International Journal of Hospitality Management 112 (2023) 103383

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International Journal of Hospitality Management

journal homepage: www.elsevier.com/locate/ijhm

Toward understanding healthcare hospitality and the antecedents and

outcomes of patient-guest hospital-hotel choice decisions: A scoping review
Salman Majeed a, b, Woo Gon Kim b, *
a
SILC Business School, Shanghai University, Shanghai, China
b
International Center for Hospitality Research & Development, Dedman College of Hospitality, Florida State University, Tallahassee, FL 32306, USA

A R T I C L E I N F O A B S T R A C T

Keywords: The healthcare industry is increasingly interested in using the power of hospitality to improve the patient
Healthcare hospitality experience. However, the conceptual understanding of hospitality in healthcare remained shallow, mixed, and
Hospital-hotel choice fragmented in previous studies. To reconceptualize and push the boundaries of hospitality in healthcare, we
Patient-guest experience
analyzed 73 literature items published between the years 2000 and 2022, adopting the scoping review approach.
Health and well-being
Consumer behavior
We unearthed the conceptual understanding of healthcare hospitality alongside the antecedents and outcomes of
Marketing hospital-hotel choice that may impact patient-guest experience (PGE), health and well-being (HWB), and
behavioral intention. A conceptual framework is presented to show that patient-guest hospital-hotel choice is
based on service attractions that hinge on healthcare and hospitality service operations, which may determine
PGE, HWB, and behavioral intention. Besides theoretical contributions, this review offers important practical
implications, with examples, for the healthcare industry as it struggles to improve the patient experience.

1. Introduction estimate, about 75% of healthcare services to patients resemble

hotel-like hospitality services (DeMicco, 2017a). As well as contributing
Hospitality has an important role in improving the healthcare to HWB, hospitality in healthcare pumps up hospital business multifold
experience and has attracted the widespread attention of scholars and (Cheng et al., 2021).
practitioners in different frontiers of healthcare, hospitality, health The notion of healthcare hospitality encapsulates both complex
tourism, wellness tourism, medical tourism, and consumer behavior service attributes of the healthcare industry (e.g., conventional allo­
(Erickson and Rothberg, 2017; Majeed and Kim, 2022; Suess and Mody, pathic medical treatment, qualification of doctors and paramedical staff
2017a). Healthcare hospitality refers to healthcare services with to render quality healthcare services, accreditation of hospitals, alter­
hotel-like services (Suess and Mody, 2018). The notion of healthcare native health treatments, etc. (Han, 2013; Han and Hwang, 2018a;
hospitality expands on two service industries, i.e., the healthcare in­ Majeed and Kim, 2022; Zygourakis et al., 2014) and the hospitality in­
dustry (mainly hospitals) and the hospitality industry (mainly hotels), to dustry (e.g., comfortable amenities, a harmonious mixture of food,
boost individuals’ health and well-being (HWB), i.e., health leads to beverage, and shelter through restaurant and room service, nourish­
well-being (the healing associations among mind, body, and soul), and ment, protocol, easy access parking lots, etc.) to meet hotel customer
vice versa; HWB embodies improvement in individuals’ quality of life, expectations, perceptions, needs, and wants, which consequently has
life satisfaction, and happiness (Majeed and Kim, 2022). The global positive impacts on hotel customer experience and behavioral intention
definition of health also refers to a complete state of mental, physical, (Han, 2013; Kelly, 2015; Klaus, 2018; Russell-Bennett et al., 2017;
and social well-being, which is not merely the absence of disease Zygourakis et al., 2014). With the boom in medical tourism and wellness
(Hunter-Jones et al., 2020). The Latin philosophy of “hospitalitat” pre­ tourism worldwide, some terms, such as “healthcare hotel,” “hospital-­
sents hospitality as providing heartfelt acts to sick and vulnerable people hotel,” “hospitel,” and “medical hotel,” were used by scholars to show the
alongside physical comfort to travelers (Cheng et al., 2021). “Hospital­ practices of healthcare hospitality for patient/guest/visitor HWB (Borg
itat” is derived from the word “hospes,” which is the root of the English et al., 2015; Han, 2013; Han and Hwang, 2013; Han et al., 2015). Given
words hotel, hospitality, and hospital (Pizam, 2020). According to an this, we use the term “hospital-hotel” in this study to refer to a

* Corresponding author.
E-mail addresses: [email protected] (S. Majeed), [email protected] (W.G. Kim).

https://doi.org/10.1016/j.ijhm.2022.103383
Received 5 September 2022; Accepted 1 November 2022
Available online 5 November 2022
0278-4319/© 2022 Elsevier Ltd. All rights reserved.
S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

healthcare service provider that offers healthcare hospitality. From the perspective of medical tourism, Han and Hwang (2013) and Han et al.
conjoined perspectives of healthcare and hospitality, we refer to the (2015) note that tourist choice of healthcare hotel sometimes experi­
beneficiary of healthcare hospitality as patient-guest in this review. ences bottleneck due to the lack in the areas of medical treatments,
The emerging nexus between conventional medical treatments, advanced technological facilities, alternative health treatments,
alternative health treatments, and hotel-like environments, such as in aesthetic treatments, food and beverages, and accommodation facilities,
The Grand Resort Bad Ragaz (a 5-star hotel in Switzerland) (Majeed and which reflects loopholes in the implementation of healthcare hospitality
Kim, 2022) and Mount Elizabeth Hospital in Singapore (Majeed and in hospital-hotels. However, such research remained limited in clari­
Ramkissoon, 2020), plays a synergistic role in improving patient-guest fying the important roles of health treatments with conventional hos­
experience (PGE) and behavioral intention (Hunter-Jones et al., pitality services. This might be because the understanding of the
2020). PGE is a patient-guest state of mind reflecting his/her cognitive, healthcare hospitality concept is still developing and there are not many
affective, sensorial, and behavioral reactions while experiencing medical facilities that practically demonstrate healthcare hospitality.
memorable healthcare services (Hunter-Jones et al., 2020). PGE draws Therefore, it is important to understand: (1) What is healthcare hospi­
on the multi-faceted essence of healthcare hospitality in hospital-hotels, tality in hospital-hotel choice? (2) How does hospital-hotel choice
such as built environment design, aesthetic environment, healthcare improve PGE? (3) What are the antecedents of hospital-hotel choice? (4)
treatment itself, interaction with doctors and paramedical staff, and What are the outcomes of PGE in hospital-hotel? These debates
information provision (Kelly, 2015; Klaus, 2018; Suess and Mody, remained mixed, fragmented, superficial, and deeply under-explored in
2017a). Extant literature on psychology, hospitality, wellness tourism, the previous studies on hospitality, medical tourism, wellness tourism,
and health management indicates that service-oriented culture in a health management, and allied research frontiers, such as marketing,
healthcare facility may gear up the patient healing process after medical social psychology, and consumer behavior.
intervention, leading to optimal HWB (Han, 2013; Han and Hwang, To fill the research gaps, a conceptual framework is presented after
2018a; Majeed and Kim, 2022; Mody et al., 2020; Severt et al., 2008; stitching together the broken theoretical connections among the notions
Ulrich, 2001). of healthcare and hospitality in the hospital-hotel context, to glean the
The perceived image of conventional hospitals is clinical, with the antecedents of hospital-hotel choice that impact PGE and influence
unpleasant smell of medicine and injections in hospital lobbies and patient-guest HWB and behavioral intention. Given the complex and
rooms, uncomfortable in-patient stay rooms, the (sometimes) impolite under-explored topic of healthcare hospitality in the domains of public
responses from healthcare staff, various stresses, limited or no avail­ health, hospitality, and tourism, a scoping review approach (Levac et al.,
ability of patient food and unhygienic food handling, limited access to 2010; Munn et al., 2018) was deemed appropriate to fill the lacuna. This
family and friends visiting patients, and the inconvenience caused by review may broaden the conceptual understanding of healthcare hos­
overloaded parking lots as patients and accompanying family members pitality and hospital-hotel choice, impacting PGE, HWB, and behavioral
attempt to reach the main service area of the hospital for treatment—all intention. This review will act as a torchbearer to guide the stakeholders
of these assumptions create an unattractive image for hospitals. To of the healthcare industry, such as medical hotels, healthcare hotels, and
maximize guest experience, previous studies draw on the notions of built hotel marketers, to find myths of healthcare hospitality and offer health
design, aesthetic environment, pleasant indoor aroma, and welcoming treatments with hospitality services to attract patient-guests for
attitude, in parallel to a caring and polite guest reception and departure, improved PGE and HWB.
attempting to highlight the importance of hotel services in improving
patient well-being and positive attitude (Kim et al., 2021; Mody et al., 2. Methodology
2020; Severt et al., 2008; Ulrich, 2001); this provides a launching
platform to further understand the vibrant role of hospitality in the This review adopted the scoping review approach to understand
healthcare industry, such as in a hospital-hotel, to promote PGE, HWB, healthcare hospitality and the antecedents and outcomes of patients’
and behavioral intention. hospital-hotel choice decisions. Extant literature provides direction to
The reason for including hospitality in hospitals is to improve their conduct scoping reviews, supporting this novel approach. A scoping
guest experience, as hotels are always concerned with the providing review allows the researchers to examine the volume of available
guests an optimal visit experience (Kelly, 2015; Klaus, 2018; literature items, analyzing the themes that emerge on a given topic, and
Russell-Bennett et al., 2017; Zygourakis et al., 2014). Recipients of clarifying research questions to inform future research (Arksey and
healthcare hospitality may have unique PGE due to their stressful O’Malley, 2005; Levac et al., 2010; Munn et al., 2018; Pham et al.,
cognitive reactions, i.e., intensified emotions due to the fear of illness, 2014). Studies on healthcare, medical tourism, and wellness tourism
surgery, medicine, and doubts about the relevant expertise of doctors support the adoption of the scoping review approach to review topics
and paramedical staff (Lopes et al., 2017). Since hotel-building design that are complex, heterogeneous, and new (Majeed and Kim, 2022;
improves guest experience and HWB (Bangwal et al., 2022), some Snyder et al., 2011). Therefore, to identify literature types and examine
research asserts the importance of hotel-alike built and aesthetic envi­ the emerging themes of existing studies on healthcare hospitality and
ronments to refine the environmental impact of hospitals and thus hospital-hotel choice, this review adopts the scoping review approach.
improve PGE (Suess et al., 2017; Suess and Mody, 2017a, 2018). How­
ever, the concept that physical environment improves patient outcomes 2.1. Literature searching
is not new, and hotel-like building and aesthetic design elements are not
the only conditions improving PGE, HWB, and behavioral intention, We conducted an initial search in Google scholar and Web of Science
such as willingness to pay extra (Suess et al., 2017). The healthcare for literature published between the years 2000 and 2022 and found
environment may also impact PGE and HWB (Suess and Mody, 2018). mixed literature items linked to the research questions in this review. At
For hotel-like services with healthcare treatments, some traces of dis­ this stage, we reviewed 35 research articles and identified keywords to
cussion can be found in previous studies on wellness and medical fit within the 5 keywords strategy (see Table 1) (Majeed and Kim, 2022;
tourism. For example, from the perspective of wellness tourism, Majeed Snyder et al., 2005). Based on identified keywords, we searched pub­
and Kim (2022) indicated the conjoined roles of eastern and western lished literature on healthcare hospitality between the years 2000 and
health treatment and healthcare hospitality in improving tourists’ 2022 in Sage, Web of Science, Taylor and Francis, Google Scholar,
overall wellness experience, HWB, and behavioral intention. However, Springer, Emerald, MDPI, and Scopus. For relevant searching, we used
their work reflects a superficial understanding of healthcare hospitality. different sets of keywords as search criteria, such as title, year, and
This lacuna demands more research attention to understand the vibrant abstract. Utilizing the reference mining technique (Majeed and Ram­
role of healthcare hospitality in hospital-hotels. Moreover, from the kissoon, 2020), we found additional relevant literature on the topic

