"Building bonds: Key drivers of patient loyalty in healthcare": A mini-review
Patient loyalty
DOI:
https://doi.org/10.47577/sustainability.v9i.12814Keywords:
“patient loyalty”, “patient satisfaction”, “service quality”, “continuous improvement”.Abstract
Introduction: The hospital environment is characterized by increased competition, accelerated development of medical technologies, greater complexity and technicality of care, as well as increased patient demands. To meet these demands, hospitals must provide quality care that meets patients' needs and expectations. They must also develop long-term relationships with their patients to create a bond of trust and loyalty.
Objective: This work aims to synthesize the factors affecting patient loyalty in hospitals and to identify possible areas for improvement.
Results: The determinants of a patient’s loyalty in a hospital start with the management approach and patient satisfaction, the service quality and the brand image of the hospital, and include hospitality services, visibility of the hospital, communication and confidentiality, reputation and availability of doctors, nursing care, and leadership and the relationships between doctors, nurses, and patients. In addition to health care services that comprise administrative procedures and support programs for patients and families, artificial intelligence and diagnostic platforms have been highlighted as principal factors affecting patient loyalty and trust. Marketing in the healthcare sector can affect patient trust, and demographic and psychosocial profiles of patients also influence patient loyalty.
Each factor can affect patient loyalty in a hospital to a specific degree.
Although classic patient loyalty programs exist in some hospitals, inspired by other sectors, they are part of rather patient retention strategies and lack specificity and connection to factors influencing loyalty behavior.
Conclusion: Measurement and analysis of the impact of determinants of patient loyalty in hospitals improves the performance of healthcare providers and hospital profitability.
References
K. Setiawati and S. Lailiyah, “Factors that Affecting Patient Loyalty in Hospital. Media Gizi Kesmas..,” pp. 1041–1046, 2023, doi: https://doi.org/10.20473/mgk.v12i2.2023.
S. Lonial, D. Menezes, M. Tarim, E. Tatoğlu, and S. Zaim, “An evaluation of SERVQUAL and patient loyalty in an emerging country context,” Total Qual. Manag. Bus. Excell., vol. 21, no. 8, pp. 813–827, 2010, doi: 10.1080/14783363.2010.487663.
C. Iuliana Stoian and O. Tugulea, “Developing a Scale to Measure Customer Loyalty,” Procedia Econ. Finance, vol. 3, pp. 623–628, 2012, doi: https://doi.org/10.1016/S2212-5671(12)00205-5.
I. Skačkauskienė, N. Vilkaitė-Vaitonė, and S. Vojtovic, “Model for measuring customer loyalty towards a service provider,” J. Bus. Econ. Manag., vol. 16, no. 6, pp. 1185–1200, Nov. 2015, doi: 10.3846/16111699.2015.1112829.
D. Ray, Mesurer et développer la satisfaction clients. Paris: Eyrolles, 2001.
C. Shaw, The DNA of Customer Experience. New York: Palgrave Macmillan, 2016.
C. Barbaray, Satisfaction, fidélité et expérience client. Paris: Dunod, 2016.
F. Reichheld, The Loyalty Effect : The Hidden Force Behind Growth, Profits, and Lasting Value. Boston: Harvard Business Review Press, 2001.
A. Jacques, C. Ruben, and S. Valerie, L’étude de la relation client. Belgium: La Charte, 2015.
K. Kobeissi and B. Aubert, “Le patient, un « client » presque comme les autres...,” Expans. Manag. Rev., vol. 154, no. 3, pp. 51–57, Sep. 2014, doi: 10.3917/emr.154.0051.
C. R. S. Prakoeswa, N. Hidayah, and A. Dewi, “A Systematic Review on Hospital’s Patient Satisfaction and Loyalty in Indonesia.,” Open Access Maced. J. Med. Sci., vol. 10, no. F, pp. 655–664, 2022, doi: https://doi.org/10.3889/oamjms.2022.10100.
M, & Minar, I. P. (2018)., “Patients’ Loyalty Improvement in Public Hospital”.
K. Kobeissi and B. Aubert, “Le patient, un « client » presque comme les autres...,” Expans. Manag. Rev., vol. 154, no. 3, pp. 51–57, 2014, doi: 10.3917/emr.154.0051.
