Business and Entrepreneurial Review Vol.17, No.

1, April 2017
E-ISSN : 2252-4614 Page 1 - 14

Patient Satisfaction, Hospital Image and Patient Loyalty

in West Sulawesi Province

Abdul Haeba Ramli

Master of Management, Trisakti University
E-mail: abdul.haeba@trisakti.ac.id

ABSTRACT

The purpose of this study was to examine and analyze the effect of patient satisfaction and
hospital image on patient loyalty. The research design uses a survey method with cross-section
data collection through a questionnaire. As a sample in this study, 124 patients were
hospitalized at a Private Hospital located in West Sulawesi Province and taken by simple
random sampling. The data analysis method used in hypothesis testing is Structural Equation
Modeling (SEM). The results of the study provide evidence that patient satisfaction affects and
can improve the image of the hospital. High patient satisfaction also has an impact on patient
loyalty, as well as the high Sakityang house image has a positive and significant influence on
patient loyalty.

Keywords: Patient Satisfaction; Hospital Image; and Patient loyalty.

2 Business and Entrepreneurial Review Vol.17, No.1, April 2017

INTRODUCTION

With the increasing and development of technological advances, especially in the health
sector, marketing the Hospital and becoming an important thing. Especially if we see the
relationship between the progress of the world of health services and economic growth that
are closely interrelated (Ramani and Dileep, 2006). The variety of products of a brand, will
increase the awareness of customers to choose and determine the services they want (Ramli,
2010), and have an impact on service providers to create strong brands or increase customer
satisfaction that the company has (Ramli, 2016a).
Branding plays an important role in a service company, because it is proven to be able to
increase customer loyalty (Berry, 2000), and allows customers to better visualize the service
products obtained (Kim et al., 2008; Ramli, 2012a), can act to choose one of several products
that available (Motameni and Shahrokhi, 1998) and provide value to customers. This affects
what factors contribute to the formation of value in the eyes of customers (Bamert and
Wehrli, 2005).
Health services are a very important and very personal need for patients (Kemp et al., 2014).
Therefore, several health services or hospitals such as the Mayo and Cleveland Clinic, Johns
Hopkins, Memorial Sloan-Kettering and Massachusetts, have shown their efforts to
strengthen the Hospital's Image (Thomaselli, 2010). Likewise with efforts to improve
Hospital Image carried out by Maris Hospital in Makassar (Ramli, 2012b) and several Type-
C Private Private Hospitals in Makassar (Ramli, 2013). A brand acts as a promise to
consumers, implying that staff provide health services needed (Kemp et al., 2014).
Research on corporate image problems in this regard is health organizations, which have
economic and social aspects, exposing that health organizations are primarily customer-
oriented. Therefore, to achieve sustainable success and maintain its existence, health
organizations also need to get help and meet the needs of their target markets. Health
organizations can successfully create a positive image by maintaining their relationships
with patients well (Karafakioglu, 1998; Cinaroglu and Sahin, 2011). Positive images direct
patients to prefer hospitals to other hospitals and apply to selected hospitals while
Business and Entrepreneurial Review Abdul Haeba Ramli 3

determining their priorities; in other words contribute to the creation of patient loyalty
(Derin and Demirel, 2010).
At present, most patients make choices from hospitals that offer the same comfort, have the
same value and similar transportation facilities (Ramli, 2016b). In such an environment,
hospitals can increase patient loyalty and thus improve organizational performance by
developing their strategies in the right way by defining their image. Starting from this idea,
this research is expected to contribute to the literature with scientific findings by attracting
health managers' attention to this problem.
Customer satisfaction is the best guarantee to create and maintain customer loyalty and
defense in the face of global competition. Creating superior service quality must be
supported by reliable human resources and adequate technology (Kotler, 2009). Satisfaction
is someone's pleasure from a comparison between the impression of goods or services with
their expectations. If the reality is the same as expectations, then the service is called
satisfactory, and vice versa, if reality is lower than expectations, the service is called
unsatisfactory (Kim, et al., 2008, Kotler, 2009). Providing high-quality services can increase
benefits through customer satisfaction, because empirically there is a relationship between
customer satisfaction and benefits. Customers who feel satisfied and re-purchase will
increase the benefits, so that a good image will be formed for the hospital (Francken, et al.,
1981, Anderson, 1994, Cronin, et al., 1992, Kang, et al., 2004, Alrubaiee, 2011).