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S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

Table 1
Keywords for review themes.
Focus What Who Why Where

Healthcare hospitality Healthcare in hospitality Hospitality stakeholders Health optimization Central America
Hospitality and healthcare Hospitals Well-being South America
Hospitality experience in hospitals Hotels Healthcare and hospitality choice North America
Hospitals with hospitality The medical industry Quick recovery during recuperation Oceania countries
Hospitality in hospitals The hospitality industry Healthcare experience Africa
Medical hotels Health with hospitality experience Europe (including the UK）
Healthcare hotels Caribbean countries
Asia

under consideration in this review. 156 healthcare hospitality literature items. However, we removed 29
literature items at this stage that demonstrated mismatched content in
2.2. Literature screening titles, abstracts, and keywords. Additionally, literature items published
before the year 2000 (23 literature items) and duplicate search records
We invited a team of 5 experts, comprised of 1 full professor, 2 as­ (13 literature items) were ignored for the final scoping review. Before
sistant professors, and 2 industry experts with relevant research, the final scoping review, we removed a total of 18 literature items due to
teaching, and/or industry experience in healthcare and hospitality, to irrelevant content in the main body of the literature. Thus, we kept 73
assist in developing different aspects of keywords (Table 1), the inclu­ literature items for the final scoping review. Media literature items were
sion of published literature on the topic for the final scoping review, and reviewed in full because of “no” keywords. The researchers of this re­
screening out irrelevant literature regarding the topic of healthcare view held weekly team meetings to discuss the progress of the review,
hospitality. In the initial search of the literature, we identified a total of reconcile reviewed literature findings, and identify emerging themes.

Fig. 1. PRISMA flow diagram of healthcare hospitality.

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S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

The PRISMA flow diagram (Fig. 1) shows different stages of literature Table 2
searching, inclusion, and exclusion in this review. Distribution of published journal articles.
Journal name N Percentage
2.3. Charting, collating, and data summarization
International Journal of Hospitality Management 7 11.864
International Journal of Contemporary Hospitality 5 8.474
To chart, collate, and summarize the findings of this review, re­ Management
searchers extracted data from the finalized list of literature items, such The Service Industries Journal 4 6.779
as the methodology, data analysis technique, study variables, main Journal of Quality Assurance in Hospitality and Tourism 3 5.084
Tourism Management 2 3.390
findings, and other relevant information for the scoping review, and Journal of Hospitality and Tourism Research 2 3.390
independently recorded the extracted data in a securely accessed Frontiers in Psychology 2 3.390
spreadsheet. Factors that determine the choice of hospital-hotel under Journal of Healthcare Management 2 3.390
the umbrella of healthcare hospitality alongside the likely impacts on Journal of Clinical Nursing 2 3.390
Sustainability 2 3.390
PGE (including PGE outcomes) were identified and discussed in re­
Journal of Business Research 1 1.695
searchers’ team meetings for consensus. Journal of Travel and Tourism Marketing 1 1.695
Alongside the theoretical support for developing the concept of Cornell Hospitality Quarterly 1 1.695
healthcare hospitality and hospital-hotels, a total of 8 emerging themes Journal of Hospitality Marketing and Management 1 1.695
that act as antecedents to hospital-hotel choice, i.e., patient-focused Journal of Hospitality and Tourism Management 1 1.695
Journal of Service Management 1 1.695
hotel-like built environment, environmental aesthetics, conventional Boston Hospitality Review 1 1.695
medical treatment facilities, alternative health treatment facilities, food Journal of Retailing and Consumer Services 1 1.695
service management, hotel-like hospitality services, robot-assisted Sage Open 1 1.695
healthcare and hospitality services, and hospitable healthcare staff, a Tourism and Hospitality Research 1 1.695
Journal of Hospitality and Tourism Insights 1 1.695
total of 2 outcomes of PGE, i.e., HWB and behavioral intention, and a
Almatourism-Journal of Tourism, Culture and Territorial 1 1.695
total of 2 intervening stimuli, i.e., health status and feeling of inde­ Development
pendent control (FIC), were finalized for further consideration. European Journal of Integrative Medicine 1 1.695
Global Public Health 1 1.695
3. Results Cyberpsychology, Behavior, and Social Networking 1 1.695
JMIR Mhealth and Uhealth 1 1.695
International Journal of Quality and Reliability Management 1 1.695
3.1. Descriptive results Surgical Neurology International 1 1.695
International Journal of Social Robotics 1 1.695
Out of 73 literature items in this scoping review, there were 59 Robotics 1 1.695
Progress in Transplantation 1 1.695
journal articles (80.822%), 7 book chapters (9.589%), 4 conference
Nursing Forum 1 1.695
proceedings (5.479%), 2 books (2.740%), and 1 item of media literature Environment and Behavior 1 1.695
(1.370%). Between the years 2000 and 2022, most literature on Journal of Applied Social Psychology 1 1.695
healthcare hospitality was published in the International Journal of International Journal of Arts and Commerce 1 1.695
Hospitality Management (See Table 2) in the year 2017 (See Fig. 2), UAS Journal of Management and Commerce 1 1.695
Scandinavian Journal of Caring Sciences 1 1.695
adopted quantitative methodology (survey) (see Table 3), and employed Clinical Nutrition 1 1.695
structural equation modeling (SEM) for data analysis (See Fig. 3). Total 59 100
Fig. 2 shows that the trend in healthcare hospitality research
remained mixed between the years 2000 and 2022. Although there is a
growing number of healthcare hospitality literature items in the past
years, the trend line shows that the research on the topic is falling in the
recent context. Table 4 presents emerging themes, i.e., conceptual un­
derstanding of healthcare hospitality and hospital-hotel, hospital-hotel
choice, PGE, antecedents of hospital-hotel choice, outcomes of PGE, and
intervening stimuli (health status and feeling of independent control
(FIC)), and consequences of customer perceptions of greenwashing, and
emerging themes that were filtered from the scoping review of the
literature.

