track, football court and Venice. The latter is described as follows:

Besides spaces, medical clowns also playacted a resident being transformed into something else, such as a house, a piano, a painting, a cat – or even the Earth’s orbit. Sometimes, the residents participated actively in role plays, as Wilma did:

Play related to animals was also used when the clowns playacted an object being transformed into a living being. In this way, they frequently presented a toy dog that was treated like a real dog by both the clowns and the residents. Furthermore, medical clowns also used other methods of unconventional utilization of the servicescape dimensions. They slept on the armrests of the chairs, sat upside down (head pointing to the ground) on the sofa, and danced while sitting down by moving their feet in the air.

To sum up, the medical clowns utilized the dimensions of the servicescape either by drawing attention to a particular dimension of the servicescape, by fictitiously changing a dimension into something else, or by using the dimension in another, unconventional way. These behaviors evoked both interest and amusement in the residents. The ways in which these behaviors supported the residents are discussed next.

Unexpected utilization of servicescape dimensions also indicated the creation of support for customers experiencing vulnerabilities. We identified several subcategories of support that could be further grouped using the types of support discussed in the theoretical background section: empowerment, engagement, connection and dignity (see Table 5).

It is worth noting that our data did not reveal a particular pattern or taxonomy of linkages between the way in which the servicescape was utilized and the type of support for the customers experiencing vulnerabilities. Rather, it seemed that using diverse ways of unexpected utilization of servicescape dimensions enabled the clowns to interact and connect with customers who had differing conditions, needs and moods, which also fluctuated over time.

Empowerment was created by asking advice from a resident, asking opinions of a resident, praising a resident, comforting a resident, solving a problem together with a resident and sharing secrets with a resident. An example of the latter was observed when a medical clown revealed a romantic secret to Phil in his room in Ixora:

This, and all the other types of empowerment, seemed to increase the influence and control of the residents. Residents’ engagement was supported by giving full attention to residents, asking residents questions and making residents curious. In the latter, the appearance and dressing of clowns was often utilized to evoke curiosity, as shown in the following:

The increased engagement was sometimes manifested in active participation in the discussion, sometimes in just an active monitoring of the situation and sometimes in active gestures or the clown and the resident mirroring each other’s behavior.

Sometimes, the clowns did not try to engage the residents, but instead fostered their social connections. This was done by making the similarities between the clown and a resident explicit, by the clown imitating a resident, and by supporting residents’ connections with each other:

We also noted that the interaction between the residents often continued for some time after the clowns left elsewhere.

The clowns emphasized frolics and laughter but tried to do it with dignity. They treated the residents in a courteous manner and, for example, always asked for permission to enter residents’ rooms and sing or dance. The residents seemed to welcome the politeness, but it ought to be acknowledged that a few residents seemed to be slightly annoyed by the presence of the medical clowns, and in some cases, we interpreted this as stemming from their experience that clowns were not “serious” with them. These residents typically did not have considerable memory disorders and preferred to spend time in their own rooms – away from those living with dementia. They highlighted their sharp wit and mentioned that they did not like to play. Thus, these residents may have experienced the playful interactions with medical clowns as disrespectful or otherwise personally unpleasant, which may have even amplified their experienced vulnerability.

In summary, the unexpected utilization of servicescape dimensions by medical clowns supported the residents in various ways, especially through fostering residents’ empowerment, engagement and connection, and, thus, creating both elevating and reassuring experiences. Support through dignity was also noted, but it was occasionally challenging due to the different states of the residents. These different types of support seemed to evoke immediate positive emotions (such as happiness, enthusiasm and pride) and thereby increased customer wellbeing. Even though the residents may not recall these experiences and emotions afterward, they seemed to be meaningful for the residents in the particular moment. This aligns with the current research proposing that momentary experiences of positive emotions have an important role in the wellbeing of those living with dementia (Miklitz et al., 2024; Phinney, 2016; Son et al., 2002). We did not study the long-term effects on customer wellbeing, but we based this interpretation on the findings of previous studies (e.g. Cho, 2018; Huang and Yuan, 2024) on short-term interventions on the wellbeing of customers living with dementia, and we assume that the clown visits promoted wellbeing even when individuals did not consciously recall these experiences.