C. M. Christensen, T. Levitt, P. Kotler, and F. Reichheld, HBRs 10 Must Reads on Strategic Marketing. Boston: Harvard Business Review, 2013.
F. Reichheld, Loyalty Rules! How Today’s Leaders Build Lasting Relationships. Boston: Harvard Business Review Press, 2001.
P. Kotler and L. Keller Kevin, Marketing Management, 16th ed. Upper Saddle River, NJ, USA: Pearson, 2016.
M.-L. Gavard-Perret, “Philip Kotler – Une pièce maîtresse dans l’évolution du concept marketing,” Gd. Auteurs En Mark., pp. 171–198, 2016, doi: https://doi.org/10.3917/ems.jolib.2016.01.0171.
M.-L. Gavard-Perret, “VIII. Philip Kotler – Une pièce maîtresse dans l’évolution du concept marketing,” in Les Grands Auteurs en Marketing, vol. 2, EMS Éditions, 2016, pp. 171–198. doi: 10.3917/ems.jolib.2016.01.0171.
L. Tran, “Herbert Simon et la rationalité limitée,” Cairn, vol. 2018/1, no. n° 22, pp. 54–57, 2018, doi: 10.3917/rce.022.0054.
F. Reichheld and B. Markey, The Ultimate Question 2.0 (Revised and Expanded Edition): How Net Promoter Companies Thrive in a Customer-Driven World. Boston: Harvard Business Review Press, 2011.
N. L. Rane, A. Achari, and S. P. Choudhary, “Enhancing Customer Loyalty Through Quality of Service: Effective Strategies to Improve Customer Satisfaction, Experience, Relationship, and Engagement,” Int. Res. J. Mod. Eng. Technol. Sci. IRJMETS, vol. 5, no. 5, pp. 427–452, 2023, doi: https://www.doi.org/10.56726/IRJMETS38104.
F. Reichheld, “Lead for loyalty,” Harv. Bus. Rev., vol. 79, no. 7, pp. 16-84,144, 2001.
B. Künzle, M. Kolbe, and G. Grote, “Ensuring patient safety through effective leadership behaviour: A literature review.,” Saf. Sci., vol. 48, no. 1, pp. 1–17, 2010, doi: https://doi.org/10.1016/J.SSCI.2009.06.004.
S. Aali, A. Ibrahimi, V. R. Mirabi, and Z. Shahram, “The Role of Organizational Leadership in Customer Loyalty through Managing Conflict between Employees and Customers,” Int. J. Organ. Leadersh., vol. 8, no. 3, pp. 1–16, 2020, doi: 10.33844/ijol.2020.60479.
C. Wong, G. Cummings, and L. Ducharme, “The relationship between nursing leadership and patient outcomes: a systematic review update,” J. Nurs. Manag., vol. 21, no. 5, pp. 709–24, 2013, doi: https://doi.org/10.1111/jonm.12116.
“Press-Ganey-white-paper-2021-Health-Care-Consumer-Experience-Trends.pdf.” Accessed: Apr. 10, 2025. [Online]. Available: https://insync.com.au/wp-content/uploads/Press-Ganey-white-paper-2021-Health-Care-Consumer-Experience-Trends.pdf
“2020 Global health care sector outlook | Deloitte,” Deloitte Kazakhstan. Accessed: Apr. 10, 2025. [Online]. Available: https://www2.deloitte.com/kz/en/pages/life-sciences-and-healthcare/articles/global-health-care-sector-outlook.html
T. E. Gunawan, P. Permatasari, M. E. Setiawati, and D. Utari, “Relationship Between Hospital Image With Patient Loyalty In Hospitalized Patients.,” J. Kesehat. Prima, vol. 14, pp. 68–74, 2020, doi: https://doi.org/10.32807/jkp.v14i1.271.
S. Liu, G. Li, N. Liu, and W. Hongwei, “The Impact of Patient Satisfaction on Patient Loyalty with the Mediating Effect of Patient Trust,” Inq. J. Med. Care Organ. Provis. Financ., vol. 58, p. 469580211007221, 2021, doi: 10.1177/00469580211007221.
D. Supangat, Y. Thamrin, and N. Noor, “The Effect of Brand Image and Patient Satisfaction on Patient Loyalty in Outstanding Installations Dr. Tadjuddin Chalid Makassar. Journal of Asian,” Multicult. Res. Med. Health Sci. Study, vol. 3, no. 3, pp. 1–9, 2022, doi: https://doi.org/10.47616/jamrmhss.v3i3.300.