3.2. Healthcare hospitality, hospital-hotel, and PGE

The integration of healthcare with hospitality is an emerging patient-

guest-service approach that fuels the efficiency of healthcare and hos­
pitality services multifold (Lopes et al., 2017; Suess and Mody, 2017a).
The notion of healthcare hospitality mirrors two service industries, i.e.,
the healthcare industry and the hospitality industry, and hospitals and
hotels are major stakeholders in delivering healthcare hospitality.
However, it is fair to raise two questions: (1) Does a hospital reflect a Fig. 2. Published literature distribution and trend between the years 2000
and 2022.
commercial hospitality space? (2) Does an exchange between patients
and doctors/nurses/caregivers fit within the conventional realms of
hospitality? service operations (Jenkins et al., 2011): room reservation, room ser­
While hospitals and hotels are distinctly different from each other in vice, food and beverage service, housekeeping, flow of inventories be­
serving their customers, i.e., a customer/patient/guest in a hospital is tween specialized departments (Jenkins et al., 2011), interaction
sick, a hospital-hotel offers healthcare and hospitality services under one between host and guest, room and bed management, 24/7 service,
roof (Borg et al., 2015). In a case study on four South Wales hospitals, it concierge, security, and hierarchy of workers with different re­
is documented that hospitals and hotels are similar in the following sponsibilities for patient-guest physical and psychological comfort

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Table 3 Table 4
Methodology analysis of published literature. Concepts: healthcare hospitality in hospital-hotel.
Methodology N Percentage Main extract Emerging themes References

Quantitative Conceptual Healthcare Borg et all., 2015;Cheng et al.

Survey 22 30.137 understanding of hospitality, hospital- (2021);Cormany (2017);
Psychological experiment 3 4.110 healthcare hotel DeMicco and La Forgia (2020);
Qualitative hospitality Giordano et al. (2021);Han
Exploratory study 19 26.027 (2013);Han and Hwang
Case study 9 12.329 (2018);Hume and Demicco
Interview 4 5.479 (2007);Jenkins et al. (2011);
Focus groups 1 1.370 Kelly (2015);Klaus (2018);
Hermeneutic phenomenological methodology 1 1.370 Lopes et al. (2017);Losekoot
Mixed methods 3 4.110 and Theresa (2018);Majeed
N/A 11 15.068 et al. (2018);Majeed and Kim
Total 73 100 (2022);Pizam (2007, 2020);
Severt et al. (2008);Suess and
N/A = not applicable. Mody (2017a);Zygourakis
et al. (2014)
Hospital-hotel choice Hospital-hotel choice Majeed and Lu (2017);Han
and patient-guest (2013);Han and Hwang
experience (PGE) (2013), 2018a;Shabbir et al.
(2016)
Patient-guest Kelly (2015);Klaus (2018);
experience (PGE) Mastandrea et al. (2019);
Severt et al. (2008);Suess and
Mody (2017a);Russell-Bennett
et al. (2017);Shabbir et al.
(2016)
Antecedents of Patient-focused hotel-
hospital-hotel choice like built environment
Building design Bangwal et al. (2022);Kelly
(2015);Kim et al. (2021);Lopes
et al. (2017);Majeed and Kim
(2022);Mody et al. (2020);Ouf
et al. (2021);Russell-Bennett
Fig. 3. Published literature data analysis techniques. Note: SEM= structural et al. (2017);Shabbir et al.
(2016);Suess and Mody
equation modeling, ANOVA = analysis of variance, N/A= not applicable.
(2017a) (2017b);Suess et al.
(2017);Wu et al. (2013)
(Kelly, 2015; Losekoot and Theresa, 2018; Severt et al., 2008). Room design DeMicco et al., 2017;Kareem
Furthermore, hospitals and hotels share the trait of embodying huge and Jamgade (2021);Kim et al.
(2021);Ouf et al. (2021);
variations in service, such as the range offered by French brand Accor’s
Russell-Bennett et al. (2017);
Raffles (luxury), Novotel (midscale), and ibis styles (economy), Amer­ Shabbir et al. (2016);Suess and
ican brand Hilton’s Waldorf Astoria (luxury), Double Tree (premium), Mody (2017a) (2018);van
Hilton Garden Inn (midscale), and Blackstone Group’s Motel 6 (budget), Sprang and Groen (2016)
Environmental Harris et al. (2002);
to name a few; similarly, hospitals are different in terms of size, medical
aesthetics Hunter-Jones et al. (2020);
facilities, and healthcare service quality, such as hospital-hotels like the Iyendo and Alibaba (2014);
Mayo Clinic in the USA, Bumrungrad Hospital in Thailand, Mount Kelly (2015);Kim et al. (2021);
Elizabeth Hospitals in Singapore, Doctors Hospital in Pakistan, and Majeed and Kim (2022);
conventional hospitals without the essence of hospitality like Sarasota Majeed and Ramkissoon
(2020);Mastandrea et al.
Memorial and Baptist Hospital in the USA.
(2019);Russell-Bennett et al.
In the context of hospital-hotels, the role of healthcare wrapped in (2017); Schreuder et al., 2016;
hospitality is important to improve PGE (Severt et al., 2008). PGE is a Shabbir et al. (2016);Suess and
trade-off between patient-guest expectations and perceptions in Mody (2017b) (2018);Suess
et al. (2020);Woo and Lin
response to implied cognitive mechanisms triggered by the loss of pri­
(2016)
vacy, illness, the fear of the outcome of health treatment, the feeling of Conventional medical Cormany (2017);DeMicco
an unwilling guest living at a hospital, and an uncomfortable physical treatment facilities (2017c);Majeed et al., (2020,
and aesthetic environment during a stay at a hospital-hotel (Severt et al., 2022);Majeed and Kim (2022)
2008; Suess and Mody, 2017a). In the context of hospitals, patients are Alternative health Chen et al. (2013);Cormany
treatment facilities (2017);Han (2013);Han and
anxious and stressed amid ongoing illness, the outcome of medical
Hwang (2013);Han et al.
intervention, stranger feelings, and communication with doctors and (2015);Jiang and Wen (2020);
paramedical staff, which may undermine their patient experience during Majeed and Kim (2022);Mast
patient health treatment at a hospital (Zygourakis et al., 2014). A and DeMicco (2017);Severt
et al. (2008)
hospital-hotel may improve PGE underpinned by the associated emo­
Food service Cormany (2017);DeMicco
tions of healthcare and hospitality philosophies. management (2017c); Edmonds et al., 2000;
The lessons of the hospitality industry, such as hospitableness, or Jonsson et al., 2021;Kareem
meeting guest needs with pleasure, have been welcomed by the and Jamgade (2021);Majeed
healthcare industry to improve PGE (Zygourakis et al., 2014). Feelings and Kim (2022);Mast and
DeMicco (2017);Meier et al.
of ease, psychological comfort, physical comfort, security, and polite
(2021);Lim et al. (2012);Pizam
communication (typically demonstrated in hotels) alongside medical (2017)
treatment during a hospital stay may create positive impacts on PGE (continued on next page)
(Kelly, 2015). Moreover, basic hospitality (typically offered in airlines,

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S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

Table 4 (continued ) facilities, doctors’ qualifications, personalized attentive medical care,

