Economos :Jurnal Ekonomi dan Bisnis Volume 8.
Nomor 3.
Desember 2025 p-ISSN.
e-ISSN.
2655-321X
THE INFLUENCE OF SERVICE QUALITY.
HOSPITAL REPUTATION,
AND PROMOTION STRATEGIES ON PATIENT LOYALTY
Andi Aulya Puji Tenriangka.
Andi Thalia Resky Aulia.
Febi Melindah MR.
Innocentius Bernarto Email : andiaulyapuji@gmail.
com , andithalia@yahoo.
febimelindah79@gmail.
, innocentius.
bernarto@uph.
Master of Hospital Administration Management.
Pelita Harapan University Jl.
MH.
Thamrin Boulevard 1100.
Lippo Village.
Tangerang 15811 Abstract This study examines the influence of service quality, hospital reputation, and promotion strategies on patient loyalty in a private hospital in Bone.
South Sulawesi.
Patient loyalty is a critical factor for hospital sustainability amid increasing competition in the healthcare sector.
Using a descriptive qualitative approach, data were collected through semi-structured interviews with patients, medical personnel, and marketing managers, complemented by service observations and analysis of promotional documents.
A purposive sampling technique was applied, involving 18 participants, and data were analyzed using thematic analysis with triangulation to ensure validity.
The findings reveal three dominant themes.
First, service quality particularly responsiveness, clear and empathetic communication, and service reliability emerges as the primary determinant of patient satisfaction and loyalty.
Second, hospital reputation, built through professional credibility, patient testimonials, and a positive institutional image, significantly strengthens patient trust and repeat visit intentions.
Third, promotion strategies mainly function to increase public awareness through social media, health education programs, and community partnerships.
however, promotion alone is insufficient to sustain loyalty without consistent service quality.
The study concludes that patient loyalty is formed through the integration of high-quality service, strong hospital reputation, and ethical promotional strategies.
These findings highlight the importance of aligning service management and marketing efforts to enhance long-term patient loyalty and hospital sustainability.
Keywords: service quality, hospital reputation, promotion strategy, patient loyalty INTRODUCTION Competition in the health industry in Indonesia is getting tighter as public awareness of the quality of health services and facilities increases.
Hospitals are required not only to provide quality medical services, but also to build long-term relationships with patients through loyalty.
Patient loyalty plays an important role in the sustainability of the hospital because loyal patients tend to make repeat visits, recommend to others, and provide positive feedback that shapes the image of the organization (Nurfitriani, 2024.
Rachmatillah & Munawar, 2025.
Sari et al.
, 2.
Research shows that service quality factors, reputation, and promotional strategies have a significant influence on creating patient satisfaction and loyalty in various hospital contexts (Putri et al.
, 2024.
Mahendrayana et al.
, 2024.
Marisya et al.
, 2024.
Bahari & Siaga, 2.
The quality of service is the main determinant in shaping patient perception.
The SERVQUAL theory developed by Parasuraman.
Zeithaml, and Berry is often used to measure service quality with five dimensions: reliability, responsiveness, assurance, empathy, and Recent studies confirm that the dimensions of communication, reliability, and empathy are the dominant aspects that contribute to patient satisfaction and loyalty (Marisya et , 2024.
Mahendrayana et al.
, 2024.
Nurfitriani, 2024.
Suryani & Dewi, 2.
Research in Balikpapan.
Bone, and Surabaya revealed that consistent service quality encourages patient trust and increases the intention of repeat visits (Putri et al.
, 2024.
Purnamasari & Hartono.
Rahmawati & Anwar, 2.
In addition, patient experience is seen as a mediating variable that strengthens the influence of service quality on loyalty (Rachmatillah & Munawar.
Widyaningsih et al.
, 2.
ISSN: 1978-1520
The reputation of the hospital is also a crucial factor in the patient's decision.
According to organizational reputation theory, a positive image is formed from professional credibility, consistent service quality, and public trust.
Research shows that hospital reputation is closely related to patient satisfaction and affects long-term loyalty (Eneng Wiliana et al.
, 2023.
Ramadhani et al.
, 2024.
Susanti & Hidayat, 2.
Case studies in Tangerang and Padang Panjang found that a good reputation, both through religious image and the quality of medical personnel, is the main reason for patients choosing to return to the hospital (Ramadhani et al.
Eneng Wiliana et al.
, 2.
