Information Management and Business Review (ISSN 2220-3796)

Vol. 16, No. 3(S), pp. 440-451, Sep 2024

The Impact of Healthcare Service Quality on Patient Satisfaction at University Health Center

*Noor’ain Mohamad Yunus1,4, Mohd Zulkifli Abdullah1, Nurul Fatihah binti Ramdan2,
Huda Al Shaiba Bedaia Safsouf Alnuaimi3
1Faculty of Business and Management, University Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
2Faculty of Health & Life Sciences, Management & Science University (MSU), Shah Alam, Selangor, Malaysia
3Ambulatory Healthcare Services, Al Salam Street, Abu Dhabi
4Research Group: Sustaining Quality of Life, Faculty of Business and Management, University Teknologi

MARA, Puncak Alam Campus, Malaysia

*[email protected], [email protected], [email protected], [email protected]
Corresponding Author: Noor’ain Mohamad Yunus

Abstract: Patient satisfaction is a critical aspect of healthcare service quality that needs to be periodically
evaluated and improved. Understanding various factors, including empathy, assurance, reliability, tangibility,
and responsiveness, is necessary to enhance healthcare quality and improve patient satisfaction. This research
aims to investigate the level of patient satisfaction and the relationship between patient satisfaction and service
quality, using the five SERVQUAL model as a framework. A positivist approach was used to explore the
relationship between variables. Data collection was carried out for two weeks using online questionnaires. For
this research, 120 UiTM respondents were chosen using convenience sampling. Data was analyzed using SPSS
version 29. The findings revealed a significant positive relationship between tangibility, responsiveness, and
empathy with patient satisfaction. This study highlights the importance of regularly assessing patient
satisfaction and identifying areas for improvement in healthcare service quality. University health centers can
enhance patient satisfaction and provide better student healthcare services by focusing on tangibility,
responsiveness, and empathy.

Keywords: Patient satisfaction; University healthcare center; SERVQUAL; Health service quality

1. Introduction and Background

Despite limited medical resources, providing the highest-quality healthcare services has long been the primary
goal for healthcare systems worldwide. Providing high-quality healthcare services is fundamental to ensuring
positive patient outcomes and overall population well-being. The most important aspect of healthcare delivery
services is the patient's satisfaction, representing the whole experience and the standard of care received.
Patient satisfaction, which reflects the degree to which a patient's expectations and perceptions of healthcare
services are met, has emerged as a critical measure of healthcare quality.

As the demand for healthcare quality has increased, healthcare systems are constantly changing and improving,
so it is necessary to find a way to assess outputs while evaluating patient satisfaction. Patient satisfaction
impacts various aspects, including clinical outcomes, hospital reputation, and patient retention. Healthcare
systems are constantly changing and improving, so finding a way to assess outputs while evaluating patient
satisfaction is necessary. The need to monitor and assess patient satisfaction has increased along with the
demand for healthcare quality, prompting the creation of guidelines for patient satisfaction monitoring
(Gavurova et al., 2021; Al-Qudimat et al., 2024). Improving an understanding of and enhancing patient
satisfaction can benefit healthcare organizations by increasing patient loyalty, producing better results, and
enhancing their reputation (Ferreira et al., 2023).

Healthcare service quality in Malaysia's university healthcare centers is a crucial aspect that significantly
affects the behavioral intentions of university students. While access to healthcare is guaranteed in Malaysia,
there is a growing emphasis on evaluating the quality of services offered within higher education institutions.
A survey on customer satisfaction is considered an effective way to provide healthcare service providers with
beneficial information. As customers of the healthcare center, the students' views should be considered, as they
can serve as strategic inputs in assessing their satisfaction. The issue of healthcare quality and student
satisfaction has been studied by many researchers across the globe over the past few years (Alshurideh, 2014;
Lee & Kim, 2017; Rezaian & Selamat, 2015; Abdullah et al., 2022). However, the study on the relationship
between service quality and satisfaction, specifically in public universities, is limited and has inconsistent

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findings.

