P-ISSN: 2827-9832
E-ISSN: 2828-335x
http://ijsr.internationaljournallabs.com/index.php/ijsr
765
THE EFFECT OF PATIENT SATISFACTION ON PATIENT LOYALTY
MEDIATED BY PATIENT TRUST AND HOSPITAL BRAND IMAGE AT
THE JAKARTA EDUCATION DENTAL AND ORAL HOSPITAL
Tanya Aya Sofia
Faculty of Economics and Business, Universitas Trisakti
tanyaayasofia@gmail.com
ABSTRACT
This study aims to find out and analyze "The Effect of Patient Satisfaction on Patient Loyalty mediated by
Patient Trust and Hospital Brand Image at Jakarta Educational Dental and Oral Hospital". The data
collection technique method uses non-probability sampling with a purposive sampling method. The data
was collected directly from a sample that had adjusted the criteria and disseminated through a questionnaire
to 250 respondents using a Likert scale of 1-5 where 1 showed strong disapproval, while 5 indicated
strongly agreed. The statements in this study consisted of 25 statements obtained from four variables,
namely patient satisfaction, patient loyalty, patient trust, and hospital brand image. The questionnaire is
distributed through Google Forms. The analytical methods used in this study are Partial Least Square (PLS)
and Structural Equation Model (SEM). The results of this study show that patient satisfaction has a positive
influence on patient loyalty, patient satisfaction has a positive influence on patient trust, patient trust has a
positive influence on patient loyalty, patient satisfaction has a positive influence on hospital brand image,
Hospital Brand Image has a positive influence on patient loyalty, patient satisfaction has a positive influence
on patient loyalty mediated by patient trust, patient satisfaction has a positive influence on patient loyalty
mediated by Hospital Brand Image.
Keywords: Hospital Brand Image, Patient Loyalty, Patient Satisfaction, Patient Trust
This article is licensed under CC BY-SA 4.0
INTRODUCTION
Under the market economy system, the core of corporate competition is customer-oriented,
acquiring and creating customer preferences and loyalty to the quality of the company's
services in order to achieve the continuous development of the enterprise. The concept of
customer loyalty is the core of marketing, and patient loyalty comes from customer loyalty in
business (Liu et al., 2021). From the perspective of public economic research, patient care is
the process of exchanging the value of labor between medical service providers. The patient is
passively treated in the hospital, and the patient is subjectively reluctant to come back.
Therefore, customer loyalty in the healthcare industry differs significantly from other industries
(Liu et al., 2021).
In this era of globalization, every company and public institution needs to improve services
professionally in their respective fields. Currently, public awareness has grown of the
importance of good health, makes health services a top priority for the community. In
accordance with the provisions of Law Number 36 of 2009 concerning Health, that all parties,
both government and private, organize health development in a coordinated, effective, and
efficient manner. The goal is to achieve the highest level of health (RI, 2009). It also highlights
everyone's right to access safe, quality, and affordable health sector resources and health
services (Juhana et al., 2015).
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand Image at
the Jakarta Education Dental and Oral Hospital
766 2, 3., February 2023
The doctor-patient relationship is the customer relationship. Medical services for patients
are based on the relationship of trust between the supply and demand sides of health services.
This is manifested in the patient's willingness to be loyal to the real attitudes and behaviors of
the hospital. This situation can bring economic and social benefits to the hospital, reduce the
cost of developing and maintaining new customers, provide health value to the patients
themselves, and reduce the loss of customers in the hospital. In addition, loyal customers are
willing to pay more, express higher purchase intentions, and resist conversions (Liu et al.,
2021).
Hospitals are healthcare providers with the principle of trust, and their success is largely
determined by the quality of service, satisfaction, and patient loyalty (Yusri et al., 2017). The
challenge faced in the service industry is that hospitals must be able to try to provide the best
service to patients (Zahra et al., 2022). There is convincing evidence that when patients receive
high-quality services in a hospital, they are more likely to return to the same hospital in the
future. In addition, the patient will also say positive things and recommend them to their friends
and relatives (Arab et al., 2012). Referrals from friends, relatives, and other patients are
considered an important source of information for the selection of providers (Arab et al., 2012).
