Patient influences on satisfaction and loyalty for GP services

The Impact of Patient Satisfaction on Patient Loyalty with the Mediating Effect of Patient Trust

This research is primarily focused on the issues of customer loyalty in the healthcare industry, particularly from the perspective of public hospitals in China. The research developed a theoretical model to test the relationship between patient satisfaction (PS), patient trust (PT), and patient loyalty (PL). The empirical data were collected from 1696 patients through the survey questionnaires from the public hospitals in Henan province. This research is an explanatory study, and adopts quantitative method. The measurement scales used in the survey were assessed and refined and the data analysis was performed using AMOS 19.0 to test the theoretical model and hypotheses developed. In addition, an exploratory factor analysis was used to identify the dimensions of PS, PT, and PL. Their reliability and validity were established through confirmatory factor analysis, and the structural equation modeling (SEM) was used in the related hypotheses. The findings indicate that PT is an important antecedent of PL, and PS has no direct relationship with PL. It is worth noting that PS can lead to PL with PT as the mediating variable. The survey results will help public hospital managers to formulate effective strategies and provide a basis for studying PL. The research will prompt hospital managers to pay attention to the factors which contribute to PS, PT, and PL, and maintain the loyalty of patients to medical institutions. This study is one of the few studies on the relationship between PS, PT, and PL in Chinese public hospitals, and it also explores the direct and indirect effects of PT on PL. The results have practical implications for the Chinese healthcare industry.

The Cognitive Dimension and the Affective Dimension in the Patient's Experience

This article deals with the experience of the specific client of health services, that is, the patient. Satisfaction questionnaires are usually applied to assess patient experience. However, this tool provides only a cognitive evaluation; it does not afford an affective dimension of the experience. The objective of the present study is to verify the relationship between the cognitive dimension of patient experience, collected through questionnaires, and the affective dimension, derived from the analysis of neurophysiological data. We propose a novel methodology that integrates physiological data collected by facial expression analysis to identify patients' emotions. A first, qualitative procedure was carried out to define the patient journey. This was recorded on video and later used in the experiment. The experiment collected information from the participants using two techniques. First, as they viewed the videos, facial expression analysis (FEA) was applied to assess their responses. Second, after they watched the videos, traditional questionnaires were presented. The results provided by the two techniques were then compared. The results show that there is no relationship between the emotional valence reported by questionnaires and the neurophysiological data. This reflects the two different dimensions of the experience, one cognitive and the other affective. Both facilitate the understanding of patient satisfaction.

Predictors of Patients' Loyalty Toward Doctors on Web-Based Health Communities: Cross-Sectional Study

Background

Web-based health communities provide means for patients to not only seek care but also to promote their relationship with doctors. However, little is known about the predictors of patients’ loyalty toward doctors in Web-based health communities.

Objective

This study aimed to investigate the predictors of patients’ loyalty toward doctors in Web-based health communities.

Methods

On the basis of sociotechnical systems theory and attachment theory, we propose that social factors including emotional interaction, perceived expertise, and social norm influence patients’ loyalty through their emotional attachment, whereas technical factors including sociability, personalization, and perceived security affect patients’ loyalty through functional dependence. To validate our proposed research model, we used the survey method and collected 373 valid answers. Partial least square was used to analyze the data.

Results

Our empirical analysis results showed that all the social factors including emotional interaction (beta=.257, t₃₅₀=2.571; P=.01), perceived expertise (beta=.288, t₃₅₀=3.412; P=.001), and social norm (beta=.210, t₃₅₀=2.017; P=.04) affect patients’ emotional attachment toward doctors significantly, whereas except sociability (beta=.110, t₃₅₀=1.152; P=.25), technical factors such as personalization (beta=.242, t₃₅₀=2.228; P=.03) and perceived security (beta=.328, t₃₅₀=3.438; P=.001) impact functional dependence significantly. Considering the effect of working mechanisms, both emotional attachment (beta=.443, t₃₅₀=4.518; P<.001) and functional dependence (beta=.303, t₃₅₀=2.672; P=.008) influence patients’ loyalty toward doctors in Web-based health communities significantly.

Conclusions

Patients’ loyalty toward doctors in Web-based health communities is important for the effectiveness of doctors’ advice or service in Web-based health communities. The research results not only fill the gaps in the literature of the patient-doctor relationship and Web-based health communities but also has many implications for establishing patients’ loyalty on Web-based health communities and in physical context.

