Patient loyalty in the emergency department: An extended SERVPERF approach comparing first-visit and return patients

BACKGROUND: Emergency departments (EDs) often experience unpredictable patient flows, high-stress environments, and asymmetric information, which make it highly challenging for hospitals to establish patient trust and loyalty and protect their reputations. This study investigated which service quality indicators would affect patient loyalty and the differential impact of service quality on loyalty among first-visit and return patients, a critical distinction in patient relationship management. METHODS: Responses from 199 emergency patients were collected from the emergency department of a regional hospital in central Taiwan. A two-phase analytical approach was employed. First, Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to validate the extended SERVPERF model and analyze the influence of service quality on patient loyalty. Second, the Brunner-Munzel test was used to examine differences between first-visit and return patients. RESULTS: The results showed that assurance (β = 0.268, p < 0.001) was the most critical construct of medical service quality. Medical service quality significantly affected both revisits (β = 0.268 = 0.587) and word-of-mouth (WOM) intention (β = 0.222). First-visit patients exhibited a significantly higher WOM intention (p < 0.01), whereas return patients showed a significantly higher revisit intention (p < 0.01). CONCLUSION: This study confirmed that medical service quality is a key driver of patient loyalty in the ED. This study provides the first empirical evidence that first-visit and return patients form loyalty through different pathways (WOM versus retention), offering a new perspective on developing targeted patient relationship management strategies.

• ✓Medical service quality significantly affected both revisits (β = 0.268 = 0.587) and word-of-mouth (WOM) intention (β = 0.222).
• ✓First-visit patients exhibited a significantly higher WOM intention (p < 0.01), whereas return patients showed a significantly higher revisit intention (p < 0.01).
• ✓CONCLUSION: This study confirmed that medical service quality is a key driver of patient loyalty in the ED.
• ✓This study provides the first empirical evidence that first-visit and return patients form loyalty through different pathways (WOM versus retention), offering a new perspective on developing targeted patient relationship management strategies.