The Importance of Hospital Image, Service Trust Level, and Physiotherapy Service Satisfaction on Patient Loyalty: A Case Study in a Type D Private Hospital

Gabrina Selvi Yanuarista; Septo Pawelas Arso; Sri Winarni

doi:10.56741/IISTR.jphs.002126

Authors

Gabrina Selvi Yanuarista
gabrinayanuar@gmail.com
Diponegoro University
Septo Pawelas Arso Diponegoro University
Sri Winarni Diponegoro University https://orcid.org/0000-0002-9436-1581

Keywords:

Hospital Image, Patient Loyalty Physiotherapy, Patient Satisfaction, Patient Trust

Abstract

Patient loyalty is essential for sustaining physiotherapy services, where prolonged treatment and discomfort often lead to high drop-out rates. This mixed-methods observational study examined how hospital image and patient trust shape satisfaction and loyalty among physiotherapy outpatients at KS Hospital between March and May 2025. A total of 160 outpatients were recruited through accidental sampling and completed a structured questionnaire, analyzed using partial least squares structural equation modeling (PLS-SEM). Qualitative data were gathered through in-depth interviews with a service manager, a specialist, and patients, triangulated to validate and enrich the quantitative findings. Hospital image significantly predicted satisfaction (β = .544, p < .001) and indirectly influenced loyalty through satisfaction (β = .202, p < .001). Patient trust showed both direct (β = .274, p < .001) and satisfaction-mediated (β = .294, p < .001) effects on loyalty. Satisfaction was the central mediating variable, explaining 70% of the variance in loyalty (R² = .695), with word-of-mouth emerging as its strongest indicator. Interview findings reinforced that service uniqueness and facility quality strengthen image and trust, which in turn foster satisfaction and encourage patients to return. These results underscore satisfaction's pivotal role in translating hospital image and trust into patient loyalty. Hospital management should prioritize improving service responsiveness and distinctiveness while ensuring equitable, empathetic care to strengthen long-term patient commitment to physiotherapy services. As a result, patient visit numbers can be maintained or even improved.

Downloads

Download data is not yet available.

Author Biographies

Gabrina Selvi Yanuarista, Diponegoro University

is affiliated with the Faculty of Public Health, Diponegoro University, Semarang, Indonesia. She works as a general practitioner and is actively involved in hospital management. Her research interests include healthcare quality, patient satisfaction, hospital management, and health service improvement. She combines clinical practice with healthcare management to support evidence-based decision-making in hospital services. (email: gabrinayanuar@gmail.com).

Septo Pawelas Arso, Diponegoro University

is a senior lecturer at the Faculty of Public Health, Diponegoro University, Semarang, Indonesia. His expertise covers public health, health policy, healthcare management, and medical education. He has contributed to numerous research projects and publications in health services and public health and actively supervises undergraduate and postgraduate students. (email: septo.arso@undip.ac.id).

Sri Winarni, Diponegoro University

is a senior lecturer and Vice Dean of the Faculty of Public Health, Diponegoro University, Semarang, Indonesia. Her research interests include public health, health promotion, healthcare management, and community health. She has extensive experience in teaching, research, and academic leadership, with numerous publications in national and international journals. (email: winarni@live.undip.ac.id).

References

A. Ghufroni, R. B. Adriani, and D. Tamtomo, "Effects of Patient and Physiotherapist Characteristics on Perceived Quality of Physiotherapy Care at Dr. Moewardi Hospital, Surakarta," Journal of Health Policy and Management, vol. 2, no. 1, pp. 67–78, 2017. DOI: 10.26911/thejhpm.2017.02.01.06. DOI: https://doi.org/10.26911/thejhpm.2017.01.02.06

M. Emilia, D. A. Sekararum, A. D. Latifa, and D. N. Alpiah, "Patient Satisfaction with Physiotherapy Services in Hospital," International Journal of Social Research, vol. 2, no. 4, pp. 178–189, 2024. DOI: 10.59888/insight.v2i4.36. DOI: https://doi.org/10.59888/insight.v2i4.36

