April–June 2008
156
Servicescape: Physical environment
of hospital pharmacies and hospital
pharmacists’ work outcomes
Blossom Yen-Ju Lin
Wen-Jye Leu
Gerald-Mark Breen
Wen-Hung Lin
Background: In health care, architects, interior designers, engineers, and health care administrators need to pay
attention to the construction and design of health care facilities. Research is needed to better understand how health
professionals and employees perceive their work environment to improve the physical environment in which they work.
Purpose: The purpose of this study was to test the effect of the physical environment of hospital pharmacies on
hospital pharmacists’ work outcomes.
Methodology: This cross-sectional mailed survey study of individual hospital pharmacists used a structured
questionnaire developed to cover perceptions of the ambient conditions and the space/function(s) of pharmacists’ work
environments. It included aspects such as dispensing areas, pharmaceuticals areas, storage areas, and administrative
offices. Work outcomes were job satisfaction, intentions to leave or reduce job working hours, and job-related stress.
Hospital pharmacists in Taiwan (n = 182) returned the mailed surveys. Structural equation modeling was performed
to validate the construct of the physical environment of a hospital pharmacy and the causal model for testing the
effect of the physical environment on pharmacists’ work outcomes.
Findings: For hospital pharmacy workplaces, more favorable perceptions of the workplace’s physical environment were
positively associated with overall job satisfaction, but such perceptions were also negatively related to intentions to
quit employment or to reduce working hours. However, the effect of the physical environment on job stress within the
workplace was not supported.
Practice Implications: The designs of physical environments deserve attention to create more appropriate and healthier
environments for hospital pharmacies. Further research should be devoted to trace more psychological responses to
the physical environment from a longitudinal perspective.
H
ealth care work environments of employees
have been described by organizational behavior
professionals in dimensions ranging from in-
tangible psychological to tangible physical conditions
(Allvin & Aronsson, 2003). The psychological dimension refers to work situations in line with the concept
Key words: hospital pharmacy, pharmacy management, physical environment, servicescapes, work outcomes
Blossom Yen-Ju Lin, PhD, is Assistant Professor, Institute of Health Service Administration, China Medical University, Taichung, Taiwan,
ROC. E-mail: [email protected].
Wen-Jye Leu, MS, is Researcher, Institute of Health Service Administration, China Medical University, Taichung, Taiwan, ROC.
Gerald-Mark Breen, MS, is Doctoral Student and Research Assistant, Co-Editor of Public Affairs Review Journal, Department of Public
Affairs, University of Central Florida, Orlando.
Wen-Hung Lin, BS, is Retired (January 15, 2008) from Special Executive Assistant of CEO, Chief of Hospital Pharmacy, Taichung Hospital,
Department of Health, Executive Yuan, Taiwan, ROC.
Health Care Manage Rev, 2008, 33(2), 156-168
Copyright A 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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Effect of Physical Environment on Pharmacists’ Work
proposed by two-factor theory, which emphasizes
employees’ inner ‘‘motivation’’ factors such as growth
and enrichment and outer ‘‘hygiene’’ factors such as
rewards, supervision, effectiveness of organization,
fellow employees, and others (Ivancevich & Matteson,
1996; Wineman, 1982). On the other hand, occupational and environmental professionals perceive a
healthy work environment in more physical terms,
emphasizing employees’ physical comfort levels, including ambient conditions, ergonomics, privacy and social
integration, and symbolic identification (Steele, 1973;
Wineman, 1982). The concept of ‘‘servicescape’’ has
been used in marketing and health care marketing to
emphasize the impact of physical environments on
employees in service settings through emotional,
affective, cognitive, and psychological states and
perceptions (Bitner, 1992; Hutton & Richardson,
1995). In a similar vein, other researchers have studied
constructs from the pathogenic perspective, including
the reduction of exposure risks to diseases, in addition to
the psychological, social, and spiritual needs according
to the salutogenic perspective, which focuses on health
promotion processes in health care facilities (Dilani,
2000).
This study could very well serve as the first to
consider pharmacists’ perceptions of their working
environments, which is different from similar studies
characterizing the health of the working environment in
the health care industry from a more psychologyoriented perspective (Desselle & Holmes, 2007; Mott,
Doucette, Gaither, Pedersen, & Schommer, 2004) or
job-characteristics perspectives (Lin, Yeh, & Lin, 2007).
This study extends and expands on the concept of
servicescapes in the health care industry and tries to
verify the importance of the physical environment on
work outcomes in health care workplaces from a
theoretical perspective and according to evidence-based
research, especially via structural equation modeling
that factored in overall job satisfaction, intention to quit
or reduce working hours, and job stress.
