Volume 7.
Number 1, 2026 https://ijble.
com/index.
php/journal/index The Effects of Service Quality.
Healthcare Facilities, and Waiting Time-Patient Trust on Patient Satisfaction at Urip Sumoharjo Hospital.
Bandar Lampung Febi FaulinaA.
Nadia Riska OktariA.
Indah Permata SariA.
FebriantyA.
Reza Hardian PratamaA AUniversitas Malahayati.
Bandar Lampung.
Indonesia Correspondence: febi58348@gmail.
ABSTRACT
Patient satisfaction is a critical outcome indicator for hospital performance because it reflects how patients evaluate the technical, functional, and environmental aspects of care.
This study examined the effects of service quality, healthcare facilities, and waiting time-patient trust on patient satisfaction at Urip Sumoharjo Hospital.
Bandar Lampung.
A quantitative cross-sectional explanatory design was employed.
Data were collected through a structured questionnaire using a five-point Likert scale and analyzed using partial least squares structural equation modeling (PLSSEM).
The study involved 90 respondents, with demographic data indicating 44% were female and 61.
11% were younger than 25 years.
The measurement model screening retained indicators with adequate outer loadings and removed weaker items below the recommended threshold.
The structural model showed strong explanatory power, with service quality, healthcare facilities, and waiting time-patient trust explaining 70.
8% of the variance in patient satisfaction (RA = 0.
adjusted RA = 0.
Path analysis demonstrated that service quality had a positive and significant effect on patient satisfaction ( = 0.
t = 4.
p < 0.
, followed by waiting time-patient trust ( = 0.
t = 3.
p < 0.
and healthcare facilities ( = 0.
t = 3.
p = 0.
These findings indicate that patient satisfaction is shaped not only by tangible facilities but also by reliable, responsive, and trustworthy service processes.
Hospital management should prioritize staff responsiveness, communication clarity, waiting time control, facility cleanliness, and equipment readiness to strengthen patientcentered service quality.
DOI.
https://doi.
org/10.
56442/ijble.
Keywords: service waiting time.
patient trust.
PLSSEM.
INTRODUCTION
Hospitals operate in an increasingly competitive healthcare environment in which patient experience, service quality, and trust have become important strategic indicators.
Contemporary quality frameworks emphasize that high-quality health services should be effective, safe, people-centered, timely, equitable, integrated, and efficient (World Health Organization, 2.
In hospital management, patient satisfaction is therefore not merely a subjective response but an outcome indicator that reflects the alignment between patient expectations and the services actually received.
The assessment of hospital quality is commonly anchored in DonabedianAos structure-process-outcome framework.
In this framework, healthcare facilities, equipment, human resources, and physical infrastructure represent the structural foundation of quality.
patient-provider interaction, responsiveness, communication, and Volume 7.
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and patient satisfaction represents a key outcome of care (Donabedian, 1.
This framework is relevant for Urip Sumoharjo Hospital.
Bandar Lampung, because the hospital is expected to provide safe, reliable, accessible, and comfortable services for patients in a competitive regional healthcare Service quality is also frequently measured through the SERVQUAL framework, which conceptualizes service quality through tangibles, reliability, responsiveness, assurance, and empathy (Parasuraman et al.
, 1.
In healthcare settings, these dimensions are highly applicable because patients evaluate not only clinical competence but also staff communication, administrative efficiency, responsiveness to complaints, perceived safety, facility comfort, cleanliness, and the clarity of information delivered by healthcare personnel.
Prior studies in healthcare settings have shown that perceived service quality is associated with patient satisfaction and subsequent behavioral intentions, including loyalty and willingness to recommend the hospital (Andaleeb, 2001.
Dagger et al.
, 2007.
Ferreira et al.
, 2.
In the Indonesian hospital context, dissatisfaction may arise from long waiting times, insufficient responsiveness, unclear communication, inadequate facility maintenance, and perceived mismatch between expectations and service delivery.
Previous Indonesian studies also report that healthcare service quality, patient safety, and facility-related aspects are related to patient satisfaction and loyalty (Ahmad et al.
Kartika et al.
, 2023.
Widiasari et al.
, 2.
However, many hospital-level studies remain descriptive and do not simultaneously test the contribution of service quality, healthcare facilities, and waiting time-related trust within an integrated structural model.
This creates an opportunity to strengthen empirical evidence using PLS-SEM, especially in a hospital-specific case such as Urip Sumoharjo Hospital.
Based on this background, this study aims to analyze the effects of service quality, healthcare facilities, and waiting time-patient trust on patient satisfaction at Urip Sumoharjo Hospital.