A. Nurfikri, "Physiotherapy Service without Documentation at a Community-Based Rehabilitation for Children with Disabilities in Makassar City: A Case Study of Physiotherapist's Perspective," Jurnal Sosial Humaniora Terapan, vol. 2, no. 2, pp. 162–171, 2020. DOI: 10.7454/jsht.v2i2.83. DOI: https://doi.org/10.7454/jsht.v2i2.83

R. L. Oliver, "Whence Consumer Loyalty?," Journal of Marketing, vol. 63, no. 4 (Special Issue), pp. 33–44, 1999. DOI: 10.2307/1252099. DOI: https://doi.org/10.1177/00222429990634s105

P. I. Listyorini, W. Maryati, and S. Anjani, "Hospital Patient Loyalty: In Terms of Brand Image, Service Quality, Patient Satisfaction, and Trust," in Proceedings of International Conference on Health and Technology (ICOHETECH), 2021. [Online]. Available: https://ojs.udb.ac.id/index.php/icohetech/article/view/1103.

S. G. Abramovich, "Physiotherapeutic Service of the Irkutsk Region: Present Status, Problems, and Prospect," Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury, vol. 97, no. 3, pp. 83–86, 2020. DOI: 10.17116/kurort20209703183. DOI: https://doi.org/10.17116/kurort20209703183

Sugiyono, Metode Penelitian Kualitatif, vol. 3. Bandung: Alfabeta, 2024.

I. Ghozali, PLS Konsep, Teknik, dan Aplikasi menggunakan SMART PLS 4.0, 1st ed. Semarang: Yoga Pratama, 2016.

M. Siregar, Z. A. Ritonga, and Valentina, "Hubungan Mutu Pelayanan BPJS Kesehatan dengan Kepuasan Pasien BPJS di Instalasi Rawat Inap Kelas III di RSU Imelda Pekerja Indonesia Medan Tahun 2023," Jurnal Manajemen Informasi Kesehatan Indonesia, vol. 12, no. 2, 2024. DOI: 10.33560/jmiki.v12i2.643. DOI: https://doi.org/10.54816/jk.v12i2.940

S. I. Wardani, K. Saiban, S. H. Jatmikowati, and B. Ngarawula, "Correlation of Administrative Services and Pharmacy Services to BPJS Patient Satisfaction," International Journal of Research in Social Science and Humanities, vol. 5, no. 2, pp. 15–34, 2024. DOI: 10.47505/ijrss.2024.2.3. DOI: https://doi.org/10.47505/IJRSS.2024.2.3

Y. M. Cheng, "Investigating Medical Professionals' Continuance Intention of the Cloud-Based E-Learning System: An Extension of Expectation-Confirmation Model with Flow Theory," Journal of Enterprise Information Management, vol. 34, no. 4, pp. 1169–1202, 2021. DOI: 10.1108/JEIM-12-2019-0401. DOI: https://doi.org/10.1108/JEIM-12-2019-0401

Y. Yuliani, "Influences of Brand on Hospital Performance and Patient Behavioral Expectations," Jurnal Administrasi Rumah Sakit Indonesia, vol. 5, no. 3, 2019. DOI: 10.7454/arsi.v5i3.2898. DOI: https://doi.org/10.7454/arsi.v5i3.2898

S. Choi, "Servicescape Factors Affecting Consumer's Brand Image and Brand Loyalty: Focused on the General Hospital Industry in Korea," Physical Therapy Rehabilitation Science, vol. 12, no. 4, pp. 493–501, 2023. DOI: 10.14474/ptrs.2023.12.4.493. DOI: https://doi.org/10.14474/ptrs.2023.12.4.493

Y. A. Sihombing, Patient Loyalty: A Review of Service Aspects, Satisfaction, Trust, Commitment, Brand Equity, and Hospital Image. Pekalongan, Indonesia: PT. Nasya Expanding Management, 2022.