Main extract Emerging themes References and accreditation of hospitals, for the best healthcare outcome and quick
recovery during recuperation (Majeed et al., 2017, 2018), which may
Hotel-like hospitality Edwards et al. (2000);Han and
services Hwang (2013); Hume and
ultimately improve PGE in the context of hospital-hotels. A
DeMicco, 2017;Jonsson et al. hospital-hotel presents a bigger picture of healthcare hospitality due to
(2020);Lopes et al. (2017); the provision of not only aesthetic healthcare services, such as YOMERE
Severt et al. (2008);Shabbir (yoga, meditation, recreation) (Majeed and Kim, 2022), but also surgical
et al. (2016);Wu et al. (2013)
interventions, such as heart transplants, knee replacements, emergency
Robot-assisted DeMicco and Poorani (2017);
healthcare and Etemad-Sajadi and Sturman rooms, cosmetic surgeries, and cancer treatment, alongside personalized
hospitality services (2022);Holland et al. (2021); attentive care from doctors and paramedical staff and in parallel to
Jiang and Wen (2020);Kang hotel-like comfort and services (Han, 2013; Majeed and Kim, 2022;
et al. (2022);Kim et al. (2021); Majeed et al., 2017, 2020). Thus, the budding knowledge of healthcare
Li et al. (2022); Widerhold,
2017
hospitality sheds light on the important role of alternative health
Hospitable healthcare Cheng et al. (2021);DeMicco treatments, conventional medical treatments, and hotel-like service
staff (2017b);DeMicco and Poorani (including service providers’ attentive and caring attitude), all under
(2017);Gilje (2004);Kelly one roof as in a hospital-hotel, to improve PGE.
(2015);Kelly et al. (2020);
Klau, 2018;Kristiansen et al.
(2022);Majeed and 3.2.1. Patient-guests’ hospital-hotel choice and PGE
Ramkissoon (2020);Pizam Patient experience in a hospital reflects the continuous process of
(2020);Shabbir et al. (2016); interaction, such as surgical intervention and interaction with medical
Suess and Mody (2018);Wu staff and others involved in lodging, maintenance, and food services,
et al. (2013);Zygourakis et al.
(2014)
which shapes patient emotions, spiritual feelings, sensorial responses,
Outcomes of Patient- Health and well-being Andrade et al. (2016); Garg, expectations, and perceptions leading to overall patient experience
guest experience (HWB) 2016;Kim et al. (2021);Majeed (Klaus, 2018; Russell-Bennett et al., 2017). Moreover, a hospital that
(PGE) and Kim (2022);Majeed and offers a pleasant environment (involving polite admission and discharge
Ramkissoon (2020);Mody et al.
procedures that hinge on the notion of “interaction”) alongside skilled
(2020);Pizam (2020);Suess
and Mody (2018) doctors and a caring attitude toward patients may develop patient
Behavioral intention Han and Hwang (2013);Jiang perception that their healthcare experience during their hospital stay
and Wen (2020);Kim et al. had a positive tone (Shabbir et al., 2016). From a psychological
(2021);Klaus (2018);Majeed perspective, a positive outcome to expectations and perceptions may
and Kim (2022);Mody et al.
trigger positive feelings (Majeed and Ramkissoon, 2022). Patients
(2020);Russell-Bennett et al.
(2017);Saiprasert et al. (2021); expect medical and non-medical service quality at a healthcare facility
Severt et al. (2008);Shabbir (Klaus, 2018; Majeed et al., 2017, 2020). Patients’ medical experience
et al. (2016);Suess and Mody depends on the gap between their expectations and the perceived per­
(2017b) (2018)
formance of hospital healthcare service quality in terms of clinical care,
Intervening stimuli Health status Cormany (2008);Majeed and
Kim (2022);Majeed et al. qualified medical staff, and efficient administrative work (Shabbir et al.,
(2022);Mody et al. (2020); 2016), and these exist in the external environment of a patient during a
Suess and Mody (2017a);Suess hospital stay.
et al. (2017);Whittaker (2008) Environmental stimuli may shape customer experience (Suess and
Feeling of Cheng et al. (2021);Mody et al.
Mody, 2017a), and external stimuli, such as product features and in­
independent control (2020);Suess and Mody
(FIC) (2018);Zhao et al. (2019) formation, may stimulate an individual’s cognitive reactions, such as
perceptions, positive feelings, and motivation (noted as PGE in this re­
view), and willingness to consume products and services (Han, 2013).
restaurants, and hotels) and personal hospitality (person-to-person Since PGE, in the context of hospital-hotel choice, is a constellation of
interaction and information sharing) at the nursing station, reception cognitive reactions, the right combination of physical and aesthetic
desk, and cafeteria of a hospital-hotel, in parallel to therapeutic hospi­ environment may shape PGE (by meeting patient-guest healthcare ex­
tality (establishing people-to-people relationships to alleviate feelings of pectations, perceptions, needs, and wants alongside triggering
social distancing and loneliness) may shape positive PGE (Severt et al., patient-guest positive cognitive responses, such as the feeling of
2008). Healthcare facilities show interest in imitating hospitality oper­ happiness and satisfaction), in parallel to healthcare facilities (including
ations, such as Mayo Clinic luxury healthcare and Tisch Hospital (New qualified medical staff) and hospitality services (which collectively are
York) cooperation care unit (Cormany, 2017). Given this, hospitals have external environmental stimuli in a hospital-hotel setting) (Severt et al.,
started to approach hospitality academics and practitioners in the USA, 2008). In a study on medical tourism highlighting tourists’ changing
Switzerland, and in some countries in Europe, to help hospitals trans­ preferences in medical tourism, Majeed and Lu (2017) presented the
form the conventional hospital image to a hotel-like image, like a MTRT Steps model that illuminates the importance of the choice of a
hospital-hotel, to alleviate the stress levels of people who are not healthy healthcare facility, which offers health treatment and hospitality, and its
and need medical assistance (Pizam, 2007, 2020). impact on the tourist-guest positive healthcare experience. The theo­
Unprecedented growth in the medical and wellness facets of health retical background of the MTRT Steps model reveals that the instru­
tourism has highlighted a new style of healthcare that hinges on hotel- mental inter-linked coordination of communication, comfortable
like comfort, in tandem with conventional and alternative health lodging choice matching tourist expectations, perceptions, needs, and
treatments in a healthcare facility, to improve health-seeking tourists’ wants, airport pickup and drop off, comfortable transportation (which is
cognitive reactions and healthcare experiences (Han, 2013; Han and traditionally offered in hotels), doctor office appointment, and the
Hwang, 2018; Majeed et al., 2018; Majeed and Kim, 2022), such as PGE provision of technologically advanced health treatments with the
in this review. Despite comfortable accommodation and medically courtesy of doctor visits to patients in patient home countries (if
equipped comfortable vehicles for patient movement, insights filtered needed), may trigger tourists’ positive feelings during health treatments
from medical and wellness tourism literature unravel the paramount at a host medical facility. This generates a reason for understanding the
importance of quality medical treatments, in terms of advanced medical importance of the right choice of host medical facility (hospital-hotel in

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S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