Bandar Lampung.
The study contributes to hospital service management by identifying which determinants have the strongest influence on patient satisfaction and by providing practical recommendations for improving patient-centered service delivery.
Literature Review and Hypotheses Development Service Quality in Hospital Care Service quality refers to the extent to which services meet or exceed customer In hospitals, this concept includes both clinical and non-clinical dimensions.
The SERVQUAL model remains widely used because it captures five service dimensions:
tangibles, reliability, responsiveness, assurance, and empathy (Parasuraman et al.
Reliability refers to the hospitalAos ability to provide promised services accurately and consistently.
responsiveness reflects staff willingness to help patients quickly.
assurance reflects competence and courtesy that build confidence.
empathy captures individualized attention.
and tangibles represent the physical appearance of facilities, equipment, and personnel.
From a hospital management perspective, service quality is directly linked to patient satisfaction because patients often evaluate the care experience through Volume 7.
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php/journal/index interactions with doctors, nurses, administrative staff, pharmacists, and support Prompt registration, clear explanation of procedures, courteous communication, and efficient complaint handling can strengthen patientsAo perceived value and trust.
Conversely, delays, unfriendly behavior, unclear instructions, and fragmented information can produce dissatisfaction even when clinical treatment is technically The broader healthcare literature has consistently positioned service quality as a strong predictor of satisfaction and future behavioral intentions (Andaleeb, 2001.
Dagger et al.
, 2007.
Zeithaml et al.
, 2.
H1: Service quality has a positive and significant effect on patient satisfaction.
Healthcare Facilities and Patient Satisfaction Healthcare facilities represent the tangible and structural elements of hospital They include medical equipment, diagnostic support, waiting rooms, inpatient rooms, sanitation facilities, parking areas, accessibility features, lighting, ventilation, and Within DonabedianAos framework, facilities form part of the structure of care and provide the foundation for safe and effective service delivery (Donabedian, 1.
Within SERVQUAL, facilities also correspond to the tangibles dimension, which influences first impressions and perceived professionalism.
The physical environment can affect patient comfort, perceived safety, and Clean toilets, well-maintained medical equipment, comfortable waiting rooms, and accessible service areas may reduce anxiety and increase confidence in the BitnerAos servicescape theory also explains that physical surroundings shape customer evaluations and behavioral responses in service encounters (Bitner, 1.
healthcare settings, this is particularly important because patients may be vulnerable, anxious, or physically uncomfortable during treatment.
Therefore, facility quality is expected to enhance patient satisfaction.
H2: Healthcare facilities have a positive and significant effect on patient satisfaction.
Waiting Time.
Patient Trust, and Patient Satisfaction Waiting time is a critical process indicator in hospital service delivery.
Timeliness is recognized by the World Health Organization as one of the core dimensions of quality health services (World Health Organization, 2.
In practical terms, waiting time includes the duration between registration and consultation, the length of administrative procedures, and the time required to obtain examinations or treatment.
Long or unpredictable waiting times may reduce satisfaction, especially when patients receive insufficient information regarding queue status or expected delays.
Patient trust is closely related to waiting time because patients are more likely to tolerate service delays when staff communicate clearly, provide realistic time estimates, and demonstrate professional concern.
Trust may function as a psychological bridge between process efficiency and satisfaction.
When hospitals provide timely services and clear information, patients tend to perceive the institution as reliable and accountable.
Accordingly, waiting time-patient trust is expected to influence patient satisfaction.
H3:
Waiting time-patient trust has a positive and significant effect on patient satisfaction.
Conceptual Framework The conceptual framework positions service quality, healthcare facilities, and waiting time-patient trust as exogenous variables that influence patient satisfaction as the Volume 7.
Number 1, 2026 https://ijble.
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Patient loyalty was identified in the preliminary framework as a potential downstream outcome of satisfaction.
however, the available empirical model focuses on patient satisfaction because path coefficients for loyalty were not available in the analyzed output.
Future studies may extend the model by examining patient satisfaction as a mediator of patient loyalty.
Figure 1.
Conceptual framework of the study.
METHODS
This study used a quantitative cross-sectional explanatory design.
The design was appropriate because the study aimed to test the relationships among latent constructs at a single point in time and to estimate the contribution of service quality, healthcare facilities, and waiting time-patient trust to patient satisfaction.
The study was conducted at Urip Sumoharjo Hospital.
Bandar Lampung.
Indonesia.
The target population consisted of hospital service users at Urip Sumoharjo Hospital during the study period.
The preliminary population estimate was approximately 5,000 patients based on hospital service records.