LITERATURE REVIEW

Effect of patient satisfaction on hospital image

Corporate image is a commitment and opinion of an individual to an organization
(Minkiewicz, et al. 2011). Researches on corporate image are often done on companies that
promote tangible products, but on the contrary very little conducted for research on service
companies (Nguyen and LeBlanc, 1998, 2002). As for Belanger et.al (2002) has a different
view of the image of the organization which considers it as a welcome speech from the
impression that arises from an individual towards an organization or company.
To buy or choose a service that has a positive, special, important and valuable image for an
individual, accelerates and facilitates customer choices. A good brand image makes
4 Business and Entrepreneurial Review Vol.17, No.1, April 2017

consumers believe in product quality and helps consumers to make choices and to feel
comfortable when buying their products. (Chih-Chung et al., 2012). Kotler (1991) refers to
brand image as combining name, fame (reputation), design and symbol. Used by consumers
to differentiate products and services from competitors. Farquhar (1989) states that brand
image has additional value beyond the function and service of the product. Greve (2014) also
measures brand image using a scale containing three items: value, manifested (perceived)
quality and uniqueness. Kim et al. (2012), adopted Lemmink's et al. (2003), brand image
measured using two classifications. Intangible brand image (standard medical, positive
reputation, kind personnel, etc.) and real brand image (equipment, parking facilities,
dependents / subsidiaries, etc.) Dodds et al. (1994) claim that the brand image provides all
information about the product; influence of higher brand image overall assessment and
perceived quality.
The theory of Kotler & Keller (2012) says that patient satisfaction is to see how the internal
and external zones of the company / organization have an impact on the conclusions of
business design made in order to advance business capacity. The dominance of patient
satisfaction with a health service is how to get the service from a number of things that
cannot be controlled by the company that must always be observed and carried out
corrective actions.
Previous research provides evidence, as stated by Marzaweny & Hadiwidjoyo, 2012;
Andaleeb, 1998; Nguyen & LeBlanc, 2002, that patient satisfaction has a positive and
significant effect on Hospital Image / organization. Based on these empirical evidence, the
hypothesis is proposed as follows:
H1: Patient satisfaction has a positive and significant effect on Hospital Image.

Effect of patient satisfaction on patient loyalty

The patient satisfaction framework has developed progressively since 1970 (Sardana, 2003;
Cooper et al., 1979; Kotler and Zaltman, 1970). Raftopoulos (2005), Kang and Jeffrey (2004),
Chahal and Sharma (2004), Sardana (2003), Brady and Cronin (2001), Corbin et al. (2001),
Newman (1998) and Gilson et al. (1994) determine various aspects of patient satisfaction.
For example, Sardana (2003) conceptualizes patient satisfaction using five aspects: first,
doctor and care; second, support staff; third, convenient visiting hours and emergency
Business and Entrepreneurial Review Abdul Haeba Ramli 5

