Competition in the healthcare industry is increasing, requiring hospitals to provide better services to retain patients. Patient loyalty is a crucial factor in a hospital's sustainability and is influenced by various aspects, including patient experience and patient engagement. This study aims to analyze the influence of patient experience and patient engagement on patient loyalty, with inpatient satisfaction as an intervening variable at Latersia Hospital Binjai. A quantitative method with the Partial Least Square – Structural Equation Modeling (PLS-SEM) approach was used. The results indicate that patient experience and patient engagement have a positive and significant effect on patient satisfaction, which subsequently influences patient loyalty. The better the patient’s experience and engagement in their care, the higher their satisfaction, leading to increased loyalty to the hospital. Additionally, patient satisfaction serves as a mediating variable, strengthening the relationship between patient experience, patient engagement, and patient loyalty. This study contributes to the development of strategies for improving hospital services, focusing on enhancing patient experience and engagement to increase satisfaction and loyalty. Understanding the factors that influence patient loyalty enables hospitals to enhance their competitiveness and deliver higher-quality healthcare services to the community.
In the ever-evolving digital era, the utilization of information and communication technology has become an inseparable part of society’s daily life. This development not only impacts the business and trade sectors but has also extended into the healthcare field. Hospitals, as providers of healthcare services, are required to adapt to technological advancements in order to remain relevant and competitive. One of the strategies that can be implemented is digital marketing. The rapid technological progress in recent years, supported by the increasing number of internet service providers and ease of access for consumers, has driven various industries into the digital era. Companies that adopt technology in their interactions with consumers gain a competitive advantage, while those that continue to rely on traditional strategies tend to experience a decline in competitiveness (Durmaz & Efendioglu, 2016).
The current phenomenon shows a shift in public preference when choosing hospital services. Patients no longer only consider the quality of medical care but also pay attention to their involvement in each stage of treatment and to having a satisfying patient experience. According to data from the Indonesian Private Hospital Association (ARSSI) in 2023, there has been an increase in competition among hospitals to attract and retain patients, particularly in urban areas. As one of the referral hospitals in Binjai, Latersia Hospital is required to be competitive and become the top choice for the community, especially in providing quality inpatient services in Binjai and surrounding areas.
However, there are indications that patient loyalty in the Inpatient Unit at Latersia Hospital still needs improvement, as some patients in the VVIP rooms have expressed unwillingness to recommend the hospital. Based on the hospital’s internal survey conducted in early 2024, it was found that although most patients were satisfied with the services received, only about 55% expressed a willingness to return to the same hospital for future treatment. This indicates a gap between patient satisfaction and loyalty. The lack of impactful patient experiences on their health outcomes and the variability in service quality are suspected to be factors affecting patient loyalty in the Inpatient Unit.
Based on these phenomena and issues, this study aims to analyze the influence of patient experience and price on patient loyalty, with patient satisfaction as an intervening variable, in the Inpatient Unit of Latersia Hospital. This research is expected to provide recommendations for hospital management in improving patient satisfaction and loyalty, as well as assist the hospital in staying competitive within the increasingly dynamic healthcare service industry.
Patient experience refers to patients' perceptions of various interactions and services they receive while in the hospital, including interactions with medical staff, the quality of facilities, access to medical information, and the ease of care processes.
Customer experience is an internal and subjective consumer response resulting from direct or indirect interaction with a company (Meyer & Schwager, 2007).
Patient engagement refers to the extent to which patients actively participate in managing their own health. Patients who feel empowered and actively involved in their care are more likely to be loyal to the hospital or healthcare provider. They feel more connected to the medical team, which enhances trust and long-term commitment to the service.
Patient loyalty is a crucial element in healthcare management, especially in the hospital sector. Loyalty is a strong commitment to repurchase or reuse a preferred product or service consistently in the future, despite external circumstances that might influence behavior (Oliver, 1999). Customer loyalty refers to customers who not only repurchase goods and services but also maintain a positive attitude toward the service provider, for example, by recommending it to others (Islam et al., 2021).