The level of oral health problems is influenced by many factors, such as low income, lack
of access to care, and lack of awareness about the need for such care. It was also found that
oral health status is influenced by individual beliefs, socioeconomic background, number of
visits to the dentist, and oral health behaviors. Furthermore, levels of anxiety and depression
are thought to contribute to oral health outcomes. Poor dental and oral health is a major public
health problem in Indonesia, with around 89% and 74% of the population suffering from dental
caries and periodontitis, respectively. One of the most important steps in maintaining good oral
health is regular visits to the dentist, as it allows the dentist to assess the risk of oral health
problems and provide preventive and restorative care (Santoso et al., 2020).
Consumer reaction to poor service can be measured by two factors, namely loyal or
switching to another service provider. Services are difficult to prove until a patient visits and
get hospital services. In addition, the quality of services provided to customers may vary from
specific hospital visits, which can have an impact on satisfaction and loyalty. One possible
cause of declining loyalty is patient dissatisfaction with treatment. The patient then decides to
stop using the service for himself or his family (Sofia et al., 2018).
Satisfaction is considered a predictor of behavioral intentions. Satisfied patients will return
to the same provider and recommend them to their family and friends (positive word of mouth).
It is considered that satisfaction reflects a positive assessment of patients from their healthcare
experience (Lacap & Alfonso, 2022). Customers who are satisfied with the quality of the
services provided cause customer loyalty and increase customer purchase intent. This study
was conducted to test the relationship between patient satisfaction and patient loyalty to health
services (Yusri et al., 2017).
METHOD
Research Design
This study uses hypothesis testing which aims to test the effect of patient satisfaction free
variables on bound variables, namely patient loyalty with mediation variables, namely patient
trust and hospital brand image. The unit of analysis of this study is patients who come regularly
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand
Image at the Jakarta Education Dental and Oral Hospital
767 2, 3., February 2023
to the Jakarta Education Dental and Oral Hospital in the last 2 (two) years. The data from this
study is cross-sectional data, that is, the data is obtained only within a certain period of time.
Variables and Measurements
Patient Satisfaction
The free variable in this study was patient satisfaction which was defined as the feeling
felt by patients based on their assessment of the suitability between their expectations and the
performance of the service provider. Customers are happy when performance meets or exceeds
expectations, and will be disappointed when not (Sumaedi et al., 2014). The question items
used to measure patient satisfaction are:
1. The medical treatment I received was perfect
2. During medical visits, I am always allowed to say all my complaints
3. My doctor is very competent
4. The hospital is strategically located
5. There are a few things about the medical system that need to be improved
6. Follow-up after treatment is good
7. I feel confident that I can get the medical care I need without financial restraint
8. Patients do not have to wait long for treatment in this hospital
9. If I need hospitalization, I can be registered directly without any difficulty
Patient loyalty
The variable tied to this study is patient loyalty which is defined as a firmly held
commitment to consistently reuse preferred services in the future leading to the use of the same
service or brand (Zhou et al., 2017). The question items used to measure patient loyalty are:
1. I will still go to the same hospital in the next five years
2. If I were given the option to choose another hospital, I would still choose the same hospital
3. I consider myself loyal to this hospital
4. For me, this hospital is definitely better than other hospitals
5. I will still be treated in this hospital even if the price of treatment has increased a bit
6. I won't change hospitals if other hospitals offer better prices
Patient trust
The mediation variables in this study were patient trust and hospital brand image. Patient
trust is defined as the patient's belief that a doctor has the skills to perform the diagnosis and
treatment necessary for the benefit of the patient so that the patient can receive medical services
with confidence (Yang & Wu, 2018). The question items used to measure patient trust are:
1. The hospital and its services are in accordance with existing claims
2. Hospitals can fulfill agreements and commitments given
3. Honest and trustworthy staff
4. Hospital staff care and are committed to solving patient problems
5. Hospital staff want the best for patients
6. The hospital is committed to meeting the needs and satisfaction of patients
Brand Image
Brand image is a mediating variable that can be defined as the brand perception that is
stored in the customer's memory and reflects the customer's overall impression. A positive
brand image is considered an important ability of the company to maintain its market position
(Vimla & Taneja, 2020). The question items used to measure brand image are:
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand Image at
the Jakarta Education Dental and Oral Hospital
768 2, 3., February 2023
1. The hospital has a good reputation
2. The hospital has excellent facilities
3. The hospital has a comfortable environment
4. The hospital provides excellent service
Data Collection Methods
In this study, questionnaires were used as a data collection method. A questionnaire is a
method of collecting data that can be given directly to respondents through questions or written
explanations. This study used google Forms to get samples without being restricted by region.
