The Effectiveness of Service Quality on Patient Satisfaction Based on Outpatient and Inpatient Services

Authors

  • Yusufa Ibnu Sina Setiawan Universitas Ciputra, Indonesia
  • Hastuti Naibaho Universitas Ciputra, Indonesia
  • Fahrul Riza Universitas Ciputra, Indonesia

DOI:

https://doi.org/10.59261/inkubis.v8i4.548

Keywords:

HEALTHQUAL, Inpatient, Outpatient, Patient Satisfaction, Service Quality

Abstract

Background: Competition among private maternal and child hospitals requires service quality improvement that addresses both clinical performance and the overall patient experience.

Objective: This study examined how HEALTHQUAL dimensions (empathy, tangibles, safety, efficiency, and degree of improvement of care services (DoI)) relate to patient satisfaction and whether the pattern differs between outpatient and inpatient services at Melati Husada Hospital (MH) and Melati Children Hospital (MCH).

Methods: A quantitative explanatory repeated cross-sectional survey was conducted at both hospitals. The analysis included 625 respondents (324 at MH and 301 at MCH) with nearly balanced outpatient and inpatient groups. HEALTHQUAL measured service quality and KKP-2017 measured satisfaction. Cronbach’s alpha and corrected item-total correlation assessed instrument quality, followed by descriptive analysis, independent-samples t-tests, and multiple linear regression.

Results: Inpatient satisfaction exceeded outpatient satisfaction at both hospitals (MH: 4.39 vs. 4.14; MCH: 4.29 vs. 4.04; p < 0.001). All regression models were significant. DoI was the most consistent predictor across hospital and admission models, followed mainly by efficiency and tangibles. Safety contributed significantly, particularly at MCH, whereas empathy showed no independent significant effect despite high descriptive scores. Open-ended comments similarly emphasized perceived improvement and tangible facilities.

Conclusion: Service improvement should prioritize perceived care outcomes, process efficiency, and physical facilities while maintaining interpersonal empathy and patient safety. Findings should be interpreted within the two-hospital setting and in light of ceiling effects and multicollinearity among HEALTHQUAL dimensions.

Downloads

Download data is not yet available.

References

Aagja, J. P., & Garg, R. (2010). Measuring perceived service quality for public hospitals (PubHosQual) in the Indian context. International Journal of Pharmaceutical and Healthcare Marketing, 4(1), 60–83. https://doi.org/10.1108/17506121011036033

Acharyulu, G. V. R. K., & Shekhar, B. R. (2014). Development of HospitalQual: A service quality scale for measuring in-patient services in hospital. Operations and Supply Chain Management, 7(2), 54–63. https://doi.org/10.31387/oscm0170108

Alkhatib, S. F. S., & Aloqaily, Y. H. T. (2024). Private hospitals quality assessment: Evidence from Jordan using HEALTHQUAL model. Quality Management Journal, 31(1), 43–57.

Allahham, L., Mouselli, S., & Jakovljevic, M. (2022). The quality of Syrian healthcare services during COVID-19: A HEALTHQUAL approach. Frontiers in Public Health, 10, 970922. https://doi.org/10.3389/fpubh.2022.970922

Almadana, A. V, Suharnomo, S., & Perdhana, M. S. (2025). Understanding hospital quality: Empirical insights from patients’ perspectives in the growing hospital sector. Health Services Management Research. https://doi.org/10.1177/09514848251361317

Astuti, E. R. (2025). Methods for Measuring Patient Service Satisfaction in Health Services: Systematic Literature Review. Care: Jurnal Ilmiah Ilmu Kesehatan, 13(2), 363–376.

Badejo, M. A., Ramtin, S., Rossano, A., Ring, D., Koenig, K., & Crijns, T. J. (2022). Does adjusting for social desirability reduce ceiling effects and increase variation of patient-reported experience measures? Journal of Patient Experience, 9, 23743735221079144. https://doi.org/10.1177/23743735221079144

Bradács, A. I., Voiță-Mekeres, F., Daina, L. G., Davidescu, L., & Hozan, C. T. (2025). Assessing patient satisfaction with hospital services: Perspectives from Bihor County Emergency Hospital, Romania. Healthcare, 13(7), 836. https://doi.org/10.3390/healthcare13070836

Brinkman, N., Looman, R., Jayakumar, P., Ring, D., & Choi, S. (2025). Is it possible to develop a patient-reported experience measure with lower ceiling effect? Clinical Orthopaedics and Related Research, 483(4), 693–703. https://doi.org/10.1097/CORR.0000000000003262

