Business Management Vol.
5 No 1 Februari 2026 p-ISSN:2828-7606, e-ISSN:2828-8203 DOI: 10.
58258/bisnis.
10382/https://ejournal.
org/index.
php/Bisnis Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method Mhd.
Syahwildan1.
A Rohendi2.
Agus Hadian Rahim3 Universitas Adhirajasa Reswara Sanjaya12 Universitas Padjadjaran3 Article Info Article history:
Accepted: 20 February 2026 Publish: 21 February 2026 Keywords:
Patient Satisfaction.
Service Quality.
Importance Performance Analysis.
Hospital.
Servqual.
Abstract This study examined patient perceptions of service quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital using the Importance Performance Analysis (IPA) method integrated with Servqual.
A qualitative descriptive research design was employed, involving 38 inpatients selected through double sampling.
Five service quality dimensions were evaluated: Tangibles.
Reliability.
Responsiveness.
Safety, and Empathy.
Servqual analysis revealed that negative gap values predominated across 19 of 27 attributes, with the Empathy dimension recording the largest mean gap (Oe0.
IPA
quadrant mapping identified six attributes requiring immediate improvement, four to be maintained, five of low priority, and twelve exceeding patient expectations.
Improvement strategies are recommended in three domains: physical facility expansion, staff communication training, and service timeliness enforcement.
The findings underscore the centrality of interpersonal dimensionsAi particularly Empathy and ResponsivenessAiin shaping overall patient satisfaction in military hospital settings.
This is an open access article under the Lisensi Creative Commons Atribusi-BerbagiSerupa 4.
0 Internasional Corresponding Author:
Mhd.
Syahwildan Universitas Adhirajasa Reswara Sanjaya Email: muhammadsyahwildan@gmail.
INTRODUCTION
The contemporary healthcare landscape has transformed hospitals from purely clinical institutions into complex service organizations that must simultaneously meet patients' medical needs and their broader expectations of comfort, respect, and responsiveness.
Indonesia, the promulgation of Law No.
44 of 2009 on Hospitals formalized this dual mandate, requiring hospitals to deliver prime individual healthcare services across inpatient, outpatient, and emergency settings .
The subsequent expansion of the national health insurance program (BPJS) further elevated patient expectations by guaranteeing universal access, making service quality a decisive differentiator among competing healthcare providers .
At the theoretical core of healthcare service quality lies the Servqual framework developed by Parasuraman.
Zeithaml, and Berry .
, .
, which conceptualizes service quality as the gap between what patients expect and what they actually experience.
This framework identifies five dimensionsAiTangibles.
Reliability.
Responsiveness.
Assurance (Safet.
, and EmpathyAieach capturing a distinct facet of the service encounter.
Empirical research consistently demonstrates that these dimensions exert differential effects on overall patient satisfaction depending on cultural context, hospital type, and patient demographics .
In Indonesian public hospitals, studies have highlighted the Empathy dimension as particularly sensitive, given cultural expectations of warmth, personalized attention, and respectful communication from medical personnel .
285 | Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method (Mhd.
Syahwilda.
Business Management e-ISSN : 2828-8203, p-ISSN: 2828-7606 Charles P.
Suoth Lanud Sam Ratulangi Hospital, a military-affiliated inpatient facility in Manado.
North Sulawesi, provides healthcare services primarily to Indonesian Air Force personnel, their families, and the surrounding civilian community.
Despite adequate infrastructure, the hospital experienced a sustained and escalating pattern of patient complaints: 29 complaints were recorded in 2019, 31 in 2020, 56 in 2021, and 55 in the first half of 2022 alone.
These complaints were submitted through multiple channelsAisocial media, direct verbal feedback, and suggestion boxesAiand converged primarily on inpatient service quality.
This upward trajectory suggests a structural misalignment between the hospital's service delivery and patient expectations, rather than isolated incidents.
