The Role of Communication and Empathy in Building Emergency Patient Loyalty: A Mediation Study of Doctor-Patient Relationships
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Aug 27, 2025
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Abstract
The Emergency Department (ER) plays a central role as the first point of contact for critically ill patients, shaping their initial perceptions of hospital service quality. This study investigated the impact of communication and empathy demonstrated by ER doctors at Cideres Regional Hospital, Majalengka, on patient loyalty, with the doctor-patient relationship as a mediating variable. Using an exploratory quantitative approach, this study aimed to identify the relationship between variables. The number of samples obtained in this study meets the minimum required number of samples, and the validity test of the instrument data uses the Pearson correlation method and the reliability test uses the Cronbach's Alpha test. The Sobel test was used in the mediation approach and the t-test for the influence approach. The results showed that all data instruments passed the validity and reliability tests, and all research hypotheses were accepted. It was found that doctor communication and empathy, both directly and mediated by the doctor-patient relationship, positively and significantly increased ER patient loyalty. Empathy was identified as the dominant variable. Increased positive patient perceptions of empathetic behavior of health workers or doctors significantly correlated with increased ER patient loyalty at Cideres Regional Hospital. These findings underscore the importance of healthcare workers, particularly doctors, demonstrating a high level of empathy and effective communication when providing services in the ER.
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References
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Ettinger, A., Grabner-Kräuter, S., Okazaki, S., & Terlutter, R. (2021). The Desirability of CSR Communication versus Greenhushing in the Hospitality Industry: The Customers’ Perspective. Journal of Travel Research, 60(3), 618–638. https://doi.org/10.1177/0047287520930087
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Giovaningrum, P., & Fristasya, A. (2020). Pengaruh Kualitas Pelayanan Terhadap Kepuasan Dan Loyalitas Pasien Rawat Jalan. Journal of Hospital Administration and Management, 1(2), 33–35. https://doi.org/10.54973/jham.v1i2.216
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Nasiri, M., Amini, M., Mani, A., Delavari, S., Kiani, M., Sagheb, M., & Tabari, P. (2021). Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy. Journal of Education and Health Promotion, 10(1), 1–6. https://doi.org/10.4103/jehp.jehp_1539_20
Nurmaliyati, N., Anwar, S., & Chairani, R. (2022). Analisis Hubungan Empati, Caring dan Komunikasi Perawat Dengan Kepuasan Keluarga Terhadap Pelayanan Keperawatan Anak Thalasemia di Wilayah Kabupaten Bekasi. Jurnal Ilmiah Kesehatan, 14(1), 81–95. https://doi.org/10.37012/jik.v14i1.408
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Permatasari, D. (2020). Konseling Kelompok Analisis Transaksional dalam Meningkatkan Keterampilan Komunikasi Interpersonal Mahasiswa. SCHOULID: Indonesian Journal of School Counseling, 5(1), 1–11. https://doi.org/10.23916/08445011
Pertiwi, M. R., Annalia, W., Raziansyah, Lucia, F., Annisa, F., Yohana, S., Dely, M., Widya, A., Ikhsan, F., & Arniati. (2022). Komunikasi terapeutik dalam kesehatan.