Brookes, G., & Baker, P. (2023). Cancer services patient experience in England: Quantitative and qualitative analyses of the National Cancer Patient Experience Survey. BMJ Supportive & Palliative Care, 13(e3), e1149–e1155. https://doi.org/10.1136/spcare-2022-003543

Calys-Tagoe, B. N. L. (2024). Satisfaction levels and associated influencing factors among inpatients and outpatients with breast cancer at a tertiary health facility in Ghana. Ghana Medical Journal, 58(1), 7–16. https://doi.org/10.4314/gmj.v58i1.3

Chen, L.-H., Chen, C.-H., Loverio, J. P., Wang, M.-J., Lee, L.-H., & Hou, Y.-P. (2024). Examining soft and hard attributes of health care service quality and their impacts on patient satisfaction and loyalty. Quality Management in Health Care, 33(3), 176–191. https://doi.org/10.1097/QMH.0000000000000420

Cui, J., Du, J., Zhang, N., & Liang, Z. (2025). National Patient Satisfaction Survey as a predictor for quality of care and quality improvement – Experience and practice. Patient Preference and Adherence, 19, 193–206. https://doi.org/10.2147/PPA.S496684

Darzi, M. A., Islam, S. B., Khursheed, S. O., & Bhat, S. A. (2023). Service quality in the healthcare sector: A systematic review and meta analysis. LBS Journal of Management Research, 21(1), 13–29.

Duc, T. N., My, A. B. T., Xiem, C. H., Quynh, A. P., Tien, P. H., Thi Phuong, T. N., Huu, Q. C., Ha, V. T., & Thanh Hung, P. (2022). Patient satisfaction with healthcare service quality and its associated factors at one polyclinic in Hanoi, Vietnam. International Journal of Public Health, 67, 1605055. https://doi.org/10.3389/ijph.2022.1605055

Endeshaw, B. (2021). Healthcare service quality-measurement models: A review. Journal of Health Research, 35(2), 106–117. https://doi.org/10.1108/JHR-07-2019-0152

Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis. Healthcare, 11(5), 639. https://doi.org/10.3390/healthcare11050639

Friedel, A. L., Siegel, S., Kirstein, C. F., Gerigk, M., Bingel, U., Diehl, A., Steidle, O., Haupeltshofer, S., Andermahr, B., Chmielewski, W., & Kreitschmann-Andermahr, I. (2023). Measuring patient experience and patient satisfaction—How are we doing it and why does it matter? Healthcare, 11(6), 797. https://doi.org/10.3390/healthcare1106797

Guan, T., Chen, X., Li, J., Zhang, Y., & Liu, M. (2024). Factors influencing patient experience in hospital wards: A systematic review. BMC Nursing, 23, 527. https://doi.org/10.1186/s12912-024-02054-0

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th ed.). Cengage Learning. https://scholar.google.com/scholar?q=Multivariate+data+analysis

Hair, J., & Sabol, M. A. (2025). Overview of multivariate data analysis, An. In International encyclopedia of statistical science (pp. 1853–1856). Springer.

Hodgson, C. R., Mehra, R., & Franck, L. S. (2024). Child and family outcomes and experiences related to family-centered care interventions for hospitalized pediatric patients: A systematic review. Children, 11(8), 949. https://doi.org/10.3390/children11080949

Imaninda, V., & Azwar, S. (2016). Modifikasi Patient Satisfaction Questionnaire Short Form (PSQ-18) ke dalam Bahasa Indonesia. Gadjah Mada Journal of Psychology, 1(1), 8–21.

Jayalie, V. F., Tecoalu, M., Fushen, F., & Wahyoedi, S. (2023). Kepuasan pasien memediasi pengaruh HEALTHQUAL terhadap repurchase intention pada Rumah Sakit Murni Teguh Sudirman Jakarta. Nommensen Journal of Medicine, 9(1), 20–27.

Keshtkar, L., Madigan, C. D., Ward, A., Ahmed, S., Tanna, V., Rahman, I., Bostock, J., Nockels, K., Wang, W., Gillies, C. L., & Howick, J. (2024). The Effect of Practitioner Empathy on Patient Satisfaction: A Systematic Review of Randomized Trials. Annals of Internal Medicine, 177(2), 196–209. https://doi.org/10.7326/M23-2168

Kusumaningrum, A. (2017). Persepsi pengunjung terhadap tingkat kenyamanan bangunan pelayanan kesehatan: Studi kasus RSIA Melati Husada Kota Malang. Universitas Brawijaya.