C.-C. Wu, “The impact of hospital brand image on service quality, patient satisfaction and loyalty,” Afr. J. Bus. Manag., vol. 5, no. 12, pp. 4873–4882, 2011, doi: https://doi.org/10.5897/AJBM10.1347.
A. S. Tanya, “The effect of patient satisfaction on patient loyalty mediated by patient trust and hospital brand image at the jakarta education dental and oral hospital,” J. Soc. Res., vol. 2, no. 3, pp. 765–780, Feb. 2023, doi: doi.org/10.55324/josr.v2i3.727.
A. O. Trisno and M. P. Berlianto, “The Effect of Perceived Value, Brand Image, Satisfaction, Trust and Commitment on Loyalty at XYZ Hospitals, Tangerang.,” J. Manaj. Kesehat. Indones., vol. 11, no. 1, pp. 22–33, 2023, doi: https://doi.org/10.14710/jmki.11.1.2023.22-33.
A. Meesala and J. Paul, “Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future,” J. Retail. Consum. Serv., vol. 40, no. 4, pp. 261–269, 2018, doi: 10.1016/J.JRETCONSER.2016.10.011.
H. D. Sevin, “Hotel Services In Hospitals,” J. Tour. Gastron. Stud., vol. 6, no. 1, pp. 451–459, 2018, doi: https://doi.org/10.21325/JOTAGS.2018.198.
M. Mody, T. Dogru, and C. Suess, “Restorative Servicescapes in Health Care: Examining the Influence of Hotel-Like Attributes on Patient Well-Being,” Cornell Hosp. Q., vol. 61, no. 1, pp. 19–39, 2020, doi: https://doi.org/10.1177/1938965519879430.
C. Suess and M. Mody, “Hospitality healthscapes: A conjoint analysis approach to understanding patient responses to hotel-like hospital rooms,” Int. J. Hosp. Manag., vol. 61, pp. 59–72, 2017, doi: https://doi.org/10.1016/J.IJHM.2016.11.004.
M. Jung and M.-S. Hong, “Positioning patient-perceived medical services to develop a marketing strategy. The health care manager,” Health Care Manag., vol. 31, no. 1, pp. 52–61, 2012, doi: 10.1097/HCM.0b013e318242d331.
P. Merks, J. Kaźmierczak, A. E. Olszewska, and M. Kołtowska-Häggström, “Comparison of factors influencing patient choice of community pharmacy in Poland and in the UK, and identification of components of pharmaceutical care,” Patient Prefer. Adherence, vol. 8, pp. 715–726, 2014, doi: doi.org/10.2147/PPA.S53829.
A. E. Sharma, B. Huang, M. Knox, R. Willard-Grace, and M. B. Potter, “Patient Engagement in Community Health Center Leadership: How Does it Happen?,” J. Community Health, vol. 43, no. 6, pp. 1069–1074, Dec. 2018, doi: 10.1007/s10900-018-0523-z.
A. Shie et al., “Exploring the Relationship Between Hospital Service Quality, Patient Trust, and Loyalty From a Service Encounter Perspective in Elderly With Chronic Diseases,” Front. Public Health, vol. 10, no. 876266, 2022, doi: doi.org/10.3389/fpubh.2022.876266.
M. Yarmen, S. Sumaedi, G. M. Y. Bakti, T. Rakhmawati, N. J. Astrini, and T. Widianti, “Investigating patient loyalty: An integrated framework for trust, subjective norm, image, and perceived risk (a case study in Depok, Indonesia),” Int. J. Qual. Serv. Sci., vol. 8, no. 2, pp. 179–196, 2016, doi: https://doi.org/10.1108/IJQSS-01-2015-0005.
M. Mardaleta, L. Abdul Rahman, D. Yossi, and Heru, Fahlevi, “Determinants of patient behavioural loyalty on primary health centres: Evidence from a cross-sectional study in Indonesia,” F1000Research, vol. 11, p. 440, 2022, doi: https://doi.org/10.12688/f1000research.110684.2.
N. S. Lampus and D. S. Wuisan, “Correlation between Doctor-Patient Communication with Patient Satisfaction and Loyalty.,” Med. Scope J., vol. 6, no. 2, pp. 149-158., 2024, doi: https://doi.org/10.1080/15332969.2018.1514797.
