Nature and patient waiting: Mediating effects of anxiety and perceived wait time on the association between nature and service perception

Visitors to emergency department waiting areas often experience high anxiety, which results in discomfort during their waits. Our findings offer empirical evidence for the positive impact of including natural elements in these waiting areas. We created four high-fidelity virtual environments that incorporated natural elements in three ways, i.e., the presence of plants, the use of nature images and natural materials, and a combination of those two, in addition to a controlled environment without natural elements. We tested how subjects responded to each environmental setting. Our findings demonstrated that the inclusion of natural elements significantly lowered patients' anxiety in hospital environments, confirming previous research, and the presence of natural elements improved perceived wait time, as well as service quality through anxiety and perceived wait time. The combination yielded higher scores in anxiety, perceived wait time, and service quality than the other conditions. Serial mediation analysis results revealed that underlying anxiety and patients' perceived wait time mediated the effect of natural elements on perceived service quality. Among the five dimensions of service quality, the mediating effects of anxiety and perceived wait time appeared stronger in reliability and responsiveness.