Patient-Centred Healthcare Management: Investigating the Relationship Between Service Quality, Patient Trust and Loyalty

Abstract

Purpose: When strengthening patient-physician relationships in health care, it is important to understand how the patient's care-based experience is directly connected to the quality and sustainability of the relationships. Drawing on the SERVQUAL model and commitment– trust theory, this paper examines the relationships between five dimensions of healthcare service quality and patient trust and loyalty, the mediating role of trust, and differences between public and private hospital settings. Methods: Cross-sectional survey of 412 adult patients (public and private) in tertiary-care hospitals in Pune, Maharashtra, India. The data were analyzed using partial least squares structural equation modelling (PLS-SEM) comprising 5,000-resample bootstrapping, PLSpredict, importance–performance map analysis (IPMA), measurement invariance of composites (MICOM) and permutation-based multigroup analysis. Results: All measures were reliable with sufficient validity. Each tangible, reliability, responsiveness, assurance, and empathy had a positive effect on patient trust (R2 = .530), and trust was the strongest predictor of loyalty (beta = .404, p < .001; R2 = .541). Trust was found to be a full mediator of the path of tangibles and reliability to loyalty and a partial mediator of the path between responsiveness and loyalty as well as between assurance and empathy and loyalty. The model was found to have high out-of-sample predictive power. Partial measurement invariance was achieved and results demonstrated that the trust–loyalty relation was stronger in the private than in public hospitals (Δβ = −.209, p = .037). Conclusions: Service quality is the key mechanism leading to patient trust and loyalty to the healthcare providers. Hospital management should treat trust as a managed outcome, emphasizing communication and responsiveness to patients, and develop patient-focused solutions based on their understanding of the ownership context.