In the contemporary healthcare landscape, the quality of services provided within health centers plays a pivotal
role in shaping patient experiences and satisfaction. With the evolution of the healthcare system, particularly
within university health centers that cater to diverse student populations, understanding the dynamics of
service quality becomes increasingly important. Assessing customer satisfaction through surveys effectively
gathers beneficial information for healthcare service providers (Marzo et al., 2021). Thus, it is essential to
determine the influence of healthcare service quality on students’ satisfaction. This study attempted to fill this
gap by examining the impact of healthcare service quality on student satisfaction at UiTM Selangor Campus.

2. Literature Review

Patient Satisfaction
Research on patient satisfaction began in the early 1950s, focusing on the interaction between doctors and
patients. It gained a significant increase in interest in the 1960s, with extensive studies conducted to explore
various dimensions of patient satisfaction. Patient satisfaction has garnered significant interest in the
healthcare sector because it is a critical indicator that captures the quality of care delivered and the overall
patient experience. Traditionally, patient satisfaction was viewed as a customer service initiative, but recent
research has highlighted its importance as a critical dimension of healthcare quality (Hefner et al., 2019).

The concept of patient satisfaction has been defined variably across studies. Generally, it reflects the degree to
which patients' expectations regarding healthcare services are met (Al-Abri & Al-Balushi, 2014). Some
researchers view it as a measure of attitudes toward care (Goodrich & Lazenby, 2023), while others define it
as the congruence between patient expectations and their actual experiences of care (Agency for Healthcare
Research and Quality, 2020; Lateef, 2011; El-Haddad et al., 2020), which posits that the gap between
expectations and actual experiences influences satisfaction. These definitions illustrate the complexity of
patient satisfaction, emphasizing its dependence on individual perceptions, expectations, and the specific
attributes of care received. Understanding these nuances is essential for healthcare providers aiming to
enhance patient experiences and satisfaction levels.

Patient satisfaction is a critical determinant of healthcare providers' success (Kalaja & Krasniqi, 2022), as it
includes the treatment outcome, overall experience, and interactions with healthcare providers (Manzoor et
al., 2019). It reflects the state of pleasure or happiness that patients experience while utilizing healthcare
services (Manzoor et al., 2019). Moreover, patient satisfaction is a multi-aspect concept closely related to the
main attributes of services and providers (Hussain et al., 2019). This emphasizes that patient happiness is an
essential quality measure in healthcare settings. By integrating patient satisfaction metrics into healthcare
assessments, healthcare providers can pinpoint development opportunities and elevate the general standard
of care provision. Understanding and improving patient satisfaction will be essential as healthcare evolves,
enhancing the quality of care and patient outcomes.

Service Quality Gap Model (SERVQUAL Model)

The service Quality Gap Model, or SERVQUAL model, developed by Parasuraman, Zeithaml, and Berry (1988),
is a widely applied service quality framework to determine the level of satisfaction among patients across the
globe (Alshrbaji et al., 2022). The SERVQUAL model represents service quality as the discrepancy between a
customer's expectations of service offering and the customer's perceptions of the service received
(Parasuraman et al., 1985). The SERVQUAL model includes five dimensions: tangible, reliability,
responsiveness, empathy and assurance. The dimensions of the SERVQUAL model are explained in the
following:

Tangible
Tangible is an essential factor in patient satisfaction and healthcare service quality. The term "tangibility"
describes the physical spaces, tools, staff, and informational resources that patients encounter while receiving
medical care. These specific factors greatly influence patients' opinions about the quality and satisfaction of the
services they receive. To shape patients' views of service quality, for example, research by Parasuraman et al.
(1985) highlights the significance of tangible cues, such as the appearance of medical equipment, the

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cleanliness of facilities, and the professionalism of staff apparel. Modern facilities and well-maintained
equipment are positive, tangible features that can boost patients' confidence in the healthcare provider and
increase overall patient satisfaction.