Theoretical/Conceptual Framework
The Role of Physical Environments
in the Workplace
From a marketing or health marketing perspective,
Bitner (1992) presented a framework of servicescape
for service organizations to examine the effect of the
physical environment on both customers and employees,
with an emphasis on the impact of physical environments on employees in service settings through the
emotional, affective, cognitive, and psychological statuses and perceptions. In turn, these lead to employees’
behavioral consequences including enhancing affiliation, exploration, longer stay, commitment, and complete plan; these behaviors may produce desirable
outcomes of quality, values, satisfaction, willingness to
return, and willingness to recommend the providers
(Hutton & Richardson, 1995). Steele (1973) identified
a set of physical environmental needs for the health and
well-being of employees, including physical comfort,
task instrumentality, privacy and social integration, and
symbolic identification. The physical comfort aspect of
the ambient conditions includes heating, ventilation,
and air conditioning. Ergonomics, task instrumentality,
focuses on body dimensions and the physical capabilities
of the workers (with physical design), including the
space/function(s) of the furnishings, layout and size of
the workplace, as well as the adequacy and arrangement
of work groups and support services; these factors each can
influence personal comfort and efficiency levels with
respect to performing tasks. Privacy refers to the design and
management of the physical environment which influences workers’ communication and their abilities to obtain
visual and acoustical privacy. Visual privacy refers to
privacy from the view of others. Acoustical privacy refers to
a separation from annoying noises, such as nearby and
audible telephone conversations and social talking, the
sound level, and the level of background sound; these
privacy factors have the ability to interfere with the level
of task performance. Social interaction comprises relationships with peers, supervisors, and subordinates in supportive social relationships that can reduce the severity of
perceived workloads. Finally, symbolic identification refers to
status markers, which reflects an occupant’s status; these
include the space size, the amount of enclosure provided by
walls, partitions, and doors; the location of an office; and
the amount and quality of furnishings (Wineman, 1982).
Physical comforts on employees’ work outcomes.
Barnaby (1980) found that lighting conditions in workplaces are positively related to workers’ productivity,
accuracy, and satisfaction, yet they are negatively related
to work errors. Donchin and Seagull (2002) argued that
lighting affects providers’ stress levels. Gottardi (1998)
described how a film library supervisor in a hospital asked
the staff members to respond to the positive and negative
aspects of their work space to design better soundproofing,
lighting, and storage space. Niemela, Rautio, Hannula,
and Reijula (2002), in a study of employees of storage
facilities, found that improved work environments, specifically those that had better thermal climate and better
lighting conditions, are related to increased productivity.
Hashiguchi, Hirakawa, Tochihara, Kaji, and Karaki
(2005) examined the thermal environment (temperature
and humidity) and the symptoms of nurses and nurse aid
staff in sickrooms, nursing stations, and corridors in a
hospital during the winter season and found that most
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Health Care Management REVIEW
staff members were working while having itchy skin
and thirstiness due to low humidity. Staff members of
postanesthesia care units have positive attitudes toward a
designed music environment (Thorgaard et al., 2005). An
interesting finding was that cleanliness and orderliness
of the work sites were main determinants for hospital
employees’ compliance with safe work practices (Gershon
et al., 2000).
Task instrumentality on employees’ work outcomes. Better ergonomic design for keyboard height,
drawers, and even the height of the sliding glass window
in the reception area was recommended by the staff
members in a hospital’s film library for creating the
positive aspects of their work space (Gottardi, 1998).
Del Nord (1999) highlighted that the humanization
of spaces (i.e., layouts, technology, furniture and furniture designs, and ways finding) is an important physical
environment factor for hospital architectures, often
influencing employees. A natural quasi-experimental
longitudinal field study was examined to determine the
effects of an office station’s ergonomics intervention
program on employees’ perceptions of their workstation
characteristics, level of persistent pain, eyestrain, and
workstation satisfaction. It was found that workstation
improvements led to more positive perceptions of the
workstation (May, Reed, Schwoerer, & Potter, 2004).
Mroczek, Mikitarian, Vieira, and Rotarius (2005)
studied employee satisfaction in a medical center and
found that the building design may produce a significant
impact on staff satisfaction. Rumreich and Johnson
(2003) surveyed the Indiana University faculty radiologists and indicated that the faculty members are least
satisfied with their work space ergonomics, room layouts, and amount of work space, yet 98% of respondents
indicated that ideal environments would have a positive
effect on their work efficiency.
