abstract: A growing body of research shows that characteristics of the built environment in healthcare facilities impact patients' well-being. Research findings suggest that patients form judgments of perceived quality care based on environmental characteristics. Patient outcomes and ratings of quality of care are linked to the environments' ability to reduce patient stress as well as influence perceptions of quality of care. Historically, this research has been focused in the hospital environment. The United States healthcare system heavily relies on hospitals to treat (rather than prevent) illness, leading to a high per capita healthcare expenditure. Currently, this healthcare system is shifting to rely heavily on ambulatory care settings and primary care providers to detect, prevent, and manage expensive medical conditions. The highest rates of preventable disease and the lowest rates of primary care usage are found in the young adult population (ages 18 to 24). More than any other patient population, this segment rates their satisfaction with healthcare significantly low. For this population education, early detection, and monitoring will be key for a primary care focused model to have the greatest impact on care and long-term savings. Strong patient-physician connections ensure the success of a primary care focused model. The physical environment has the opportunity to provide a message consistent with a physician's practice values and goals. Environmental cues in the waiting area have the potential to relay these messages to the patient prior to physician contact. Through an understanding and optimization of these cues patient perception of quality of care may be increased, thus improving the patient-physician relationship. This study provides insight on how to optimize environmental impact on the healthcare experience. This descriptive exploratory study utilized a non-verbal self-report instrument to collect demographic information and measure participant's responses to two panoramic photos of primary care provider waiting areas. Respondents were asked to identify physical elements in the photos that contributed to their perceptions of the quality of care to be expected. The sample population consisted of 33, 18 to 24 year-olds leaving a total of 234 emotional markers and comments. Qualitative and quantitative revealed three key themes of appeal, comfort, and regard. Physical elements, in the photos, related to the themes include: General areas that were important to the respondents were the seating and reception areas, as well as the overall appearance of the waiting area. Key elements identified to be significant characteristics influencing perceptions of quality of care are presented in this study. / Dissertation/Thesis / M.S.D. Design 2012