assistance. Chahal and Sharma (2004) claim that doctors, nurses and managers; fourth,
facilities and fifth, cleanliness is the main factor that influences patient satisfaction.
Doctors and nurses complement each other and both must be studied if service quality needs
to be improved (Jakobsson and Holmberg, 2012). Kang and Jeffrey (2004) and Raftopoulos
(2005) consider that food, room characteristics, and treatment are important in explaining
patient satisfaction. Staff comportment also had a significant effect on patient satisfaction.
The way staff behave with patients is an important factor (Andaleeb, 1988).
Based on the Health Services Research Unit (NHSRU) report, carried out jointly by the
nursing faculty at Toronto and McMaster universities (Ontario Ministry of Health, 2014),
several factors that lead to an increase or decrease in health services are identified: socio-
economic status (SES); doctor supply; policies and beliefs; risk behavior; and health
status. SES is an education, income and demographic information (gender, age and ethnicity)
measure. It is believed that SES has a significant influence on utilization behavior in several
aspects such as needs, recognition and response to symptoms, knowledge of disease,
motivation to recover and access to health services (Anderson, 1988; Hulka and Wheat,
1985). In addition, health status (Anderson, 1988; Hershey et al., 1975; Hulka and Wheat,
1985), national values (Barer et al., 1988) and access to doctors (Barer et al., 1988; Hulka
and Wheat, 1985) are other factors that influence the use of health services.
Previous research has provided data and the fact that patient / customer satisfaction is
significant and positive for patient / customer loyalty. This result is evidenced by the findings
of Chung & Shin, (2010); Kantsperger & Kunz, (2010); Jani & Han, (2011); Ramli &
Sjahruddin, (2015). Based on these empirical evidence, the hypothesis is proposed as
follows:
H2: Patient satisfaction has a positive and significant effect on patient loyalty.

Effect of Hospital Image on patient loyalty

Kennedy (1977) has indicated that there are two elements in brand image, namely functional
and affective aspects. Functional aspects are related to real characteristics that can be easily
measured, while the emotional aspects are related to psychological aspects manifested
through feelings and attitudes toward the company. As for Delgado and Munuera (2001),
each loyalty arises based on personal experiences of individuals towards the brand so that
6 Business and Entrepreneurial Review Vol.17, No.1, April 2017

the results not only comes from direct relationships arising from the use of services, but
indirectly also will be obtained from the production of advertisements made by the
company. So that customer perceptions of socially responsible behavior from service
provider companies will be able to strengthen brand loyalty (Keller and Aaker, 1992),
different value systems (Turban and Greening, 1997), by exposing respect for customers will
certainly increase loyalty to companies (Maignan et al., 1999).
Brand loyalty is determined by brand image (Park et al., 2004; Brunneret al., 2007). In
looking for the main determinants of customer brand loyalty, some researchers have
proposed brand image as a key element found in this construction associated with loyalty
(Andreassen and Lindestad, 1998; Park et al., 2004; Brunner et al., 2007). In the tourism
industry, as found by Kandampully and Suhartanto (2000) which explain that brand image
is one of the most important factors for hotel guests to advise their colleagues to use the
service. However, the relationship between brand image and loyalty is considered unclear
(Ziaul et al., 2010) because some studies have failed to expose the direct impact of brand
image on customer loyalty (Davies and Chun, 2002). Similarly, brand loyalty has been widely
studied in relation to customer satisfaction, while brand image has received less attention
(Brunner et al., 2007). Regarding this, Andreassen and Lindestad (1998) argue that in
complex service services, brand image is the main element that will lead to brand loyalty.
The company's image is important for health organizations in several ways. Like how the
hospital leaders manage and distribute their resources. Because problems will arise if the
hospital is negatively imaged, because it will experience the impact of decreasing
preferences in the eyes of consumers and all stakeholders, which will reduce the market
share of the hospital. On the other hand, the image of a good hospital will increase the
tendency of patients to be loyal in choosing the hospital in the future (Kim and Kim, 2008).
To create a positive corporate image, which is very important in shaping patient loyalty, the
hospital managers must make these patients feel that they are protected, employees who
serve them are friendly so that they can be trusted, services are provided in a timely manner,
patient privacy who are made to use well-kept medical records, organizations can be
recognized, use modern equipment from the latest technology, the environment is designed
with charm and charm (Kim and Kim, 2008; Laohasirichaikul et al., 2011). Patient loyalty
Business and Entrepreneurial Review Abdul Haeba Ramli 7