The list of questions includes respondent data and questions about the effect of patient
satisfaction on patient loyalty mediated by patient trust and hospital brand image at the Jakarta
Educational Dental and Oral Hospital. The data in this study was obtained from a sample of
patients who had been treated regularly at the Jakarta Educational Dental and Oral Hospital for
the last 2 (two) years. The number of samples in this study refers to the calculation according
to Hair et. al (2017) with a minimum of 250 respondents.
Sampling Methods
The population of this study is all patients who have been treated at the Educational Dental
and Oral Hospital, Jakarta which includes: RSGM-P Trisakti University, RSGM-P Universitas
Indonesia, RSGM-P Universitas Yarsi, and RSGM-P Universitas Prof. Dr. Moestopo. The
sampling technique in this study is a purposive sampling technique with a non-probability
sampling method with the condition that you have done at least 2 treatments in the last 2 years
at the Educational Dental and Oral Hospital, Jakarta. The age of respondents is at least 17 years
old, which is classified as an adult when filling out the questionnaire.
Table 3.1
Respondent Profiles by Place of Care
RSGM-P
Number of
Respondents
Percentage (%)
Trisakti University
93
37,2%
University of Indonesia
53
21,2%
Prof. Dr. Moestopo University
71
28,4%
Yarsi University
33
13,2%
Total
250
100%
The table of respondents' profiles based on the place of treatment shows that the majority of
respondents are patients who received treatment at RSGM-P Trisakti University as many as 93
people with a percentage of 37.2%. Furthermore, the second most respondents came from
RSGM-P Universitas Prof. Dr. Moestopo as many as 71 people with a percentage of 28.4%.
Then from RSGM-P Universitas Indonesia as many as 53 people with a percentage of 21.2%,
and RSGM-P Yarsi University as many as 33 people with a percentage of 13.2%.
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand
Image at the Jakarta Education Dental and Oral Hospital
769 2, 3., February 2023
Table 3.2
Respondent Profile by Gender
Gender
Number of
Respondents
Percentage (%)
Men
115
46%
Woman
133
54%
Total
250
100%
Source: Outpus SPSS (attached)
In label’s profile, respondents showed that the majority of respondents by gender were
women as many as 133 people with a percentage of 54%. There were 115 respondents of the
male gender with a percentage of 46%.
Table 3.3
Respondent Profiles by Age
Gender
Number of
Respondents
Percentage (%)
17 – 25 years old
159
63,6%
26 – 35 years old
69
27,6%
36 – 45 years old
22
8,8%
46 – 55 years old
8
3,2 %
Total
250
100%
Source: Outpus SPSS (attached)
The results of the frequency of the total respondents showed that the majority of
respondents who took part in the study aged 17-25 years were 159 people or 63.6%, followed
by the age of 26-35 years as many as 69 people or 27.6%, aged 36-45 years as many as 22
people or 8.8%, aged 46-55 years as many as 8 people or 3.2%.
Table 3.4
Respondent Profile Based on the Number of Treatments Received at RSGM-P in the
Last 2 Years
Number of treatments
Number of
Respondents
Percentage (%)
2 times
174
69,6%
> 2 times
76
30,4%
Total
250
100%
Source: Outpus SPSS (attached)
The frequency results of the total respondents showed that the majority of respondents
treated 2 times at RSGM-P in the last 2 years as many as 174 people with a percentage of
69.6%, and > 2 times as many as 76 people with a percentage of 30.4%.
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand Image at
the Jakarta Education Dental and Oral Hospital
770 2, 3., February 2023
Data Analysis
This study used partial least square (PLS) and variance-based structural equation modeling
(SEM) analysis. There are 2 test models in the PLS test, namely the measurement model and
the structural model. This study uses a measurement model, which tests validity and reliability.
Structural models are used to see the relationships between research variables.