Patient satisfaction in healthcare settings is intricately linked to the quality of services, particularly the tangible
aspect of care. Tangible dimensions of healthcare quality, such as the physical environment, equipment, and
facilities, are crucial in shaping patient perceptions and experiences (Suhadi et al., 2022). Studies have shown
that the quality of amenities, which falls under the tangible dimension, positively influences patient loyalty and
satisfaction (AlOmari & Hamid, 2022). Additionally, the tangible dimension is one of the critical components of
service quality that significantly impacts patient satisfaction (Fadila et al., 2022). Therefore, the following
research hypothesis is proposed:
H1: Tangible positively influences patient satisfaction

Reliability
The service's reliability means that patients receive the treatment they believe is correct for their health
problems. Reliability in healthcare service quality is a crucial aspect that directly impacts patient satisfaction.
The reliability of healthcare services is defined as their consistency and dependability in meeting patients'
needs and expectations (Endeshaw, 2020). It is one of the critical dimensions used for measuring the quality of
healthcare services (Endeshaw, 2020; Osarobo & Adekunle, 2022). Studies have identified reliability as a
fundamental characteristic of high-quality healthcare services, alongside other dimensions like
responsiveness, assurance, and empathy (Jordan et al., 2021). Ensuring reliability in healthcare services is
essential for building patients' trust and delivering consistent care that meets their expectations (Endeshaw,
2020).

The relationship between reliability in healthcare service quality and patient satisfaction is intricate. Studies
have shown that the reliability of healthcare services is positively associated with patient satisfaction
(Endeshaw, 2020). When patients perceive healthcare services as reliable, consistent, and dependable, it
enhances their overall satisfaction with their care (Endeshaw, 2020). Reliability builds patient trust, a critical
factor in patient satisfaction (Endeshaw, 2020). Therefore, healthcare providers must ensure reliability to
improve patient satisfaction (Endeshaw, 2020). According to the discussions, the hypothesis is proposed.
H2: Reliability positively influences patient satisfaction.

Responsiveness
Responsiveness is the ability and willingness of healthcare providers to address patients' needs and concerns
successfully. Responsiveness requires effective communication, which is also necessary to promote desirable
patient-provider interactions. When healthcare services are responsive, patients feel valued, listened to, and
cared for, leading to higher satisfaction levels (Ugwu et al., 2022). Healthcare providers are highly valued by
their patients because they actively listen to their concerns, offer clear explanations, and involve them in
decision-making. Renedo and Marston's (2015) article highlighted how communication influences patients'
views of responsiveness and made the case that polite, honest communication increases patient satisfaction.

Responsiveness in healthcare service quality pertains to the promptness and willingness of healthcare
providers to assist patients and deliver care when required. It encompasses timely appointments, quick
responses to inquiries, and efficient handling of patient needs (Nguyen & Pham, 2023). Studies have
consistently shown that responsiveness is a critical dimension of healthcare service quality that significantly
influences patient satisfaction (Ugwu et al., 2022). Patients highly value healthcare facilities that are responsive
to their needs and concerns, as they enhance their overall experience and perception of the care received (Kaur
et al., 2022). A previous study by Chandra et al. (2019) and Uguwu et al. (2022) reported that patient
satisfaction and responsiveness correlate positively. Patient satisfaction was more vital in healthcare facilities
with higher responsiveness scores (Li et al., 2023), and this highlights how crucial it is for healthcare providers
to put responsiveness at the top of their service delivery structure to improve patient outcomes and satisfaction
(Ugwu et al., 2022). Thus, it is hypothesized that:
H3: Responsiveness positively influences patient satisfaction

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Assurance
Assurance is reflected in the patient's reliance on the doctor and hospital staff and their confidence in their
qualifications and competence (Parasuraman et al., 1996). Assurance encompasses medical professionals'
skills, service reliability, and patient-provider trust development. Patients are more likely to feel satisfied with
the quality of care they receive when they have faith in the abilities and knowledge of their healthcare
providers. Patients place a high value on reliability in healthcare settings because it eliminates ambiguity and
cultivates trust in the healthcare system, increasing patient satisfaction with their care.