Figure 1 summarizes the findings related to different methods and outcomes of the unexpected utilization of servicescape dimensions for customers experiencing vulnerabilities. This research contributes to service marketing theory in three ways. First, we advance the field of servicescape research by showing that all the dimensions of servicescapes identified by Bitner (1992) and Rosenbaum and Massiah (2011) can also be utilized in unexpected ways in encounters with customers experiencing vulnerabilities. Our findings showed that medical clowns used all the dimensions (physical, social, socially symbolic and natural) and purposefully created positive distractions for customers by using these dimensions. This supports the notion of dynamic servicescapes (Kuppelwieser et al., 2023), where emotional resonance and inclusion are essential (Espitia et al., 2025), but extends the discussion to servicescapes in which stability and predictability have often been highlighted in healthcare servicescapes (e.g. Gopaldas et al., 2022) and other utilitarian servicescapes (Nair et al., 2022).

Our study reveals that even in these servicescapes, there is room for services that purposefully create unpredictability and surprise for customers and thus increase the potential for the innovative use of those servicescapes that have often been perceived as rather stable. This notion is important because it has been shown that positive, unpredictable distractions in healthcare servicescapes may positively influence customer experience and wellbeing (e.g. Pati and Nanda, 2011; Suess and Mody, 2018). Furthermore, our study indicates that the features traditionally connected to hedonic servicescapes – that is, excitement, playfulness and entertainment (Kumar et al., 2017) – may have untapped potential that could also be harnessed for healthcare servicescapes.

Second, we also identified different methods of the unexpected utilization of servicescape dimensions for customers experiencing vulnerabilities: service providers may draw the customer’s attention to a particular dimension of the servicescape, fictionally transform the space, the customer or an object into something else or use the dimension of the servicescape in another, unconventional way. The application of these methods was largely improvised so that the encounters also contained unexpectedness for those customers who recalled the medical clowns and expected their visits. These methods may help to include aspects of novelty and innovation in servicespaces that as a whole are – and need to be maintained as – stable and secure, such as long-term care facilities for older adults (cf. Leino et al., 2023; Sandberg et al., 2022). Furthermore, it seems that these methods help support customers who may otherwise be rather inactive and unresponsive. This leads to the following third contribution.

Our third contribution adds to the research on customer vulnerability and extends the understanding of supporting customers experiencing vulnerabilities through servicescapes. Our findings provide empirical evidence supporting existing research (Gao et al., 2023; Yamaguchi et al., 2006) that short-term interventions can mitigate customer vulnerability in healthcare services. Our empirical findings are in line with the conceptual proposal by Kabadayi et al. (2020), in which support can be divided into empowerment, engagement, connection and dignity. However, the partly inductive analysis used in our study provided an important opportunity to identify the subcategories of these support types (see Figure 1). Identifying different types of support is important because customized support has been stated to optimize the wellbeing of customers experiencing vulnerabilities (Kabadayi et al., 2020). This was also shown in our study, for example, in the challenges related to giving support through dignity.

Instead of showing specific linkages between the way in which the servicescape was utilized and the type of support for customers experiencing vulnerabilities, our findings suggest that the connection between these types of utilization and support is dependent on the spatial and temporal context in which the servicescape utilization takes place. The context includes the state of a customer (e.g. condition and mood) at the time of the encounter. Furthermore, as both the state and context are constantly evolving, servicescape utilization requires a dynamic and improvised interaction that allows for greater customization in healthcare.

In the context of customers experiencing vulnerabilities, this study indicates that, on the more abstract, general level, the support can be seen to consist of elements that create elevating and reassuring experiences, which are both relevant for mitigating vulnerability. These outcomes of elevation and reassurance respond to the goals that are set for service collaborations to elevate the human experience and to provide transformative improvements in wellbeing (Fisk et al., 2020).