Prathama, C. I., & Soelaiman, L. (2023). Faktor-Faktor yang Mempengaruhi Loyalitas Sikap dan Loyalitas Perilaku Konsumen Kaos Rockstereo. Jurnal Manajerial Dan Kewirausahaan, 5(1). https://doi.org/10.24912/jmk.v5i1.22559
Rahmadianti. (2020). Analisis Faktor-Faktor Kualitas Pelayanan Terhadap Kepuasan Pasien Rawat Inap Di Rumah Sakit Al-Islam Bandung. JSMA (Jurnal Sains Manajemen Dan Akuntansi), 12(2), 77–85. https://doi.org/10.37151/jsma.v12i2.52
Rambe, E., Utami, T. N., & -, J. (2022). Efektifitas Komunikasi Dokter Terhadap Kepuasan Pasien Rawat Jalan Di Rsu Imelda Pekerja Indonesia Kota Medan. Jurnal Kesmas Prima Indonesia, 3(1), 22–30. https://doi.org/10.34012/jkpi.v3i1.1769
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Segura, L., Estévez, J. F., & Estévez, E. (2020). Empathy and emotional intelligence in adolescent cyberaggressors and cybervictims. International Journal of Environmental Research and Public Health, 17(13), 1–14. https://doi.org/10.3390/ijerph17134681
Suhayat, J., Suwatno, S., & Buchdadi, A. D. (2023). Pengaruh Iklim Organisasi Terhadap Kinerja Guru Berdasarkan Persepsi Kepala Sekolah. Journal of Accounting, Management, Economics, and Business (ANALYSIS), 1(1). https://doi.org/10.56855/analysis.v1i1.179
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Titin Hargyatni, Kusna Djati Purnama, Danang Wiratnoko, Robby Andika Kusumajaya, & Sri Handoko. (2022). The Framework of Customer Engagement on Customer Satisfaction : The Antecedents and Consequences. Journal of Management and Informatics, 1(1), 21–34. https://doi.org/10.51903/jmi.v1i1.146
Ubab, A. J. (2022). Penerapan Tafsir Ekologis Dalam Usaha Merawat Lingkungan Pesantren. The International Journal of Pegon : Islam Nusantara Civilization, 8(02), 93–106. https://doi.org/10.51925/inc.v8i02.69
Wang, Y., Wu, Q., Wang, Y., & Wang, P. (2022). The Effects of Physicians’ Communication and Empathy Ability on Physician–Patient Relationship from Physicians’ and Patients’ Perspectives. Journal of Clinical Psychology in Medical Settings, 29(4), 849–860. https://doi.org/10.1007/s10880-022-09844-1
Wardiati, D., Zulkarnain, & Widiyatsari, A. (2020). Pengaruh Kualitas Pelayanan Terhadap Kepuasan Dan Loyalitas Pasien Pada Instalasi Rawat Inap Di Rsud Indrasari Rengat. Jurnal Economica, 8(1). https://doi.org/10.46750/economica.v8i1.27
Zakaria, M., Mazumder, S., Faisal, H. M., Zannat, R., Haque, M. R., Afrin, T., Cheng, F., & Xu, J. (2024). Physician Communication Behaviors on Patient Satisfaction in Primary Care Medical Settings in Bangladesh. Journal of Primary Care and Community Health, 15, 1–12. https://doi.org/10.1177/21501319241277396
Addo, A. A., Wang, W., Dankyi, A. B., Abban, O. J., & Bentum-Micah, G. (2020). The Mediating Role of Patient Satisfaction in the Relationship between Quality of Doctor Services and Patient Loyalty: Empirical Evidence from the Health Sector of Ghana. Saudi Journal of Business and Management Studies, 05(02), 154–163. https://doi.org/10.36348/sjbms.2020.v05i02.007
Bahadur, W., Khan, A. N., Ali, A., & Usman, M. (2020). Investigating the Effect of Employee Empathy on Service Loyalty: The Mediating Role of Trust in and Satisfaction with a Service Employee. Journal of Relationship Marketing, 19(3), 229–252. https://doi.org/10.1080/15332667.2019.1688598
Chowdhury, S., & Chakraborty, P. pratim. (2017). Universal health coverage ‑ There is more to it than meets the eye. Journal of Family Medicine and Primary Care, 6(2), 169–170. https://doi.org/10.4103/jfmpc.jfmpc
Crothers, C., Bornmann, L., & Haunschild, R. (2020). Citation concept analysis (Cca) of robert k. merton’s book social theory and social structure: How often are certain concepts from the book cited in subsequent publications? Quantitative Science Studies, 1(2). https://doi.org/10.1162/qss_a_00029
Dian Agustina Saputri, Yuni Istanto, & Wisnalmawati Wisnalmawati. (2024). The effect of service quality on customer loyalty through satisfaction and trust as mediators (survey of nail art brand customers “it’s rare” Yogyakarta). World Journal of Advanced Research and Reviews, 22(2), 2138–2151. https://doi.org/10.30574/wjarr.2024.22.2.1630
Dubey, U. K. B., & Kothari, D. P. (2022). Research Methodology : Techniques and Trends Umesh (1st ed.). CRC Press.
Ettinger, A., Grabner-Kräuter, S., Okazaki, S., & Terlutter, R. (2021). The Desirability of CSR Communication versus Greenhushing in the Hospitality Industry: The Customers’ Perspective. Journal of Travel Research, 60(3), 618–638. https://doi.org/10.1177/0047287520930087
Fauziyah, N. L. L., Prayoga, D., Gerry, M., & Mahendra, M. G. D. (2022). Faktor Yang Mempengaruhi Kepuasan Dan Loyalitas Pasien Rumah Sakit : Literature Review. Jurnal Kesehatan Masyarakat, 6(3), 1881–1889.
