The research was conducted between June and August 2025 involving 442 inpatient and outpatient respondents at Poso Regional General Hospital. Researchers found that better service management significantly increased patient satisfaction and encouraged patients to return for future treatment and recommend the hospital to others.
The issue has become increasingly important as public hospitals across Indonesia face growing competition and higher expectations from patients. Prior to the study, Poso Regional Hospital had received several public complaints regarding service speed, fairness, communication, and transparency of healthcare costs. These concerns raised questions about the hospital’s ability to maintain public trust and patient retention.
To examine the issue, the researchers used a quantitative cross-sectional approach. Data were collected through structured questionnaires using a Likert scale to measure Total Quality Management, patient satisfaction, and patient loyalty. The study evaluated hospital service processes, staff interactions, and the overall healthcare environment.
The findings revealed that more than 62 percent of respondents rated the hospital’s TQM implementation as good. The hospital environment received the highest positive evaluation at 64.5 percent, while patient interaction with healthcare staff reached 59 percent.
Patient loyalty also showed strong results. Around 85.3 percent of respondents stated they intended to return to the hospital for future healthcare services, while 90 percent said they were willing to recommend the hospital to friends and family members.
Patient satisfaction levels were similarly positive. Approximately 63.1 percent of respondents expressed satisfaction with supporting healthcare services such as laboratory and pharmacy facilities. More than 60 percent also reported satisfaction with medical treatment quality and healthcare costs.
Statistical analysis showed that TQM had a significant effect on patient loyalty, with a significance value of 0.002. This means that improvements in hospital management and service quality strongly influence patient commitment to the hospital.
The study also confirmed that patient satisfaction plays a major role in strengthening loyalty. Researchers found a significant relationship between patient satisfaction and loyalty with a significance value of 0.001. Patients who were satisfied with their healthcare experience were more likely to trust the hospital, revisit for future care, and recommend the institution to others.
According to dr. Muhammad Ali Asdar, quality management in hospitals should not focus solely on technical procedures and administrative systems. Patient experience, communication, comfort, and trust are equally important in building long-term loyalty.
“Patients who feel respected and receive positive healthcare experiences are more likely to remain loyal to the hospital,” the researchers explained in the study discussion.
One of the study’s most important findings is that patient satisfaction acts as a mediating factor between TQM and patient loyalty. In other words, improving hospital management systems becomes more effective when those improvements successfully increase patient satisfaction first.
A mediation analysis using the Sobel test produced a significance value of 0.000, confirming that patient satisfaction is the strongest pathway connecting service quality and patient loyalty. Researchers identified this framework as a “partial mediation model,” where TQM influences loyalty both directly and indirectly through patient satisfaction.
The study also emphasized that patient loyalty is shaped not only by medical outcomes but also by emotional and interpersonal experiences during treatment. Relationships with doctors and nurses, feelings of safety, and trust in healthcare providers all contribute to long-term patient commitment.
These findings are highly relevant for hospitals throughout Indonesia and other developing healthcare systems. Modern hospitals are no longer evaluated only by medical facilities and technology. Patient-centered experiences now play a major role in determining healthcare quality and institutional reputation.
The research further supports management theories developed by quality experts such as W. Edwards Deming and Joseph M. Juran, who emphasized continuous organizational improvement. In healthcare settings, continuous improvement includes efficient service processes, better communication, cleaner facilities, and active involvement of healthcare workers in maintaining service quality.
For healthcare policymakers and hospital administrators, the study provides practical evidence that strengthening management quality can improve public trust and patient retention. Hospitals that focus on patient-centered care are more likely to maintain sustainable relationships with the communities they serve.
The researchers also noted several limitations in the study. Some respondents were more comfortable speaking local dialects than Indonesian, creating communication challenges during questionnaire completion. In some cases, family members assisted patients in answering survey questions, which may have influenced response interpretation.
Despite these limitations, the study concludes that Total Quality Management has a strong relationship with patient satisfaction and patient loyalty at Poso Regional General Hospital. The findings demonstrate that improving healthcare quality can strengthen long-term relationships between hospitals and the public.
Author Profiles
dr. Muhammad Ali Asdar is a staff member of the Department of Pulmonology and Respiratory Medicine at Poso Regional General Hospital, Central Sulawesi. His expertise focuses on healthcare management, respiratory medicine, and hospital service quality improvement.
Siswanto Pabidang serves as Regional Coordinator XIV East Java at the Health Facilities Accreditation Institution, with research interests in healthcare quality management and hospital accreditation systems.
Research Source
The study titled “The Effect of Total Quality Management on Patient Loyalty, with Patient Satisfaction as a Moderating Variable, at Poso Regional General Hospital” was published in Asian Journal of Healthcare Analytics Volume 5 Number 1, 2026.
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