must be an important part of the marketing strategy that will be made by the hospital and
get support from hospital management (Erdem et al., 2008; Wu, 2011).
The research has been carried out by Hart and Rosenberg (2004), Kandampully and
Suhartanto (2000), in the service sector by Nguyen and Leblanc (2001), Dursun (2001) and
Hong Goo (2004), exposing that there are strong, positive and relationship influences
statistically significant between company image and customer loyalty. Based on these
empirical evidence, the hypothesis is proposed as follows:
H3: Hospital image has a positive and significant effect on patient loyalty.

RESEARCH METHODS

The research design uses an explanatory research approach because the aim of the study is
to test and empirically influence the satisfaction and image of the Hospital, on the loyalty of
patients in West Sulawesi Province, then to confirm the conclusions or reject the theory or
results of previous studies.
The location of the study was Hospital services in West Sulawesi Province with the object of
family patients so that the analysis in this study was inpatients in the period June to
December 2016 which amounted to 457 patients who had used health services in West
Sulawesi Province. The sampling technique uses simple random sampling, the amount of the
sample in this study is determined by using the Slovin formula (Sekaran, 2006), so that the
number of samples drawn is 124 people with conditions (1) inpatients in health services in
West Sulawesi Province, at a minimum being an inpatient for 3 days, (2) patients who are
sampled in this study are patients who can provide information or can communicate well so
that they can fill out questionnaires, whereas if patients cannot provide information about
this study, they can be replaced by family or couples, (3) samples are adult patients who can
provide data representative and understand the filling out of the questionnaire after being
explained by the researcher. The analysis method starts from looking at data characteristics
through descriptive statistics and further analysis of multivariate data analysis includes
factor analysis and Partial Least Square (PLS)
8 Business and Entrepreneurial Review Vol.17, No.1, April 2017

RESULTS AND DISCUSSION

Testing of the proposed hypothesis is done using Structural Equation Modeling (SEM) with
the help of PLS software. Hypothesis test decision making is to look at the results of t-value,
where if the value is positive it means that the variable has a positive effect, while to see its
significance is to refer to the t-statistic value between variables, if the t value obtained is
greater than t-table amounting to 1.96, meaning that the effect is significant (Hair, et al.
2010). The results of this study, can be seen in the table below:
Table 1: Hypothesis Test Results

Variables T Statistics (|O/STERR|)

Patient satisfaction -> Hospital image 2.3235

Patient satisfaction-> Patient loyalty 2.5492

Hospital Image -> Patient loyalty 1.9978

Source: PLS Data Results, 2017

In the table above shows that all the influence between one variable to another variable
shows positive values, including:
Effect of patient satisfaction on patient loyalty is positive and significant because the value
of t-value is 2.3235 which means positive and significant because it is greater than the t-table
of 1.96.
The effect of patient satisfaction on the hospital image is positive and significant because the
t-value is 2.5492 which means positive and significant because it is greater than the t-table
of 1.96.
The effect of patient loyalty on hospital image is positive and significant because the t-value
is 1.9978 which means positive and significant because it is smaller than t-table of 1.96.

CONCLUSION
Business and Entrepreneurial Review Abdul Haeba Ramli 9

The conclusions of this research are formulated based on the results of hypothesis testing,
namely:
Patient satisfaction has a positive and significant effect on patient loyalty.
Patient satisfaction has a positive and significant effect on the Image of the Hospital. With
the highest results from the other two hypotheses, point out that the influence of patient
satisfaction must be a major concern for companies to increase the image of their hospitals.
Patient loyalty has a positive and significant effect on Hospital Image, but among the three
hypotheses of the relationship between variables, the influence of patient loyalty on the
Hospital Image is the smallest compared to the other two hypotheses.

This exposes that although it is not a top priority, the company still has to pay attention to
patient loyalty, because its influence on the Hospital Image is positive and significant.

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