Assurance in healthcare service quality encompasses factors such as the competence of health workers, the
courtesy of their behavior, reliability, and the safety of services provided. Patient satisfaction is a crucial
outcome in healthcare services, influenced by various service quality dimensions, including assurance (Laela
et al., 2022). The relationship between assurance and patient satisfaction is significant, as the ability of
healthcare providers to convey trust and competence directly impacts how satisfied patients are with the care
they receive (Laela et al., 2022). Patients who perceive high levels of assurance from healthcare providers are
more likely to be satisfied with their care (Laela et al., 2022). This emphasizes the importance of delivering
quality healthcare services and ensuring that patients feel confident in their care, which can positively impact
their overall satisfaction with the healthcare experience. Therefore, it is hypothesized that:
H4: Assurance positively influences patient satisfaction.

Empathy
Empathy in healthcare service quality refers to the ability of healthcare professionals to understand and share
their patients' feelings, show compassion, and provide personalized care (Moudatsou et al., 2020). It is
fundamental in establishing a therapeutic relationship between carers and patients, contributing significantly
to better health outcomes (Moudatsou et al., 2020). Studies have consistently highlighted the importance of
empathy in healthcare, emphasizing its role in optimal communication between medical professionals and
patients (Haddad et al., 2023). Empathy is crucial for developing a positive patient-provider relationship, linked
to improved patient outcomes, higher levels of patient satisfaction, and an enhanced sense of well-being among
patients (Holmes & Starr, 2022).

The relationship between empathy and patient satisfaction is further supported by evidence showing that
patient-perceived empathy is linked to reduced anxiety and distress and increased satisfaction (Hoffstädt et al.,
2020). Additionally, empathy has been identified as a critical factor in determining the quality of service in
healthcare, with aspects such as a calm working demeanor, effective communication, appealing appearance,
and the ability to address patient concerns contributing to patient satisfaction (Laela et al., 2022). Moreover,
empathy facilitates positive communication relationships, personal attention, and understanding of patient
needs, all of which are essential for enhancing patient satisfaction (Simanullang et al., 2021). Therefore, this
study proposed the following hypothesis:
H5: Empathy positively influences patient satisfaction.

Conceptual Framework
The conceptual framework of this study was guided by SERVQUAL, developed by Parasuraman, Zeithaml, and
Berry in 1988. The SERVQUAL model, developed by Parasuraman, Zeithaml, and Berry, is widely used to assess
and comprehend service quality from the consumer's viewpoint in various service industries, including
healthcare. Figure 1 shows the conceptual framework of this study.

Figure 1: Conceptual Framework

Tangible

Responsivenes
s
Reliability Patient
Satisfaction

Assurance

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3. Research Methodology

Design, Sample, and Setting

A positivist approach was used to explore the relationship between variables. The study was primarily
conducted via a survey among students in UiTM Puncak Alam. The G*Power software was used to calculate the
sample size for this study. The effect size was set at 0.15 (medium effect), α at 0.05, and power at 0.80; thus,
the sample size is 92. However, the researcher distributed the questionnaire to 150 students to obtain an
excellent response rate. The inclusion criteria were established to ensure that the sample accurately reflects
the population of interests: 1) participants must have utilized the university health clinic UiTM Puncak Alam at
least once during the academic year, and 2) willing to participate in the survey. This study utilized convenience
sampling for data collection due to its accessibility, efficiency, and willingness to engage participants, aligning
with research objectives and university context, making it a practical choice.