On the other hand, a negative reputation, such as complaints about services, has the potential to reduce patients' interest in using services again (Sari & Putra, 2023.
Nugraha & Yuliani, 2.
Promotional strategies within the service marketing mix .
P) framework also play an important role.
Effective promotion is able to increase awareness and influence patient decisions, especially through digital media and technology-based marketing communication (Bahari & Siaga, 2022.
Tonis et al.
, 2022.
Susanto et al.
, 2.
Research shows that the use of social media, patient testimonials, and public health campaigns has been shown to increase positive perception and loyalty (Purnamasari & Hartono, 2023.
Wulandari & Pratama, 2022.
Fitriani & Gunawan, 2.
However, some studies emphasize that promotional strategies cannot stand alone.
its effectiveness is highly dependent on the quality of service and reputation of the hospital (Mahendrayana et al.
, 2024.
Marisya et al.
, 2024.
Putri et al.
, 2.
This shows the need for integration between promotion, service quality, and reputation management in building patient loyalty.
Although many quantitative studies confirm the link between service quality, reputation, promotional strategies, and patient loyalty, qualitative studies that explore patient experiences and hospital management perspectives are still limited.
In fact, a qualitative approach is important to understand the narrative, motivation, and deep perception of patients who are not always represented in survey figures (Widyaningsih et al.
, 2022.
Susanti & Hidayat, 2.
This study seeks to fill this gap by exploring the experiences of patients, marketing managers, and medical personnel at Bone private hospitals.
By referring to the SERVQUAL theoretical framework, organizational reputation theory, and service marketing mix, this research is expected to make a theoretical and practical contribution in improving service quality, strengthening reputation, and developing ethical promotion strategies to support patient loyalty.
RESEARCH METHODS
This research employs a qualitative approach with a descriptive design to explore experiences, perceptions, and meanings conveyed by patients, marketing managers, and medical personnel regarding service quality, hospital reputation, and promotional strategies in building patient loyalty.
The study was conducted at Hapsah Hospital, a private hospital in Bone City.
South Sulawesi, from September 24 to October 10, 2025.
The location was selected due to its high patient visitation rate and ongoing efforts to improve service quality and promotional Data were collected through semi-structured interviews, non-interventional participatory observations, and analysis of hospital promotional documents, allowing for an indepth understanding that cannot be fully captured through quantitative methods.
Participants were selected using purposive sampling based on criteria relevant to the research objectives, including patients with repeated hospital service experiences, medical personnel with at least six months of direct patient contact, and marketing managers actively involved in promotional strategy development.
The study involved 18 participants: 10 patients .
utpatient and inpatien.
, 5 medical personnel, and 3 marketing managers, which was considered sufficient to reach data saturation.
The data consisted of interview transcripts, observation notes, and official hospital documents, collected using interview guidelines, observation sheets, and audio recordings with participantsAo consent.
Data analysis was conducted using thematic analysis, encompassing data reduction, data display, and conclusion drawing, while ensuring validity through source and method triangulation as well as member
RESULTS AND DISCUSSION
Research Result This research produced three main themes related to the influence of service quality, hospital reputation, and promotional strategies on patient loyalty.
Data analysis was carried out thematically through coding interview transcripts, observation of service interactions, and review of hospital promotional documents.
Quality of Service as the Foundation of Patient Loyalty The majority of patients stated that the quality of service was the most decisive factor in their decision to return to hospital services.
The quality of the service in question includes three main dimensions: responsiveness, communication, and Responsiveness of Medical Personnel and Staff Many patients emphasize the importance of the speed and responsiveness of medical and non-medical staff in serving their needs.
"The nurses came right away as soon as I rang the bell, so I felt cared for.
(Patient .
"The administration is quick to serve, not long-winded.
" (Patient .
Clear and Empathetic Communication Communication between doctors and patients is also a crucial aspect.
The easy-tounderstand explanation, as well as the doctor's empathetic attitude, makes the patient feel appreciated.
"The doctor always explained my illness in simple language, not difficult medical " (Patient .
"I feel calmer because the doctor is willing to listen to my complaints patiently.
(Patient .
Service Reliability Patients appreciate the hospital's consistency in providing services according to schedule, for example the accuracy of consultation hours or the availability of This increases trust and satisfaction.
"The doctor's schedule was appropriate, so I didn't wait too long.
" (Patient .