Customer satisfaction is the feeling of pleasure or disappointment resulting from comparing a product’s or service’s perceived performance with expectations (Oliver, 1980). In the business world, customer satisfaction levels are crucial because they affect customer retention, loyalty, and long-term profitability.
Customer satisfaction is a post-purchase evaluation where the chosen alternative at least meets expectations, whereas dissatisfaction arises when the results fail to meet expectations (Eugel et al., 1995).
This study uses a quantitative approach and is conducted at Latersia Hospital Binjai, located at Jl. Soekarno Hatta No. 451-453 KM 18, East Binjai, North Sumatra. The research period is from November to January 2025. This study aims to examine the relationships or influences among variables using statistical measurements. In this case, variables such as Patient Experience, Patient Engagement, Patient Satisfaction, and Patient Loyalty will be measured through questionnaires or other instruments that generate numerical data.
This research consists of three main variables:
Patient Experience (X1)
Patient Engagement (X2)
These influence Patient Loyalty (Y) through the intervening variable Patient Satisfaction (Z).
The results of the study show that patient experience has a positive and significant effect on inpatient satisfaction at Latersia Hospital Binjai. Based on data analysis, the Original Sample (O) value is 0.41, with a T Statistic of 3.04 and a P Value of 0.00, indicating that the hypothesis is accepted. This implies that the better the patient experience during hospitalization, the higher the level of satisfaction felt by the patient.
These findings demonstrate that aspects of patient experience—such as communication with medical staff, facility comfort, ease of access to services, and responsiveness of the healthcare team—play a crucial role in enhancing patient satisfaction. A T Statistic greater than 1.96 and a P Value below 0.05 confirm that the relationship is statistically significant. Therefore, improving the quality of patient experience is a key factor in increasing patient satisfaction at Latersia Hospital Binjai.
The analysis shows that patient engagement has a significant influence on inpatient satisfaction at Latersia Hospital Binjai. According to the statistical test, the Original Sample (O) value is 0.26, with a T Statistic of 2.85 and a P Value of 0.01. These values indicate that the higher the patient engagement in the care process and medical decision-making, the higher their satisfaction with the hospital’s services.
The relationship between patient engagement and satisfaction is reinforced by a T Statistic greater than 1.96 and a P Value less than 0.05, confirming statistical significance. This suggests that hospital efforts to involve patients—such as providing clear information about their condition, listening to patient needs, and encouraging active participation in treatment decisions—can increase satisfaction levels.
The results indicate that patient experience has a positive and significant effect on inpatient loyalty at Latersia Hospital Binjai. Statistical testing shows an Original Sample (O) value of 0.46, with a T Statistic of 4.60 and a P Value of 0.00. Thus, the hypothesis that patient experience affects patient loyalty is accepted. The T Statistic exceeding 1.96 and the P Value being below 0.05 indicate that hospital service experiences influence patients’ likelihood of returning to the same facility in the future. Positive experiences, including friendly service, competent healthcare providers, and comfortable facilities, can increase patient loyalty to the hospital.
The analysis reveals that patient engagement has a negative and significant effect on patient loyalty at Latersia Hospital Binjai. According to the statistical test, the Original Sample (O) value is -0.23, with a T Statistic of 2.91 and a P Value of 0.00. The negative Original Sample value indicates that the higher the patient engagement, the lower their loyalty to the hospital tends to be.
This suggests that patients who are more actively involved in decision-making about their care may be more inclined to evaluate various available healthcare options and are not necessarily loyal to a single provider. Nevertheless, a T Statistic above 1.96 and a P Value below 0.05 indicate statistical significance.