Instrument Development
The research instrument for this study was developed based on an extensive literature review that combined
existing validated measurements. The questionnaire, which consisted of seven sections measuring
demographic data, namely tangible, reliability, responsiveness, assurance, empathy, and patient satisfaction,
was used to collect the data. The respondents were requested to complete the questions about their
demographic backgrounds, such as gender, age, semester, type of residency, and faculty. A total of 37 items
were adapted from Abdullah et al. (2023) to measure all the variables. The researchers employed a five-point
Likert scale ranging from strongly disagree to agree.

Data collection procedures

Data was collected from the respondents using an online survey via Google Forms. The questionnaire was
distributed via WhatsApp. The respondents took approximately 5 to 10 minutes to complete the
questionnaires. One hundred fifty questionnaires were distributed via Google Forms to the respondents, and
only 120 were returned.

4. Results

Data were analyzed using SPSS version 26.0. Most of the respondents were female, in semester five from the
Faculty of Business and Management, aged 18-23 years old and staying in the college residency. The results are
presented in Table 1.

Table 1: Demographic Profile of the Respondents

Variable Frequency Percentage (%)
Gender
Male 29 24.2
Female 91 75.8
Semester
1 20 16.7
2 14 11.7
3 10 8.3
4 14 11.7
5 50 41.7
6 8 6.7
7 4 3.3
8 20 16.7
Faculty
Faculty of Business and Management 92 76.7
Faculty of Hotel and Tourism Management 7 5.8

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Faculty of Accountancy 3 2.5

Faculty of Health Science 6 5.0
Faculty of Education 8 6.7
Faculty of Pharmacy 2 1.7
Kolej Pengajian Alam Bina 1 0.8
Kolej Pengajian Seni Kreatif 1 0.8
Age
18 - 23 years old 89 74.2
24 - 29 years old 30 25.0
30 years old and above 1 0.8
Type of Residency
College 95 79.2
Non - resident 25 20.8

Table 2 below presents the descriptive statistics results of the study, including mean, standard deviation,
skewness, kurtosis and Cronbach's alpha value. The normality test was run to determine the distribution's
shape. The assumptions were tested by running the descriptive statistics, and the Skewness and Kurtosis
results were presented. The normality test shows that the data was generally distributed since the value of the
skewness and kurtosis was ±3 for each variable (Ng & Coakes, 2013). In this study, reliability analysis was
performed by computing Cronbach's alpha values for each variable. The findings revealed that the scale has
good internal consistency.

Table 2: Descriptive Statistics

Variable Mean SD Skewness Kurtosis No of Item Cronbach Alpha
Tangible 3.885 0.764 -0.661 1.126 6 0.912
Reliability 3.892 0.814 -0.715 0.829 7 0.949
Responsiveness 3.892 0.814 -0.670 0.719 7 0.937
Assurance 4.063 0.790 -0.898 1.084 5 0.953
Empathy 3.968 0.834 -0.770 0.585 6 0.951
Patient Satisfaction 4.019 0.830 -0.812 0.613 6 0.954

The association between the independent and dependent variables (patient satisfaction) was investigated
using the Pearson product-moment correlation coefficient. Preliminary analyses were performed to ensure no
normality, linearity and homoscedasticity assumptions were violated. The findings revealed a strong positive
correlation between all independent and dependent variables. A summary of the correlation result is
presented in Table 3.

Table 3: Pearson correlation coefficient

1 2 3 4 5 6
Tangible 1
Reliability .906** 1
Responsiveness .906** 1.000** 1
Assurance .822** .898** .898** 1
Empathy .829** .896** .896** .914** 1
Patient Satisfaction .865 ** .897** .897** .885** .899** 1

Multiple regression analysis was used to measure the relationship between the variables. This multiple
regression addressed which variable in a set of independent variables can be considered the best predictor or
most significant factor influencing the dependent variable. Table 4 shows the results of the multiple regression

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analysis conducted in this study. The result shows no collinearity problem as the value of the VIF was less than
ten, and the tolerance value was below 1.0, given from the three independent variables. The R2 value of 0.871
indicates that 87.1 percent of the variation in the dependent variable is explained by the independent variables.
Another 12. percent of the variance in patient satisfaction was explained by other factors. The F-test is
significant at the p-value <0.05 (0.000); therefore, the linear model is valid overall.