D. Purnomo and I. Irmawati, "Brand Satisfaction, Brand Trust and Brand Loyalty," Jurnal Lentera Bisnis, vol. 13, no. 1, pp. 391–399, 2024. DOI: 10.34127/jrlab.v13i1.1039. DOI: https://doi.org/10.34127/jrlab.v13i1.1039

R. A. Rather, S. Tehseen, M. H. Itoo, and S. H. Parrey, "Customer Brand Identification, Affective Commitment, Customer Satisfaction, and Brand Trust as Antecedents of Customer Behavioral Intention of Loyalty: An Empirical Study in the Hospitality Sector," Journal of Global Scholars of Marketing Science, vol. 29, no. 2, pp. 196–217, 2019. DOI: 10.1080/21639159.2019.1577694. DOI: https://doi.org/10.1080/21639159.2019.1577694

E. Garbarino and M. S. Johnson, "The Different Roles of Satisfaction, Trust, and Commitment in Customer Relationships," Journal of Marketing, vol. 63, no. 2, pp. 70–87, 1999. DOI: 10.1177/002224299906300205. DOI: https://doi.org/10.1177/002224299906300205

I. C. Huang, P. L. Du, L. S. Lin, T. Y. Liu, T. F. Lin, and W. C. Huang, "The Effect of Perceived Value, Trust, and Commitment on Patient Loyalty in Taiwan," Inquiry, vol. 58, 2021. DOI: 10.1177/00469580211007217. DOI: https://doi.org/10.1177/00469580211007217

L. Bricci, J. Antunes, and A. Fragata, "The Effects of Trust, Commitment and Satisfaction on Customer Loyalty in the Distribution Sector," Journal of Economics, Business and Management, vol. 4, no. 2, pp. 173–177, 2016. DOI: 10.7763/JOEBM.2016.V4.386. DOI: https://doi.org/10.7763/JOEBM.2016.V4.386

C. Bleustein, D. B. Rothschild, A. Valen, E. Valatis, L. Schweitzer, and R. Jones, "Wait times, patient satisfaction scores, and the perception of care," Am. J. Manag. Care, vol. 20, no. 5, pp. 393–400, 2014.

Z. Xie, C. Or, and H. Wang, "Benchmarking hospital outpatient waiting time and associated factors in China," BMJ Open, vol. 7, no. 7, Art. no. e016969, 2017, doi: 10.1136/bmjopen-2017-016969. DOI: https://doi.org/10.1136/bmjopen-2017-016969

B. Prakash, "Patient satisfaction," J. Cutan. Aesthet. Surg., vol. 3, no. 3, pp. 151–155, 2010, doi: 10.4103/0974-2077.74491. DOI: https://doi.org/10.4103/0974-2077.74491

P. Foroudi, K. Dinnie, P. J. Kitchen, T. C. Melewar, and M. M. Foroudi, "IMC antecedents and the consequences of planned brand identity in higher education," Eur. J. Mark., vol. 51, no. 3, pp. 528–550, 2017, doi: 10.1108/EJM-08-2015-0527. DOI: https://doi.org/10.1108/EJM-08-2015-0527

T. S. Dagger, J. C. Sweeney, and L. W. Johnson, "A hierarchical model of health service quality: Scale development and investigation of an integrated model," J. Serv. Res., vol. 10, no. 2, pp. 123–142, 2007, doi: 10.1177/1094670507309594. DOI: https://doi.org/10.1177/1094670507309594

S. W. Mercer and W. J. Reynolds, "Empathy and quality of care," Br. J. Gen. Pract., vol. 52, Suppl., pp. S9–S12, 2002.

A. S. Dick and K. Basu, "Customer loyalty: Toward an integrated conceptual framework," J. Acad. Mark. Sci., vol. 22, no. 2, pp. 99–113, 1994, doi: 10.1177/0092070394222001. DOI: https://doi.org/10.1177/0092070394222001

C. E. Kim, J. S. Shin, J. Lee, Y. J. Lee, M. R. Kim, A. Choi, J. H. Lee, and I. H. Ha, "Quality of medical service, patient satisfaction, and loyalty with a focus on patients covered by national health insurance," PLoS ONE, vol. 12, no. 9, Art. no. e0184903, 2017, doi: 10.1371/journal.pone.0184903. DOI: https://doi.org/10.1371/journal.pone.0184903