Privacy and social integration on employees’ work
outcomes. Most previous studies were majorly focused
on the acoustical privacy factors, including annoying
noises, the sound levels, and the level of background
sounds. Heerwagen, Heubach, Montgomery, and Weimer
(1995) contended that physical environments lacking
control over the environment are characterized as having
distractions from coworkers, lacking privacy, being noisy
and crowded, and having environmental deprivations.
Such environments play an important role in occupational
stressors. Melamed, Fried, and Froom (2001) determined
that exposure to occupational noise has a negative effect
on changes in blood pressure and job satisfaction over
time and among employees performing complex tasks
and in stress (Donchin & Seagull, 2002). Walsh-Sukys,
Reitenbach, Hudson-Barr, and DePompei (2001) examined neonatal intensive care units and put forward that
April–June 2008
staff members were highly satisfied with reductions in
sound levels. In a noise study in an ambulatory health
care setting, Schuster and Weber (2003) found that a
quiet environment resulted in an overall positive environment for the employees by increasing productivity
and reducing stress.
Symbolic identification on employees’ work
outcomes. Folkins, O’Reilly, Roberts, and Miller
(1977) examined new and old mental health clinic
buildings and found that the mental health team staff
members who relocated to new satellite clinics reported
significant increases in satisfaction with their physical
surroundings, whereas those staff members located in
the old central clinic buildings were less satisfied.
Furthermore, satisfaction with physical surroundings
held some degree of influence on overall staff satisfaction ratings and might be a mediating variable for staff
morale and effectiveness. Tyson, Lambert, and Beattie
(2002) examined the old and new wards of a rural
psychiatric hospital and found that the newly constructed wards were associated with primarily positive
changes in nursing staff’s behavior, burnout, and job
satisfaction.
Characteristics of Hospital Pharmacists’
Workplaces in Connection to Proposed
Model and Hypotheses
Hospital pharmacies are the major employers of pharmacists in Taiwan, based on the statistics from the national
medical and pharmaceutical workforce reports (www.doh.
gov.tw). There are 21.7% more pharmacists in hospitals
than other health care settings, according to those from
the 2003 Taiwan Actively Practicing Pharmacist List.
There are several distinct differences in Taiwanese hospital pharmacists as compared with those in Western
nations. First, Taiwanese hospital pharmacies are important not only with regard to inpatient services, but also
with respect to outpatient dispensing services. Hospitalbased outpatient dispensing prescriptions account for
25% of all outpatient dispensing prescriptions in Taiwan
(www.doh.gov.tw). Second, in Taiwan, the hospital pharmacists’ professional relationships encompass physicians
and nurses, as well as direct relationships with outpatients
and often indirect relationships with inpatients via nurses.
The components and responsibilities of pharmacists’ work
in hospital pharmacies include the provisions of drug
information to patients including recommending medications, monitoring drug therapy, and prescription and
dispensing management. The provision of pharmacists’
consultations to physicians and the community at large is
also a common task. In addition, hospital pharmacists also
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159
Effect of Physical Environment on Pharmacists’ Work
engage in general management (planning, organizing,
leading, and controlling), inventory management, human
resource management, marketing management, and financial management of pharmacies (Lin et al., 2007).
Dilani (2005) pointed out that hospital employee’s
workplaces have been limited to indoor environments,
with more than 80% of their working time spent indoors
within these hospital settings. Moreover, hospital pharmacists spend almost the whole business day in indoor
working environments, including the basement portions
of the buildings, where many hospitals carry out most
of their pharmaceutical functions (ranging from dispensing rooms to the storage rooms). This article partly
expands Bitner’s (1992) servicescape concept for service
organizations to examine the effects of the physical
environment on employees’ work outcomes, along with
information from the employees’ perspectives. From the
literature reviewed, we thus evaluate the impact of hospital pharmacists’ perceptions of the physical environment of hospital pharmacies on these employees’ work
outcomes.
The proposed conceptual framework is shown in
Figure 1. The physical environments of hospital pharmacies were composed of hospital pharmacists’ perceptions of dispensing areas (outpatients, inpatients, and
emergency); pharmaceutical areas; storage areas; and
administrative offices in hospital pharmacies. The hospital pharmacists’ work outcomes factored in overall
job satisfaction, intention to leave or reduce working
hours, and job-related stress. In addition, several previous
studies have raised the point that human demographics could play important roles in the individual’s
perceptions of the physical environment. For example,
Bortkiewicz et al. (2006) found that female workers
seemed to be more sensitive to stress of cold climates than
male workers. In a similar vein, age and gender might
be risk factors for neck pain in the workplace (Hush,
Maher, & Refshauge, 2006). Satisfaction with the
physical environment of outpatient waiting areas was
associated with gender and age (Tsai et al., 2007). In
addition, a pharmacists’ working duration (in terms of
years worked) as pharmacy professionals—and in the
surveyed pharmacy—could be a potential confounding
variable on how pharmacists perceive their physical environment in their workplaces because humans might
adapt or adjust to their surroundings as their working
careers lengthen.