this review), which offers healthcare and hospitality services matching literature demonstrate that well-maintained facilities (e.g., those with
visitor cognitive filters (patient-guest in this review), to improve the fresh air, lighting, furniture), interior design, facility aesthetics, and
tourist healthcare experience (PGE in this review). ambiance may influence the patient-guest choice of a health facility and
PGE (Hunter-Jones et al., 2020; Kim et al., 2021; Shabbir et al., 2016).
Drawing on the work of Majeed and Kim (2022) and Suess and Mody
3.3. Antecedents of hospital-hotel choice (2017b) (2018), ambient lodging, decoration, and state-of-the-art ar­
chitecture at a hotel may attract patient-guests in parallel to triggering
3.3.1. Patient-focused hotel-like built environment patient-guest positive sensorial feelings about the host hospital-hotel.
Hospitality-induced interior design features may help to reduce
3.3.1.1. Building design. Using the Servicescape framework in health­ patient-guest stress (Suess and Mody, 2017b). This has been supported
care and hotel contexts, scholars found that the design of the physical by Harris et al. (2002) in the context of hospital environmental aes­
environment may improve healthcare quality (Mody et al., 2020) and thetics as a healing environment, where the authors note that despite the
reduce patient stress (Kelly, 2015; Suess et al., 2017). Hotel appearance ambient environment and interior design, hospital choice and associated
is a part of the hotel’s physical environment and may impact guests’ patient feelings are susceptible to hospital architecture. Based on patient
feelings and attitudes (Kim et al., 2021). In a study on blood donor and visitor interviews conducted at a blood donor center, it was sug­
centers, Russell-Bennett et al. (2017) document that the non-clinical gested that healthcare facilities offering different colors, such as colorful
physical layout of wellness centers and hospitals makes patients feel cushions and curtains that brighten up the day, furniture (including big
comfortable during their health treatment. Despite meeting regulatory and nice, comfortable chairs), comfortable indoor temperature, and
requirements in the healthcare industry, the hotel-like building design of pleasant indoor aroma may mirror the non-clinical image of healthcare
hospitals positively impacts patient-guest expectations, perceptions facilities and might help attract patients and uplift the patient healthcare
(Lopes et al., 2017), healing, and cognitive reactions, which may experience (Russell-Bennett et al., 2017).
determine PGE (Wu et al., 2013). Exposure to sunlight, pleasant indoor aromas, designer-inspired
A well-designed physical environment, comprised of building layout, furniture, colorful walls, and high-end material finishes in a hotel-like
disability access, elevator access (Majeed and Kim, 2022), waiting room environment fall under the scope of positive distractions that may
access, corridor design with well-structured places for beds (Shabbir reduce stress and pain (Suess and Mody, 2018). Additionally, reduced
et al., 2016), and areas of solitary occupancy and social interaction (Ouf noise levels, artwork, a variety of plants and flowers, and pleasant music
et al., 2021), presents the physical environment as less stressful and solidify the impact of environmental aesthetics in healthcare hospitality
more promising to patient-guest healing (Suess and Mody, 2018). Pos­ (Suess and Mody, 2017b). To indicate the aesthetic impacts of landscape
itive distraction locations, such as movie theatres and gaming centers, design on wellness-seeking tourists’ health and wellness tourism choices
and executive lounges inside the boundaries of a healthcare facility and associated emotional ambivalence, it was noted that natural scenery
develop a positive image of the healthcare facility and increase the reflecting calm water scenes exerts a positive impact on healthcare fa­
healing impact of individuals’ positive cognitive reactions (Suess and cility visitors (Majeed and Ramkissoon, 2020). Sensory comfort pro­
Mody, 2017a). One important facility-related factor is wayfinding vided by environmental aesthetics improves patient experience during
(Hunter-Jones et al., 2020). Easy-to-see directions and patient-guest healthcare treatment (Schreuder et al., 2016).
ability to navigate through the physical environment in finding facility
entry and exit doors may impact PGE (Suess and Mody, 2017b). 3.3.3. Conventional medical treatment facilities
The role of conventional medical treatment facilities in healthcare
3.3.1.2. Room design. The size of the bedroom, space, bathroom, and hospitality is better understood in light of arguments taken from medical
outside view from the room are a few of the factors that impact guest and wellness tourism literature (Cormany, 2017; DeMicco, 2017a,
perceptions and purchase decision-making of a night stay at a hotel 2017b, 2017c; Majeed and Kim, 2022). Whether tourists travel to find
room (Kim et al., 2021). In a Dutch nursing home case study, it was healthcare treatment for a critical disease condition, such as organ
found that healthcare facility residents prefer to have a two-room unit, i. transplants and heart operations, a non-critical disease condition, such
e., one bedroom and one living room, to protect their privacy and as dental implants and rheumatoid arthritis (Majeed et al., 2022; Majeed
encourage homey and hospitable feelings toward the healthcare facility and Kim, 2022), or lifestyle procedures, such as wrinkle removal, face­
(van Sprang and Groen, 2016). Well-designed bed areas (Shabbir et al., lifts, and cosmetic dentistry (Majeed et al., 2020), tourists expect hos­
2016) and a dedicated family zone (DeMicco et al., 2017) in a room may pitality services and conventional medical treatment facilities, made up
trigger pleasant feelings in a patient-guest. Hiding medical facilities and of doctors, paramedical staff, operation theatres, and drugs, to occur in a
equipment from view in a patient-guest room, such as placing medical hotel-like environment under the control of a healthcare facility, such as
equipment cables behind the walls or ceiling and medical equipment in a at a hospital-hotel (Cormany, 2017).
closed box at the level of walls, may strengthen patient-guest positive Currently, hospitals practice different healthcare hospitality models
emotional states with reduced stress (Russell-Bennett et al., 2017). to serve patients, such as performing surgical intervention at a hospital
Additionally, smooth edges in the room may help patients feel relaxed and then moving patients to a resort for convalescence, medical inter­
and safe during healthcare treatment (Kareem and Jamgade, 2021). A vention at a resort (for example, Barbados Fertility Centre, Palace of the
room with a self-service kitchenette, marble bath (Suess and Mody, Golden Horses in Kuala Lumpur, etc.), and medical check-up on an
2018), nature views (Ouf et al., 2021; Suess and Mody, 2017a), airplane with public hospitality essence (e.g., in Air Emirates) to di­
sound-absorbing ceiling tiles, personalized lighting, music, and tem­ agnose the cause of disease while traveling to receive hospital medical
perature control functions (DeMicco et al., 2017) are important attri­ care at a host destination (Cormany, 2017). Healthcare with hospitality
butes of a patient-guest room to improve PGE. services, like The Grand Resort Bad Ragaz in Switzerland, i.e., a 5-star
hotel that offers allopathic doctors of different specialties, therapy
3.3.2. Environmental aesthetics rooms, and drugs facilities with state-of-the-art hospitality services
Environmental aesthetics refers to the interaction between a person under its hotel roof, presents the emerging patient-guest choice of hos­
and the environment. While launching a project in 2004 to transform the pital and hotel care at one place to maximize PGE (DeMicco, 2017c;
healthcare environment of 120 hospitals in the UK, HRH the Prince of Majeed and Kim, 2022).
Wales commented, “It could not be easy to be healed in a soulless con­
crete box with characterless windows, inhospitable corridors, and 3.3.4. Alternative health treatment facilities
purely functional wards” (Kelly, 2015). Insights filtered from the extant A typical hospital stay may disrupt patients’ spiritual balance and

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S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

leave patients with unpleasant emotional experiences. The human need which may help a patient-guest feel cared for and relaxed, and, conse­
for spiritual healing has been addressed well by the healthcare facilities quently, such activities improve PGE. In the context of a hospital, how
that offer a blend of hospital and hospitality services. To minimize patient food is served is of paramount importance in terms of taste,
surgical side effects, recover quickly, and restore the immune system, temperature, food smell, portion size, texture, and service staff presen­
people expect alternative health treatments, which hinge on healthcare tation, and should be in accordance with patient perception of the
and hospitality philosophies, during their stay in a facility (Majeed and quality of food to make mealtime enjoyable (Edwards et al., 2000;
Kim, 2022). From the perspectives of medical tourism and healthcare, Jonsson et al., 2020); these practices are similar to those of the food and
surgical and non-surgical patients prefer medical hotels and healthcare beverages department of a conventional hotel. Moreover, asking pa­
hotels that offer healthcare experience grounded in alternative health tients about their choice of food from a restaurant-type food menu
treatment facilities (Han, 2013; Han and Hwang, 2013; Han et al., (Severt et al., 2008), whether they prefer to consume food in bed, in the
2015), such as medical spa, massage, YoMeRe, hydrotherapy, cupping chair beside the bed, or at a place away from the ward (in cases where
therapy, life coaching, and work out facilities, to name a few, under the patients are mobile and day rooms are near wards) makes patients’
supervision of trained alternative healthcare practitioners with mealtime pleasant and creates a nice image of a hospital (Edwards et al.,
hotel-like hospitality to alleviate patient stress, provide comfort, and 2000). From the perspective of a medical hotel, it is found that
support spiritual healing (Cormany, 2017; Majeed and Kim, 2022; chef-prepared food, room service, butler service, concierge service, and
Majeed et al., 2019; Mast and DeMicco, 2017). A hotel stay with alter­ valet-parking services similar to those in conventional hotels signifi­
native health treatments restores guest health with pleasant lifestyle cantly attract patient-guests and make their PGE memorable (Han and
feelings (Chen et al., 2013). Hotel stays with sleep hygiene programs, Hwang, 2013; Severt et al., 2008). Dedicated and friendly employees in
detox programs, meditation programs, and fitness programs may meet the hotel-like environment of a hospital earn patient appreciation,
patient-guest expectations and perceptions of a better healthcare expe­ which may boost the patient-guest choice of a hospital-hotel (Lopes
rience (Jiang and Wen, 2020). et al., 2017; Wu et al., 2013).