The findings demonstrate that patient satisfaction has a positive and significant impact on loyalty at Latersia Hospital Binjai. The analysis yielded an Original Sample (O) value of 0.29, with a T Statistic of 2.59 and a P Value of 0.01. A T Statistic above 1.96 and a P Value below 0.05 show that the relationship between patient satisfaction and loyalty is statistically significant. Patients who are satisfied with the services provided tend to return to the same hospital for future treatments. This confirms that increasing patient satisfaction can be an effective strategy to enhance patient loyalty.
The results show that patient experience has an indirect effect on patient loyalty through patient satisfaction as a mediating variable. Based on the statistical test, the Original Sample (O) value is 0.12, with a T Statistic of 1.98 and a P Value of 0.05. This suggests that patient satisfaction is a significant mediator in the relationship between patient experience and loyalty at Latersia Hospital Binjai.
This finding implies that positive experiences during care—such as high- quality medical services, effective communication with healthcare workers, and facility comfort—contribute to increased satisfaction. This satisfaction, in turn, affects patient loyalty, as reflected in their tendency to reuse the hospital's services. Although the indirect effect is smaller than the direct effect, the results still highlight that improving patient experience can enhance patient loyalty through increased satisfaction.
The analysis shows that patient engagement has an indirect effect on loyalty through patient satisfaction as a mediating variable. Based on the statistical test, the Original Sample (O) value is 0.07, with a T Statistic of 2.17 and a P Value of 0.03. A T Statistic above 1.96 and a P Value below 0.05 indicate statistical significance.
The result suggests that higher levels of patient engagement in their care process lead to increased satisfaction, which in turn enhances their loyalty to the hospital. Patients who feel more involved in medical decisions are more likely to feel ownership over the services they receive, making them more satisfied and more inclined to continue using the same hospital services.
Although this indirect effect is relatively small, the findings confirm that patient satisfaction can play a vital role in bridging the relationship between patient engagement and loyalty. Therefore, hospitals should continue to promote patient engagement as a strategy to enhance both satisfaction and long-term loyalty.
Table 4.13: Indirect Effects Analysis Results with T-Statistics and P-Values
|
|
|
|
|
|
|
|---|---|---|---|---|---|
|
Patient Engagement → Satisfaction → Loyalty |
0.07 |
0.07 |
0.03 |
2.17 |
0.03 |
|
Patient Experience → Satisfaction → Loyalty |
0.12 |
0.12 |
0.06 |
1.98 |
0.05 |
The analysis shows that patient experience has a positive total effect on patient loyalty with a value of 0.58, consisting of a direct effect of 0.46 and an indirect effect (through satisfaction) of 0.12. This indicates that better patient experience not only directly enhances loyalty but also does so indirectly by increasing satisfaction.
The indirect effect of patient experience on patient loyalty through patient satisfaction was also found to be significant, with a path coefficient of 0.11 and a t-value of 1.97 (p = 0.049), thus hypothesis six (H6) is accepted. This indicates that patient satisfaction acts as a mediating variable in the relationship between patient experience and patient loyalty.
Finally, patient engagement also has a positive and significant influence on patient loyalty through patient satisfaction, with a path coefficient of 0.07 and a t-value of 2.16 (p = 0.031), thus hypothesis seven (H7) is accepted. Therefore, patient engagement in their care not only increases satisfaction but also indirectly affects their loyalty to the hospital.
