The influence of hospital facilities and communication quality on patient satisfaction through patient experience at Aji Muhammad Parikesit Regional General Hospital, Tenggarong, 2026

¹Faculty of Public Health, Hasanuddin University, Makassar, Indonesia

^&Corresponding author
Nurul Salamah, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia

Introduction    

Patient satisfaction is an important indicator of perceived hospital service quality because it reflects patients' overall evaluation of the care they receive. In inpatient settings, patients remain in contact with the hospital environment and healthcare workers for extended periods, so their evaluations may reflect both structural aspects of care and interpersonal service processes. Patient satisfaction therefore provides relevant information for evaluating and improving hospital services [1]. Patient experience is conceptually related to, but distinct from, patient satisfaction. Whereas satisfaction represents an evaluative judgment of care, patient experience concerns what patients perceive and encounter during interactions with the healthcare system. Wolf et al. [2] conceptualized patient experience as encompassing interactions across the continuum of care that are shaped by organizational culture. The 2014 NHS Adult Inpatient Survey [3] assesses inpatient experience across domains including admission, the hospital and ward environment, care and treatment, operations and procedures, hospital staff, discharge information, and leaving hospital. These domains informed the measurement of patient experience in the present study.

Hospital facilities represent the physical environment in which care is delivered and are directly observable by patients. Within the physical-evidence perspective described by Booms and Bitner [4], tangible aspects of the service environment contribute to patients' perceptions of service quality. Facilities can also be considered structural components within Donabedian's structure-process-outcome framework [5]. The physical environment may therefore be associated with patients' experiences of care and their subsequent evaluations of hospital services. Communication quality represents an important interpersonal component of healthcare delivery. Effective communication facilitates the exchange of clear and understandable information, supports patients' involvement in care, and contributes to the therapeutic relationship between healthcare workers and patients [6]. From a structure-process-outcome perspective, communication can be considered a process-related component of care and may therefore be associated with both patients' experiences during hospitalization and their overall satisfaction with the services received.

Although hospital facilities, communication quality, patient experience, and patient satisfaction are related dimensions of hospital service quality, understanding how these factors relate within a single analytical model helps identify which aspects of inpatient care warrant greater managerial attention. Examining patient experience as an intermediate variable can clarify whether the associations of hospital facilities and communication quality with patient satisfaction are observed directly, indirectly through patient experience, or both. At Aji Muhammad Parikesit Regional General Hospital (RSUD AM Parikesit), Tenggarong, examining these relationships among inpatients may provide evidence relevant to service-quality management by distinguishing the roles of the physical service environment, communication processes, and patients' experiences in relation to satisfaction. This study therefore examined the direct associations of hospital facilities and communication quality with patient satisfaction and patient experience; the direct association between patient experience and patient satisfaction; and the indirect associations of hospital facilities and communication quality with patient satisfaction through patient experience. The study also compared the relative magnitudes of the estimated pathways within the specified model.

Methods     

Study design: this study used a quantitative, observational-analytic, cross-sectional design to examine the relationships among hospital facilities, communication quality, patient experience, and patient satisfaction among inpatients at Aji Muhammad Parikesit Regional General Hospital (RSUD AM Parikesit), Tenggarong, Indonesia. The study assessed these variables at a single point in time for each participant.

Study setting: the study was conducted from January to August 2026 at the Inpatient Installation of Aji Muhammad Parikesit Regional General Hospital (RSUD AM Parikesit), Tenggarong, Kutai Kartanegara Regency, East Kalimantan, Indonesia. The study involved inpatient services across the VIP, Class I, Class II, and Class III wards. The January-August period represents the overall study period and included study preparation, data collection, analysis, and reporting activities.