3.3.5. Food service management 3.3.7. Robot-assisted healthcare hospitality

Edmonds et al. (2000) analyzed hospital food service management Extant literature supports the role of robots in improving customer
through the hospitality lens and asserted that food menu adequacy like experience. For example, in an experimental study, a humanoid robot
in hotels is important because patients may stay in a hospital for a long called “Pepper” performed remote control concierge services and was
time, and patients expect a variety of hygienic food that may assist in found to meet customer expectations and perceptions, maximizing
quick healing. Hospital food often reflects the poor image and its customer experience (Etemad-Sajadi and Sturman, 2022). Traces of
negative impact on patient expectations and acceptability (Edmonds discussion in the extant literature showcase healthcare robotics’ effi­
et al., 2000). This might be one of the reasons for food waste in hospitals, ciency in improving patient-guest experience (DeMicco and Poorani,
and Meier et al. (2021) document that 1 kg of food waste in the 2017). Emerging healthcare robots are wired with healthcare and hos­
healthcare sector produces 2.9 kg of CO2e and impacts 48.4 liters of pitality philosophies to transport food and supplies to patient rooms,
water consumption and 1.9 m2 of land. assist doctors in virtual checks on patients and facility rounds, and help
Patient-guest in a hospital-hotel may belong to old age cohorts, and food service staff to know about the menu needs of a patient/guest
malnutrition disorders in the older generation are greater than in the (DeMicco and Poorani, 2017). Robots like Robear (a bear-faced robot
young generation (Jonsson et al., 2021). Malnutrition disorders may introduced as a “strong robot with a gentle touch” to assist patients who
reduce quality of life, increase patient’s length of hospital stay, and fuel are elderly and/or need help in safe movement with enough gentle
healthcare costs and stress levels (Lim et al., 2012). In light of the patient lifting and placing support), Paro (a therapeutic robot to help patients
food management insights of Jonsson et al. (2021), it is discerned that a with socialization, interaction, and reduce patient stress), and Raley (a
hospital-hotel offering quality hygienic food matching patient-guest “butler robot” that safely navigates densely human-occupied spaces,
nutritional needs, such as through the Culinary Medicine approach such as those in the healthcare and hospitality industries) are healthcare
(Pizam, 2017), is an attraction for those attempting to find a healthcare facility attractions competing to improve patient experience (Wieder­
place conducive to quick healing during convalescence. hold, 2017).
From the perspective of wellness tourism, tourists expect a healthy The COVID-19 pandemic has unraveled new demands from hotel
diet and remain concerned about hygienic food consumption during the customers, i.e., “safety first” and “reduced contact” (Li et al., 2022). The
wellness treatment and recovery phase while experiencing healthcare use of artificial intelligence (AI) and robotics technology in the health­
hospitality (Majeed and Kim, 2022). Patient-focused menu cards and care and hospitality industries showed accelerated growth during the
fresh food served when ordered (Kareem and Jamgade, 2021) to avoid COVID-19 pandemic to minimize human-to-human contact during ser­
patient-guest malnutrition disorders and support patient-guest quick vice encounters (Holland et al., 2021; Jiang and Wen, 2020; Kim et al.,
recuperation may create an attractive image for a hospital-hotel. A 2021; Li et al., 2022). Robots that measure body temperature for
facility’s ability to understand patient’s dietary needs and make dietary COVID-19 virus screening at hospitals, hotels, and shopping malls are in
food available at patient’s request, such as gluten-free food and operation in different countries (Holland et al., 2021), which is a con­
low-sodium food within doctors’ or dietitians’ prescribed limits (Mast tactless safety measure and creates a good image of the service facilities
and DeMicco, 2017), may meet patients’ quality food expectations and that adopted such safety measures during and post the COVID-19
perceptions during the hospital-hotel stay, such as at the Grand Resort pandemic. Given the contagion cues of COVID-19, hotel guests show a
Bad Ragaz (Cormany, 2017; DeMicco, 2017c; Majeed and Kim, 2022; willingness to adopt hospitality service robots for completely contactless
Mast and DeMicco, 2017). services to ensure physical and psychological comfort (Kang et al.,
2022); for example, using robot receptionists for facial scans, and robot
3.3.6. Hotel-like hospitality services check-in and concierge services may reduce COVID-related anxiety,
Hospital-hotel maintenance activities—for example, placing dust­ stress, fears, and worries among guests (Jiang and Wen, 2020).
bins and spittoons in hospital corridors, toilet and washroom cleaning, Due to the COVID-19 pandemic, hotel guests’ demands for extra
patient-guest room maintenance (Shabbir et al., 2016), patient-guest hygienic and clean facilities have been heightened because a service
bed turn down, bed linen maintenance, placing a chilled bottled water facility’s surfaces are perceived to be dirty disease transmission sources,
at the patient-guest bedside, and phone in reach when patient-guest due to, for instance, the existence of microbial counts (Jiang and Wen,
returns after surgery or medical check-up (Hume and DeMicco, 2017), 2020). Moreover, the likelihood of disease transmission from facility
etc.—fall within the scope of conventional hotel housekeeping services, surfaces is greater in healthcare facilities. Robots are made intelligent to

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deliver medicine, perform cleaning functions, and provide basic susceptible to the cognitive reactions of patient-guests to the impacts of
companionship and guidance (Wiederhold, 2017), which are conjoined hospital-hotel environmental stimuli, such as people, places, and pro­
attributes of healthcare hospitality. Taking all the above together, since cesses, i.e., antecedents of hospital-hotel choice, in the stream of
hospital-hotel customers may not be healthy and likely demand extra healthcare hospitality.
care to regain the momentum of healthy life, robot-assisted healthcare
hospitality services seem an important attraction of a hospital-hotel in 3.4.2. PGE and behavioral intention
providing safe PGE during and after the COVID-19 pandemic. Theoretical underpinnings in the domains of hospitality, healthcare,
medical tourism, and wellness tourism shed light on the conceptual
3.3.8. Hospitable healthcare staff understanding of behavioral intention and define it as tourist likelihood
From the perspective of medical tourism, it is noted that successful to take a particular action, for example, spreading word-of-mouth
medical treatment with unpleasant customer service, which is not (WOM), recommendations, referrals, revisit, complaint intention,
appreciated by medical tourists, may undermine a memorable medical intention to pay extra, etc. (Han and Hwang, 2013; Majeed and Kim,
tourism experience (DeMicco and Poorani, 2017). The soft environment 2022; Shabbir et al., 2016). Hospitals that hinge on new looks and
in healing places, such as polite medics in hospitals and medical hotels, hospitality feelings to maximize the patient experience trigger patient
reflects a holistic medicine approach, which may skyrocket individuals’ willingness to pay extra in response to improved experience (Suess and
positive healthcare experience and quick recovery (Majeed and Ram­ Mody, 2017b, 2018). Scholars note that hotel guests who experience
kissoon, 2020). Empathy, courtesy, patience, and the friendly attitude of improved cleanliness and sanitization to combat the spread of disease
paramedical staff in delivering healthcare services may positively in­ show willingness to pay more to hotels (Jiang and Wen, 2020). Better
fluence patients during healthcare treatment (Pizam, 2020; Shabbir patient experience in the hotel-like environment of a hospital-hotel in­
et al., 2016). While elaborating on “a Disney approach to healthcare,” duces patients to demonstrate positive postexperience behavior, such as
DeMicco (2017b) presents that a successful medical treatment wrapped loyalty, WOM, and recommendation (Mody et al., 2020). The satisfied
in a healthcare provider’s empathy, cheerfulness, courtesy, responsive patient experience stimulates patient motivation to repurchase or revisit
attitude, and quality communication, is an attractive healthcare service hospital services with the intention to share medical treatment experi­
attribute to boost PGE. ences with others (Suess and Mody, 2017b). In hospitals and hotels,
In the context of hospitality in a dementia-friendly environment, patients, guests, and visitors determine their behavioral intention, such
findings show that healthcare staff’s responsive attitude, attention, and as returning or not to returning, after experiencing the services of a host
responsible communication in updating patients and their caregivers facility (Severt et al., 2008). From the perspective of luxury patient
about patient health conditions improves a hospital’s image, which is experience, it is noted that patient positive experience of healthcare
often perceived as chaotic and exhausting with discomfort (Kristiansen services fuels the probability of patient return and patient loyalty
et al., 2022). Studies on neurosurgery reveal that a physician’s global alongside decreasing the likelihood of swapping service providers
rating depends on the physician’s respectful attitude to patients, atten­ (Klaus, 2018).
tive listening skills, communication skills, and spending enough time
with patients during doctor-patient interactions to address patient 3.4.3. Impact of HWB on behavioral intention
concerns (Zygourakis et al., 2014), which mirrors the importance of HWB acts as an antecedent to behavioral intention (Majeed and Kim,
hospitality-induced provider healthcare skills for a satisfactory patient 2022). Drawing on a comparative study between domestic and inter­
experience. From the perspective of hospitality in a hospice context, it is national medical destinations exploring behavioral intention in response
found that a nurse’s way of receiving hospice patients makes patients to medical quality and well-being, Saiprasert et al. (2021) reveal that
feel relaxed and welcomed (Gilje, 2004; Kelly, 2015; Kelly et al., 2020). positive behavioral intention depends on positive HWB. From the
A doctor’s practice of “hospitality principles” alleviates patients’ nega­ perspective of hospitality and brand loyalty in the COVID-19 pandemic,
tive feelings (Cheng et al., 2021). Therefore, healthcare staff with hos­ scholars document that guest-perceived well-being stimulates guest
pitality training is a pleasant essence of healthcare hospitality and is behavioral intention, such as brand loyalty (Kim et al., 2021). Patient
rated high by patients for a great experience in a hotel-like healthcare satisfaction, which is an important component of HWB, is noted as an
environment (Klaus, 2018; Suess and Mody, 2018; Wu et al., 2013). important factor influencing patient loyalty and intention to use hospital
services in the future (Shabbir et al., 2016). Therefore, the above helps
3.4. Outcomes of hospital-hotel choice decision: PGE, HWB, and to demonstrate that patient-guest HWB may impact patient-guest
behavioral intention behavioral intention toward a hospital-hotel.