Respondents were selected using nonprobability convenience sampling, locally referred to as accidental sampling, in which eligible and willing respondents were recruited after receiving healthcare services.
The final demographic table contained 90 respondents.
Eligibility criteria included being at least 25 years old or otherwise eligible to provide an independent assessment, being conscious and able to complete the questionnaire, and having completed the relevant service process at the hospital.
Primary data were collected using a structured questionnaire with a five-point Likert scale ranging from 1 .
trongly disagre.
to 5 .
trongly agre.
The questionnaire measured service quality, healthcare facilities, waiting time-patient trust, and patient Table 1 summarizes the operational definitions and indicators used in this Table 1.
Operational definitions and measurement indicators Construct Service quality (X.
Healthcare facilities (X.
Operational definition The perceived ability of healthcare personnel and service units to provide prompt, accurate, friendly, and professional services.
The completeness, cleanliness, comfort, accessibility, and Indicators Reliability.
Completeness of medical Scale Five-point Likert scale Five-point Likert scale Volume 7.
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php/journal/index Construct Operational definition maintenance of physical facilities and equipment supporting hospital Waiting timepatient trust (X.
The perceived efficiency of service processes and the extent to which time-related communication builds confidence in the hospital.
Patient satisfaction (Y) The patientAos overall evaluation after receiving healthcare services, based on whether the service experience meets expectations.
Indicators waiting area comfort.
treatment room availability.
Registration speed.
service speed.
waiting time before meeting the doctor.
process efficiency.
Expectation fulfilment.
satisfaction with services.
satisfaction with facilities.
willingness to return.
willingness to recommend.
Scale Five-point Likert scale Five-point Likert scale Primary data were obtained through questionnaires distributed directly after respondents completed their healthcare service process.
Secondary data were obtained from hospital-related information and relevant literature.
The instrument was designed to capture patient perceptions of service processes, facility quality, waiting time, trust, and overall satisfaction.
Before submission to a journal, the authors should insert the institutional permission or ethics approval number, if available, and confirm that written or verbal informed consent was obtained from all respondents.
Data were analyzed using partial least squares structural equation modeling (PLSSEM).
PLS-SEM is suitable for prediction-oriented research involving latent variables, smaller samples, and models that may not meet strict multivariate normality assumptions (Hair et al.
, 2022.
Ringle et al.
, 2.
The measurement model was assessed through outer loadings, convergent validity, internal consistency reliability, and discriminant Items with outer loadings below the recommended threshold of 0.
70 were removed when they weakened construct measurement quality.
Discriminant validity should be assessed using the Fornell-Larcker criterion and the heterotrait-monotrait ratio (HTMT), as recommended in the PLS-SEM literature (Fornell & Larcker, 1981.
Henseler et al.
, 2.
The structural model was evaluated using path coefficients, t-statistics, p-values, coefficient of determination (RA), adjusted RA, and predictive relevance where available.
Hypotheses were considered supported when the direction of the coefficient was positive and the p-value was below 0.
RESULTS AND DISCUSSION
Respondent Characteristics The demographic profile of the respondents is shown in Table 2.
The sample was dominated by female respondents .
44%) and respondents younger than 25 years .
11%).
The role or affiliation category was dominated by respondents classified as AuothersAy .
22%), followed by pharmacists and administrative personnel .
22% eac.
, nurses .
11%), and doctors .
78%).
Most respondents were associated with rotating shifts .
00%).
These characteristics should be interpreted cautiously because the respondent-role categories need to be checked against the final inclusion criteria before journal submission.
Volume 7.
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Respondent characteristics Characteristic Gender Gender Gender Age group Age group Age group Age group Age group Age group Role/affiliation Role/affiliation Role/affiliation Role/affiliation Role/affiliation Role/affiliation Role/affiliation Work shift Work shift Work shift Work shift Work shift Work shift Category Female Male Total < 25 years 25-35 years 36-45 years > 45 years Unknown Total Others Pharmacist Administration Nurse Doctor Unknown Total Rotating shift Morning shift Afternoon shift Night shift Unknown Total Frequency Percentage Descriptive Summary of Construct Items The descriptive item-level results indicated that most responses were below the neutral midpoint of the five-point scale.
Patient satisfaction item means ranged from 1.
34, healthcare facility item means ranged from 1.
72 to 2.
18, and waiting time-patient trust item means ranged from 2.
13 to 2.
These values suggest that respondents tended to evaluate several service attributes as low to moderate, indicating an important managerial need to improve the patient service experience.
Table 3.