| Hypothesis | Path Coefficient | T-Value | Sig. | Research Result |
|---|---|---|---|---|
| Patient experience has a positive and significant effect on patient satisfaction among inpatients at Latersia Hospital | 0.41 | 3.04 | 0.001 | H1 accepted |
| Patient engagement has a positive and significant effect on patient satisfaction among inpatients at Latersia Hospital | 0.26 | 2.85 | 0.010 | H2 accepted |
| Patient experience has a positive and significant effect on patient loyalty among inpatients at Latersia Hospital | 0.58 | 6.84 | 0.001 | H3 accepted |
| Patient engagement has a positive and significant effect on patient loyalty among inpatients at Latersia Hospital | -0.16 | 2.11 | 0.040 | H4 accepted |
| Patient satisfaction has a positive and significant effect on patient loyalty among inpatients at Latersia Hospital | 0.29 | 2.59 | 0.010 | H5 accepted |
| Patient experience has a positive and significant effect on patient loyalty through patient satisfaction among inpatients | 0.11 | 1.97 | 0.049 | H6 accepted |
| Patient engagement has a positive and significant effect on patient loyalty through patient satisfaction among inpatients | 0.07 | 2.16 | 0.031 | H7 accepted |
Patient experience and patient satisfaction are two critical aspects in determining the quality of healthcare services. A comprehensive understanding of these concepts shows that effective communication, the use of technology, and empathetic care greatly influence the level of patient satisfaction. When patients feel respected, heard, and receive services that align with their expectations, their loyalty to the healthcare facility increases. These factors are key to building a better healthcare system where patients not only receive optimal medical treatment but also have a positive overall experience during their care journey (Chowdhury et al., 2024).
One of the main factors affecting patient satisfaction is communication between medical staff and patients. Good communication can build trust and increase patient compliance with the prescribed treatment. In these interactions, empathy and cultural understanding are essential to prevent misunderstandings that may reduce satisfaction (Chowdhury et al., 2024; Saeed et al., 2025). Patients are generally more satisfied when they feel that medical staff truly care and understand their condition and needs. Therefore, communication training for healthcare providers is a crucial aspect of improving patient experience in healthcare facilities.
In addition to communication, the integration of technology in healthcare services also plays a significant role in enhancing patient satisfaction. The use of telemedicine and patient portals has improved accessibility and convenience for patients in receiving medical care. However, challenges such as varying levels of digital literacy remain a barrier to the full implementation of these technologies. Patients with limited technological skills may face difficulties accessing digital services; thus, healthcare facilities need to provide education and support to ensure that all patients can optimally benefit from technology (Chowdhury et al., 2024; Omaghomi et al., 2024).
Furthermore, overall patient experience is directly correlated with patient satisfaction and loyalty to the healthcare facility. Studies show that the more positive the patient’s experience, the higher their satisfaction level, which in turn contributes to their loyalty to the services provided. Therefore, hospitals and healthcare centers must continuously improve their service standards, including physical facilities, service speed, and the quality of interactions between medical staff and patients (Rosally et al., 2024; Rao et al., 2025). Enhancing patient experience not only affects how patients perceive the healthcare services but can also boost the hospital's reputation as a whole.
Despite significant progress in improving patient experience and satisfaction, several challenges remain. These include limited resources, the need for more culturally sensitive care, and changing patient expectations in the post- COVID-19 era (Chowdhury et al., 2024). Additionally, there is ongoing debate over finding the balance between patient satisfaction and clinical effectiveness. While patient satisfaction is important, some argue that the main focus should still be on achieving optimal clinical outcomes. Therefore, the challenge for healthcare providers is to strike a balance between providing a pleasant experience and maintaining high medical standards (Saeed et al., 2025).
Patient engagement is a critical component in modern healthcare systems, influencing patient satisfaction significantly. Factors such as age, gender, socioeconomic status, and health condition play a substantial role in determining the level of patient engagement. A study in the field of radiation oncology revealed that patients over the age of 65 and women were more likely to participate in patient satisfaction surveys, with participation rates of 60.7% and 57.2% respectively (Loving et al., 2025). However, lower socioeconomic status was associated with reduced participation, where each one-point increase in the Area Deprivation Index (ADI) reduced the likelihood of survey completion by 1% (Loving et al., 2025). Additionally, patients with specific types of cancer, such as head and neck cancers, were more engaged in surveys compared to those with high comorbidity or mental health issues (Loving et al., 2025).