Therefore, using individual hospital pharmacists as a
unit of analysis, the hypothesized relationships are
shown in Figure 1 and are listed below:
Ha: Controlling personal background characteristics, hospital pharmacists’ perceptions of the
physical environment in hospital pharmacies are
positively associated with their job satisfaction.
Hb: Controlling personal background characteristics,
hospital pharmacists’ perceptions of the physical
environment in hospital pharmacies are negatively
associated with their intentions to leave their jobs.
Hc: Controlling personal background characteristics, hospital pharmacists’ perceptions of the
physical environment in hospital pharmacies are
negatively associated with their intentions to
reduce their working hours.
Hd: Controlling personal background characteristics, hospital pharmacists’ perceptions of the
physical environment in hospital pharmacies are
negatively associated with their job stress.
Methods
This was a cross-sectional mailed survey study. Using
individual hospital pharmacists as the unit of analysis,
this study examined the effect of hospital pharmacists’
perceptions of the physical environment of hospital
pharmacies on their work outcomes. The study participants and sampling, survey instrument development,
and analytical techniques are as follows.
Study Participants
The study population consisted of 5,551 hospital pharmacists listed in the 2003 Taiwan Actively Practicing
Pharmacist List. All sampled pharmacists were selected
using systematic sampling, whereby each member of the
study population was assembled and listed with the
hospital accreditation levels (the first stratified variable)
and administrative geographical locations (city/county;
the second stratified variable) because facility scales
might have different equipment and designs in the
physical environments of pharmacies across different
hospital accreditation levels. We also wanted to capture
the representativeness of hospital pharmacists across
national geographical locations to include the various
rural–urban areas. A random start number (4,675) was
designated in this study. Members of the population
were selected at equal intervals to collect a total of
1,110 hospital pharmacists as our sample participants.
Structured questionnaires were distributed by mail from
February 2005 to April 2005.
Survey Instrument
Physical environment measures. First, the structured questionnaire was drafted from the theoretical
and practical literature and focus groups of pharmacists
to construct four major working spaces of hospital
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Health Care Management REVIEW
Figure 1
Model for testing the relationship between hospital pharmacists’ perceived satisfaction
with physical environments and work outcomes
pharmacists: (1) dispensing areas, (2) pharmaceutical
areas, (3) storage areas, and (4) administrative offices.
Under each type of space, the ambient conditions (e.g.,
temperature, air quality, music, odors, lighting, textures,
etc.) and space/function(s) (e.g., crowding, equipment,
furnishings, layout, etc.) of pharmacists’ working
Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
161
Effect of Physical Environment on Pharmacists’ Work
environments were identified (Hutton & Richardson,
1995). This led to 45 items for descriptions of dispensing
areas (15 items each for outpatient, emergency, and
inpatient dispensing areas); 16 for pharmaceutical areas;
14 for storage areas; and 12 for administrative offices.
The structured questionnaires were examined by two
professors for theoretical accuracy and three senior
practicing pharmacists (including a pharmacy chief) to
ensure the ability for accurately capturing possible
hospital pharmacists’ physical working environments.
One pilot study was pretested for 15 hospital pharmacists across different hospital accreditations as there are
various possible working conditions of physical environments. The wordings and meanings of each question
item were confirmed to assure content validity, and
factor analyses were performed for individual dimensions of physical environments of hospital pharmacies,
including outpatient dispensing areas, emergency dispensing areas, inpatient dispensing areas, pharmaceutical areas, drug storage areas/rooms, and administrative
office areas for construct validity. The reliability values,
calculated by Cronbach’s alpha, for individual dimensions of physical environments of hospital pharmacies
range from .94 to .98 (see Table 1). All items were
measured on 5-point Likert scales, with 1 representing
least satisfied and 5 representing most satisfied. A question
Table 1
Descriptive analyses and reliability tests
for dimensions of hospital pharmacists’
perceived satisfaction with physical
environments in hospital pharmacies
Dimensions
of physical
environments
1. Outpatient
dispensing
areas
2. Emergency
dispensing
areas
3. Inpatient
dispensing
areas
4. Pharmaceutical
areas
5. Storage
areas/rooms
6. Administrative
areas
Number
of items M
SD
Cronbach’s a
15
3.11
0.66
0.94
15
3.18
0.65
0.96
15
3.20
0.63
0.95
16
3.28
0.54
0.98
14
3.24
0.62
0.96
12
3.22
0.70
0.96
Note. The instrument is available upon request.
item with which the respondents had no experience was
recorded as ‘‘not applicable.’’