Lau, S. Y. Z., Tse, M. P., Dhalla, I., & Nayyar, D. (2026). Understanding online hospital patient reviews: A nationwide cross-sectional analysis of polarity, actionability and themes. BMJ Open Quality, 15(3), e004117. https://doi.org/10.1136/bmjoq-2025-004117

Lee, D. (2016). HEALTHQUAL: A multi-item scale for assessing healthcare service quality. Service Business, 11. https://doi.org/10.1007/s11628-016-0317-2

Marpaung, F. I., & Chalidyanto, D. (2025). The impact of hospital administration service quality on patient satisfaction in outpatient installation: A systematic review. Jurnal Ilmiah Ilmu Keperawatan Indonesia, 15(3). https://doi.org/10.33221/jiiki.v15i03.3828

Mason, J. J., Coleman, L., Dawod, M., Wathen, K., Houston, S., Waldron, M., & Hinds, P. S. (2024). Child and caregiver voices about inpatient care: What do they report as positive and as needing improvement? Journal of Pediatric Nursing, 75, 213–220. https://doi.org/10.1016/j.pedn.2024.01.013

Nemati, R., Bahreini, M., & Pouladi, S. (2020). Hospital service quality based on HEALTHQUAL model and trusting nurses at Iranian university and non-university hospitals: A comparative study. BMC Nursing, 19, 118. https://doi.org/10.1186/s12912-020-00513-y

Nguyen, N. X., Tran, K., & Nguyen, T. A. (2021). Impact of service quality on in-patients’ satisfaction, perceived value, and customer loyalty: A mixed-methods study from a developing country. Patient Preference and Adherence, 15, 2523–2538. https://doi.org/10.2147/PPA.S333586

Pundhiningtyas, H., Utami, W., & Teofilus. (2025). ANOVA-based analysis of the effect of HEALTHQUAL dimensions on customer satisfaction in healthcare facility XYZ’s market segments. Journal Research of Social Science, Economics, and Management, 5(3), 3796–3809. https://doi.org/10.59141/jrssem.v5i3.1150

Setyaningrum, D., Sriatmi, A., & Arso, S. P. (2024). Patient satisfaction on hospital outpatient service quality based on the Donabedian model. Journal of Public Health for Tropical and Coastal Region, 7(3), 22.

Sharifi, K., & Kalhor, F. (2025). Enhancing pediatric satisfaction in healthcare services: An integrative review. Sage Open Pediatrics, 12, 1–9. https://doi.org/10.1177/30502225251310503

Sharifi, T., Hosseini, S. E., Mohammadpour, S., Javan-Noughabi, J., Ebrahimipour, H., & Hooshmand, E. (2021). Quality assessment of services provided by health centers in Mashhad, Iran: SERVQUAL versus HEALTHQUAL scales. BMC Health Services Research, 21(1), 397. https://doi.org/10.1186/s12913-021-06405-4

Shie, A.-J., Huang, Y.-F., Li, G.-Y., Lyu, W.-Y., Yang, M., Dai, Y.-Y., Su, Z.-H., & Wu, Y. J. (2022). Exploring the relationship between hospital service quality, patient trust, and loyalty from a service encounter perspective in elderly with chronic diseases. Frontiers in Public Health, 10, 876266. https://doi.org/10.3389/fpubh.2022.876266

Sukmawati, T., Ramadania, R., & Pebrianti, W. (2024). Enhancing patient satisfaction by healthcare service providers: A systematic literature review. Asian Journal of Economics, Business and Accounting, 24(12), 342–356. https://doi.org/10.9734/ajeba/2024/v24i21613

Wang, Y., Liu, C., & Wang, P. (2023). Patient satisfaction impact indicators from a psychosocial perspective. Frontiers in Public Health, 11, 1103819. https://doi.org/10.3389/fpubh.2023.1103819

Woo, S., & Choi, M. (2021). Medical service quality, patient satisfaction and intent to revisit: Case study of public hub hospitals in the Republic of Korea. PLOS ONE, 16(6), e0252241. https://doi.org/10.1371/journal.pone.0252241

Zhang, H., Ma, W., Zhou, S., Zhu, J., Wang, L., & Gong, K. (2023). Effect of waiting time on patient satisfaction in outpatient: An empirical investigation. Medicine, 102(40), e35184. https://doi.org/10.1097/MD.0000000000035184

Downloads

Published

2026-11-09