L. Gérard, M. François, M. de Chefdebien, O. Saint-Lary, and A. Jami, “The patient, the doctor, and the patient’s loyalty: a qualitative study in French general practice.,” Br. J. Gen. Pract. J. R. Coll. Gen. Pract., vol. 66, no. 652, pp. e810-e818., 2016, doi: https://doi.org/10.3399/bjgp16X687541.
M. Akbolat, M. Amarat, Ö. Ünal, and E. S. Sütlü, “The mediating role of hospital reputation in the effect of doctor reputation on patients loyalty.,” Int. J. Healthc. Manag., vol. 16, no. 1, pp. 12–18, 2022, doi: https://doi.org/10.1080/20479700.2022.2062853.
N. M. Suki, “Assessing patient satisfaction, trust, commitment, loyalty and doctors’ reputation towards doctor services.,” Pak J Med Sci, vol. 27, no. 5, pp. 1207–1210, 2011.
L. Luo, A. J. Forster, K. Gartke, J. Trickett, and F. D. Rubens, “Developing a Strategy for the Improvement in Patient Experience in a Canadian Academic Department of Surgery,” J Patient Exp, vol. 6, no. 1, pp. 11-20., 2019, doi: 10.1177/2374373518774399.
B. Bumpers, V. Dearmon, and P. Dycus, “Impacting the Patient’s Experience in a Children’s Hospital Using a Communication Bundle Strategy,” J. Nurs. Care Qual., vol. 34, no. 1, pp. 86–90, 2019, doi: 10.1097/ncq.0000000000000336.
H. N. Park, D. J. Park, S. young Han, Y. T. Ji, and K.-H. Jung, “Effect of inpatient experiences on patient satisfaction and the willingness to recommend a hospital: The mediating role of patient satisfaction: A cross-sectional study,” Health Sci. Rep., vol. 5, no. 6, p. e925, 2022, doi: 10.1002/hsr2.925.
S. G. Saleem et al., “Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan,” Pak. J. Med. Sci., vol. 38, no. 2, pp. 351–355, 2022, doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785.
P. Esmaeilzadeh, “The Impacts of the Perceived Transparency of Privacy Policies and Trust in Providers for Building Trust in Health Information Exchange: Empirical Study,” JMIR Med. Inform., vol. 7, no. 4, p. e14050., 2019, doi: https://doi.org/10.2196/14050.
H. Merkt et al., “Forensic mental health professionals’ perceptions of their dual loyalty conflict: findings from a qualitative study,” BMC Med. Ethics, vol. 22, no. 1, p. 123, 2021, doi: https://doi.org/10.1186/s12910-021-00688-2.
W.-J. Zhou, Q.-Q. Wan, X. Feng, and S. Shang, “Determinants of patient loyalty to healthcare providers: An integrative review,” Int. J. Qual. Health Care, vol. 29, no. 4, pp. 442–449, 2017, doi: 10.1093/intqhc/mzx058.
J. F. Figueroa, Y. Feyman, X. Zhou, and K. Joynt Maddox, “Hospital-level care coordination strategies associated with better patient experience,” BMJ Qual. Saf., vol. 27, no. 10, pp. 844–851, Oct. 2018, doi: 10.1136/bmjqs-2017-007597.
M. Sarmad and S. Bashir, “Impact of Nurses’ Personality on Patients’ Satisfaction; an Occupational Focus on Spirituality at work as Moderator,” Abasyn J. Soc. Sci., vol. 9, no. 1, pp. 69–85, 2016.
N. L. P. S. Yudhawati, “Effect Between Quality of Nursing Service on Inpatient’s Loyalty and Satisfaction in dr. Soepraoen Hospital Malang.,” J. Res. Public Health, vol. 1, no. 1, pp. 21–27, 2019.
X. Chen, W. Zhao, J. Yuan, C. Qin W. H., and Y. Zhang, “The Relationships Between Patient Experience with Nursing Care, Patient Satisfaction and Patient Loyalty: A Structural Equation Modeling,” Patient Prefer. Adherence, vol. Volume 2022, no. 16, pp. 3173–3183, 2022, doi: 10.2147/PPA.S386294.