Patient Segmentation Based on Patient Loyalty

The present study aims to perform a segmentation of patients based on their loyalty behaviour. The analysis focuses on Valencia, a region in Spain that features a capitated financing and free-elective framework; such a framework is particularly suitable for this type of study because patient loyalty directly affects the system’s budget and economic viability. Using secondary data from the regional health council, the study focuses on relationships of influence and latent segmentation in answering seven research questions. The two-pronged statistical analysis is designed to analyse relationships of influence, on the one hand, and latent segmentation, on the other. Significant differences were found among the various scales analysed in the three patient loyalty behavioural models (capture, retention and desertion) for each variable within the scope, that is, subjective (gender, age and nationality) and circumstantial (size of the assigned and receiving hospital, location of the province of the assigned hospital). This finding indicates that it may be possible to develop patient profiles based on such variables to analyse different loyalty behaviours in patients and the impact of hospital communication strategies on these behaviours. Patient loyalty is essential to the viability of a capitated health care financing and management system. Likewise, identifying patient profiles would contribute to a better Valencian public health management. Accordingly, it might be applied to evaluate other health care financing systems.

Determinants of patient loyalty to healthcare providers: An integrative review

Purpose

Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors.

Data sources

PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched.

Study selection

Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included.

Data extraction

Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles.

Results of data synthesis

Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty.

Conclusion

This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty.

Hospital healthcare service quality, patient satisfaction and loyalty

Purpose

The purpose of this paper is to explain the patients’ views towards private healthcare service providers. The study focussed on hospital service quality and analysed the relative significance of quality measurements in anticipating the patients’ satisfaction and loyalty. The mediating role of patient satisfaction is assessed between quality of hospital healthcare services and patient loyalty.

Design/methodology/approach

A total 611 patients (both indoor and outdoor) participated in a questionnaire survey from the six private hospitals of capital city, Islamabad, Pakistan. Data were analysed through descriptive statistics, common method variance, reliability, correlation and regression in order to investigate customer perceived service quality and how the quality of services stimulates loyalty intentions towards private service suppliers.

Findings

Findings depict that private healthcare service providers are attempting to deliver well improved healthcare services to their customers. Results confirmed that better quality of healthcare services inclines to build satisfaction and loyalty among patients. The healthcare service quality aspects (i.e. physical environment, customer-friendly environment, responsiveness, communication, privacy and safety) are positively related with patient loyalty which is mediated through patient satisfaction.

Practical implications

Findings will help the hospital managers to articulate effective strategies in order to ensure superior quality of healthcare services to patients. The study will induce hospital management to deliver attentions towards the quality of private healthcare service systems and improvements towards the deficient healthcare services. Furthermore, the study will present a clear picture of patient’s behavioural attitudes; satisfaction and loyalty intentions towards the quality of healthcare services.

Originality/value

The study provides the views and perceptions of patients towards the quality of healthcare services. The healthcare service quality dimensions, i.e., physical environment, customer-friendly environment, responsiveness, communication, and privacy and safety were assessed. Hospital healthcare service quality was examined in order to find out its effect on patient satisfaction and patient loyalty.

The patient, the doctor, and the patient's loyalty: a qualitative study in French general practice

BACKGROUND

The term loyalty can be defined as the attachment that characterises someone who consistent in their feelings, affections, or habits. By introducing the Declaration of General Practitioner (or preferred doctor declaration) in 2004, France adopted a formal incentive for patients to be faithful to their doctor since it entailed optimal coverage of medical care by their national health insurance There has been no research evaluating the impact of this measure and to determine the components of doctor-patient loyalty.

AIM

To explore what builds and maintains patients' loyalty to their GP.

DESIGN AND SETTING

Qualitative study based on semi-structured interviews close to Paris (the département of Yvelines'), France.

METHOD

Twenty-eight patients were interviewed in five surgeries of self-employed GPs with different demographics. Interviews were transcribed and a thematic analysis conducted to categorise the data. Phenomenological analysis was used to analyse the transcripts.

RESULTS

Patient loyalty is based mainly on trust. Trust can be reinforced by certain comforting factors such as the ability to listen, a sense of carefulness, and the quality of care. Loyalty is both a dynamic construct and a relational exchange subject to various influences. Patients find advantages in being loyal. The model of the 'family doctor' has always been the archetype of loyalty for several generations within one family. A GP's inability to meet all of the patient's requirements is not necessarily a determining factor in breaking the patient's loyalty.

CONCLUSION

Loyalty is more complex than commonly assumed and involves dimensions of trust, listening, quality of care, availability, and familiarity. The observations drawn out from this study warrant a larger scale investigation.

The Effects of Organization Design and Patient Perceptions of Care on Switching Behavior and Reliance on a Health Care System Across Time

Sustaining ongoing relationships with patients is a strategic, clinically relevant goal of health care systems. This study develops and tests a conceptual model that aims to account for the influence of organization design, perceptions of quality of patient care, and other patient-level factors on the extent to which patients sustain reliance on a health care system. We use a longitudinal survey design and structural equation modeling to predict increases or decreases in patient reliance on the Department of Veterans Affairs health care system across a 4-year period for Veterans with Parkinson's Disease. Our findings show that specialized and integrated clinical practices have a positive association with the quality of patient care. Health care systems may be able to foster long-term relations with patients and improve service quality by allocating resources to form integrated, specialized, disease-specific centers of care designed for patients with chronic illnesses.