Life expectancy is rising, and consequently, so is the number of individuals in need of long-term care, and therefore, it is necessary to develop resource-efficient ways to improve customer wellbeing. Our findings imply that service providers can support customers experiencing vulnerabilities through the unexpected utilization of servicescape dimensions. We showed different methods that service providers may use in this process, making the scape dynamically adaptable to particular customer needs. Customers experiencing similar vulnerabilities, however, need to be treated individually. Thus, to succeed in the unexpected utilization of servicescape dimensions, service providers need to constantly assess and respond to customers’ conditions and emotional states. This may require additional training focusing on emotional intelligence, interaction and improvised methods. Collaboration between healthcare service providers and professional medical clowns may be utilized for a transformative impact that can be achieved through boundary-crossing services and unexpected ways of using the servicescape dimensions.

Feelings of identity confirmation, belonging and social contact have been regarded as enhancing one’s quality of life (e.g. Phillips, 2006). However, moving to a long-term care facility may often increase the social isolation of the customer (Boamah et al., 2021; Leino et al., 2023; Paananen et al., 2025); therefore, it is essential to take care of the social wellbeing of these customers. Studies have also shown that adding personal dimensions to interactions and behaving informally can enhance the quality of interactions in the context of long-term care facilities (Rannikko et al., 2023). Our study shows that novel ways of using servicescape dimensions can play a role in this and increase interactions between service providers and customers, as well as among customers.

Furthermore, when developing services for customers experiencing vulnerabilities, service providers can deliberately emphasize the particular types of support identified in this study. Through these support types, service providers can both elevate and reassure customers. These positive impacts may extend to other social interactions in the servicescape and thus potentially decrease negative customer-to-customer interactions (cf. Furrer et al., 2023) and negative spillovers (cf. Sandberg et al., 2022).

Our research has a few limitations that should be addressed in future studies. First, our interpretation of the unexpected utilization of servicescape dimensions was formed by observing the visits of medical clowns in the long-term care facilities; thus, we may have neglected the residents’ feelings related to the unexpectedness that were not visible for observers. Therefore, more research is required to validate our results.

Second, while this research provides an extensive analysis covering all the servicescape dimensions identified by Bitner (1992) and Rosenbaum and Massiah (2011) and all the support types suggested by Kabadayi et al. (2020), and even though this study advances and deepens our understanding of these extensively used classifications, our partially deductive analysis is also limited by these classifications. Pure inductive analysis could have brought up different insights.

Third, our data was collected in long-term care facilities for older adults and thus applying findings to other contexts involving diverse customer vulnerabilities needs to be completed using caution. Consequently, future studies should extend our findings with data from different contexts.

Finally, we propose that the unexpected utilization of servicescape dimensions can also have potential relevance beyond primary customers through positive spillovers in a servicescape (Sandberg et al., 2022), meaning that for a secondary customer (typically a family member), support received by the primary customer can be very meaningful and comforting (Leino et al., 2021). Thus, the unexpected utilization of servicescape dimensions can have extended implications for customer entities. Our data provided indications of this phenomenon, but since the focus of this study was on primary customers, further research is needed to analyze the implications for family members. In addition, the influence on other service personnel (e.g. nurses) would also need to be examined.

While the existing studies on servicescapes for customers experiencing vulnerabilities have emphasized the stability and predictability in servicescape dimensions, our research shows how the servicescape dimensions can be utilized in unexpected ways to support customers experiencing vulnerabilities. We identify different unexpected ways of utilizing servicescape dimensions and show the related diverse ways of support for customers experiencing vulnerabilities. Recognizing this wider potential that has so far been partly hidden in servicescape dimensions is important for both services marketing research and for better and more targeted service for individual customers experiencing vulnerabilities.

The authors are grateful to the Foundation for Economic Education for supporting this research.