Work outcome measures. Hospital pharmacists’ work
outcomes were measured in terms of four variables: (1)
job satisfaction, (2) intention to leave the job, (3)
intention to withdraw working hours, and (4) job stress.
Four variables were measured applying 0–100 as scores,
with higher scores meaning higher inclination of measured work outcomes. Information about each pharmacist’s gender, age, education, work experience, working
hospital accreditation, and geographic distribution was
also collected.
Analytical Techniques
The data were analyzed applying descriptive analysis,
including the means and standard deviations for continuous variables and frequency and percentage for
categorical variables. The mean method was used to
aggregate perception scores of the individual question
items for inpatient dispensing area, outpatient dispensing area, and emergency area, respectively.
The multivariate statistical approach conducted in this
study was the structural equation model (SEM), also
known as linear structural relationships and the covariance structural model. Two parts were performed in
the SEM or linear structural relationships model: One
employed the measurement modeling, whereas the other
used structural equation modeling. The measurement
model was first used to validate how the latent variables
were measured by the observed indicators. The secondorder measurement model (physical environments of
hospital pharmacists) is presented in Figure 2, with the
following four indicators: (1) dispensing areas, (2) pharmaceutical areas, (3) storage areas, and (4) administrative areas. The dispensing area indicator was also
indicated by three factors: (1) outpatient dispensing areas,
(2) inpatient dispensing areas, and (3) emergency dispensing areas.
After the measurement models were validated, the
SEM was performed to specify the causal relationship
among exogenous and endogenous variables. All analytical processes involved model construction, parameter
estimation of the model, test for the fit of the model,
and model modification, using the maximum likelihood
estimation procedure (Bollen, 1989). The SEM was
designed to test our hypotheses. The hypotheses were
empirically examined using a two-tailed test for their
statistical significance at the .05 or at a lower level.
Because the multivariate analysis was performed for testing
the hypotheses, the conclusions drawn from the results can
be stated as the net effect of a given predictor on the
endogenous variable while other variables are simultaneously being controlled.
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Figure 2
Measurement model of latent constructs: perceived satisfaction of physical
environment of hospital pharmacy
Satisfactory model fit includes the following: (a) a
nonsignificant chi-square test ( p > .05), (b) root mean
square error of approximation (RMSEA) values less
than .08, (c) P_CLOSE (close fit) values larger than
.05, (d) Hoelter’s critical N values larger than 200,
and (e) normed fit index (NFI) and comparative fit
index (CFI) for model goodness-of-fit larger than .90
(Arbuckle, 2005). Statistical analyses were performed
using SPSS 12.0 software for descriptive analyses, factor analyses, and reliability analyses. The AMOS 6.0
software was used for the structural equation modeling.
Findings
This study aimed to portray the physical working
environments for hospital pharmacists and to explore
their effects on hospital pharmacists’ work outcomes.
The respondents were 182 hospital pharmacists, with a
16.4% response rate (100% 182 respondents/1,110
sampled). Most hospital pharmacists were female, with
undergraduate degrees, and were less than 40 years old.
The average work experience as pharmacists was 10.0
years, and the average work experience working in the
surveyed hospital pharmacies was 6.7 years. There were
no significant differences between the study population
and pharmacists who responded regarding the background information related to gender, age, hospital accreditation, and geographical distribution ( p > .05).
Other detailed pieces of personal information of respondents are shown in Table 2.
Descriptive Analyses of the Perceived
Satisfaction of Physical Environments
According to the item-by-item examination of the physical environments of hospital pharmacies, most items,
on average, showed higher satisfaction scores over 3.0.