Patient proactivity: behaviors, attitudes, and its relationship with satisfaction with the American health care delivery system

A sample of 1,031 U.S. adult residents provided information regarding actions that fall within the realm of patient proactivity, that is to say efforts that are overtly designed to maintain or regain one's health. An assessment of consumers revealed that they engage in, or at least support, behaviors that would be characterized as proactive. Furthermore, there is a significant relationship between some elements of patient proactivity and the level of satisfaction with the American health care system. The relationships are modest, but they offer managerial insight that will benefit those responsible for both delivering and marketing health care.

Patient Satisfaction With the Family Physician Program in Sabzevar, Iran

BACKGROUND AND OBJECTIVES

Patient satisfaction with the family physician program is an important factor for more favorable treatment results. Evaluation of patient satisfaction improves the services and approximates them to patient's preferences. The family physician program has been executed since late March, 2005 in Iran. This study aimed to measure patient satisfaction with family physician services and determines factors affecting the level of satisfaction in order to propose appropriate suggestions for providing medical services based on patients' expectations.

METHODS

Forty-one centers provide healthcare services in rural and urban areas. The participants in this study comprised 1263 people. The data were collected by an inventory with 11 items about demographic specifications, waiting time and the importance of physician's sex and 40 items for assessing the level of patient satisfaction.

RESULTS

A total of 1199 patients participated in the current study, 72.1% of them were female and 19.6% waited 10-20 minutes for receiving services. About 55.72% of the participants chose high and very high for the items of the inventory. Total satisfaction with the family physician program decreased with age (p-value=0.029).Moreover, total satisfaction did not show any significant differences in different groups in terms of sex, place of residence, education level and marital status. Also family physicians' sex did not affect patient satisfaction significantly. Based on results of regression model, an increase in patients' age by one year decreased their satisfaction by 0.12 and level of satisfaction in rural patients was lower than that in urban patients by 7.93.

CONCLUSIONS

The level of patient satisfaction with family physician services was moderate, which mostly arose from the components of the family physician program and services such as the waiting time, costs, welfare facilities, accessibility and the service-providing team rather than patients' personal characteristics.

The role of affect in consumer evaluation of health care services

Health care services are typically consumed out of necessity, typically to recover from illness. While the consumption of health care services can be emotional given that consumers experience fear, hope, relief, and joy, surprisingly, there is little research on the role of consumer affect in health care consumption. We propose that consumer affect is a heuristic cue that drives evaluation of health care services. Drawing from cognitive appraisal theory and affect-as-information theory, this article tests a research model (N = 492) that investigates consumer affect resulting from service performance on subsequent service outcomes.

Discontinuities between maternity and child and family health services: health professional's perceptions

BACKGROUND

Continuity in the context of healthcare refers to the perception of the client that care has been connected and coherent over time. For over a decade professionals providing maternity and child and family health (CFH) services in Australia and internationally have emphasised the importance of continuity of care for women, families and children. However, continuity across maternity and CFH services remains elusive. Continuity is defined and implemented in different ways, resulting in fragmentation of care particularly at points of transition from one service or professional to another.This paper examines the concept of continuity across the maternity and CFH service continuum from the perspectives of midwifery, CFH nursing, general practitioner (GP) and practice nurse (PN) professional leaders.

METHODS

Data were collected as part of a three phase mixed methods study investigating the feasibility of implementing a national approach to CFH services in Australia (CHoRUS study). Representatives from the four participating professional groups were consulted via discussion groups, focus groups and e-conversations, which were recorded and transcribed. In total, 132 professionals participated, including 45 midwives, 60 CFH nurses, 15 general practitioners and 12 practice nurses. Transcripts were analysed using a thematic approach.

RESULTS

'Continuity' was used and applied differently within and across groups. Aspects of care most valued by professionals included continuity preferably characterised by the development of a relationship with the family (relational continuity) and good communication (informational continuity). When considering managerial continuity we found professionals' were most concerned with co-ordination of care within their own service, rather than focusing on the co-ordination between services.

CONCLUSION

These findings add new perspectives to understanding continuity within the maternity and CFH services continuum of care. All health professionals consulted were committed to a smooth journey for families along the continuum. Commitment to collaboration is required if service gaps are to be addressed particularly at the point of transition of care between services which was found to be particularly problematic.

Increasing loyalty to breastfeeding: investigating a product development strategy

This article demonstrates how social marketing insights were used to influence women's loyalty to breastfeeding. The article reports on a social marketing campaign undertaken by the Australian Breastfeeding Association and a government health department, which used a product development strategy in order to increase breastfeeding loyalty. Seeking new approaches to support breastfeeding behaviors is critical and timely, because while initiation rates of breastfeeding are high in developed countries such as the United Kingdom, Australia, Canada, and the United States, duration rates are significantly lower. Results indicate that a product- focused strategy influences pregnant women's loyalty to exclusively breastfeeding.