Giovaningrum, P., & Fristasya, A. (2020). Pengaruh Kualitas Pelayanan Terhadap Kepuasan Dan Loyalitas Pasien Rawat Jalan. Journal of Hospital Administration and Management, 1(2), 33–35. https://doi.org/10.54973/jham.v1i2.216
Hariputra, R. P., Defit, S., & Sumijan. (2022). Analisis Sistem Antrian dalam Meningkatkan Efektivitas Pelayanan Menggunakan Metode Accidental Sampling. Jurnal Sistim Informasi Dan Teknologi. https://doi.org/10.37034/jsisfotek.v4i2.127
Hidayat, M. (2024). The Influence of Entrepreneurial Leadership on Innovativeness Mediated by Digital Leadership. Almana : Jurnal Manajemen Dan Bisnis, 8(2), 376–386. https://doi.org/10.36555/almana.v8i2.2620
Indah Wahyu Putri, F., & Surianto, M. A. (2022). Strategi Mengelola Hubungan Pelanggan Pada Kajian Business To Business PT Wakabe Indonesia. Jurnal Indonesia Sosial Sains, 3(1), 44–56. https://doi.org/10.36418/jiss.v3i1.501
Jain, V., Mogaji, E., Sharma, H., & Babbili, A. S. (2024). A multi-stakeholder perspective of relationship marketing in higher education institutions. In Journal of Marketing for Higher Education (Vol. 34, Issue 2). https://doi.org/10.1080/08841241.2022.2034201
Keelson, S. A., Addo, J. O., & Amoah, J. (2024). The impact of patient engagement on service quality and customer well-being: an introspective analysis from the healthcare providers’ perspective. Cogent Public Health, 11(1), 1–12. https://doi.org/10.1080/27707571.2024.2340157
Kotler, P., Armstrong, G., & Balasubramanian, S. (2023). Principles of Marketing. In Pearson.
Kotler, P., Keller, K. L., & Alexander Chernev. (2023). Marketing Managemen (16th ed.). Pearson.
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. In BMC Nursing (Vol. 20, Issue 1, pp. 1–10). https://doi.org/10.1186/s12912-021-00684-2
Levy, S. (2022). Brand bank attachment to loyalty in digital banking services: mediated by psychological engagement with service platforms and moderated by platform types. International Journal of Bank Marketing, 40(4). https://doi.org/10.1108/IJBM-08-2021-0383
Lu, R., Zhao, S., Wang, X., Zhou, J., Ou, W., Jiang, Y., Wen, J., & Hu, L. (2023). Insights Into the Relationships Between Health Communication and Doctor-patient Relationship: A Scientometric Analysis Based on CiteSpace and Validation of Questionnaires. Inquiry (United States), 60, 1–20. https://doi.org/10.1177/00469580231152071
Nasiri, M., Amini, M., Mani, A., Delavari, S., Kiani, M., Sagheb, M., & Tabari, P. (2021). Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy. Journal of Education and Health Promotion, 10(1), 1–6. https://doi.org/10.4103/jehp.jehp_1539_20
Nurmaliyati, N., Anwar, S., & Chairani, R. (2022). Analisis Hubungan Empati, Caring dan Komunikasi Perawat Dengan Kepuasan Keluarga Terhadap Pelayanan Keperawatan Anak Thalasemia di Wilayah Kabupaten Bekasi. Jurnal Ilmiah Kesehatan, 14(1), 81–95. https://doi.org/10.37012/jik.v14i1.408
Nyan, L. M., Rockson, S. B., & Addo, P. K. (2020). The Mediation Effect of Customer Satisfaction on the Relationship Between Service Quality and Customer Loyalty. Journal of Management and Strategy, 11(3), 13. https://doi.org/10.5430/jms.v11n3p13
Perez Benegas, J. Y., & Zanfardini, M. (2025). Customer engagement and loyalty: the moderating role of involvement. European Journal of Management and Business Economics, 34(3), 319–339. https://doi.org/10.1108/EJMBE-03-2022-0074
Permatasari, D. (2020). Konseling Kelompok Analisis Transaksional dalam Meningkatkan Keterampilan Komunikasi Interpersonal Mahasiswa. SCHOULID: Indonesian Journal of School Counseling, 5(1), 1–11. https://doi.org/10.23916/08445011
Pertiwi, M. R., Annalia, W., Raziansyah, Lucia, F., Annisa, F., Yohana, S., Dely, M., Widya, A., Ikhsan, F., & Arniati. (2022). Komunikasi terapeutik dalam kesehatan.
