Purpose The purpose of this study is to explore the role of the physical environment in patient satisfaction ratings as communicated in narratives on the social media platform such as Facebook. Design/methodology/approach Publicly available Facebook reviews (n = 4,502) of a reputable healthcare system in the USA were analyzed. A thematic analysis was conducted to explore architectural elements of the physical environment that play a role in patient satisfaction. Findings Facebook reviews were examined for the presence of design-related factors within the physical environment. Of the 627 posts (14 per cent) with relevant content, 56 involved factors related to the physical environment. The factors include: location, parking, cleanliness, privacy, waiting rooms, music and temperature. The results showed that environmental and design-related factors are part of patient satisfaction in hospitals. Social implications The patient satisfaction is related to the physical environment of healthcare facilities. Some social media narratives reflect it and can be used to improve patient satisfaction. Originality/value Although some studies examine social media narratives on patient satisfaction, fewer studies examine these narratives in relation to the built environment. Created by a team of interdisciplinary researchers, this study provides a novel approach to examine social media ratings.