Overall, good service quality drives patient satisfaction, which then leads to loyalty in the form of an intention to return and recommend the hospital to others.
The Hospital's Reputation as a Trust Builder Hospital reputation has been shown to play an important role in influencing patient From the interview data, it was found that reputation is built through several factors: patient testimonials, professionalism of medical personnel, and the image of hospitals in the community.
Patient Testimonials and Personal Recommendations Many patients choose this hospital because they hear recommendations from relatives or co-workers.
The recommendation reinforces their positive perception before A ISSN: 1978-1520 "I came here because my friend said this hospital has good service.
" (Patient .
Professionalism of Medical Personnel Doctors and nurses who are considered competent increase patients' trust in the quality of hospital services.
"I believe it because the doctors here are famous experts in their fields.
" (Patient The Image of Hospitals in the Community The image of the hospital that is perceived as professional, modern, and friendly, further strengthens its reputation.
The researcher's observation found that clean and neatly arranged facilities also give a positive impression.
"Not only the service, but the big name of this hospital makes me confident to get treatment here.
" (Patient .
These findings show that reputation comes not only from individual experiences, but also from the collective opinions of society.
A positive reputation strengthens loyalty through increased trust.
Promotion Strategy as a Means of Increasing Awareness From interviews with marketing managers, it is known that hospital promotions are carried out through several media: social media, brochures, health seminars, and cooperation with the community.
Digital Promotion Through Social Media Instagram and Facebook are the main channels for introducing new services, health programs, and hospital social activities.
"Through Instagram we can reach the wider community quickly.
" (Marketing Manage.
Educational promotion through seminars and health campaigns This strategy aims to increase public awareness while building the image of the hospital as an institution that cares about health education.
"The health seminar makes people know us, not only as a place for treatment, but also as a place to learn to live a healthy life.
" (Medical Personnel .
Direct promotion through brochures and community partnerships Brochures are distributed to patients and the community, while cooperation with schools or companies helps expand the network of patients.
However, some patients emphasize that promotions only serve to attract initial interest.
Their decision to return is determined by the quality of service.
"I know this hospital from Instagram, but I still judge from my first experience of " (Patient .
Integration of Quality.
Reputation, and Promotion in Forming Loyalty A thorough analysis shows that patient loyalty is formed through the integration of three factors.
Promotions serve as an entrance that attracts new patients, the quality of service becomes a determining factor in satisfaction, while reputation strengthens trust for repeat visits.
An overview of this integration can be seen in the statement of one of the patients:
"At first I knew about it from advertisements, but I came back again because the service was good and it was already a professional reputation.
" (Patient .
Thus, patient loyalty is not the result of a single factor, but a synergy between service experience, good reputation, and targeted promotional strategies.
Table 1 Summary of Results Theme Subtheme Quality of Responsiveness Hospital Communication "The doctor always explained my illness in simple " (Patient Reliability "The doctor's schedule was appropriate, so I didn't wait too " (Patient .
Patient "I came here because my friend said this hospital has good service.
(Patient .
Professionalism of medical "I believe it because the doctors here are famous experts in their fields.
(Patient .
"The big name of this hospital makes me confident to seek treatment here.
(Patient .
"Through Instagram we can reach the wider Hospital image Promotion Key Quotes (Participant.
"The nurses came right away as soon as I rang the bell, so I felt cared for.
(Patient .
Social Media Summary of Results High responsiveness reflects operational efficiency and attentiveness, which reduce patient anxiety and function as a critical driver of perceived service excellence and emotional security, ultimately fostering repeat visit intentions.
Clear and empathetic communication enhances patientsAo cognitive and emotional understanding of care processes, strengthening trust and reinforcing relational bonds between patients and healthcare providers.
Service reliability signals organizational consistency and professionalism, which stabilizes patient expectations and contributes to sustained satisfaction and loyalty Word-of-mouth recommendations operate as informal reputation mechanisms that shape previsit expectations and lower perceived risk in healthcare decision-making.
Professional credibility of medical staff strengthens institutional legitimacy and reinforces patientsAo confidence in clinical outcomes, thereby consolidating long-term loyalty.
A strong institutional image functions as symbolic capital, amplifying patient trust beyond individual service encounters and sustaining loyalty even in competitive environments.
Digital promotion increases visibility and awareness but primarily influences initial engagement rather than long-
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Health Community Factor Synergy of (Marketing Manage.