Descriptive summary of construct item means Construct
Patient satisfaction Patient satisfaction Patient satisfaction Patient satisfaction Patient satisfaction Healthcare facilities Healthcare facilities Healthcare facilities Healthcare facilities Healthcare facilities Waiting time-patient trust
Waiting time-patient trust
Waiting time-patient trust
Waiting time-patient trust
Waiting time-patient trust
Item
KP1
KP2
KP3
KP4
KP5
FK1
FK2
FK3
FK4
FK5
WTKP1
WTKP2
WTKP3
WTKP4
WTKP5
Mean Volume 7.
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php/journal/index Measurement Model Screening Indicator screening was conducted by examining outer loadings.
In line with common PLS-SEM recommendations, indicators with loadings below 0.
70 were not retained in the final measurement model when they did not meet the recommended The retained indicators included LP3 and LP4 for service quality.
FK1.
FK3,
and FK5 for healthcare facilities.
KP1.
KP4, and KP5 for patient satisfaction.
and WTKP1.
WTKP2, and WTKP3 for waiting time-patient trust.
The preliminary reliability values reported for service quality ( = 0.
, healthcare facilities ( = 0.
, and patient satisfaction ( = 0.
indicate acceptable internal consistency, although the final manuscript should report CronbachAos alpha, composite reliability, rho_A.
AVE, and HTMT for all constructs.
Table 4.
Indicator screening based on outer loadings Construct item statement Services are provided quickly and accurately according to patient expectations.
Employees are always ready and responsive in handling patient complaints.
Employees possess adequate knowledge and are courteous when answering questions.
Customer service staff demonstrate patience and full attention to patients.
Employees maintain a neat, clean appearance and wear appropriate uniforms.
The working environment is clean and comfortable.
Medical equipment is complete and well maintained.
Sanitation facilities are adequate.
Parking facilities are sufficient.
Lighting and ventilation in the healthcare facilities are The current quality of service makes patients satisfied.
Healthcare facilities contribute to patient satisfaction.
The operational costs of the facilities are balanced with the benefits received.
Patients frequently recommend this hospital to others.
Overall, patients are satisfied with the services provided.
Administrative and examination processes are carried out without excessive delays.
Staff provide accurate and clear estimates of waiting times.
The waiting time from registration to meeting the doctor meets patient expectations.
Service speed increases patientsAo trust in the hospital.
Staff knowledge and prompt responses build patientsAo confidence in the services provided.
Code
Outer
Decision LP1
Removed LP2
Removed LP3
Retained LP4
Retained LP5
Removed FK1
FK2
FK3
FK4
Retained Removed Retained Removed FK5
Retained KP1
KP2
Retained Removed KP3
Removed KP4
KP5
Retained Retained WTKP1 Retained WTKP2 Retained WTKP3 Retained WTKP4 Removed WTKP5 Removed Structural Model Results The structural model demonstrated strong explanatory power.
The RA value for patient satisfaction was 0.
708 and the adjusted RA value was 0.
697, indicating that service quality, healthcare facilities, and waiting time-patient trust jointly explained 70.
8% of the Volume 7.
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This suggests that the model has substantial predictive relevance for explaining patient satisfaction in the hospital context.
Table 5.
Coefficient of determination Endogenous variable Patient satisfaction RA Adjusted RA Interpretation Strong explanatory power Path coefficient analysis showed that all three predictors had positive and statistically significant effects on patient satisfaction.
Service quality had the strongest effect ( = t = 4.
p < 0.
, followed by waiting time-patient trust ( = 0.
t = 3.
p < 0.
and healthcare facilities ( = 0.
t = 3.
p = 0.
Therefore.
H1.
H2, and H3 were supported.
Table 6.
Path coefficients and hypothesis testing Hypothesis Path Service quality -> Patient satisfaction Healthcare facilities -> Patient Waiting time-patient trust -> Patient t-statistic p-value < 0.
Decision Supported Supported < 0.
Supported Discussion The Effect of Service Quality on Patient Satisfaction The findings confirm that service quality has a positive and significant effect on patient satisfaction.
This result indicates that patients place high value on service accuracy, staff responsiveness, politeness, clarity of explanation, and empathetic The path coefficient for service quality was the strongest among the tested predictors, suggesting that interpersonal and process-related dimensions of care may be more influential than facilities alone.
This finding is consistent with SERVQUAL theory and previous healthcare studies showing that reliable and responsive service improves patient evaluations and behavioral intentions (Andaleeb, 2001.
Dagger et al.
, 2007.
Parasuraman et al.
, 1.
For Urip Sumoharjo Hospital, this result implies that improving patient satisfaction requires more than physical facility improvement.