Measurement Model (Outer Model)
Evaluation of the outer model is basically to conduct early detection of the ability of
each indicator to influence each latent variable in the study. convergent validity and composite
reliability are criteria used as parameters in conducting outer model analysis using SmartPLS.
Structural Model (Inner Model)
The next step after doing the outer model test is to do the inner model test. Inner model
testing is carried out to see the relationship between the construct, significance value, and R-
square of the research model.
Chart 2. Structural Model
Evaluation of the PLS structural model begins by looking at the R-square of each
dependent latent variable. R-squared is used to assess how much influence a particular
independent latent variable has on the dependent latent variable. The table below is the result
of the R-square using PLS.
Table 3.10. R-square
Variables
R Square
R Square Adjusted
Patient Loyalty
0,503
0,497
Patient Trust
0,322
0,319
Brand Image
0,221
0,218
Source: Outpus PLS (attached)
The value (R-square adjusted) for the patient loyalty variable was 0.497 or 49.7%. This
value indicates that the patient loyalty variable can be explained by the patient satisfaction,
patient trust, and hospital brand image variables of 49.7% while the remaining 50.3% is
influenced by other variables not found in the study.
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand
Image at the Jakarta Education Dental and Oral Hospital
771 2, 3., February 2023
The value (R-square adjusted) for the patient trust variable was 0.319 or 31.9%. The value
indicates that the patient trust variable can be explained by the patient satisfaction variable of
31.9% while the remaining 68.1% is influenced by other variables not found in the study.
The value (R-square adjusted) for the brand image variable is 0.218 or 21.8%. This value
indicates that the brand image variable can be explained by the patient satisfaction variable of
21.8%. While the remaining 78.2% was influenced by other variables that were not contained
in the study.
Hypothesis Test
Testing of structural relationship models explains the relationships between research
variables. Structural model testing is tested using the T-test. The basis for direct hypothesis
testing is the output of images and values contained in the output of patch coefficients and
indirect effects. Here's a full explanation of hypothesis testing:
This test was conducted to see whether each independent variable had a significant
influence on its dependent variables. The basis for taking the hypothesis is as follows:
a. If the p-value > 0.05 then H0 is accepted which can be inferred that there is no
significant relationship between the two variables
b. If the p-value ≤ 0.05 then H0 is rejected which can be concluded that there is a
significant relationship between the two variables
RESULTS AND DISCUSSION
Descriptive Statistics
Descriptive statistical tests are performed to describe and characterize the data in detail.
Descriptive statistical tests are examined based on mean and standard deviation. The mean is
the average value of the respondent's answer, and the standard deviation value indicates the
variance of the respondent's answer. A standard deviation value close to zero means less
variability in respondents' responses. However, if the standard deviation value is farther from
zero, it can be interpreted that the respondent's answer is more different. The following is the
result of a descriptive statistical calculation of each variable described through the average
value (mean) and standard deviation:
Table 4.1
Descriptive Statistics of Patient Satisfaction Variables
No.
Questionnaire
Mean
Standar
d
Deviatio
n
1.
The medical treatment I received was perfect
3,976
0,728
2.
During medical visits, I am always allowed to say all
my complaints
4,192
0,725
3.
My doctor is very competent
4,356
0,638
4.
The hospital is strategically located
4,300
0,517
5.
There are a few things about the medical system that
need to be improved
4,328
0,598
6.
Follow-up after treatment is good
4,436
0,513
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand Image at
the Jakarta Education Dental and Oral Hospital
772 2, 3., February 2023
7.
I feel confident that I can get the medical care I need
without financial restraint
4,124
0,692
8.
In this hospital, patients do not have to wait long for
treatment
4,292
0,607
9.
If I need hospitalization, I can be registered directly
without any difficulty
4,116
0,738
Average Patient Satisfaction Score
4,236
0,639
Based on the results of descriptive patient satisfaction statistics, an average score of 4,236
was obtained, which showed that the average respondent had felt satisfaction with treatment at
RSGM-P. The standard deviation value in the patient satisfaction variable is 0.639. The value
indicates that respondents' responses are quite varied.