"The health seminar makes the community know " (Medical Personnel .
"I know this hospital from Instagram, but I still judge from my first experience of (Patient .
"At first I knew from the advertisement, but I came back because the service was good and it was already (Patient .
term loyalty without experiential Educational promotion positions the hospital as a socially responsible institution, indirectly strengthening reputation and trust rather than directly generating loyalty.
Promotional exposure attracts first-time visits.
however, loyalty formation remains contingent upon actual service experience, indicating the limited standalone impact of Patient loyalty emerges from the dynamic interaction between promotional awareness, high-quality service encounters, and accumulated institutional reputation, rather than from any single factor in Discussion Quality of Service as the Foundation of Patient Loyalty The findings of this study show that the quality of service is the dominant factor that determines patient satisfaction and loyalty.
Medical responsiveness, clarity of communication, and reliability in service delivery consistently impact the patient This shows that loyalty is not just the result of emotional factors, but is built through the patient's concrete experiences when interacting with health workers and administrative staff.
This research is in line with Mahendrayana et al.
, who found that aspects of speed and friendliness in healthcare are important indicators that increase patient trust.
Marisya et al.
also show that physician empathic communication not only increases satisfaction, but also creates a patient's sense of emotional attachment to the healthcare institution.
Meanwhile.
Rachmatillah & Munawar .
emphasized that patient experience functions as a mediator that strengthens the relationship between service quality and loyalty, so that the patient's real experience becomes more influential than promotion.
Theoretically, these findings are consistent with the SERVQUAL model (Parasuraman et al.
, in modern adaptation of Fitriani & Gunawan, 2.
which emphasizes five main dimensionsAitangibles, reliability, responsiveness, assurance.
In the context of this study, responsiveness and empathy emerged as the most powerful factors in influencing loyalty.
Thus, the results of this study add to the evidence that improving the quality of services, especially in the aspects of empathic communication and responsiveness, is the main strategy to retain patients in the long The Hospital's Reputation as a Patient Trust Builder A hospital's reputation was found to be an important element in strengthening Factors that shape reputation include patient testimonials, professionalism of medical personnel, and the image of institutions in society.
Patients tend to trust hospitals that get positive recommendations from the people closest to them, as well as have a big name that is synonymous with professionalism and successful case These findings are consistent with Susanti & Hidayat .
, who state that the reputation of healthcare organizations plays a big role in creating patient trust.
Eneng Wiliana et al.
even identified reputation as a mediator between service quality and patient loyalty, meaning that reputation is able to strengthen the positive effects of service quality.
Research by Ramadhani et al.
also confirms that reputation is a symbolic asset of an organization formed from the credibility of medical personnel, transparency of services, and consistency of quality.
From the perspective of organizational reputation theory, a positive image serves as social capital that increases public perception of service quality.
In this study, reputation is not only the result of the patient's personal experience, but also the result of the collective opinion of the community, including the media and the community.
This explains why hospitals with a good reputation are more likely to maintain loyalty even though there are other competitors with similar facilities.
The Effectiveness of Promotional Strategies in Increasing Awareness Promotion has proven to serve as an entrance in introducing hospital services to the public.
Data shows that social media, health campaigns, and community cooperation are the main strategies in increasing awareness.
This strategy is in line with the trend of digital marketing in the healthcare sector that increasingly emphasizes online interactions.
The results of this study corroborate the findings of Bahari & Siaga .
, which emphasizes that social media is effective in increasing the reach of health care Tonis et al.
also stated that digital campaigns help increase brand awareness, but do not automatically generate loyalty without support for service quality.
Similarly.
Widyaningsih et al.
warn that promotions that are inconsistent with service quality have the potential to lower patient confidence.
Thus, promotion in the context of hospitals cannot be understood solely as a commercial marketing activity.
Promotions must contain aspects of health education, information transparency, and are in line with reputation and quality of service.
Hospitals that prioritize an educational approach in promotion are more likely to reinforce a positive image than simply aggressively promote.
Integration of Quality.
Reputation, and Promotion in Building Loyalty The findings of this study show that patient loyalty is not determined by a single factor, but rather by the interaction between the quality of service, the hospital's reputation, and promotional strategies.
Promotions help attract new patients, quality of service creates satisfaction, while reputation strengthens patients' intention to return.
These findings are in line with Putri et al.
, who found that patient satisfaction mediates the relationship between service quality and loyalty.