Addressing this misalignment requires a diagnostic tool capable of simultaneously capturing importance and performance assessments across multiple service attributes and translating those assessments into actionable managerial priorities.
The Importance Performance Analysis (IPA), originally proposed by Martilla and James .
and subsequently validated across diverse service industries, meets this requirement by mapping service attributes onto a Cartesian quadrant matrix.
Each quadrant carries a distinct strategic implication: attributes in Quadrant I .
igh importance, low performanc.
require concentrated improvement.
those in Quadrant II .
igh importance, high performanc.
should be maintained.
those in Quadrant i .
ow importance, low performanc.
represent lower priorities.
and those in Quadrant IV .
ow importance, high performanc.
indicate potential over-investment .
By integrating Servqual gap scores with IPA mapping, this study offers both a precise diagnosis of where service quality deficits lie and a structured roadmap for their resolution.
The objectives of this study are: .
to measure the gap between patient expectations and perceived service performance across five Servqual dimensions using the Servqual .
to classify service attributes into IPA quadrants to identify priority areas for and .
to formulate targeted managerial strategies aligned with the IPA The results are intended to guide hospital management in resource allocation decisions that maximize patient satisfaction within operational constraints.
RESEARCH METHOD
This study adopted a qualitative descriptive research design, aligning with SugiyonoAos conceptualization of qualitative inquiry as emphasizing meaning, contextual depth, and interpretive understanding rather than statistical generalization.
The research was conducted at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital, located in Manado.
Data collection took place throughout 2022, with the active inpatient ward serving as the primary research site.
The selection of a qualitative framework was grounded in the studyAos objective to explore how patients perceive and evaluate service quality.
Such perceptions are inherently subjective, embedded within specific organizational and social contexts, and not entirely reducible to numerical indicators alone.
The study population consisted of all inpatients treated at the hospital during the research period.
Administrative records from 2022 documented an annual inpatient volume of 1,692 patients over eleven months, with an average monthly Length of Stay (LOS) of 154 patients.
For sampling purposes, this LOS figure was treated as the operational population, as it represents individuals who were actively receiving inpatient services and thus directly experiencing the dimensions of service quality under examination.
Sampling was conducted using a double sampling strategy that integrated quota sampling and purposive sampling techniques.
Quota sampling was applied to ensure proportional representation between short-stay patients, defined as those hospitalized for 286 | Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method (Mhd.
Syahwilda.
Business Management e-ISSN : 2828-8203, p-ISSN: 2828-7606 less than two times twenty-four hours, and long-stay patients, defined as those hospitalized for two times twenty-four hours or more.
Subsequently, purposive sampling was employed to identify respondents who met the inclusion criteria, namely being at least 18 years of age and expressing willingness to participate in the study.
Patients under 18 years of age and those who declined participation were excluded.
The sampling quota was determined at 25 percent of the average LOS population, resulting in a target sample size of 38 respondents.
The distribution of this allocation is presented in Table 1.
Table 1.
Sample Distribution of Inpatients .
Population No.
Criterion (LOS avg.
< 2y24 hours Ou 2y24 hours Total Quota The measurement instrument consisted of a structured questionnaire developed from the Servqual framework as adapted for hospital settings by Al-Borie and Damanhouri.
The instrument comprised 27 items distributed across five dimensions of service quality.
The Tangibles dimension included seven items capturing aspects of the physical environment, medical equipment, staff appearance, and accessibility.
Reliability was measured through four items reflecting service consistency and timeliness.
Responsiveness consisted of eight items addressing staff promptness, courtesy, and communication practices.
The Safety dimension included four items related to patientsAo perceptions of safety, staff competence, and trustworthiness.
Finally.
Empathy was measured through four items encompassing individualized attention, complaint handling, empathetic interaction, and the accuracy of medical records.
Each item was assessed twice using a five-point Likert scale: first to measure perceived importance, ranging from 1 (Not Importan.
to 5 (Very Importan.