The first question item gets a mean value of 3,976 indicating that the medical care received
is impeccable. The second question item gets a mean value of 4.192 which indicates that during
a medical visit, the patient is always allowed to say all patient complaints. The third question
item gets a mean value of 4,356 which indicates the doctor is very competent. The fourth
question item gets a mean value of 4,300 indicating that the hospital is strategically located.
The fifth question item gets a mean value of 4,328 which indicates that there are some things
regarding the medical system that need to be improved. The sixth question item earned a mean
value of 4,436 indicating that follow-up after treatment was good. The seventh question item
earned a mean value of 4,124 indicating that the patient felt confident he could get the medical
care he needed without financial restraint. The eighth question item gets a mean value of 4,292
which indicates that in this hospital patients do not have to wait long for treatment. The ninth
question item gets a mean value of 4,116 which indicates that if it requires hospitalization then
the patient can be immediately registered without difficulty.
Table 4.2
Descriptive Statistics of Patient Loyalty Variables
No.
Questionnaire
Mean
Standard
Deviation
1.
I will still go to the same hospital in the next five years
4,060
0,712
2.
If I were given the option to choose another hospital, I would
still choose the same hospital
4,212
0,699
3.
I consider myself loyal to this hospital
4,144
0,725
4.
For me, this hospital is definitely better than other hospitals
4,140
0,734
5.
I will still be treated in this hospital even if the price of treatment
has increased a bit
4,116
0,693
6.
I won't change hospitals if other hospitals offer better prices
4,072
0,736
Average Patient Loyalty Value
4,124
0,716
Based on the results of descriptive patient loyalty statistics, an average score of 4,124 was
obtained, which showed that the average respondent had the closest loyalty to the hospital
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand
Image at the Jakarta Education Dental and Oral Hospital
773 2, 3., February 2023
where they received treatment. The standard deviation value on the patient loyalty variable is
0.716. The value indicates that respondents' responses are quite varied.
The first question item got a mean value of 4,060 indicating that the respondent would still
go to the same hospital in the next five years. The second question item gets a mean value of
4,212 which indicates that if the respondent is given the choice to choose another hospital, then
the respondent will still choose the same hospital. The third question item got a mean value of
4,144 indicating that the respondent considered himself loyal to this hospital. The fourth
question item got a mean value of 4,140 which indicates for respondents this hospital is clearly
better than other hospitals. The fifth question item got a mean value of 4,116 indicating that
respondents would continue to seek treatment at this hospital even though the price of treatment
increased slightly. The sixth question item got a mean value of 4,072 indicating that the
respondent would not switch hospitals if other hospitals offered better prices.
Table 4.3
Descriptive Statistics of Patient Trust Variables
No.
Questionnaire
Mean
Standard
Deviation
1.
The hospital and its services are in accordance with existing
claims
4,036
0,685
2.
Hospitals can fulfill agreements and commitments given
4,248
0,648
3.
Hospital staff are honest and trustworthy
4,328
0,605
4.
Hospital staff care and are committed to solving patient problems
4,372
0,547
5.
Hospital staff want the best for patients
4,368
0,531
6.
The hospital is committed to meeting the needs and satisfaction
of patients
4,152
0,647
Average Patient Trust score
4,251
0,610
Based on the results of descriptive statistics of patient trust, an average value of 4,251 was
obtained, which showed that the average respondent felt that RSGM-P had been able to
generate patient trust. The standard deviation value on the patient trust variable is 0.610. The
value indicates that respondents' responses are quite varied.
The first question item gets a mean value of 4,036 indicating that the patient agrees that the
hospital and its services match the existing claim. The second question item gets a mean value
of 4,248 indicating that the hospital can fulfill the agreements and commitments given. The
third question item earned a mean value of 4,328 indicating that the hospital staff was honest
and trustworthy. The fourth question item earned a mean value of 4,372 indicating that hospital
staff care and are committed to solving patient problems. The fifth question item earned a mean
value of 4,368 indicating that hospital staff wanted the best for the patient. The sixth question
item earned a mean score of 4,152 indicating that the hospital is committed to meeting patient
needs and satisfaction.
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand Image at
the Jakarta Education Dental and Oral Hospital
774 2, 3., February 2023
Table 4.4
Descriptive Statistics of Hospital Brand Image Variables
No.
Questionnaire
Mean
Standard
Deviation
1.
The hospital has a good reputation
4,340
0,567
2.
