User evaluation of hospitals: service quality and hospitals’ physical obsolescence

Architectures for health have a crucial role in collectivity: according to international ranking scores (for example, CEOWorld Magazine’s Health Care Index), in Italy, there are very advanced and well-functioning healthcare services, even though many facilities are old and obsolete, unorganized, dilapidated, and sometimes unsafe. It has been estimated that 60% of facilities have been built more than 40 years ago. Recent studies suggest that the service life of hospitals should be set around 60 years; after reaching this age, the structure must be redesigned. The present contribution analyses this “rule of thumb” in relation to its impact on user perception. It adopts a Multi-Criteria Decision Analysis (MCDA) method to assess the importance users attribute to the quality of the structure and the personnel working there. Specifically, 9 criteria have been selected, including extrinsic and intrinsic features not directly associated with the abovementioned issues. With this approach in mind, we analyzed the 10 best Italian hospitals’ structures and the quality of treatments. The contribution highlights a significant methodological gap in identifying the relationship between building characteristics and their effects on the service, which are often treated as separate. Thus, the research proposes an innovative method by placing users at the center of the evaluation of priorities. This is particularly crucial in healthcare facilities where all the individuals (patients and staff) and the systems’ processes affect each other. This research line has several possible results; here, it preliminarily involves questioning the 60-year-old threshold for providing highquality services in hospitals.