, and second to measure perceived satisfaction, ranging from 1 (Not Satisfie.
to 5 (Very Satisfie.
addition to the questionnaire, data collection was enriched through documentation review, direct observation within the inpatient ward, and informal interviews with hospital staff to provide contextual understanding and triangulation.
Instrument validity was evaluated using the Pearson Product Moment correlation An item was considered valid when the calculated correlation coefficient .
exceeded the critical value of 0.
= 38, = 5%).
Reliability testing was conducted using CronbachAos Alpha, adopting the minimum threshold of 0.
60 as recommended by Sugiyono.
Items that failed to meet these criteria would have been revised or excluded.
however, all 27 items satisfied both validity and reliability standards and were therefore retained for analysis.
Servqual gap scores were subsequently calculated for each attribute using the formula G = Satisfaction Oe Importance.
Negative gap scores indicate that perceived performance falls below patient expectations.
Mean gap values were then computed for each dimension to identify patterns of systemic underperformance.
To deepen interpretive insight.
ImportanceAePerformance Analysis (IPA) mapping was conducted by plotting mean importance scores on the vertical axis and mean satisfaction scores on the horizontal axis.
The overall grand means of both scales were used as quadrant boundary lines.
Attributes positioned within each quadrant were analyzed interpretively to generate targeted managerial recommendations aimed at improving service quality performance.
287 | Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method (Mhd.
Syahwilda.
Business Management e-ISSN : 2828-8203, p-ISSN: 2828-7606
RESULTS AND DISCUSSION
1 Instrument Validity and Reliability All 27 items achieved r-count values above the critical value of 0.
320 in both the importance and satisfaction ratings, confirming that the instrument validly measures its intended constructs.
For the importance dimension, r-count values ranged from 455 (Tangible.
890 (Responsivenes.
, while for the satisfaction dimension they ranged from 0.
405 (Tangible.
968 (Responsivenes.
The comparatively lower rcount for Tangibles in both scales reflects the greater heterogeneity of physical environment items relative to the more behaviourally focused dimensions, but all values remained comfortably above the threshold.
Cronbach's Alpha values confirmed adequate internal consistency across all For the importance scale.
Alpha values ranged from 0.
653 (Empath.
to 850 (Tangible.
For the satisfaction scale, values were considerably higher, ranging 865 (Empath.
945 (Tangible.
, suggesting that patients showed greater consensus in their satisfaction ratings than in their importance ratings.
The higher satisfaction-scale alphas may reflect the more concrete, experience-based nature of satisfaction judgments compared to the more abstract and individually variable importance judgments.
All values exceeded the 0.
60 threshold, confirming reliable measurement across all five dimensions.
2 Servqual Gap Analysis The Servqual analysis produced 27 individual gap scores, of which 19 were negative .
ndicating under-performanc.
and only 7 were positive.
This overall imbalanceAithree times as many underperforming attributes as satisfactorily performing onesAiconfirms that patient satisfaction at the hospital is systematically below expectations rather than reflecting isolated failures.
Table 2 summarizes the mean gap scores by dimension, providing a dimension-level overview of the service quality landscape.
Table 2.
Servqual Gap Analysis Ae Dimension Mean Scores Mean Dimension Mean Satisfaction Mean Gap Importance Tangibles Oe0.
Reliability Oe0.
Responsiveness Oe0.
Safety Oe0.
Empathy Oe0.
Overall Direction Negative (Majorit.
Slightly Negative Negative (Majorit.
Negative (Majorit.
Negative (Al.
The Empathy dimension recorded the most substantial aggregate deficit .
ean gap Oe0.
, with its worst-performing attribute being the accuracy and error-freeness of medical records .
ap score Oe0.
This finding is particularly significant because it touches on patient safety as well as satisfaction: inaccurate medical records not only frustrate patients but also carry clinical risk.
The second most problematic attribute in the Empathy dimension was staff responsiveness to patient questions and complaints .
ap Oe0.
, pointing to a communication culture that patients perceive as 288 | Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method (Mhd.