The hospital has excellent facilities
4,352
0,618
3.
The hospital has a comfortable environment
4,216
0,635
4.
The hospital provides excellent service
4,184
0,669
Hospital Brand Image average score
4,273
0,622
Based on the results of descriptive statistics of hospital brand image, an average value of
4,273 was obtained, which shows that the average respondent felt that the hospital had been
able to provide a good brand image to patients. The standard deviation value on the hospital
brand image variable is 0.622. The value indicates that respondents' responses are quite varied.
The first question item received a mean value of 4,340 which indicates that the hospital has
a good reputation. The second question item received a mean value of 4,352 which indicates
that the hospital has superior facilities. The third question item received a mean value of 4,216
which indicates that the hospital has a comfortable environment. The fourth question item gets
a mean value of 4,184 which indicates that the hospital provides excellent service.
Hypothesis Testing Results
Statistical testing of each hypothesized relationship using PLS is carried out by simulation,
namely by bootstrapping the sample. The following are the results of the PLS analysis with
bootstrapping method:
Table 4.5. R-square Hypothesis Test Results
Hypothesis
Estimate
P-
Values
Decision
H1: There is a positive influence of patient
satisfaction on patient loyalty
0,112
0,017
Supported
H2: There is a positive effect of patient satisfaction
on patient trust
0,567
0,000
Supported
H3: There is a positive influence of patient trust on
patient loyalty
0,418
0,000
Supported
H4: There is a positive influence of patient
satisfaction on hospital brand image
0,470
0,000
Supported
H5: There is a positive influence of hospital brand
image on patient loyalty
0,292
0,000
Supported
Hypothesis One
Based on Table 4.5 shows that the first hypothesis tests the effect of patient satisfaction on
patient loyalty with the sound of hypothesis zero (H0) and alternative hypothesis (Ha) as
follows:
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand
Image at the Jakarta Education Dental and Oral Hospital
775 2, 3., February 2023
H0: There is no positive effect of patient satisfaction on patient loyalty
Ha: There is a positive influence of patient satisfaction on patient loyalty
Based on the hypothesis test results in the table above, the first hypothesis has an estimated
value of 0.112 with a p-value of 0.017 ≤ 0.05 which can be interpreted to mean that Ha is
supported (H0 is rejected). Therefore, it can be concluded that patient satisfaction positively
affects patient loyalty.
Hypothesis Two
The second hypothesis tests the effect of patient satisfaction on patient trust with the
sound of the null hypothesis (H0) and the alternative hypothesis (Ha) as follows:
H0: There is no positive effect of patient satisfaction on patient trust
Ha: There is a positive influence of patient satisfaction on patient trust
Based on the hypothesis test results in the table above, the second hypothesis has an
estimated value of 0.567 with a p-value of 0.000 ≤ 0.05 which can be interpreted to mean that
Ha is supported (H0 is rejected). Therefore, it can be concluded that patient satisfaction
positively affects patient trust.
Third Hypothesis
The third hypothesis tests the effect of patient trust on patient loyalty with the sound of
the null hypothesis (H0) and the alternative hypothesis (Ha) as follows:
H0: There is no positive influence of patient trust on patient loyalty
Ha: There is a positive influence of patient trust on patient loyalty
Based on the results of the hypothesis test in the table above, the third hypothesis has an
estimated value of 0.418 with a p-value of 0.000 ≤ 0.05 which can be interpreted to mean that
Ha is supported (H0 is rejected). Therefore, it can be concluded that patient trust positively
affects patient loyalty.
Fourth Hypothesis
The fourth hypothesis tests the effect of patient satisfaction on hospital brand image with
the sound of the null hypothesis (H0) and the alternative hypothesis (Ha) as follows:
H0: There is no positive influence of patient satisfaction on hospital brand image
Ha: There is a positive influence of patient satisfaction on hospital brand image
Based on the hypothesis test results in the table above, the fourth hypothesis has an estimated
value of 0.470 with a p-value of 0.000 ≤ 0.05 which can be interpreted to mean that Ha is
supported (H0 is rejected). Therefore, it can be concluded that patient satisfaction positively
affects the hospital’s brand image.