3.4.1. PGE and HWB 3.5. Intervening stimuli

The term “HWB” was coined to showcase the health and wellness
phenomena in which physical health assists healing connections among 3.5.1. Health status
mind, body, and soul, i.e., well-being, and vice versa (Majeed and Kim, Health status encapsulates two probabilities of an individual’s health
2022). Drawing on the assertions of Mody et al. (2020) and Pizam condition, i.e., critical disease condition and non-critical disease con­
(2020), HWB is a subjective experience, i.e., an outcome of the dition (Majeed and Kim, 2022; Majeed et al., 2022). Critical disease
emotional and cognitive impacts of a human experience, such as PGE in condition refers to a life-threatening condition, such as cancer, while
this review. A hospital’s environment, which mirrors intertwined feel­ non-critical disease condition refers to a medical condition that is not
ings of places and people, shapes the patient healthcare experience, life-threatening but may compromise quality of life, such as rheumatoid
which ultimately determines HWB (Andrade et al., 2016). Because arthritis (Majeed et al., 2022). The health status of an individual may
in-patient experience in a hospital is often a stressful experience, the strengthen or weaken the relationship between the choice of
stressful hospital environment may engender patient physical and psy­ hospital-hotel attributes and PGE. This can be understood from the
chological healing (Suess and Mody, 2018). A cohesion between envi­ findings in medical and wellness tourism, as well as healthcare hospi­
ronmental stimuli, such as built environment and environmental tality, literature. For example, healthcare hospitality was included as a
aesthetics, and human feelings, visualization, cognitive reactions, ex­ part of tourist attractions in the work of Majeed and Kim (2022), and
pectations, and perceptions, i.e., PGE in this review, produces positive scholars reveal that medical tourists with critical disease conditions
mind landscapes (Majeed and Ramkissoon, 2020), which determine might be interested more in experiencing medical facilities and less
HWB (Majeed and Kim, 2022). Based on the above, HWB in a interested in tourist attractions; for example, they may be fascinated by
hospital-hotel context is a subjective experience of PGE, which is hotel attributes and stay at host facilities with alternative health

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S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

treatments during postoperative time to maximize the tourist experience convenience in accessing service from hospitable healthcare staff,
(Cormany, 2008; Whittaker, 2008). Support for such arguments can be controllable mood lighting in the room, control over technological ac­
traced to the work of Mody et al. (2020) who explored the impact of cess to entertainment, music, and television, and on-demand salon and
hotel-like attributes on patient well-being. However, this situation might spa (Mody et al., 2020; Suess and Mody, 2018). Technological control
be reversed in the case of tourists who feel better in health status, i.e., over patient room amenities, such as tablet controllable television, room
experiencing non-critical disease conditions (see wellness tourism ma­ lighting, and curtain movement, increases patient positive feelings of
trix of Majeed and Kim, 2022). control of the environment while experiencing confinement in a hospital
From the perspective of hospitality in healthcare, Suess and Mody bed (Zhao et al., 2019). From the perspective of a hospitable telemedi­
(2017a) studied the moderating impact of patient health status in the cine experience in the hospitality context, FIC of accessing reliable
relationship between environmental stimuli, such as the product and doctor service with ease and convenience improved individuals’ expe­
service dimensions of healthcare hospitality, and responses, such as rience of clearly receiving the service content (Cheng et al., 2021).
patient perceptions, preferences, and behavioral consequences, i.e., PGE Convenience in accessing patient medical records at any time, such as
in this review. Extant literature reveals that patient health status may patient control provided on a tablet in the patient’s room, without
intensify or lessen the relationship between the servicescape of health­ making calls to nursing staff, greatly improves the patient experience
care hospitality and patient cognitive reactions in a hotel-like environ­ during health treatment (Zhao et al., 2019).
ment (Mody et al., 2020; Suess and Mody, 2017a; Suess et al., 2017). Drawing on the findings as documented above, a conceptual
Patient choice of the attributes of healthcare hospitality, as demon­ framework is presented in Fig. 4.
strated in a hospital-hotel context in this review, and patient perceptions
and reactions, such as PGE in this review, are susceptible to the 4. Discussion
moderating impact of patient health status (Mody et al., 2020).
Given the lack of research on healthcare hospitality, this review
3.5.2. Feeling of independent control (FIC) unravels what happens when hospitality is combined with healthcare.
The feeling of independent control (FIC) refers to perceived auton­ This review presents a body of literature to clarify the conceptual un­
omy, liberty, and empowerment to control activities or enforce thoughts derstanding of healthcare hospitality, hospital-hotel, patient-guest
into action without any influence (Cheng et al., 2021; Mody et al., choice of hospital-hotel, PGE, HWB, and behavioral intention, under the
2020). Perceived convenience is an implied notion of FIC (Cheng et al., moderating impacts of health status and FIC. We reviewed extant liter­
2021). Multiple factors may foster FIC, such as on-demand doctor ature on healthcare hospitality to sketch a conceptual model on the
consultation, choice of food and beverages, on-call concierge service, canvas of this review to showcase antecedents of patient-guest choice of

Fig. 4. Conceptual framework.

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S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

hospital-hotel (including conventional medical treatment, alternative hospitality concept, which was presented as a part of tourist attractions
health treatment, robotics, and hospitality perspectives) and their in the work of Majeed and Kim (2022) and remained mixed and limited.
associated outcomes, such as PGE, HWB, and behavioral intention. The Since the healthcare industry is making efforts to learn from hospitality
findings reveal that the patient-guest choice of a hospital-hotel depends principles (Pizam, 2007, 2020) to attract HWB-seeking individuals
on the different service attributes of hospitals and hotels that align with worldwide, the conceptual model of this review may serve as a torch­
the shared philosophy of healthcare hospitality to improve PGE, which bearer to guide the development of the healthcare hospitality philoso­
impacts HWB and behavioral intention. This finding supports the ar­ phy, which is yet at the embryonic stage, in different contexts of the
guments of DeMicco (2017a) where the author notes that healthcare healthcare industry, such as hospitals, clinics, blood donor centers, and
hospitality connects hospitals and hotels for a total customer experience. nursing homes, as well as in the tourism industry, such as in medical
Moreover, the identified antecedents of hospital-choice have an impact hotels and healthcare hotels. Therefore, this review is one of a few
on behavioral intention through the lens of PGE. This finding is in line pebbles into the stream of healthcare hospitality literature, attempting
with the empirical evidence of Han (2013) where it was found that the to produce a ripple effect of hospitality in the healthcare industry.
dimensions of a healthcare hotel significantly impact visit intention
through cognitive reactions, perceptual filters, and the sensory experi­ 4.2. Practical implications
ence of hotel guests, all of which is taken as PGE in this review.
However, the relationship between patient-guest choice of hospital- The interior design of hospital-hotels may be improved with
hotel and PGE is influenced by the intervening stimuli of health status aesthetically appealing materials and finishes to minimize the risk of
and FIC. The findings show that health status and FIC may improve or infection (Suess and Mody, 2017), such as well-designed hand surfaces
weaken the relationship between patient-guest choice of hospital-hotel that control the spread of pathogens, and furniture materials that do not
and PGE. The expansion of hospitality to the healthcare industry is show cracks and hide infection-spreading germs, etc. Hospital-hotel
gaining academic attention, and this review provides a timely multi- rooms designed with advanced technological support may improve
dimensional angle, both for understanding healthcare hospitality and FIC and fuel PGE, WOM, and willingness to pay extra, through, for
promoting the hospital-hotel business. Place, process, and personnel, example, access to patient records, physiotherapy, entertainment con­
such as hotel-like hospital environment, quality of healthcare services, trol (for the internet, music, and TV), room temperature control, mood
and service providers’ way of rendering services, may play vital roles in lighting control, curtain movement, and bed adjustability control,
improving PGE and the luxury healthcare business (Klaus, 2018), such alongside the control of electrocardiogram (ECG) and temperature
as the hospital-hotel business. monitoring on the screen provided in an easily-accessible bedside tablet.
For this, existing service systems, such as the Skylight healthcare system
4.1. Theoretical contributions (a technology-induced service system for patient support) (Severt et al.,
2008), can be updated and modified with hospitality service controls,
This review is one of those few research attempts that reconceptu­ such as one-click concierge, food and beverages, housekeeping, and
alizes hospitality to push the boundaries of hospitality into healthcare laundry services.
(Losekoot and Theresa, 2018; Mody et al., 2020; Pizam, 2007, 2014, Additionally, the building design of hospital-hotels needs to be
2020; Suess and Mody, 2018). Although extant literature on healthcare improved to avoid fatalities linked to incidents of carbon monoxide (CO)
hospitality provides support for the impacts of environmental aesthetics poisoning. Unintentional CO poisoning caused a total of 115 fatalities
on PGE (Suess and Mody, 2017a, 2017b), such as design elements (Suess between 2005 and 2018 in USA hotels, motels, and resorts (Hampson
and Mody, 2018), a holistic view of hospital and hotel attributes, et al., 2019). For this, hospital-hotel lobbies, waiting areas, and spaces
embodying conventional medical treatments, alternative health treat­ around spittoons and trash bins must be designed to allow the inflow of
ments, and hospitality perspectives under the intervening impact of plenty of natural light and fresh air. Moreover, hospital-hotels must
physical and psychological realms, such as health status and FIC, consider locations for installing CO poisoning alarms while designing
remained mixed, shallow, and fragmented in previous studies deter­ building and room layouts. Since robots can improve a hotel’s sustain­
mining PGE and behavioral intention. This review supports the theo­ able competitiveness (Jiang and Wen, 2020), locations that are sus­
retical development of healthcare concepts under the spotlight of ceptible to CO poisoning can be accessed with service robots for
environmental psychology and behavioral psychology processes cleanliness and sanitation. Robots can be used to escort patient-guests to
(McCullough, 2009). Drawing on the notion of the hospital-hotel, this restaurants, fitness centers, laboratory tests, and other facilities inside
review bridges the theoretical gaps with an integrated angle on how the hospital-hotel to minimize the chances of CO poisoning.
hospital-based healthcare treatments and hospitality services in a To minimize the chances of patient malnutrition and food waste, the
hotel-like environment create positive impacts on patient-guest choice principles of hospitality and food service management need be to uti­
of hospital-hotel and associated outcomes, such as PGE, HWB, and lized in the healthcare industry, through elements like easily readable
behavioral intention. Additionally, the conceptual rigor of HWB is menu cards, chef-prepared food from high-quality grains, adequately
strengthened by the theoretical contribution of this review in the stream heated food (for example, soup should not be overboiled and should be
of healthcare hospitality, hospital-hotel choice, and PGE. cooked outside the serving bowls), food serving crockery put in the oven
This review stitches together the broken theoretical connections before food service to kill germs, and available help from a ward hostess
between robot-assisted hospitality services and healthcare services, in food consumption (Edwards et al., 2000). According to an estimate,
which are important to consider while redefining healthcare hospitality the growing aging population, who are more susceptible to malnutrition
service operations to improve PGE, HWB, and behavioral intention disorders, will be 152.6 million in Europe by the year 2060 (Jonsson
during and post the COVID-19 pandemic. The theoretical assertions of et al., 2020), and will be 2 billion worldwide in 2050 (Losekoot and
this review clarify that hospitality principles can be applied in the Theresa, 2018). These estimates are an alarm to the healthcare industry,
complex and multi-stakeholder settings of the healthcare industry where to improve food service management under the umbrella of a hospitality
customer experience design and patient outcomes are determined, philosophy in order to appropriately serve the mighty flood of aging
which extends the conceptual understanding of the hospitality-oriented patients who will expect hospitality in healthcare.
patient experience (HOPE) framework (Hunter-Jones et al., 2020) under From the perspective of medical tourism, healthcare staff’s
the lens of alternative health treatments, conventional medical treat­ miscommunication or ineffective communication were commonly re­
ments, and robot-assisted healthcare and hospitality services in the ported issues by medical tourists (Han and Hwang, 2018). To get the
hospital-hotel. The woven web of healthcare hospitality concepts sup­ benefits from hospitality-focused customer service training programs
ports and solidifies the theoretical understanding of the healthcare and alleviate patient stress, negative emotional feelings, and improve