M. Rostami, L. Ahmadian, Y. Jahani, and A. Niknafs, “The effect of patient satisfaction with academic hospitals on their loyalty,” Int. J. Health Plann. Manage., vol. 34, no. 1, pp. e726–e735, Jan. 2019, doi: 10.1002/hpm.2685.
F. Manzoor, L. Wei, A. Hussain, M. Asif, and S. I. A. Shah, “Patient Satisfaction with Health Care Services; An Application of Physician’s Behavior as a Moderator,” Int. J. Environ. Res. Public. Health, vol. 16, no. 18, p. 3318, 2019, doi: https://doi.org/10.3390/ijerph16183318.
A. Y. A. Fianto, “Artificial Intelligence and Novel Services: Exploring Opportunities in the Marketing Landscape.,” J. Appl. Manag. Bus., vol. 4, no. 1, pp. 49–59, 2023, doi: https://doi.org/10.37802/jamb.v4i1.399.
F. Jiang et al., “Artificial intelligence in healthcare: past, present and future,” Stroke Vasc Neurol, vol. 2, no. 4, pp. 230–243, 2017, doi: https://doi.org/10.1136/svn-2017-000101.
M. Nagy and B. Sisk, “How Will Artificial Intelligence Affect Patient-Clinician Relationships?,” AMA J. Ethics, vol. 22, no. 5, pp. E395-400, 2020, doi: https://doi.org/10.1001/amajethics.2020.395.
D. w Bates et al., “The potential of artificial intelligence to improve patient safety: a scoping review.,” NPJ Digit. Med., vol. 4, no. 1, p. 54, 2021, doi: https://doi.org/10.1038/s41746-021-00423-6.
V. Levana and F. Antonio, “Antecedents of Patient Satisfaction in Private Clinical Laboratories toward Patient Loyalty with Switching Cost and Location as Moderating Factors (An Empirical Study from Indonesia),” Open Access Maced. J. Med. Sci., vol. 10, no. E, pp. 1463–1471, 2022, doi: https://doi.org/10.3889/oamjms.2022.9809.
J. K. Elrod and J. L. Fortenberry, “Establishing Good Samaritan programs in healthcare institutions: a method for enhancing patient experiences and increasing loyalty,” BMC Health Serv. Res., vol. 18, no. 3, p. 927, Dec. 2018, doi: 10.1186/s12913-018-3677-6.
Y. L. Lan, J. Y. Hung, C.-C. Chen, and C. W. Yao, “Key factors influencing patient loyalty,” Int. J. Electron. Cust. Relatsh. Manag., vol. 10, no. 2–4, pp. 89–102, 2016, doi: 10.1504/IJECRM.2016.10003099.
M. K. Rahman, M. A. Bhuiyan, and S. Zailani, “Healthcare Services: Patient Satisfaction and Loyalty Lessons from Islamic Friendly Hospitals,” Patient Prefer. Adherence, vol. 5, pp. 2633–2646, 2021, doi: 10.2147/PPA.S333595.
J. Gummerus, V. Liljander, M. Pura, and A. van Riel, “Customer loyalty to content‐based Web sites: the case of an online health‐care service,” J. Serv. Mark., vol. 18, no. 3, pp. 175–186, Jan. 2004, doi: 10.1108/08876040410536486.
C. McClure and Y.-K. Seock, “The role of involvement: Investigating the effect of brand’s social media pages on consumer purchase intention,” J. Retail. Consum. Serv., vol. 53, no. 3, p. 101975, 2020, doi: doi: 10.1016/j.jretconser.2019.101975.
B. T. Khoa and T. T. Huynh, “The influence of social media marketing activities on customer loyalty: A study of e-commerce industry.,” Int. J. Data Netw. Sci., vol. 7, no. 1, pp. 175–184, 2023, doi: https://doi.org/10.5267/j.ijdns.2022.11.005.
J. Verkamp, “Patient loyalty and the social media effect,” J. Med. Pract. Manag. MPM, vol. 29, no. 2, pp. 96–8 ., 2013.
A. K. R. R. Sonya Dewi Wulandari, “Effect of Marketing Mix on Outpatient Loyalty at Hajj Hospital, Jakarta, Indonesia,” J. Hunan Univ. Nat. Sci., vol. 50, no. 10, Art. no. 10, 2023, Accessed: Jan. 30, 2025. [Online]. Available: https://jonuns.com/index.php/journal/article/view/1470
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