Fifth Hypothesis
The fifth hypothesis tests the effect of hospital brand image on patient loyalty by sounding
hypothesis zero (H0) and alternative hypothesis (Ha) as follows:
H0: There is no positive influence of hospital brand image on patient loyalty
Ha: There is a positive influence on hospital brand image on patient loyalty
Based on the hypothesis test results in the table above, the fifth hypothesis has an estimated
value of 0.292 with a p-value of 0.000 ≤ 0.05 which can be interpreted to mean that Ha is
supported (H0 is rejected). Therefore, it can be concluded that hospital brand image positively
affects patient loyalty.
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand Image at
the Jakarta Education Dental and Oral Hospital
776 2, 3., February 2023
Table 4.6. Indirect Relationship Hypothesis Test Results
Hypothesis
Estimate
P-
Values
Decision
H6: There is a positive influence of patient
satisfaction on patient loyalty mediated by
patient trust
0,137
0,000
Supported
(partial
mediation)
H7: There is a positive influence of patient
satisfaction affecting patient loyalty mediated by
hospital brand image
0,237
0,000
Supported
(partial
mediation)
Sixth Hypothesis
Based on Table 4.6 shows that the sixth hypothesis tests the effect of patient satisfaction on
patient loyalty mediated by the patient trust with the sound of hypothesis zero (H0) and
alternative hypothesis (Ha) as follows:
H0: There is no positive influence of patient satisfaction on patient loyalty mediated by
patient trust
Ha: There is a positive influence of patient satisfaction on patient loyalty mediated by
patient trust
Based on the hypothesis test results in the table above, the sixth hypothesis has an estimated
value of 0.137 with a p-value of 0.000 ≤ 0.05 which can be interpreted to mean that Ha is
supported (H0 is rejected). Therefore, it can be concluded that patient satisfaction positively
affects patient loyalty mediated by patient trust.
Seventh Hypothesis
The seventh hypothesis tests the effect of patient satisfaction on patient loyalty mediated by
hospital brand image with the sound of the null hypothesis (H0) and the alternative hypothesis
(Ha) as follows:
H0: There is no positive influence of patient satisfaction affecting patient loyalty mediated
by hospital brand image
Ha: There is a positive influence of patient satisfaction affecting patient loyalty mediated
by hospital brand image
Based on the hypothesis test results in the table above, the seventh hypothesis has an
estimated value of 0.237 with a p-value of 0.000 ≤ 0.05 which can be interpreted to mean that
Ha is supported (H0 is rejected). Therefore, it can be concluded that patient satisfaction
positively affects patient loyalty mediated by hospital brand image.
Discussion of Hypotheses
1. Hypothesis 1
The first hypothesis tests the effect of patient satisfaction on patient loyalty. The results of
this study show that patient satisfaction positively affects patient loyalty. The results of the
study are in line with previous studies that show results that satisfaction affects loyalty
positively and significantly in Dental and Oral Hospitals (Sari et al., 2020). Patient satisfaction
and loyalty are two strategic pillars that hospitals need to continue to develop and monitor in
order to be maintained for many years. Another study states that the higher the patient
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand
Image at the Jakarta Education Dental and Oral Hospital
777 2, 3., February 2023
satisfaction in the hospital, the higher patient loyalty will be (Utami et al., 2020). In addition,
previous researchers also stated that customer satisfaction affects buyer behavior, where
satisfied customers will become loyal. The results of this study are also supported that customer
satisfaction has a significant effect on customer loyalty (Normasari dkk, 2013).
2. Hypothesis 2
The second hypothesis tests the effect of patient satisfaction on patient trust. The results of
this study show that patient satisfaction positively affects patient trust. Previous studies have
shown that there is a positive influence between patient satisfaction and patient trust (Bajamal,
2018). Other studies have also stated that patient satisfaction affects patient confidence in
hospitals (Wididana, 2017). The results of this study support the results of previous research
conducted by Javedein which found that there is a positive and significant relationship between
consumer satisfaction and trust, in his research on sports industry services in Iran (Seyed
Javadein et al., 2008).