Nurfitriani .
added that reputation strengthens the influence of satisfaction on the intention to recommend International studies also support these findings, such as Lee et al.
who stated that the integration of service quality, brand reputation, and healthcare marketing is key to building long-term relationships with patients.
From the perspective of the service marketing mix, these findings show that promotion is only effective if it is supported by people .
edical personne.
and process .
ervice qualit.
In other words, patient loyalty can only be achieved through consistent synergy between service quality, reputation, and ethical promotion.
Theoretical Implications Strengthening the Theory of Service Quality (SERVQUAL) in the Hospital Context The results of the study showing that the quality of service has an effect on patient loyalty, either directly or through satisfaction mediation, support the SERVQUAL model developed by Parasuraman et al.
These findings confirm that the dimensions of service qualityAitangible, reliability, responsiveness, assurance, and empathyAiremain relevant to use in the context of health in Indonesia.
ISSN: 1978-1520
The Role of Patient Satisfaction Mediation This study reaffirms the theory of consumer satisfaction (Oliver, 1.
that satisfaction is an important variable that bridges service and loyalty.
Theoretically, this strengthens the concept of customer satisfaction-loyalty link in the service marketing literature, especially in the health sector.
Hospital Reputation as a Moderation/Mediation Factor Findings linking reputation to patient loyalty support the theory of brand reputation in healthcare (Fombrun & Shanley, 1.
Theoretically, this expands the scope of reputation studies that have been dominant in the general business sector, making its relevance in the health sector stronger.
Integration of Hospital Marketing and Management Perspectives This study contributes to the health management literature by integrating marketing variables .
uality of service, reputatio.
with outcomes in the form of patient loyalty.
This shows that the theory of service marketing can be adopted and further developed in the realm of hospital management.
Contribution to the Patient Loyalty Model in Indonesia Most patient loyalty research comes from Western contexts or large international With a focus on hospitals in Indonesia, this study makes a theoretical contribution in the form of adaptation and validation of models in local contexts, which can be a foothold for further research in developing countries.
Practical Implications For hospital management, the results of this study provide several important First, improving service quality should be a top priority, especially in terms of empathic communication, response speed, and service consistency.
Second, reputation management cannot be allowed to be formed naturally, but must be designed through success publications, strengthening patient testimonials, and transparency of service information.
Third, promotional strategies should not only be oriented towards increasing visits, but also educational and ethical-based, so as to be able to strengthen the image of the institution.
Limitations of Research and Recommendations The study had a relatively limited number of participants and focused on one private hospital in Bone.
Therefore, generalization of the results of this study to the context of other hospitals must be done carefully.
Further research is recommended to use a mixed methods approach, combining qualitative data with quantitative surveys, so as to provide a more comprehensive picture of the relationship between service quality, reputation, promotion, and patient loyalty .
CONCLUSIONS AND SUGGESTIONS
Conclusion This study shows that patient loyalty at private hospitals in Bone is strongly influenced by three main factors: quality of service, hospital reputation, and promotional strategy.
The quality of service is proven to be the dominant factor, where the aspects of reliability, responsiveness, and effective communication have a direct impact on patient satisfaction and intention to return.
The hospital's reputation, built through the professional credibility of medical personnel and positive patient testimonials, strengthens patients' decisions in choosing and remaining loyal to the hospital.
Meanwhile, promotional strategies have an important role in increasing public awareness, but their effectiveness in building loyalty can only be achieved if supported by consistent service quality.
Thus, the integration of service quality, a strong reputation, and an ethical promotional strategy is the key to maintaining patient loyalty and ensuring the sustainability of the hospital.
Suggestion For hospitals, it is necessary to strengthen the quality of service in a sustainable manner, especially in the aspects of empathetic communication, punctuality, and responsiveness of medical personnel and staff.
For marketing management, promotional strategies should be directed more towards health education based on community needs, not just commercial promotion, so that the credibility and reputation of hospitals will increase.
For medical personnel, it is important to maintain professionalism and service ethics, because the patient's direct experience with medical personnel is one of the main determining factors for loyalty.
For further research, it is recommended to combine qualitative and quantitative methods .
ixed method.
in order to provide a more comprehensive picture of the relationship between variables, including statistical influence tests.
In addition, the scope of the study could be extended to other hospitals to compare strategies and practices that have worked in improving patient loyalty.
REFERENCES