Prathama, C. I., & Soelaiman, L. (2023). Faktor-Faktor yang Mempengaruhi Loyalitas Sikap dan Loyalitas Perilaku Konsumen Kaos Rockstereo. Jurnal Manajerial Dan Kewirausahaan, 5(1). https://doi.org/10.24912/jmk.v5i1.22559
Rahmadianti. (2020). Analisis Faktor-Faktor Kualitas Pelayanan Terhadap Kepuasan Pasien Rawat Inap Di Rumah Sakit Al-Islam Bandung. JSMA (Jurnal Sains Manajemen Dan Akuntansi), 12(2), 77–85. https://doi.org/10.37151/jsma.v12i2.52
Rambe, E., Utami, T. N., & -, J. (2022). Efektifitas Komunikasi Dokter Terhadap Kepuasan Pasien Rawat Jalan Di Rsu Imelda Pekerja Indonesia Kota Medan. Jurnal Kesmas Prima Indonesia, 3(1), 22–30. https://doi.org/10.34012/jkpi.v3i1.1769
RSUD Cideres. (2022). Tingkat Kepuasan Masyarakat dan Staf pada Unit Pelayanan Rumah Sakit Umum Daerah (RSUD) Cideres Kabupaten Majalengka Tahun 2021.
RSUD Cideres. (2023). Indeks Kepuasan Pasien Unit Pelayanan RSUD Cideres Tahun 2023 Periode Semester 1.
Sari, N. P., Artha, B., & Hadi, A. S. (2023). Brand Loyalty: A Literature Review. International Journal of Economics, Business and Accounting Research, 7(1), 66–75.
Segura, L., Estévez, J. F., & Estévez, E. (2020). Empathy and emotional intelligence in adolescent cyberaggressors and cybervictims. International Journal of Environmental Research and Public Health, 17(13), 1–14. https://doi.org/10.3390/ijerph17134681
Suhayat, J., Suwatno, S., & Buchdadi, A. D. (2023). Pengaruh Iklim Organisasi Terhadap Kinerja Guru Berdasarkan Persepsi Kepala Sekolah. Journal of Accounting, Management, Economics, and Business (ANALYSIS), 1(1). https://doi.org/10.56855/analysis.v1i1.179
Sunaryo, A., Amrulloh, M., & Wibisono, B. (2021). Hubungan Antara Komunikasi Efektif Dokter Dengan Pasien Dan Kualitas Pelayanan Kesehatan Terhadap Kepuasan Pasien Study : Di Poliklinik Penyakit Dalam Rsud Waled. Tunas Medika Jurna Kedokteran & Kesehatan, 7(1).
Titin Hargyatni, Kusna Djati Purnama, Danang Wiratnoko, Robby Andika Kusumajaya, & Sri Handoko. (2022). The Framework of Customer Engagement on Customer Satisfaction : The Antecedents and Consequences. Journal of Management and Informatics, 1(1), 21–34. https://doi.org/10.51903/jmi.v1i1.146
Ubab, A. J. (2022). Penerapan Tafsir Ekologis Dalam Usaha Merawat Lingkungan Pesantren. The International Journal of Pegon : Islam Nusantara Civilization, 8(02), 93–106. https://doi.org/10.51925/inc.v8i02.69
Wang, Y., Wu, Q., Wang, Y., & Wang, P. (2022). The Effects of Physicians’ Communication and Empathy Ability on Physician–Patient Relationship from Physicians’ and Patients’ Perspectives. Journal of Clinical Psychology in Medical Settings, 29(4), 849–860. https://doi.org/10.1007/s10880-022-09844-1
Wardiati, D., Zulkarnain, & Widiyatsari, A. (2020). Pengaruh Kualitas Pelayanan Terhadap Kepuasan Dan Loyalitas Pasien Pada Instalasi Rawat Inap Di Rsud Indrasari Rengat. Jurnal Economica, 8(1). https://doi.org/10.46750/economica.v8i1.27
Zakaria, M., Mazumder, S., Faisal, H. M., Zannat, R., Haque, M. R., Afrin, T., Cheng, F., & Xu, J. (2024). Physician Communication Behaviors on Patient Satisfaction in Primary Care Medical Settings in Bangladesh. Journal of Primary Care and Community Health, 15, 1–12. https://doi.org/10.1177/21501319241277396