From compliance to perception: A systematic review and quantitative synthesis of indoor environmental quality in healthcare facilities

Healthcare buildings often meet regulatory thresholds for indoor environmental quality yet fall short of delivering satisfactory user experience. This review followed PRISMA guidance and quantitative analysis method to synthesize evidence on the alignment between objective compliance and subjective cognition in dynamic healthcare settings, focusing on visual, acoustic, indoor air quality, and thermal domains with physical environment as a complementary lens. Across studies, compliance and perception exhibit only a moderate coupling, with pronounced domain-specific and contextual variability. Acoustic domain emerges as a persistent weak link—improvements rarely translate proportionally into better perceived soundscapes—while air quality shows frequent decoupling from perceptions shaped by odor, freshness, and episodic events that conventional metrics overlook. Visual and thermal conditions display weak-to-moderate translation of compliance into perceived quality. The care context and user role (patient, clinical staff, visitor) systematically modulate these relationships, with controlled or mixed scenarios enabling more reliable translation from compliance to experience. Evidence further indicates a nonlinear, threshold-like pattern: moving environments from low to moderate compliance yields the largest perceptual gains, whereas benefits taper at higher levels. We propose a dual-channel evaluation framework—a saturating compliance–response curve paired with standardized perception—to diagnose “high-compliance/low-perception” and “low-compliance/low-perception” quadrants and set prioritized, domain–context–role–specific interventions. The findings argue for complementing compliance-based governance with perception-oriented design and operations to achieve user-centered healthcare environments. © 2026 The Authors.