Participants: the reference population used for sample allocation comprised 21,641 inpatients treated at RSUD AM Parikesit in 2025, distributed across the VIP (n=196), Class I (n=3,993), Class II (n=5,332), and Class III (n=12,120) wards. Participants were selected from inpatients receiving care during the 2026 study period using proportionate stratified random sampling across the four inpatient ward categories. Within each stratum, eligible patients were identified according to predefined inclusion criteria, and participants were randomly selected using marked room numbers. Patients were eligible if they were hospitalized during the study period, had been hospitalized for at least 3×24 hours, were clinically stable, were able to communicate and understand the questionnaire independently or with researcher assistance, and had received direct care from physicians or nurses. Patients were excluded if they had reduced consciousness, were sedated or disoriented, were in strict isolation, had a severe psychiatric condition that interfered with their ability to respond, had been hospitalized for less than 3×24 hours, were referred for temporary observation only, or declined participation.

Variables: the study included two exogenous predictor variables, one mediating variable, and one final endogenous outcome. Hospital facilities and communication quality were specified as exogenous predictors, patient experience as the mediating variable, and patient satisfaction as the final endogenous outcome. Hospital facilities covered the hospital building, waiting area, service and treatment area, toilets, parking, and lifts, stairs, and disability access. Communication quality covered active listening, questioning skills, explaining and clarifying, non-verbal communication, and rapport building. Patient experience covered admission, the hospital and ward environment, care and treatment, operations and procedures, hospital staff, discharge information, and leaving hospital. Patient satisfaction covered interpersonal behavior, professional and technical quality, access and convenience, and the physical environment.

Data sources and measurement: primary data were collected using a structured questionnaire developed for this study based on theoretical frameworks underlying each construct. Hospital facilities were measured with 25 items based on the physical-evidence framework of Booms et al [4]; communication quality with 29 items based on Hargie's communication framework [6]; patient experience with 26 items informed by the NHS and Scottish Government inpatient-experience domains [3]; and patient satisfaction with 21 items informed by Imaninda and Azwar [7]. All items used a four-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Negatively worded items, particularly in the hospital-facilities scale, were reverse-coded before total scores were calculated so that higher scores consistently represented more favorable assessments. Questionnaires were distributed directly to eligible inpatients. Before completion, the researcher explained the study purpose, completion procedure, and confidentiality. Participants completed the questionnaire according to their hospitalization experiences; the researcher remained available to clarify items without directing responses. Completed questionnaires were checked for completeness. The instrument was pilot-tested among 30 patients at RSUD Taman Husada Bontang who were not included in the study sample. Corrected item-total correlations were assessed against r=0.3061 (df=28; significance level 0.10). Cronbach's alpha values were 0.758 for hospital facilities, 0.739 for communication quality, 0.668 for patient experience, and 0.788 for patient satisfaction. Secondary data included the hospital profile, inpatient visits, bed occupancy rate, average length of stay, net death rate, and hospital patient-satisfaction reports.

Bias: several procedures were implemented to reduce potential sources of bias. To reduce selection bias, participants were selected within predefined inpatient strata using the sampling procedure and eligibility criteria described above. To minimize response bias, confidentiality was maintained, and participants completed the questionnaire independently, with clarification available without directing responses. Completed questionnaires were checked for completeness. Potential measurement bias was addressed through pilot testing, and negatively worded items were reverse-coded before scoring. Nevertheless, because the measures relied on patients' self-reported perceptions and experiences, residual perception and recall bias could not be completely excluded.

Study size: the minimum sample size was calculated using the Lemeshow formula for a finite population [8].

where n is the minimum sample size, N is the population size, Z is the standard normal value for a 95% confidence level, P is the expected proportion, Q=1-P, and d is the margin of error. Substituting N=21,641, Z=1.96, P=0.50, Q=0.50, and d=0.05 gave n=377.48, which was rounded up to 378 participants. The required sample was proportionally allocated across the inpatient strata as follows: VIP, 4 participants; Class I, 70; Class II, 92; and Class III, 212.

Quantitative variables: item responses were scored from 1 to 4, and negatively worded items were reverse-coded before summation. Item scores were summed to obtain a total score for each construct. Hospital facilities comprised 25 items with a theoretical score range of 25-100 and were categorized as good at scores ≥62.5 and Poor at scores <62.5. Communication quality comprised 29 items with a range of 29-116 and a cutoff of 72.5; patient experience comprised 26 items with a range of 26-104 and a cutoff of 65; and patient satisfaction comprised 21 items with a range of 21-84 and a cutoff of 52.5. For each construct, scores at or above the cutoff were categorized as good and scores below the cutoff as Poor. The cutoffs represented the midpoint of each theoretical score range. These binary categories were used for descriptive and bivariate analyses, whereas continuous total scores were used in the path analysis.