Table 4: Multiple Regression

Standardized T sig Lower Upper Tolerance VIF
Coefficients CI CI
(Beta)
Tangible 0.223 2.670 0.009 0.063 0.423 0.162 6.168
Reliability 0.120 1.360 0.177 -0.053 0.288 0.146 6.835
Responsiveness 0.190 2.092 0.039 0.011 0.405 0.137 7.310
Assurance 0.159 1.681 0.095 -0.030 0.365 0.126 7.935
Empathy 0.096 3.041 0.003 0.102 0.483 0.121 8.239
R2 0.871
Adjusted R2 0.865
F change 153.555
Sig F Change 0.000

As specified in Table 4, the result from multiple regression analysis revealed no significant relationship
between reliability and patient satisfaction (β=0.120, p>0.05) and assurance and patient satisfaction (β=0.159,
p>0.05). However, this study indicated a significant relationship between tangible (β=0.223, p<0.05),
responsiveness (β=0.190, p<0.05) and empathy (β=0.096, p>0.05). Table 5 shows the results of the
summarised hypotheses of this study.

Table 5: Summary of Hypotheses

Hypotheses Results
H1: There is a significant relationship between tangible and patient satisfaction. Supported
H2: There is a significant relationship between reliability and patient satisfaction. Rejected
H3: There is a significant relationship between responsiveness and patient satisfaction. Supported
H4: There is a significant relationship between assurance and patient satisfaction. Rejected
H5: There is a significant relationship between empathy and patient satisfaction. Supported

Discussion
Tangible elements such as the physical environment, equipment quality, staff appearance, and overall
ambiance are integral to patient satisfaction. Tangible forms the first impression of a healthcare facility and can
substantially impact a patient's overall experience. The findings revealed a positive relationship between
tangible and patient satisfaction. The finding observed in this study mirrors those of previous studies, which
show that tangibles significantly influence patient satisfaction (Purwanti et al., 2019; Koampa et al., 2023;
Zuriati & Chiew, 2020; Abdullah et al., 2022; Fadila et al., 2022; AlOmari & Hamid, 2022; Jha et al., 2020). There
are several possible explanations for this. First, when patients perceive the physical environment as clean, well-
maintained, and modern, their satisfaction levels tend to increase. Second, adequate facilities, such as waiting
areas and examination rooms, contribute to a positive patient experience. This strong relationship highlights
that patients' perceptions of tangible factors can significantly shape their overall satisfaction with healthcare
services, making it a critical area for continuous improvement and investment. Improvements in these areas
can lead to higher satisfaction as patients associate their experiences with the quality of care.

Reliability is a service provider's ability to consistently and accurately deliver promised healthcare services.
This dimension is critical for fostering patient trust and satisfaction. Key components of reliability encompass
timely and accurate diagnoses, consistent treatment outcomes, and effective communication, which
significantly shape the overall patient experience. Our study examined the reliability dimension and
surprisingly found that reliability is not a significant predictor of patient satisfaction. However, this result has
not been previously described (Smith et al., 2020; Abdullah et al., 2022; Jordan et al., 2022; Endeshaw, 2020;

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Zuriati & Chiew, 2020). The demographic characteristics of the respondents might influence a possible
explanation for this. Their age and healthcare experience may influence their perception of reliability and
satisfaction. Additionally, the context of a university health center, often characterized by limited resources and
staff, can impact service delivery and, consequently, patient perceptions of reliability and satisfaction. To
further enhance reliability in healthcare settings, it is recommended that regular staff training be provided and
a comprehensive feedback mechanism be implemented to improve service quality. Implementing strategies
that enhance reliability can lead to improved patient satisfaction outcomes. As reliable healthcare services
foster greater patient trust, satisfaction, and loyalty, healthcare providers must prioritize enhancing reliability
in their service delivery.