11
S. Majeed and W.G. Kim International Journal of Hospitality Management 112 (2023) 103383

patient experience, the healthcare industry needs to provide resources to how Mayo Hospital Lahore administers patient food service manage­
healthcare workers. Private sector hospitals are more prone to invest in ment. Besides meeting patients’ healthcare needs, Mayo Hospital
improving quality-of-service operations to uplift patient experience and administration was used to serve patient food thrice a day, i.e., break­
positive behavioral intention, while government hospitals are lagging in fast, lunch, and dinner, in different wards. Food serving trolleys were
this (Shabbir et al., 2016). Investing in hospitality-induced healthcare like those in airplanes but slightly bigger in volume. During his stay at
services in government hospitals will help patients to experience quality Mayo hospital, the Salman’s father was always served sufficient patient
healthcare treatments at an economical cost, which will impact patient food and two 0.5 liters of bottled water in a nicely packed disposable
behavioral intention. Thus, healthcare policymakers are encouraged to box, similar to those provided in takeout meals. At Mayo hospital, Sal­
invest in hospitable healthcare resources, environmental aesthetics, and man observed that alongside regular breakfast eatables, butter, jam, and
a hotel-like built environment to boost patient positive feelings during bread in small packaging, which is often served to passengers in air­
healthcare treatment at healthcare facilities. However, adopting mea­ planes, was provided, and tea in disposable cups was always served to
sures to improve PGE is not an overnight process and providing training patients after breakfast, according to patient health and willingness to
to employees may be time consuming (Mody et al., 2020). This demands eat/drink. The menu was different every day to avoid the monotonous
consistent effort to implement long-haul training programs that improve patient food routine and the menu was repeated after a week gap. Food
healthcare staff’s hospitality skills with the passage of time. serving personnel were polite, smiling, empathetic, and showed respect
while asking patients what they’d like to eat. If patients were sleeping
4.3. Examples in practice demonstrating different colors of healthcare and their caretakers were out of the ward to pick up laboratory reports
hospitality or for other patient-related matters, food was always placed in perfect
order on the table beside the patient bed.
4.3.1. Mount Elizabeth Hospital, Singapore Given the distant location of Mayo hospital from Salman’s living
Mount Elizabeth Hospital in Singapore (https://www.mounteliza­ place, food of any kind and food served in any style at the hospital was
beth.com.sg) is a hospital-hotel that is supported by the pillars of no less than a blessing. Nevertheless, sufficient patient food, tea, and
healthcare and hospitality. Besides offering world-class conventional bottled water in a nice box, wrapped in the polite, friendly, smiling, and
medical treatments, Mount Elizabeth Hospital offers hotel-like rooms respectable gestures of the food servers reduced Salman’s father stress
and amenities to patient-guests. Mount Elizabeth Novena rooms are and anxiety while elevating the feeling of a respectful healthcare
single rooms, single signature rooms, and suites, while Mount Elizabeth treatment and memorable patient experience. There was a big, wide
Orchard rooms offer Royal Suites and VIP rooms in addition to single window in the right corner of the ward to allow the inflow of plenty of
and double rooms. Room decoration, architecture, mood lighting, fresh air and natural light. This feeling of freshness supported Salman’s
furniture, bath amenities, and other facilities like a 5-star hotel, along father during his inpatient stay, helping him to feel better and to regain
with the healing hands of hospitality-educated doctors and paramedical his momentum in life. This case provides insight into improving
staff, make Mount Elizabeth Hospital one of the leading hospitality- hospitality-induced patient food service management and building
enhanced healthcare facilities in improving PGE, HWB, and behavioral design in healthcare facilities, in order to improve the patient
intention. experience.

4.3.2. The Grand Resort Bad Ragaz in Switzerland (DeMicco, 2017c; 4.4. Future research directions
Majeed and Kim, 2022)
In addition to conventional hotel service operations, The Grand This review considered literature published on healthcare hospitality
Resort Bad Ragaz, a 5-star hotel in Switzerland, offers therapies and in the year 2000 and afterward. We suggest future studies get help from
conventional medical treatments for a state-of-the-art healthcare expe­ literature published on the topic before the year 2000 to expand the
rience that improves PGE, HWB, and behavioral intention of hotel theoretical boundaries of this review. Given the language proficiency of
guests. Allopathic doctors, alternative medicine practitioners, and the authors of this review, literature items published in English data­
therapists with hospitality-enhanced training skills, along with state-of- bases were considered. The conceptual understanding of healthcare
the-art hotel environmental aesthetics, are available at The Grand Resort hospitality and associated concepts in this review can be solidified with
Bad Ragaz, all of which helps patient-guests to improve HWB. The Grand literature items published in non-English databases. This review pro­
Resort Bad Ragaz is one of the elite healthcare hospitality settings, with vides a conceptual framework to support building knowledge in
5-star hospitality services in Europe. healthcare hospitality. Future studies on healthcare hospitality are
encouraged to empirically examine the proposed constructs presented in
4.3.3. Ersta Hospital in Stockholm, Sweden (Borg et al., 2015) our conceptual framework. This review is not exhaustive and encour­
Ersta Hospital in Stockholm attempts to create excellence in food ages exploring the impacts of AI and robotics on PGE, HWB, and
service management. To provide delicious and hygienic food to patients behavioral intention in a hospital-hotel context, because AI and robotics
for quick recovery, Ersta Hospital outsourced an airline caterer, may significantly impact guest reactions, lodging experience, and
following the philosophy that food served during flights is prepared with behavioral intention during and post the COVID-19 pandemic (Jiang
the intention that nobody gets sick on board, which is in alignment with and Wen, 2020).
the hospital philosophy that nobody gets sick in the hospital due to
malnutrition. Additionally, quality food is perceived to be an attraction Conflict of interest
because quality food helps fight against illness. Ersta Hospital partnered
with another food supplier for vitamin-enriched quality food to meet The authors declare that there is no conflict of interest.
patient nutritional needs and support the patient healing process during
the post-operative period. Research shows that extra care in food service Data availability
management at Ersta Hospital improved patients’ eating capacity by
15–20% and reduced food waste. No data was used for the research described in the article.

4.3.4. Mayo Hospital Lahore, Pakistan: a self-experienced case

Between August 3, 2021 and August 21, 2021, Salman, the first
author of this review, was a caretaker of his father, who was struggling
to survive in the Neurosurgery ward at Mayo Hospital. Salman observed

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