Syahwilda.
Business Management e-ISSN : 2828-8203, p-ISSN: 2828-7606 insufficiently attentive to their individual needs.
Tjiptono .
argues that the Empathy dimension is especially salient in healthcare because patients are in a vulnerable state and therefore acutely sensitive to signals of personal attention or indifference.
The Tangibles dimension showed the second largest aggregate gap (Oe0.
, driven primarily by deficiencies in hospital facilitiesAispecifically, waiting rooms, corridors, and lift capacity .
ap Oe0.
Aiand inadequacies in medical technology and equipment .
ap Oe0.
These physical infrastructure gaps are noteworthy because Tangibles represent the first point of patient contact with the hospital environment and shape initial quality perceptions before any interaction with staff occurs.
Research by Muninjaya .
confirms that the physical environment functions as a signal of the hospital's overall commitment to quality, meaning that infrastructure shortfalls disproportionately damage first impressions.
The Safety dimension showed a mean gap of Oe0.
15, with patients reporting the largest deficit in staff transparency regarding visiting hours and administrative procedures .
ap Oe0.
This suggests that administrative clarityAiknowing what to expect and whenAiis valued by patients as a dimension of safety, likely because uncertainty about procedures generates anxiety in inpatient settings.
Conversely.
Safety P4, which measures whether patients feel safe when interacting with staff, was one of the seven positive-gap attributes ( 0.
, indicating that patients generally trust hospital personnel even if they find administrative communication lacking.
Responsiveness showed a mean gap of Oe0.
08, making it the second-best performing dimension after Reliability.
Notably.
Responsiveness P1Aistaff friendliness and courtesyAiachieved the highest positive gap score in the entire study ( 0.
indicating that hospital personnel are perceived as exceptionally warm and professional in their interpersonal manner.
This is a significant competitive strength.
However, the dimension was also home to two substantially negative attributes:
Responsiveness P5 .
taff empathy toward inpatients, gap Oe0.
and Responsiveness P3 .
taff handling of patient information confidentiality, gap Oe0.
, suggesting that while staff are friendly, patients do not consistently experience deep understanding of their individual situations.
Reliability recorded the smallest mean gap (Oe0.
, making it the dimension closest to meeting patient expectations overall.
Reliability P1Aithe commitment of staff to deliver services at the promised timeAiwas the only Reliability attribute to achieve a positive gap ( 0.
, indicating that service scheduling is generally well-managed.
The remaining three Reliability attributes all recorded small negative gaps .
anging from Oe0.
15 to Oe0.
, reflecting minor but persistent shortfalls in service consistency, the range of available medical specialties, and overall service comfort.
3 Importance Performance Analysis: Quadrant Mapping The IPA analysis plotted all 27 attributes on the Cartesian matrix, with the grand mean importance value .
and grand mean satisfaction value .
defining the quadrant boundaries.
Table 3 summarizes the resulting quadrant classification, followed by an interpretive discussion of each quadrant's managerial implications.
Table 3.
IPA Quadrant Classification Summary Quadrant Classification Service Attributes Concentrate Facility adequacy .
aiting room, corridors, lift.
Quadrant I Here staff friendliness and courtesy.
staff familiarity 289 | Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method (Mhd.
Syahwilda.
Business Management Quadrant II Keep Up the Good Work Quadrant i Low Priority Quadrant IV Possibly Overkill e-ISSN : 2828-8203, p-ISSN: 2828-7606 with patient needs.
clarity of administrative information.
overall patient trust in staff.
Hospital layout facilitates access.
room cleanliness and continuous monitoring of disease progression.
appropriate time allocation for inpatient care.
Latest medical technology and equipment.
staff dress code and staff helpfulness and sympathy.
patient safety perception when interacting with staff.
staff responsiveness to patient needs.