Statistical methods: data were processed through editing, coding, data entry, cleaning, and tabulation. Descriptive analyses summarized participant characteristics and study-variable distributions using frequencies and percentages. For bivariate analyses, total scores were categorized as good or poor according to the predefined thresholds. Associations between hospital facilities and patient satisfaction, communication quality and patient satisfaction, hospital facilities and patient experience, communication quality and patient experience, and patient experience and patient satisfaction were examined using Chi-square tests. Statistical significance was defined as a two-sided p<0.05. Path analysis using AMOS (analysis of moment structures) examined the direct and indirect relationships among the four constructs. Hospital facilities and communication quality were specified as exogenous variables, patient experience as the mediating endogenous variable, and patient satisfaction as the final endogenous variable. Continuous total scores were entered into the path analysis. Direct paths were evaluated using unstandardized regression estimates (B), standard errors (SE), critical ratios (C.R.), p-values, and standardized coefficients (β). Direct, indirect, and total effects were estimated. The statistical significance of the indirect associations of hospital facilities and communication quality with patient satisfaction through patient experience was evaluated using two-tailed Sobel tests based on the unstandardized path coefficients and their standard errors. All 378 participants had complete data; therefore, no missing-data imputation was performed. No subgroup, interaction, or sensitivity analyses were performed.

Ethical considerations: ethical approval for this study was obtained from the Health Research Ethics Committee, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia (Ethical Approval No. 2232/UN4.14.1/TP.01.02/2026; Protocol No. 18626052124), dated 29 June 2026. All 378 participants provided informed consent before participation. Participation was voluntary, and participants' identities and responses were kept confidential throughout the study.

Results     

Participants: a total of 378 eligible inpatients were included in the study and analyzed. All 378 participants had complete data for the study variables and were included in the final analysis.

Descriptive data: the sociodemographic and hospitalization characteristics of the 378 participants are presented in Table 1. The largest age group was 36-45 years (n=126, 33.3%), and 224 participants (59.3%) were female. Most participants resided in Tenggarong (n=296, 78.3%). Civil servants, military personnel, or police officers constituted the largest occupational group (n=150, 39.7%), while 218 participants (57.7%) had bachelor-level or professional education. Most participants were hospitalized in Class III wards (n=212, 56.1%), followed by Class II (n=92, 24.3%), Class I (n=70, 18.5%), and VIP wards (n=4, 1.1%). BPJS was the predominant payment source (n=308, 81.5%). There were no missing data for participant characteristics or study variables among the 378 participants included in the analysis.

Outcome data: the distributions of the study variables according to the predefined score categories are presented in Table 2. Hospital facilities were rated as good by 177 participants (46.8%) and Poor by 201 (53.2%). Communication quality was rated as good by 213 participants (56.3%) and Poor by 165 (43.7%). Patient experience was categorized as good among 219 participants (57.9%) and Poor among 159 (42.1%). For the primary outcome, patient satisfaction was categorized as good among 206 participants (54.5%) and Poor among 172 (45.5%). Complete data were available for all four study variables for all 378 participants.

Main results: the path-analysis results are presented in Table 3. Hospital facilities were not significantly associated with patient satisfaction (B=0.049, SE=0.045, β=0.049, C.R.=1.108, p=0.268) or patient experience (B=0.067, SE=0.044, β=0.068, C.R.=1.516, p=0.130). Communication quality was positively associated with patient satisfaction (B=0.278, SE=0.051, β=0.277, C.R.=5.407, p<0.001) and patient experience (B=0.492, SE=0.044, β=0.494, C.R.=11.052, p<0.001). Patient experience was positively associated with patient satisfaction (B=0.307, SE=0.052, β=0.304, C.R.=5.924, p<0.001). The indirect association between hospital facilities and patient satisfaction through patient experience was not statistically significant (indirect B=0.021; standardized indirect effect=0.021; Sobel z=1.474, p=0.140). In contrast, communication quality showed a statistically significant indirect association with patient satisfaction through patient experience (indirect B=0.151; standardized indirect effect=0.150; Sobel z=5.221, p<0.001). Because the direct association between communication quality and patient satisfaction remained statistically significant, patient experience accounted for part, but not all, of this association within the specified model.