Responsiveness, encompassing aspects such as timely care, effective communication, and attentiveness to
patient needs, emerges as a critical determinant of patient satisfaction in healthcare settings. The findings show
a positive significant relationship between responsiveness and patient satisfaction. This result generally
replicates that of past research (Ugwu et al., 2022; Kaur et al., 2022; Li et al., 2023; Abdullah et al., 2022). The
analysis highlights the importance of healthcare providers and staff being responsive to patient concerns and
needs, as it directly influences overall satisfaction levels and perceived quality of care. This may be explained
by the fact that when patients feel their healthcare providers are responsive, they are more likely to trust and
adhere to medical advice, further reinforcing the positive relationship. Thus, healthcare institutions aiming to
improve patient satisfaction should prioritize improving responsiveness to patient needs. It is recommended
that university healthcare centers prioritize and enhance their responsiveness strategies to foster better
patient satisfaction outcomes. Research by Smith et al. (2020) highlights several practical approaches,
including improving staff communication skills, optimizing appointment scheduling processes to minimize
waiting times and implementing systems to promptly resolve patient queries and concerns. These strategies
improve patient experience, operational efficiency, and quality of healthcare service. Furthermore, cultivating
a patient-centered culture in which responsiveness is ingrained as a core value among healthcare providers
and staff can significantly improve patient satisfaction metrics. Continuous monitoring and feedback
mechanisms should be implemented to gauge responsiveness levels and identify areas for improvement,
ensuring ongoing enhancement of patient satisfaction in university healthcare settings.

Assurance encompasses aspects such as the competence of healthcare providers, their ability to instill
confidence and trust, and the clarity of communication about medical procedures and diagnoses. According to
the findings, assurance is not a significant predictor of patient satisfaction. However, the current study's
findings do not support the previous research. The studies conducted by Laela et al. in 2022, Abdullah et al. in
2022, and Smith et al. in 2021 do not support the current findings. A possible explanation for the finding might
be due to the environment of a university health center, as healthcare centers often operate with limited
resources and staff, which may affect the ability of healthcare providers to instill confidence in their patients.
If students experience long wait times or feel that their concerns must be adequately addressed, this can
diminish the perceived importance of assurance in their overall satisfaction. This highlights the importance of
healthcare providers ensuring clear communication, competence in medical care, and demonstrating empathy
towards patients to improve overall satisfaction levels. Implementing strategies to enhance assurance can lead
to improvements and outcomes, reinforcing the critical role of healthcare quality assurance in patient-centered
care (Smith et al., 2021). By focusing on factors such as staff competence, communication, and the ability to
inspire trust, healthcare providers can enhance the overall satisfaction levels of their student patients.
Understanding the importance of assurance in this context can help healthcare professionals tailor their
services better to meet university students' needs and expectations.

Empathy involves understanding and sharing another person's feelings, translating to providers listening
attentively, showing concern, and addressing patients' emotional and medical needs (Hojat et al., 2011).
Consistent with the literature on the association between empathy and patient satisfaction (Johnson et al.,
2021; Abdullah et al., 2022; Holmes & Starr, 2022; Rajput et al., 2020; Laela et al., 2020; Haddad et al., 2023),
this study confirms that empathic care by healthcare providers influenced patient satisfaction, which is an
important outcome measure for healthcare quality. Patients who perceive their providers as empathetic are
more likely to report positive experiences and outcomes, including increased trust, better adherence to
treatment plans, and overall satisfaction with their healthcare encounters (Johnson et al., 2031; Derksen et al.,
2013; Kim et al., 2017). Fostering empathy among healthcare professionals is crucial for enhancing patient

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satisfaction and improving the overall quality of healthcare delivery. Therefore, strategies that enhance
empathy in university healthcare centers should be implemented to improve patient satisfaction levels further.
The recommendations include providing healthcare workers with ongoing empathy training to help them
develop their interpersonal skills, implementing patient feedback mechanisms to regularly assess and improve
empathetic communication, and cultivating a culture of compassionate care by encouraging policies and
procedures. These programs are essential to developing a compassionate healthcare environment that
enhances patient happiness and experiences.