Staff must be trained to communicate procedures clearly, respond to complaints promptly, explain waiting times honestly, and show empathy toward patients and family members.
In addition, standard operating procedures should support consistency across registration, clinical examination, pharmacy, laboratory, and complaint-handling units.
The Effect of Healthcare Facilities on Patient Satisfaction Healthcare facilities also had a positive and significant effect on patient This supports the idea that the physical environment shapes patient perceptions of comfort, safety, and professionalism.
Clean waiting areas, adequate sanitation facilities, good lighting and ventilation, complete medical equipment, and accessible service areas can reduce anxiety and improve the perceived quality of hospital This finding is consistent with DonabedianAos structure dimension and BitnerAos servicescape theory, both of which recognize the role of physical context in shaping service evaluations (Bitner, 1990.
Donabedian, 1.
Volume 7.
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php/journal/index The managerial implication is that hospital facilities should not be treated merely as supporting infrastructure.
They are part of the patient experience and can influence trust in the hospitalAos clinical capacity.
Facility maintenance, cleanliness audits, equipment readiness checks, patient-friendly signage, and accessible parking should be integrated into the hospitalAos quality improvement program.
The Effect of Waiting Time-Patient Trust on Patient Satisfaction The positive and significant effect of waiting time-patient trust indicates that service timeliness and communication about waiting processes are important determinants of The effect size was slightly larger than that of healthcare facilities, suggesting that patients may value predictable and transparent service processes as much as, or even more than, physical comfort.
This finding aligns with the WHO quality dimension of timely care and with service management theory, which highlights the role of reliability and communication in building trust (World Health Organization, 2025.
Zeithaml et al.
In practice, hospitals can improve waiting time-related trust by providing queue information, estimated service time, clear referral or examination pathways, and staff explanations when delays occur.
Digital registration systems, appointment scheduling, triage optimization, and service flow monitoring can also help reduce perceived and actual waiting time.
Theoretical Implications The study integrates SERVQUAL.
DonabedianAos quality framework, and PLS-SEM analysis in a hospital-specific empirical model.
The results support the proposition that patient satisfaction is jointly shaped by structural factors, process factors, and trustbuilding service interactions.
The high RA value indicates that the model is useful for explaining patient satisfaction in the study setting, although additional variables such as perceived value, hospital image, patient safety, clinical outcome, and cost fairness may further improve explanatory power.
Practical Implications The findings provide several practical implications for hospital management.
First, service quality improvement should prioritize staff responsiveness, communication clarity, courtesy, and empathy.
Second, facility improvement should focus on cleanliness, sanitation, ventilation, lighting, medical equipment readiness, and accessible waiting Third, waiting time management should be strengthened through queue monitoring, transparent communication, and realistic estimated waiting times.
Fourth, hospital managers should periodically measure patient satisfaction using standardized instruments and link the findings to quality improvement cycles.
Limitations and Future Research This study has several limitations.
First, the use of convenience sampling limits the generalizability of the findings beyond the study setting.
Second, the study was crosectional.
therefore, causal claims should be interpreted cautiously.
Third, the demographic variables and respondent-role categories should be rechecked before journal submission to ensure consistency with the definition of Aupatient respondents.
Ay Fourth, several indicators were removed during measurement model screening, and future research should refine item wording and test the instrument with a larger and more Volume 7.
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Finally, patient loyalty was identified in the preliminary conceptual framework but was not tested in the final structural model.
future studies should examine whether patient satisfaction mediates the effects of service quality and facilities on loyalty.
CONCLUSION
This study examined the effects of service quality, healthcare facilities, and waiting time-patient trust on patient satisfaction at Urip Sumoharjo Hospital.
Bandar Lampung.
The results show that all three predictors have positive and significant effects on patient Service quality emerged as the strongest determinant, followed by waiting time-patient trust and healthcare facilities.
The model explained 70.
8% of the variance in patient satisfaction, indicating strong explanatory power.
These findings suggest that hospital management should improve patient satisfaction through an integrated strategy that combines responsive and empathetic service delivery, well-maintained and comfortable facilities, and transparent waiting time management.
Strengthening these three dimensions can improve patient experience, trust, and the hospitalAos overall service Declarations Ethics approval and consent to participate: The authors should insert the institutional ethics approval or research permission number before submission.
All respondents should provide informed consent before completing the questionnaire.
Funding: No funding information was provided in the source draft.
The authors should complete this statement before submission.
Competing interests: The authors should declare whether any competing interests exist.
Data availability: The dataset supporting the findings should be made available upon reasonable request or deposited according to the target journal policy.
Author contributions: The authors should specify contributions using the CRediT taxonomy before submission.
References