Other analyses: in the bivariate analyses, hospital facilities were not significantly associated with patient satisfaction (p=0.474) or patient experience (p=0.255). In contrast, communication quality was significantly associated with both patient satisfaction (p<0.001) and patient experience (p<0.001). Patient experience was also significantly associated with patient satisfaction (p<0.001). These bivariate analyses were based on the predefined good/poor categories of the respective study variables. No subgroup, interaction, or sensitivity analyses were performed.

Discussion     

Key results: among 378 inpatients at RSUD AM Parikesit Tenggarong, hospital facilities were not significantly associated with either patient satisfaction or patient experience. In contrast, communication quality was positively associated with patient satisfaction and patient experience, while patient experience was positively associated with patient satisfaction. The indirect association between hospital facilities and patient satisfaction through patient experience was not statistically significant, whereas communication quality showed a significant indirect association with patient satisfaction through patient experience. Taken together, these findings indicate that patient experience accounted for part of the association between communication quality and patient satisfaction in the specified path model, whereas a comparable indirect association was not demonstrated for hospital facilities.

Interpretation: hospital facilities showed small positive but non-significant associations with patient satisfaction and patient experience. Within the facility conditions represented in this study, differences in facility scores therefore did not clearly distinguish patients with higher and lower experience or satisfaction scores. Physical facilities may function primarily as supporting conditions for care, while patients' evaluations may be more sensitive to interpersonal and process-related aspects of service. This interpretation is broadly consistent with studies emphasizing service interactions and overall care quality in patient satisfaction [9-12]. The non-significant facility pathways in this study should not, however, be interpreted as evidence that hospital facilities are unimportant to healthcare quality [13-15]. Communication quality was positively associated with patient satisfaction. This is consistent with patient-centred communication literature in which clear information exchange, interpersonal engagement, and responsiveness are associated with patients' evaluations of care [16-20]. Mehra et al. [21] also linked communication and satisfaction with patients' recommendations of physicians. Among the two exogenous predictors in the specified model, communication quality showed the stronger direct association with patient satisfaction (β=0.277) compared with hospital facilities (β=0.049), but this comparison does not establish communication as a causal determinant of satisfaction.

Communication quality also showed a strong positive association with patient experience (β=0.494), the largest standardized direct path in the specified model. This is consistent with conceptual and empirical work identifying communication and interpersonal interaction as central components of patient experience [22-28]. Evidence from Indonesian healthcare settings also supports the relevance of healthcare-provider communication to patients' experience [24-26]. The telemedicine study by Wijaya and Afifi [27] was conducted in a different service context, but likewise illustrates the importance of considering communication together with user experience when evaluating healthcare services. Patient experience was positively associated with patient satisfaction (β=0.304). This finding supports the close relationship between the two constructs while preserving their conceptual distinction: patient experience concerns what patients encounter during care, whereas satisfaction represents an evaluative judgment of that care. Previous studies and reviews have similarly linked more positive care experiences with higher satisfaction [23,29-32].