3. Hypothesis 3
The third hypothesis tests the effect of patient trust on patient loyalty. The results of this
study show that patient trust positively affects patient loyalty. The results of this study are in
line with previous studies that patient trust and commitment to the hospital will affect patient
loyalty (Patawayati, 2013). Other studies also support the results of this study which show that
trust has a significant effect on patient loyalty in hospitals (Purba et al., 2021). Trust is very
useful and important in building a relationship, but building trust is not easy and in this case, it
requires a concerted effort in relation to the Hospital. Therefore, the higher the trust, the higher
the patient's loyalty (Bajamal, 2018).
4. Hypothesis 4
The fourth hypothesis tests the effect of patient satisfaction on hospital brand image. The
results of this study show that patient satisfaction positively affects the hospital’s brand image.
Previous research has shown that there is a significant influence between customer satisfaction
and the image of the company (Normasari dkk, 2013). Previous research supports the results
of this study which states that patient satisfaction has a significant positive impact on the
hospital's brand image (Ramli, 2019). Other studies also state that customers will have the
satisfaction that the company expects if the organization builds a brand image and provides
good service (Raka Sukawati, 2021).
5. Hypothesis 5
The fifth hypothesis tests the effect of hospital brand image on patient loyalty. The results
of this study show that hospital brand image positively affects patient loyalty. The results of
this study are in line with previous studies which showed that the higher the hospital's brand
image among patients, the higher the loyalty of patients (Utami et al., 2020). Previous research
has shown that brand image has a significant positive impact on loyalty (Normasari dkk, 2013).
The image will stick in the minds of consumers if consumers perceive a brand differently from
its competitors and will eventually form loyalty to a particular brand (Rangkuti, 2002).
Previous research stated that the better the brand image of a hospital, the higher the loyalty of
patients in using medical facilities in the hospital (Wiranata & Supriyadi, 2018).
6. Hypothesis 6
The sixth hypothesis tests the effect of patient satisfaction on patient loyalty mediated by
patient trust. The results of this study show that patient satisfaction positively affects patient
The Effect of Patient Satisfaction on Patient Loyalty Mediated by Patient Trust and Hospital Brand Image at
the Jakarta Education Dental and Oral Hospital
778 2, 3., February 2023
loyalty mediated by patient trust. Patient trust in doctors is the most important factor in the
doctor-patient relationship (Liu et al., 2021). Previous research has shown that trust and
satisfaction act as important mediators between perceived qualities and the desire to return to
the hospital (Han & Hyun, 2015). Previous research has studied the relationship between
loyalty and trust in hospitals and found that the relationship between the two is significant and
very positive, with trust playing an important role as a mediating dimension, especially in the
health field (Gambarov et al., 2017).
7. Hypothesis 7
The seventh hypothesis tests the effect of patient satisfaction on patient loyalty mediated by
hospital brand image. The results of this study show that patient satisfaction positively affects
patient loyalty mediated by hospital brand image. Previous research has stated that the
hospital's brand image partially mediates the relationship between service quality and
satisfaction (Alomari, 2022). Other studies state that brand image directly affects loyalty and
brand image indirectly affects loyalty through patient satisfaction (Vimla & Taneja, 2020).
Other studies have recognized that brand image stimulates customer satisfaction. This is
because they not only build an ongoing relationship with the brand but also create a positive
WOM (Chao et al., 2015). Similarly, other researchers found that brand image is an antecedent
for customer "satisfaction and loyalty," as companies have to spend huge resources to build
and improve their brand image. Many studies also recognize that because of a strong brand
image, customers will be loyal to the brand (Taqi & Muhammad, 2020).
CONCLUSION
Based on the results of the research and discussion processed in the previous chapter, there
are 7 hypotheses that are accepted as follows:
1. Patient satisfaction has a positive influence on patient loyalty.
2. Patient satisfaction has a positive influence on patient trust.
3. Patient trust has a positive influence on patient loyalty.
4. Patient satisfaction has a positive influence on hospital brand image.
5. Hospital brand image has a positive influence on patient loyalty.
6. Patient satisfaction has a positive influence on patient loyalty mediated by patient trust.
7. Patient satisfaction has a positive influence on patient loyalty mediated by hospital brand
image.
Suggestion
1. Further research can be carried out on all Dental and Oral Hospitals in Indonesia, not
only the Education hospitals in Jakarta.
2. Further research can add other variables that can affect patient loyalty, such as service
quality variables (Rosadi et al., 2020)
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