Rapid response capability.
hospital location accessibility.
problem-solving interest.
service comfort.
availability of medical specialties.
patient information confidentiality.
inpatient-first priority.
medical team friendliness.
knowledge adequacy.
staff cooperation readiness.
handling of complaints.
accuracy of medical records .
Quadrant IAiConcentrate HereAicontains the six attributes that patients rate as most important but the hospital has failed to deliver at satisfactory levels.
These represent the hospital's most urgent improvement priorities, as underperformance on highimportance attributes is the primary driver of patient dissatisfaction .
The six Quadrant I attributes span all five Servqual dimensions: one Tangibles attribute .
acility adequac.
, one Reliability attribute .
ervice punctualit.
, two Responsiveness attributes .
taff friendliness and staff familiarity with patient need.
, one Safety attribute .
dministrative transparenc.
, and one Empathy attribute .
verall trust in The breadth of this list across dimensions signals that the hospital's quality gaps are multi-dimensional rather than concentrated in a single area, requiring a coordinated improvement strategy rather than isolated fixes.
The presence of service punctuality in Quadrant I merits particular attention.
Patients place high importance on receiving care at the agreed timeAiwhether for doctor visits, medication administration, or diagnostic proceduresAibecause delays in inpatient settings generate anxiety, discomfort, and a perception of neglect.
Improving punctuality requires systemic interventions: standardized service protocols (SOP.
with explicit time targets, coordinated scheduling across clinical units, and real-time monitoring of service delivery.
Unit heads should be formally accountable for timebased performance indicators, with deviations reported and escalated through a structured follow-up mechanism.
Staff familiarity with patient needsAithe second Responsiveness attribute in Quadrant IAireflects patients' desire to feel known as individuals rather than treated as anonymous cases.
This attribute is deeply connected to the Empathy dimension: when staff take the time to understand a patient's specific concerns, history, and preferences, the patient's perception of empathy rises markedly.
Effective communication training, including active listening techniques, structured patient handovers between shifts, and systematic documentation of patient preferences, can substantially improve performance on this attribute without requiring additional resources.
Quadrant IIAiKeep Up the Good WorkAiencompasses four attributes that patients value highly and that the hospital currently performs well on.
These are genuine service strengths and represent the foundation of the hospital's reputation.
Hospital layout and room cleanliness reflect the Tangibles dimension effectively meeting 290 | Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method (Mhd.
Syahwilda.
Business Management e-ISSN : 2828-8203, p-ISSN: 2828-7606 patient expectations.
continuous disease monitoring and appropriate time allocation reflect Responsiveness attributes that are being managed competently.
Maintaining these strengths requires continuous quality audits, staff recognition programs that reward consistent performance, and investment in the systems .
, electronic patient monitoring, housekeeping protocol.
that underpin them.
Quadrant iAiLow PriorityAicontains five attributes that patients rate as relatively less important and that the hospital also delivers at lower performance levels.
While improvement is still desirable, these attributes do not constitute urgent managerial The five attributes include medical technology adequacy, staff dress code, staff helpfulness, patient safety perception during staff interactions, and staff responsiveness to all patient needs.
The placement of staff helpfulness in Quadrant iAirather than Quadrant IAimay initially appear counterintuitive, but reflects the nuanced reality that patients prioritize the quality and timeliness of core clinical interactions over the more peripheral courtesy behaviors captured by this attribute.
Improvements in Quadrant i can be pursued through lower-cost, behavioral interventions such as dress code enforcement programs and service culture workshops.
Quadrant IVAiPossibly OverkillAiis the largest quadrant, containing 12 attributes across all five dimensions.
These attributes all perform above the grand mean satisfaction threshold but below the grand mean importance threshold, meaning the hospital consistently delivers on attributes that patients consider relatively less critical.
From a resource efficiency perspective, this represents a misallocation: investment in further improving Quadrant IV attributes yields diminishing marginal returns in patient satisfaction, while Quadrant I deficits remain unaddressed.
Hospital management should audit the resourcesAistaffing time, training programs, equipment maintenanceAicurrently directed toward Quadrant IV attributes and consider reallocating a portion toward Quadrant I improvements.