Seven items were ranked with lower scores for physical
environment, including space design of the outpatient
dispensing table (M = 2.94); functional design of the
outpatient dispensing table (M = 2.98); noise of drugrelated equipment in outpatient areas (M = 2.53),
emergency areas (M = 2.89), and inpatient areas (M =
2.89); interior design of storage areas (M = 2.99); and
space design of administrative areas (M = 2.93). In
addition to the mean and standard deviation being used
to understand the distributions across perceived satisfaction with the physical environment of hospital
pharmacies, the frequencies (percentages) were also
shown to allow the hospital administrators to capture
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Effect of Physical Environment on Pharmacists’ Work
Table 2
Personal backgrounds of hospital pharmacists who responded (n = 182)
Personal background
Gender (2 test, p = .73)
Male
Female
Age (years; 2 test, p = .28)
20–29
30–39
40–49
50 and above
Education
Technical school
Undergraduates
Graduates
Incomes (per month)
Below U.S. $1,000
U.S. $1,000–1,333
U.S. $1,334–1,667
U.S. $1,668–2,000
U.S. $2,001–2,333
Above U.S. $2,333
Hospital accreditation (2 test, p = .08)
Medical center
Regional hospital
District hospital
Geographical distributions (2 test, p = .09)
Taipei
Northern
Central
Southern
Kao-Ping
Eastern
Working experience (years)
Working as pharmacists
Working in the surveyed pharmacies
Pharmacists who responded
(n = 182)
Study population
(N = 5,551)
Frequency
%
Frequency
%
60
122
33.0
67.0
1,865
3,686
33.6
66.4
52
66
34
22
28.6
36.3
18.7
12.1
1,766
2,098
1,207
480
31.8
37.8
21.7
8.6
21
120
39
11.5
65.9
21.4
1
15
64
65
22
12
0.5
8.2
35.2
35.7
12.1
5.4
56
70
56
30.8
38.5
30.8
1,697
2,055
1,799
30.6
37.0
32.4
52
22
51
15
30
9
M
10.02
6.76
29.1
12.3
28.5
8.4
16.8
5.0
SD
7.87
6.30
1,726
726
1,099
732
1,033
235
31.1
13.1
19.8
13.2
18.6
4.2
more information on the ‘‘dissatisfied’’ values of the
respondents rather than just reading the ‘‘moderate’’
values (i.e., 3.00 as the neutral score in this study) by
means and then assuming that everything was close to
being fine (data not shown).
Measurement Model of Physical
Environment of Hospital Pharmacies
For the measurement models in this study, the secondorder construct of physical environments of hospital
pharmacies was examined. Figure 2 shows that the factor
loadings for all indicators were significant at the .05
level. The validated model was used for analyzing the
causal model in the next analysis. The overall model of
the measurement model was shown as a good fit for the
criteria in this study, including a nonsignificant chisquare test (2 = 6.66; p = .57 in this study), RMSEA
values less than .08 (.00 in this study), P_CLOSE (close
fit) values larger than .05 (.82 in this study), Hoelter’s
critical N values larger than 200 (422 in this study), and
NFI and CFI for evaluating the goodness-of-fit larger
than 0.90 (0.99 and 1.00, respectively, in this study).
Analysis of the Causal Model:
Test of Hypotheses
After validating the measurement models, the SEM was
performed. Most endogenous variables (working physical
environment and job outcomes) were moderately correlated with each other. However, we observed that several
exogenous variables were highly correlated (Table 3);
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Health Care Management REVIEW
Table 3
Correlation matrix analysis of the studied variables
OUT
OUT
ER
INP
PHA
STO
ADM
SAT
LEA
RED
STR
GENDER
AGE
WORKP
WORKH
ER
INP
PHA
STO
ADM
1
0.80***
0.83 ***
0.64 ***
0.62 ***
0.60 ***
0.49 ***
0.24 ***
0.26 ***
0.18 *
0.22 **
0.17*
0.11
0.09
1
0.79***
0.60***
0.57***
0.55***
0.42***
0.23**
0.24***
0.16*
0.20**
0.09
0.07
0.04
1
0.63***
0.61***
0.64***
0.42***
0.19*
0.21**
0.12
0.20**
0.12
0.08
0.04
1
0.58***
0.63***
0.38***
0.27***
0.22**
0.10
0.13
0.15*
0.08
0.11
1
0.64***
0.37***
0.21**
0.23**
0.09
0.21**
0.15*
0.08
0.07
1
0.37***
0.18*
0.15*
0.01
0.18*
0.10
0.03
0.03
Note. OUT: outpatient dispensing areas; INP: inpatient dispensing areas; ER: emergency dispensing areas; PHA: pharmaceutical
areas; STO: storage areas; ADM: administrative areas; SAT: job satisfaction; LEA: leaving intention; RED: intention to reduce
working hours; STR: job stress; AGE: age; GENDER: gender; WORKP: work years as pharmacists; WORKH: work years in
surveyed pharmacy.
*p < .05.
