THE SERVICE PROFIT CHAIN DALAM ORGANISASI RUMAH SAKIT: SYSTEMATIC LITERATURE REVIEW TENTANG HUBUNGAN KEPUASAN KARYAWAN, KUALITAS PELAYANAN, DAN LOYALITAS PASIEN

Authors

  • Lana Asfaradilla Universitas Adhirajasa Reswara sanjaya
  • Febryanti Febryanti Universitas Adhirajasa Reswara Sanjaya
  • Retno Sulistianingsih Universitas Adhirajasa Reswara Sanjaya
  • Dana Rizky Afina Rahma Universitas Adhirajasa Reswara Sanjaya
  • Hanna Maria Binsyowi Ondi Universitas Adhirajasa Reswara Sanjaya
  • Eveline Hongo Universitas Adhirajasa Reswara Sanjaya
  • Acep Rohendi Universitas Adhirajasa Reswara Sanjaya

DOI:

https://doi.org/10.58268/eb.v5i2.334

Keywords:

employee satisfaction; hospital; patient loyalty; service profit chain; service quality;, Employee Satisfaction; Hospital; Patient Loyalty; Service Profit Chain; Service Quality

Abstract

The Service Profit Chain (SPC) describes a sequence from internal service quality and employee satisfaction to service value, patient satisfaction and loyalty, and organizational performance. Evidence for each link in hospitals has not been mapped systematically by pathway. To synthesize empirical evidence on employee satisfaction, service quality, patient satisfaction, and patient loyalty within the SPC framework. A systematic literature review following PRISMA 2020 was conducted using 34 queries across web-indexed sources on 21 September 2026. Thirty-seven reports were included: 31 empirical studies, 5 systematic reviews/meta-analyses, and 1 conceptual analysis. Empirical studies were appraised using three criteria adapted from MMAT 2018 and synthesized narratively. Asia contributed 74.2% of empirical studies, yet only 3 of 23 Asian studies (13.0%) included the employee side. No study measured all SPC components. Service quality was positively associated with patient satisfaction in 15 studies and patient satisfaction with loyalty in 14 studies. Employee-side relationships with patient outcomes were positive in 7 studies, although outcome measures varied. Only 3 studies examined loyalty and organizational performance, with inconsistent findings. Evidence is most consistent on the patient side, whereas the internal employee link and organizational performance link remain under-tested. A hospital SPC adaptation should incorporate trust as a mediator, employee well-being as an internal construct, contextual moderators, and feedback from performance to internal investment.

References

Addo, A. A., Wang, W., Dankyi, A. B., Abban, O., & Bentum-Micah, G. (2020). Sustainability of health institutions: The impact of service quality and patient satisfaction on loyalty. European Journal of Business and Management Research, 5(4). https://doi.org/10.24018/ejbmr.2020.5.4.345

Aiken, L. H., et al. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717. https://doi.org/10.1136/bmj.e1717

Aladwan, M., et al. (2021). The relationship among service quality, patient satisfaction and patient loyalty: Case study in Jordan Mafraq hospital. Linguistics and Culture Review, 5(S3), 27–40. DOI: 10.21744/lingcure.v5nS3.1368

Ariyani, Adji, & Soepatini. (2026). The influence of service quality dimensions on patient loyalty with satisfaction as a mediating variable at PKU Muhammadiyah Wonogiri Hospital. MORFAI, 6(3).

Arslan, T., et al. (2022). Do patient experiences have mediating roles on patient loyalty? Journal of Patient Experience, 9. https://doi.org/10.1177/23743735221103027

Asnawi, Awang, Afthanorhan, Mohamad, & Karim. (2019). The influence of hospital image and service quality on patients' satisfaction and loyalty. Management Science Letters, 9, 911–920.

Barros, C., & Araujo, C. A. S. (2023). The service profit chain in healthcare services: A systematic literature exploration. International Journal of Services and Operations Management, 45(2), 271–291.