5. Managerial Implications and Recommendations

The managerial implications of research on patient satisfaction are profound for enhancing healthcare services
and the overall performance of healthcare organizations. By identifying the primary determinants of patient
satisfaction, providers at university health centers can optimize resource allocation, thereby improving patient
experiences and satisfaction levels. Moreover, the insights derived from such research can serve as strategic
guidelines for university healthcare centers, particularly regarding quality improvement initiatives, promoting
patient-centered care, and implementing staff engagement training programs.

The findings enrich the existing literature on healthcare service quality and patient satisfaction and provide a
nuanced understanding of the interplay between these elements within the specific context of university health
centers. This research contributes to establishing best practices in healthcare management and lays a
foundation for future inquiries into this critical area. The emphasis on patient satisfaction as a key performance
indicator underscores its significance in fostering patient loyalty and enhancing the reputation of healthcare
institutions. As healthcare environments become increasingly competitive, measuring and responding to
patient satisfaction will be crucial for healthcare organizations' long-term success and sustainability.

To fully understand the dynamics of patient satisfaction among university students, further research is needed
to investigate additional factors that may influence their experiences, including trust and patient-centered care.
Trust plays a crucial role in shaping students' perceptions of service quality. Establishing a trusting relationship
between healthcare providers and students can significantly enhance satisfaction. A patient-centered approach
where individual needs and preferences are prioritized can also lead to more positive outcomes. Engaging
students in their care and actively respecting their unique circumstances fosters a sense of ownership and
satisfaction. Future studies should also consider assessing patient satisfaction across different campuses. This
comparative analysis can provide valuable insights into how varying service quality and institutional practices
impact student experiences. By examining satisfaction levels in diverse settings, researchers can identify best
practices and areas for improvement, ultimately contributing to enhanced service quality and student well-
being. Future research can inform strategies to improve healthcare services and enhance student satisfaction
outcomes.

Conclusion
The research findings underscore the critical relationship between service quality dimensions and patient
satisfaction within university health centers, particularly at UiTM Puncak Alam Campus. The study identifies
tangible aspects, responsiveness, and empathy as significant predictors of patient satisfaction. This indicates
that the physical environment of the health center, the staff's willingness to assist patients, and the
compassionate demeanor of healthcare providers are pivotal in shaping patient experiences. Given the
increasing importance of patient satisfaction as a critical performance metric in healthcare, these insights are
particularly relevant for university health management. Enhancing service quality improves patient outcomes
and influences healthcare institutions' overall reputation and financial viability. The findings suggest that
university health centers should enhance their healthcare facilities and staff training programs to foster a more
supportive and effective patient care environment. While this study primarily focuses on assessing the service
quality of the university health center, it does not explicitly compare these services to those offered by external
healthcare providers. However, valuable insights can be drawn by examining service quality across various
universities and healthcare settings. In conclusion, this research highlights the necessity for university health
centers to adopt a proactive approach in addressing the identified service quality dimensions. These
institutions can significantly enhance patient satisfaction by investing in tangible improvements and fostering
a culture of responsiveness and empathy among healthcare providers. This, in turn, will lead to better health

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outcomes, increased patient loyalty, and a stronger competitive position in the healthcare market.

Acknowledgment: We thank the Faculty of Business and Management, Universiti Teknologi MARA, for
supporting the research.

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