This research investigated the variations in how users perceive the physical infrastructure of First Generation University Teaching Hospitals in Southwest Nigeria. As hospitals move beyond their traditional focus on individual care, they are collaborating more with other health sector entities and local communities to make better use of resources and enhance both individual and public health. Since university teaching hospitals are central to healthcare service delivery, gaining insight into how users view their physical environments is essential for service improvement. The research employs a mixed-methods approach, combining quantitative surveys with qualitative interviews to capture a broad range of experiences from patients, healthcare professionals, and administrative staff. At the multivariate analysis stage, a Kruskal-Wallis Post hoc test was applied to the Null Hypothesis H03b to assess whether users’ evaluations of physical facilities including layout, organization, form, circulation, accessibility, visibility, and the number of windows and doors differ across Federal Teaching Hospitals in the region. Findings showed that OAUTHC received higher ratings for physical facilities compared to LUTH and UCH. The paper addresses the practical implications for hospital management and policy, highlighting the importance of focused facility upgrades to improve patient satisfaction, staff efficiency, and overall health outcomes. The study also offers recommendations for both immediate and long-term improvements based on identified challenges.