Cleanliness, Waiting Time and Ventilation Shape Physiotherapy Patient Satisfaction More Than Previously Thought

Patient satisfaction has long served as one of the most widely used indicators of health-care quality, yet the research underpinning it has often concentrated on a narrow slice of the clinical experience. In physiotherapy especially, studies have tended to spotlight therapist-related attributes, such as communication style, empathy and technical competence, while paying far less attention to the physical environment of the clinic and the practical realities of access, including how long patients wait before being seen. A new cross-sectional study conducted at a Turkish university hospital now offers a more complete picture, showing that factors as seemingly mundane as perceived cleanliness, waiting time and the quality of ventilation and heating can independently shape how satisfied patients feel with their care.

The research, carried out in the physiotherapy and rehabilitation outpatient clinic of a hospital in Malatya, Türkiye, surveyed 198 patients between November 2023 and February 2024. Notably, this period fell in the aftermath of the February 2023 Kahramanmaraş earthquakes, a context the authors explicitly flag as important when interpreting their findings. Participants completed the 29-item Outpatient Patient Satisfaction Scale, which yields a mean item score ranging from 1 to 5, alongside questions covering sociodemographic characteristics, admission-related details and features of the hospital environment.

The headline result was that overall satisfaction fell in the moderate to high range, with a median total score of 3.7 and an interquartile range of 3.1 to 4.1. Within the scale, the staff attitude subscale scored highest, suggesting that interpersonal aspects of care remained a relative strength, while the waiting time and counselling subscale scored lowest. The instrument itself demonstrated excellent internal consistency, with a Cronbach’s alpha of 0.962, indicating that the 29 items hung together remarkably well as a measure of the overall outpatient experience.

To move beyond simple associations, the researchers employed multivariable linear regression, a statistical technique that allows each factor’s independent contribution to be estimated while holding all other measured variables constant. Cleanliness and ventilation/heating were entered as indicator variables, allowing the model to capture graded differences between response categories rather than treating them as simple yes-or-no attributes. The model achieved an adjusted R-squared of 0.331, meaning that roughly a third of the variation in total satisfaction scores could be explained by the factors examined.

The findings on cleanliness were particularly striking. Compared with patients who rated the clinic as very clean or clean, those who described it as clean but not adequate showed a reduction in total satisfaction score of 0.469 points, while those who said it was not clean showed a reduction of 0.986 points, both statistically significant at p less than 0.001. This graded pattern, in which satisfaction declines stepwise as perceived cleanliness worsens, suggests that even intermediate levels of perceived inadequacy carry a measurable penalty, and that improvements in cleaning standards could yield proportional gains in patient experience.

Waiting time also emerged as an independent predictor. For every additional minute of examination waiting time, the total satisfaction score dropped by 0.005 points, a small per-minute effect that nonetheless accumulates meaningfully over longer waits. Similarly, patients who rated the ventilation and heating system as could-be-better rather than adequate showed a 0.260-point reduction in satisfaction, independent of other factors. Female sex was also associated with a lower total score, with a coefficient of −0.209 and a p-value of 0.041, although the robustness of this particular finding proved more fragile under sensitivity testing.

Indeed, the authors took care to probe the stability of their results. Influence diagnostics identified 11 observations with disproportionate leverage on the model, and when these were excluded, the associations with cleanliness, waiting time and ventilation/heating remained materially unchanged. The association with female sex, however, was no longer statistically significant in that sensitivity analysis, a reminder that single-variable findings in moderately sized cross-sectional samples should be interpreted with appropriate caution until replicated in other settings.

What makes this study notable is its reframing of what matters in outpatient physiotherapy. The physiotherapy literature has historically emphasised the therapeutic relationship, the skill and demeanour of the therapist, and the quality of the hands-on intervention. Those elements remain important, and the high score on the staff attitude subscale in this study suggests they are being delivered well. But the regression results indicate that even when interpersonal care is strong, patients notice and are influenced by the state of the physical environment around them, by how long they sit waiting, and by whether the room feels adequately heated and ventilated. These are modifiable factors, often addressable through operational and facilities management rather than clinical retraining.

The post-earthquake context adds a further layer of interpretation. Malatya was among the regions severely affected by the February 2023 earthquakes, and health services operating in the aftermath face strained infrastructure, displaced populations and heightened patient vulnerability. The authors caution that the setting should be borne in mind when generalising the findings, since environmental perceptions and expectations may differ under disaster recovery conditions. At the same time, the study offers a rare window into patient experience in post-disaster health service delivery, a topic that remains underexplored in the health services research literature.

For clinic managers and health policy makers, the practical implications are tangible. Prioritising visible cleanliness, reducing examination waiting times and ensuring adequate ventilation and heating are concrete, measurable targets that could improve patient satisfaction without requiring changes to clinical practice itself. The authors position these environmental and access-related factors as potential targets for further evaluation, and the graded association with cleanliness in particular invites intervention studies to test whether improvements translate directly into better patient-reported experience. As health systems worldwide grapple with rising demand for rehabilitation services, this study suggests that the path to higher satisfaction may run through corridors, waiting rooms and heating systems as much as through the treatment table.

Subject of Research: Factors independently associated with patient satisfaction among physiotherapy outpatients, including cleanliness, waiting time and ventilation, in a post-earthquake Turkish hospital setting.

Article Title: Factors independently associated with patient satisfaction in a physiotherapy outpatient clinic: a cross-sectional study

Article References: Yavuz, Z. A., Kurt, O., & Erdoğan, K. (2026). Factors independently associated with patient satisfaction in a physiotherapy outpatient clinic: a cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15878-0

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15878-0

Keywords: patient satisfaction, physiotherapy, outpatient care, health services research, cleanliness, waiting time, ventilation, cross-sectional study, post-earthquake health services, quality of health care, multivariable regression, hospital environment