The indirect association between hospital facilities and patient satisfaction through patient experience was not statistically significant. The present data therefore do not provide evidence that patient experience statistically mediated the facilities-satisfaction relationship in the specified model. In contrast, communication quality showed a significant indirect association with patient satisfaction through patient experience while its direct association with patient satisfaction remained significant. Within conventional mediation terminology, this pattern is consistent with partial mediation. Broader literature supports communication as an important driver of patient-experience evaluations [33-35], while Karimbux et al. [36] emphasize the importance of systematic patient-experience measurement. Tobing et al. [37], in a different hospital-marketing context, also reported relationships between communication-related service factors and patient decisions. Given the cross-sectional design of the present study, the observed indirect pathway should be interpreted as a statistical association rather than proof of a temporal or causal mediation mechanism. Among the two exogenous predictors, communication quality showed a larger standardized direct association with patient satisfaction than hospital facilities and was additionally associated with satisfaction indirectly through patient experience. These findings identify communication quality as the more strongly associated exogenous factor in the specified model. This interpretation is consistent with literature emphasizing communication and person-centred interaction in patient evaluations of hospital care [16-17,17,35]. From a service-management perspective, the findings support continued attention to communication competencies and patient experience while adequate physical facilities remain an essential component of hospital service delivery.

Limitations: this study has several limitations. First, some questionnaire items, particularly those concerning facilities and satisfaction, had overlapping meanings despite differences in wording, which may have reduced respondents' ability to distinguish precisely between related aspects of care. Second, some questionnaire items did not apply equally to all participants because not every patient used or experienced the facilities or service stages addressed, including lifts, disability access, parking, admission and discharge processes, and specific medical procedures. Third, several negatively worded items, particularly within the hospital-facilities construct, may have introduced variation in respondents' interpretation of the questions, although these items were reverse-coded before calculation of total scores. Fourth, the measures were based on patients' self-reported perceptions and experiences and therefore remain susceptible to perception and recall bias. Fifth, because the study used a cross-sectional design, the temporal ordering of hospital facilities, communication quality, patient experience, and patient satisfaction cannot be established; path coefficients and indirect effects should therefore be interpreted as statistical associations within the specified model rather than evidence of causal effects. Finally, the study was conducted among inpatients at a single regional general hospital, so the findings may not be directly generalisable to other hospitals, outpatient populations, or healthcare settings with different patient and service characteristics.

Generalisability: the findings are most directly applicable to inpatients receiving care at RSUD AM Parikesit Tenggarong under service conditions comparable to those represented during the study period. Proportionate stratified random sampling across VIP, Class I, Class II, and Class III wards supported representation across the inpatient ward categories included in the study. Nevertheless, because the study was conducted at a single regional general hospital and included only eligible inpatients who had been hospitalized for at least 3×24 hours, caution is required when extrapolating the findings to other hospitals, outpatient services, shorter-stay patients, critically ill patients, or healthcare systems with different organizational and patient characteristics.

Conclusion     

Among inpatients at RSUD AM Parikesit Tenggarong, communication quality was positively associated with both patient experience and patient satisfaction, while patient experience was also positively associated with patient satisfaction. Communication quality additionally showed a significant indirect association with patient satisfaction through patient experience, whereas comparable direct or indirect associations were not demonstrated for hospital facilities. These findings indicate that patient experience accounted for part of the association between communication quality and patient satisfaction in the specified path model. Given the cross-sectional design, these relationships should be interpreted as statistical associations rather than causal effects. The findings support continued managerial attention to healthcare workers' communication competencies and systematic assessment of patient experience as components of hospital quality improvement. Communication initiatives may particularly address active listening, clear explanation and clarification of information, non-verbal communication, and rapport building, consistent with the communication dimensions evaluated in this study. Hospital facilities should continue to be maintained as an essential component of service delivery, despite the absence of statistically significant facility-related pathways to patient experience or satisfaction in this study.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Nurul Salamah: conceptualization, methodology, investigation, formal analysis, data curation, writing - original draft. Fridawaty Rivai: conceptualization, methodology, supervision, validation, writing - review and editing. Herlina Amir Hamzah: supervision, validation, writing - review and editing. Irwandy Irwandy: supervision, validation, writing - review and editing. Nur Arifah: supervision, validation, writing - review and editing. All authors read and approved the final version of the manuscript.

Tables      

Table 1: sociodemographic and hospitalization characteristics of study participants (N=378)

Table 2: distribution of hospital facilities, communication quality, patient experience, and patient satisfaction among study participants (N=378)

Table 3: direct and indirect associations among hospital facilities, communication quality, patient experience, and patient satisfaction

References