DETERMINANTS OF HOSPITAL PATIENT LOYALTY: THE ROLES OF PATIENT SATISFACTION, SERVICE QUALITY, HOSPITAL IMAGE, AND TRUST

Abstrak

Introduction: The shift from volume-based care to value-based healthcare has made patient loyalty a strategic priority for hospitals, as loyal patients are more likely to return, recommend services, and sustain organizational performance. This review maps the most consistent factors associated with patient loyalty in hospital settings, focusing on service quality, patient satisfaction, hospital image, and trust. Methods: A scoping review was conducted following PRISMA-ScR/PRISMA 2020 guidance. Literature searches were performed for peer-reviewed articles published between 2016–2026. Studies were included if they examined hospital contexts and reported patient loyalty. Eligible studies were charted and synthesized narratively. Results: Evidence across included studies indicates that service quality consistently improves patient satisfaction, but its direct effect on loyalty is less stable and often becomes non-significant when satisfaction and/or trust are included, suggesting predominantly indirect pathways. Patient satisfaction is the most consistent predictor of loyalty and frequently mediates the relationship between service quality and loyalty. Trust repeatedly appears as a critical relational mechanism that strengthens loyalty and often mediates the effects of service quality and satisfaction. Hospital image contributes by shaping expectations and perceived credibility, sometimes exerting direct effects depending on context. Conclusion: Hospital patient loyalty is most robustly explained through a relational pathway where service quality → satisfaction → trust → loyalty, with hospital image reinforcing expectation formation and confidence. Managerial efforts should prioritize consistent service processes, clear communication, and patient safety to strengthen satisfaction and trust.