This reallocation does not require reducing quality on Quadrant IV attributes to an unacceptable level.
it simply means ceasing to over-invest in areas where performance already exceeds 4 Integrated Managerial Recommendations Synthesizing the Servqual gap analysis with the IPA quadrant findings, three strategic priorities emerge for hospital management.
First, physical facility improvement is non-negotiable: the single Tangibles attribute in Quadrant I .
acility adequac.
is also among the attributes with the most negative gap scores in the Servqual analysis.
Hospital leadership should formally propose and prioritize the expansion of waiting areas and improvement of corridor and lift capacity, with a structured implementation timeline and follow-up evaluation cycle.
Second, staff communication and empathy training must be operationalized as a core competency development program.
The Empathy dimensionAithe worstperforming dimension in Servqual termsAiaccounts for one of the six Quadrant I attributes .
atient trust in staf.
and contributes significantly to the overall service quality deficit.
Training programs should be mandatory for all clinical and non-clinical staff, encompassing effective communication, active listening, patient-centered care principles, and culturally sensitive interaction.
Complementing this with a reward-andpunishment system that explicitly links performance appraisals to service quality metrics would create institutional incentives for behavioral change .
Third, service timeliness must be elevated to a key performance indicator at the unit The presence of service punctuality in Quadrant IAicombined with the generally 291 | Patient Perceptions of Service Quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital Using the Importance Performance Analysis (IPA) Method (Mhd.
Syahwilda.
Business Management e-ISSN : 2828-8203, p-ISSN: 2828-7606 acceptable Reliability scores for other attributesAisuggests that the hospital is capable of reliable service delivery but has not yet systematized time-based accountability across all clinical units.
Implementing inter-unit coordination protocols, daily service time monitoring dashboards, and escalation procedures for delays would transform punctuality from a discretionary aspiration into a measurable operational standard.
CONCLUSION
This study applied the Servqual and Importance Performance Analysis methods to assess patient perceptions of service quality at dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital.
The findings reveal a consistent pattern of service quality deficits: 19 of 27 attributes received negative gap scores, indicating that patient expectations systematically exceed hospital performance across most dimensions.
The Empathy dimension recorded the most severe aggregate deficit, followed by Tangibles.
Safety.
Responsiveness, and Reliability.
These results are not merely statistical artefacts.
they reflect real patient experiences of insufficient personalized attention, inadequate physical facilities, and unclear administrative communication.
The IPA analysis translates these deficits into a prioritized action agenda.
Six highimportance, underperforming attributes in Quadrant I demand immediate managerial attention: facility capacity, service timeliness, staff courtesy, staff familiarity with patient needs, administrative transparency, and overall patient trust.
Four Quadrant II attributes represent existing strengths to be actively maintained.
Five Quadrant i attributes can be improved incrementally, and twelve Quadrant IV attributesAiwhile performing wellAimay represent over-investment opportunities for resource reallocation.
Three integrated strategies are recommended: .
a structured facility expansion program addressing physical infrastructure deficits.
a mandatory staff communication and empathy training curriculum linked to performance management systems.
the institutionalization of service timeliness as a unit-level key performance indicator with monitoring and escalation protocols.
Future research should assess the longitudinal impact of these interventions on patient satisfaction scores and explore whether the identified service quality patterns differ across patient demographic groups, diagnoses, or ward types.
ACKNOWLEDGMENT
The author expresses gratitude to the management, clinical staff, and inpatients of dr.
Charles P.
Suoth Lanud Sam Ratulangi Hospital for their generous cooperation, and to thesis supervisors Prof.
Dr.
Rohendi.
and Dr.
Agus Hadian Rahim.
Sp.
OT(K)Spine.
Epid.
HKes.
MMRS (Universitas Adhirajasa Reswara Sanjay.
for their scholarly guidance throughout this research.
REFERENCES