Hospital environment and staff competence also play crucial roles in shaping patient satisfaction. A study using the Partial Least Squares Structural Equation Modeling (PLS-SEM) method found that the quality of the hospital environment and medical staff competency were stronger direct predictors of patient satisfaction than patient engagement itself (Sharma, 2024). Furthermore, the behavior and communication style of medical staff are key factors in improving patient engagement. Another study confirmed that patient-centered communication enhances engagement, health-related quality of life, and patients’ perceptions of healthcare service quality (Çakmak & Uğurluoğlu, 2024). Patient engagement is also seen as a strategic resource that can improve hospital performance. A study adopting the social resource perspective found a positive correlation between patient engagement, healthcare quality, and patient satisfaction (Cha et al., 2024). However, cultural sensitivity remains a challenge in optimizing engagement. A study in Indonesia exploring the LAFKI concept highlighted the importance of cultural understanding in bridging the gap between patient engagement and satisfaction (Rumintjap et al., 2024).
Beyond internal factors, online healthcare engagement also influences satisfaction. Research on Online Medical Teams (OMTs) found that social support and transactive memory systems within digital platforms enhance satisfaction by improving information sharing and emotional support (Wang & Zhang, 2024). However, the same study noted that OMTs may reduce emotional intensity in medical interactions, potentially lowering patient satisfaction.
Technology plays a vital role in enhancing patient engagement. Telemedicine, for instance, has been shown to increase patient participation in satisfaction surveys within oncology services, with an odds ratio of 1.148 (p = 0.006) (Loving et al., 2025). Furthermore, artificial intelligence (AI) is increasingly used in health management to support patient engagement by facilitating easier access to information and more personalized interactions (Rathore et al., 2023). From a managerial perspective, effective leadership strategies, clear communication, and continuous quality improvement initiatives are essential to driving higher levels of engagement (Omaghomi et al., 2024).
However, not all studies support the idea that patient engagement always increases satisfaction. A study in Kenya found that patient-centered communication did not improve satisfaction among patients with life-limiting chronic conditions. In fact, satisfaction scores declined in the intervention group after receiving more patient-centered communication (Sirera et al., 2024). Additionally, socioeconomic barriers and cultural differences remain key obstacles in enhancing patient engagement across various healthcare environments (Cha et al., 2024).
To improve patient engagement effectively, hospitals and healthcare providers must design strategies that account for demographic, socioeconomic, and cultural factors. Telemedicine can be used to increase participation in satisfaction surveys (Loving et al., 2025; Omaghomi et al., 2024). Training healthcare professionals in patient-centered communication and increasing cultural sensitivity are also critical steps in addressing engagement and satisfaction gaps (Çakmak & Uğurluoğlu, 2024; Rumintjap et al., 2024). In terms of technology, AI-based solutions such as chatbots and virtual assistants should be implemented while maintaining data privacy and patient trust in digital healthcare services (Rathore et al., 2023).
Patient experience has a positive and significant influence on patient satisfaction among inpatients at Latersia Hospital.
Patient engagement has a positive and significant influence on patient satisfaction among inpatients at Latersia Hospital.
Patient experience has a positive and significant influence on patient loyalty among inpatients at Latersia Hospital.
Patient engagement has a positive and significant influence on patient loyalty among inpatients at Latersia Hospital.
Patient satisfaction has a positive and significant influence on patient loyalty among inpatients at Latersia Hospital.
Patient experience has a positive and significant indirect effect on patient loyalty through patient satisfaction.
Patient engagement has a positive and significant indirect effect on patient loyalty through patient satisfaction.
This study can serve as a foundation for the development of more patient- centered healthcare management models. Academics and practitioners in healthcare management are encouraged to continue exploring strategies that optimize patient experience, including the role of health technologies in enhancing satisfaction and loyalty.
Future research is recommended to explore other factors that may contribute to patient loyalty, such as family involvement in medical decision- making, trust in healthcare professionals, and the role of digital health services in enhancing patient experiences. Additionally, longitudinal studies and demographic segmentation are needed to better understand how loyalty is shaped across different patient groups and care environments.