Batbaatar, E., et al. (2017). Determinants of patient satisfaction: A systematic review. Perspectives in Public Health, 137(2), 89–101. https://doi.org/10.1177/1757913916634136

Chen, H.-C., Cates, T., & Taylor, M. (2023). The effect of patient quality measurements and HCAHPS patient satisfaction on hospital reimbursements. Human Systems Management, 42(4), 419–433.

Chen, X., et al. (2022). The relationships between patient experience with nursing care, patient satisfaction and patient loyalty: A structural equation modeling. Patient Preference and Adherence, 16, 3173–3183.

Cronin, J. J., Jr., & Taylor, S. A. (1992). Measuring service quality: A reexamination and extension. Journal of Marketing, 56(3), 55–68.

Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743–1748.

Ekawaty, & Wibowo. (2019). Internal marketing and work satisfaction of service quality in K.H Hayyung Hospital, Selayar District. International Journal of Scientific and Publication Research, 56(01), 40–44.

Goula, A., et al. (2022). Internal quality and job satisfaction in health care services. International Journal of Environmental Research and Public Health, 19(3), 1496.

Heskett, J. L., Jones, T. O., Loveman, G. W., Sasser, W. E., Jr., & Schlesinger, L. A. (1994). Putting the service-profit chain to work. Harvard Business Review, 72(2), 164–174.

Heskett, J. L., Sasser, W. E., Jr., & Schlesinger, L. A. (1997). The service profit chain. Free Press.

Hogreve, J., Iseke, A., & Derfuss, K. (2022). The service-profit chain: Reflections, revisions, and reimaginations. Journal of Service Research, 25(3), 460–477. https://doi.org/10.1177/10946705211052410

Homburg, C., Wieseke, J., & Hoyer, W. D. (2009). Social identity and the service-profit chain. Journal of Marketing, 73(2), 38–54.

Hussain, A., et al. (2025). Antecedents of patient loyalty: Exploring mediating and moderating paradigms in public hospitals. Patient Preference and Adherence, 19, 527–542.

Iliopoulos, E., & Priporas, C.-V. (2011). The effect of internal marketing on job satisfaction in health services: A pilot study in public hospitals in Northern Greece. BMC Health Services Research, 11, 261.

Kim, C., et al. (2017). Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness. BMC Complementary and Alternative Medicine, 17, 174.

Kristinawati, Gunardi, & Fushen. (2023). The effect of service quality and patient satisfaction on patient loyalty mediated by patient trust at Rumah Indonesia Sehat (RIS) Hospital. MORFAI, 2(4), 701–717. DOI: 10.54443/morfai.v2i4.630

Kutney-Lee, A., et al. (2016). Nurse engagement in shared governance and patient and nurse outcomes. Journal of Nursing Administration, 46(11), 605–612.

Li, L. Z., et al. (2024). Nurse burnout and patient safety, satisfaction, and quality of care: A systematic review and meta-analysis. JAMA Network Open, 7(11), e2443059. doi: 10.1001/jamanetworkopen.2024.43059

Lim, Lim, Heinrichs, Al-Aali, Aamir, & Qureshi. (2018). The role of hospital service quality in developing the satisfaction of the patients and hospital performance. Management Science Letters, 8, 1353–1362. DOI: 10.5267/j.msl.2018.9.004

Mache, S., Vitzthum, K., Klapp, B. F., & Groneberg, D. A. (2012). Improving quality of medical treatment and care: Are surgeons' working conditions and job satisfaction associated to patient satisfaction? Langenbeck's Archives of Surgery, 397, 973–982. DOI: 10.1007/s00423-012-0963-3

Maqsood, et al. (2017). Effects of hospital service quality on patients satisfaction and behavioural intention of doctors and nurses. Saudi Journal of Medical and Pharmaceutical Sciences, 3(6B), 556–567. DOI: DOI: 10.36348/sjmps.2017.v03i06.013

Nguyen, N., Tran, K. T., & Nguyen, T. (2021). Impact of service quality on in-patients' satisfaction, perceived value, and customer loyalty: A mixed-methods study from a developing country. Patient Preference and Adherence, 15, 2523–2538. DOI: 10.2147/PPA.S333586

Noviyani, A., & Viwattanakulvanid, P. (2025). Service quality as a driver of perceived value satisfaction and revisit intention in Indonesia. Scientific Reports, 15, 43363. doi: 10.1038/s41598-025-29414-3

Oliver, R. L. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions. Journal of Marketing Research, 17(4), 460–469. https://doi.org/10.1177/00222437800170

Oliver, R. L. (1999). Whence consumer loyalty? Journal of Marketing, 63(4_suppl), 33–44.

