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Delivering patient-centered healthcare is now seen as one of the basic requirements of good quality care. In this research, the impact of the perceived quality of three experiential dimensions (Physical Environment, Empowerment and Dignity and Patient–Doctor Relationship) on patient's Experiential Satisfaction is assessed.

259 structured interviews were performed with patients in private and public hospitals across Italy. The research methodology is based in testing mediation and moderation effects of the selected variables.

The study shows that: perceived quality of Physical Environment has a positive impact on patient's Experiential Satisfaction; perceived quality of Empowerment and Dignity and perceived quality of Patient–Doctor Relationship mediate this relationship reinforcing the role of Physical Environment on Experiential Satisfaction; educational level is a moderator in the relationship between perceived quality of Patient–Doctor Relationship and overall Satisfaction: more educated patients pay more attention to relational items. Subjective Health Frailty is a moderator in all the tested relationships with Experiential Satisfaction: patients who perceive their health as frail are more reactive to the quality of the above-mentioned variables.

Physical Environment items are enablers of both Empowerment and Dignity and Patient–Doctor Relationship and these variables must be addressed all together in order to improve the value proposition provided to patients. Designing a hospital, beyond technical requirements that modern medicine demands and functional relationships between different medical departments, means dealing with issues like the anxiety of the patient, the stressful working environment for the hospital staff and the need to build a sustainable and healing building.

Climate change poses diverse, often fundamental, challenges to livelihoods of island peoples. The purpose of this study is to demonstrate that these challenges must be better understood before effective and sustainable adaptation is possible.

Understanding past livelihood impacts from climate change can help design and operationalize future interventions. In addition, globalization has had uneven effects on island countries/jurisdictions, producing situations especially in archipelagoes where there are significant differences between core and peripheral communities. This approach overcomes the problems that have characterized many recent interventions for climate-change adaptation in island contexts which have resulted in uneven and at best only marginal livelihood improvements in preparedness for future climate change.

Island contexts have a range of unique vulnerability and resilience characteristics that help explain recent and proposed responses to climate change. These include the sensitivity of coastal fringes to climate-environmental changes: and in island societies, the comparatively high degrees of social coherence, closeness to nature and spirituality that are uncommon in western contexts.

Enhanced understanding of island environmental and social contexts, as well as insights from past climate impacts and peripherality, all contribute to more effective and sustainable future interventions for adaptation.

The need for more effective and sustainable adaptation in island contexts is becoming ever more exigent as the pace of twenty-first-century climate change increases.