**p < .01.
***p < .001.
for example, hospital pharmacists’ age was positive and
highly correlated with their working years as professional pharmacists (r = .83, p < .001), and hospital
pharmacists’ professional experience was positive and
highly correlated with their working years in the surveyed
hospital pharmacy (r = .75, p < .001). To avoid the
multicollinearity among the exogenous variables (i.e.,
confounding variables), the variable, that is, a hospital
pharmacist’s working years as a pharmacy professional,
was excluded in the final structural equation modeling
(Table 4). The results reveal that hospital pharmacists’
satisfaction of physical environments was positively
related to their job satisfaction and negatively related
to the intention of quitting or reducing work hours,
controlling for the hospital pharmacists’ age, gender, and
working experience (in years) in the surveyed hospital
pharmacies. However, there was no statistically significant relationship between perceived satisfaction with the
physical environments and perceived job stress. In
addition, male pharmacists had higher perceived satisfaction with the physical environment than the female
pharmacists had ( p < .01). The overall model of the
causal effects was shown as a good fit in this study,
according to the five criteria, including the following: (1)
nonsignificant chi-square test (2 = 32.55; p = .88 in this
study), (2) RMSEA values less than .08 (.000 in this
study), (3) P_CLOSE (close fit) values larger than .05
(1.00 in this study), (4) Hoelter’s critical N values larger
than 200 (330 in this study), and (5) NFI and CFI for
evaluating the goodness-of-fit larger than 0.90 (0.97 and
1.00, respectively, in this study).
Discussion
To understand the effect of a physical environment on
employee’s work outcomes, this study surveyed hospital
pharmacists as the unit of analysis. The analyses
confirmed three of four hypotheses proposed in this
study; that is, better perceptions of the physical
environment in the workplace were positively associated
to overall job satisfaction (Ha) but negatively related to
the intention of leaving the job (Hb) or reducing working
hours (Hc). However, the hypothesis about the effect of
the physical environment on job stress in the workplace
(Hd) was not supported in this study. Other findings
indicate that male pharmacists had higher perceived
satisfaction than female pharmacists had with regard to
the physical environment. Furthermore, the overall
model of the causal effects was shown to have a good fit.
In this study, the relationship between the physical
environment of hospital pharmacies and hospital pharmacists’ job stress was not verified in line with previous
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165
Effect of Physical Environment on Pharmacists’ Work
SAT
LEA
RED
STR
GENDER
AGE
WORKP
WORKH
1
0.13
0.04
0.02
1
0.83***
0.58***
1
0.75***
1
1
0.41***
0.30***
0.17 *
0.15*
0.23**
0.24***
0.15*
1
0.62***
0.36***
0.01
0.18*
0.17*
0.09
1
0.51***
0.04
0.13
0.10
0.05
1
0.07
0.11
0.06
0.01
studies pointed out by Heerwagen et al. (1995) and
Schuster and Weber (2003). Wolfgang, Kirk, and
Shepherd (1985) surveyed practicing pharmacists in
Texas, and two broad categories were identified as the
highest ranking stress scores: working conditions (such as
interruptions, inadequate staffing, problems with policies
and procedures, third-party paperwork, and time pressures) and motivators (such as not taking part in decision
making, advancement, improved use of abilities, and
challenging jobs). That might be the reason the role of
physical environments appears to be relatively lower
when compared with those highest ranking stress factors.
We anticipate further inspecting or investigating the real
mechanisms of hospital pharmacists’ job stress in the
future other than the physical environment perspective
of hospital pharmacies. Also for future research, it might
prove interesting to devote energy toward tracing more
psychological responses to physical environments from a
longitudinal perspective.
From a methodological perspective, this study uses
multiple indicator modeling to validate the measurement
model’s goodness-of-fit for the underlying construct of
the physical environment of hospital pharmacies. Simultaneously, the SEM examines the relationships among
the tested factors for methodological rigor. However, the
low response rate (16.4%) was a major drawback to this
study. The questionnaires were released and mailed to
the sampled pharmacists according to their working
hospitals’ addresses. Because the sampled pharmacists
were not requested to fill out their identification in the
returned questionnaires, we called the hospital pharmacies that employed the sampled pharmacists in this study
to encourage the sampled pharmacists to respond to our
survey. As a result, we lacked information regarding who
the nonresponding pharmacists were, and this presented
a limitation in this study for nonresponse analyses,
even though there were no differences in the respondents’ gender, age, working hospital accreditation,
or geographic distribution from the study population (see
Table 2). More efforts could be made in the future
to recruit more responses from the mailed surveys.
Managerial Implications
Our study should raise concerns on professional pharmacists’ quality of life within the workplace setting.