Page, M. J., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. doi: https://doi.org/10.1136/bmj.n71

Panjakajornsak. (2009). Applying the service profit chain to a private hospital in Thailand. NIDA Development Journal, 49(2). DOI: 10.14456/ndj.2009.21

Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1), 12–40.

Popay, J., et al. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. ESRC Methods Programme. DOI:

https://doi.org/10.59188/jurnalsostech.v6i4.32785

Putri, Sapri, Yasa, Thalia, & Nurjanah. (2026). Model extended service profit chain pada rumah sakit: Tinjauan literatur sistematis tentang kualitas layanan internal, employee retention, dan kinerja organisasi. Jurnal Sosial Teknologi, 6(4), 1225–1236.

Rahardian, Iriani, & Sanaji. (2025). Pengaruh kualitas layanan terhadap kepuasan dan loyalitas pasien di Puskesmas Pakis Kota Surabaya. Journal of Economic, Business and Accounting (COSTING), 8(1), 28–38. DOI:

https://doi.org/10.31539/costing.v8i1.14138

Rosenbaum, K. E. F., Lasater, K. B., McHugh, M. D., & Lake, E. T. (2024). Changes in patient care experiences and the nurse work environment: A longitudinal study of U.S. hospitals. Medical Care Research and Review, 81(6), 444–454. https://doi.org/10.1177/10775587241282403

Rostami, M., Ahmadian, L., Jahani, Y., & Niknafs, A. (2019). The effect of patient satisfaction with academic hospitals on their loyalty. The International Journal of Health Planning and Management, 34(1), 726–735.DOI : 10.1002/hpm.2685

Scheepers, R. A., et al. (2015). A systematic review of the impact of physicians' occupational well-being on the quality of patient care. International Journal of Behavioral Medicine, 22(6), 683–698. DOI: 10.1007/s12529-015-9473-3

Shie, A., et al. (2022). Exploring the relationship between hospital service quality, patient trust, and loyalty from a service encounter perspective in elderly with chronic diseases. Frontiers in Public Health, 10, 876266. DOI: 10.3389/fpubh.2022.876266

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339. DOI: 10.1016/j.jbusres.2019.07.039

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8, 45. DOI: 10.1186/1471-2288-8-45

Tranfield, D., Denyer, D., & Smart, P. (2003). Towards a methodology for developing evidence-informed management knowledge by means of systematic review. British Journal of Management, 14(3), 207–222.

Yee, R. W. Y., Yeung, A. C. L., & Cheng, T. C. E. (2011). The service-profit chain: An empirical analysis in high-contact service industries. International Journal of Production Economics, 130(2), 236–245. DOI: 10.1016/j.ijpe.2011.01.001

Yilmaz, F. K., & Karakuş, S. (2023). The relationship between healthcare workers' satisfaction level and patients' satisfaction: Results of a path analysis model. Journal of Healthcare Quality Research, 38(6), 338–345. DOI: 10.1016/j.jhqr.2023.08.003

Zarei, E., et al. (2014). An empirical study of the impact of service quality on patient satisfaction in private hospitals, Iran. Global Journal of Health Science, 7(1), 1–9. DOI: 10.5539/gjhs.v7n1p1

Zeithaml, V. A., Berry, L. L., & Parasuraman, A. (1996). The behavioral consequences of service quality. Journal of Marketing, 60(2), 31–46. DOI: 10.2307/1251929

Published

2026-09-15