Curiously, few studies have deterred hospital executives
from being concerned on the quality of life in the work
setting for hospital pharmacists. The findings reveal and
provide insights on the effects of servicescapes for
architect designers, interior designers, and administrators, bolstering the notion that a well-designed health
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166
April–June 2008
Health Care Management REVIEW
care facility can improve the working lives of facility
employees. In this study, from the physical environment
perspective, for example, we found that noises from drugrelated equipment in the dispensing areas, including
inpatient, outpatient, and emergency areas, of hospital
pharmacies were ranked as the three least satisfied items
among all components of the possible physical environment, on average. Abel (1990) reviewed research on the
extra-auditory effects of exposure to noise and showed that
high levels of noise are particularly disruptive for dual-task
paradigms, requiring attention sharing and sequential
responding, involving speed and accuracy. Also, both the
level and type of the noise background affect memory,
severely limiting the number of stimulus dimensions that
may be simultaneously encoded and retained. Furthermore,
noise also causes annoyance, including its own by-products,
such as job dissatisfaction, irritability, and anxiety over
potential risk. We urge hospital administrators to refocus
the issue of noises occurring in hospital pharmacies to
provide some possible muffling or insulation to reduce the
noise effects of running such drug-related equipment.
Perhaps pharmaceutical engineers could extend their efforts
into this realm in the future by designing user-friendly
equipment for professional pharmacist users, especially in
light of noise issues that affect this setting and the employees
working in it.
With a score of 3 as moderate perceptions of satisfaction
with the physical environments of hospital pharmacies,
what were also revealed included several items that ranked
below the neutral perceptions. What also warrants further
notice is that all surveyed items of physical environments
of hospital pharmacies were not ranked high by the
hospital pharmacists; none of the items were ranked, on
average, beyond a score of 4 as satisfied. We further
examined the frequency percentages recoded as category
scales such as less dissatisfied, moderate, and most satisfied.
Because it is possible that extremely ranked values
(dissatisfied vs. satisfied) by equal percentages of respondents might lead to a moderate score, on average, this
might lead to an incorrect explanation regarding these
surveyed items as moderate perceptions, and the extreme
values (i.e., less satisfied) would likewise be ignored or not
managed. This phenomenon can be seen, for example, in
the dimension of outpatient dispensing areas in this study.
The respondents ranked the space design of the dispensing
counter, the functional design of the dispensing counter,
and the noise generated from the drug-related equipment
below the neural score of 3, on average. However, among
moderate perceptions of other satisfaction items, we found
that 35% of the respondents ranked air conditioning
temperature as dissatisfied, though the average (3.07) was
not low (data not shown). Furthermore, we anticipate that
more issues could be addressed in the future with respect to
the space and function design of dispensing areas, the
interior designs of storage areas, and the space design of the
administrative offices of hospital pharmacies, which are
the items not ranked as high perceptions by hospital
pharmacists through the assistance of architects and
interior design professionals.
Male pharmacists were found to have higher perceived
satisfaction than female pharmacists with respect to
the physical environment in this study. Reijula and
Table 4
Standardized parameter estimates of the structural equation model for the effect of physical
environments on hospital pharmacists’ work outcomes
Endogenous variables
Determinants
PHY
SAT
LEA
RED
STR
PHY
Confounding factors
AGE
GENDER (1 = male; 0 = female)
WORKH
R2
–
0.49***
0.29***
0.29***
0.10
0.15
0.22**
0.01
0.08
0.13
0.02
0.03
0.29
0.15
0.08
0.02
0.11
0.12
0.13
0.04
0.10
0.15
0.03
0.10
0.03
Note. Overall model fit: 2 = 32.55, df = 43 (p = .88), 2/df = 0.76, NFI = 0.97, CFI = 1.00, RMSEA = .00, P_CLOSE = 1.00, Hoelter’s critical
N = 330 (0.05 level). PHY = second-order latent variable, physical environments of hospital pharmacy; AGE = age; GENDER = gender;
WORKH = work years in surveyed pharmacy; SAT = job satisfaction; LEA = leaving intension; RED = intension to reduce working hours; STR =
job stress.
*p < .05.
**p < .01.
***p < .001.
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167
Effect of Physical Environment on Pharmacists’ Work
Sundman-Digert (2004) assessed the extent of indoor air
problems in office environments in Finland. The complaints and work-related symptoms associated with
indoor air problems were common in office workers,
and women reported indoor air problems and workrelated symptoms more often than men. Bakke, Moen,
Wieslander, and Norbäck (2007) investigated 173 staff
members in four university buildings and concluded that
gender, psychosocial, and physical environment factors
were related to symptoms and perceived indoor climate.
As such, further research should be conducted to better
understand how health professionals and employees
perceive and work in the workplace by integrating
personal variables to mediate the impact of environmental stress on health, such as intrinsic sensitivity to specific
hazards, personality, restricted capacities, other stress,
culture, personal preferences, stages of life, gender, and
perceived social support (Topf, 2000), thereby helping to
improve this dynamic and fast-paced work environment.
Acknowledgment
Many thanks are given to China Medical University for
grant support (CMU93-HSM-01).
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