The Impact of Facility Size on Patient Loyalty

by Rick Blizzard, D.B.A.
Health and Healthcare Editor

Third in a series of articles examining the effects of hospital size on patient attitudes.

The first two articles in this series examined the impact of facility size on patient trust and patient satisfaction. Patient trust and satisfaction are the key determinants of patient loyalty, defined as the likelihood of a patient to use a facility again if medical services are needed. Gallup has found patient loyalty to be the best predictor of financial performance at hospitals.

Patient trust and patient satisfaction scores often vary in opposite directions by facility size. It's partly because of this tendency that when we examine patient loyalty scores, we find less variability by facility size than for either patient trust or patient satisfaction scores alone.

Outpatient Test and Treatment Services

Examining specific service sectors offers some interesting comparisons among patient loyalty scores. When we previously looked at patient trust and satisfaction measures, we saw that outpatient test and treatment services showed the least amount of variability by facility size. With regard to loyalty, however, this sector shows the most direct variability by facility size.

In other words, the larger the facility, the more likely patients are to return for future outpatient test and treatment services. This may seem counterintuitive -- wouldn't smaller facilities be more likely to offer greater convenience for outpatients? If so, that factor may be countered by the likelihood of larger facilities to offer more sophisticated technology and the capability of performing specialized tests.

Inpatient Services

As illustrated below, patients are most likely to return for inpatient services at hospitals with 100 beds or fewer, or 400 beds or more.

Patient trust scores follow a similar trend (see Related Items). Small facilities score higher than other facilities on inpatient satisfaction (since they tend to position themselves as "high touch"), making small facility patients more likely to return. For large facilities, patient trust is high, although patient satisfaction is lower than for smaller facilities. It appears that patients are more likely to return to larger facilities because of their confidence in the quality of care available (the result of "high tech" positioning).

Emergency Department

In general, emergency departments are where patient trust and satisfaction levels are most likely to vary by facility size. This does not hold as true for patient loyalty.

One could argue that loyalty scores are less relevant to emergency departments because of the importance of geographic convenience in selecting one. However, as in the cases of patient trust and satisfaction, the highest loyalty occurs in hospitals with between 201 and 299 beds. This trend may suggest that patients may feel medium-sized facilities can offer the best "trade-off" between speed of service and sophistication of technology.

Outpatient Surgery Services

For outpatient surgery services, small facilities score higher on both patient trust and satisfaction measures, but when it comes to patient loyalty scores, there is no difference among facility sizes.

It seems that other factors are intervening in patients' likelihood to return to outpatient surgery facilities. Certainly, geographic convenience and the likelihood of a patient's surgeon to select the facility both play major roles. Furthermore, both trust and satisfaction tend to be very high in outpatient surgery settings. Despite some variation in trust and satisfaction by facility size, overall scores may be high enough to generate equal patient loyalty across facility sizes.

The most intriguing variations in trust, satisfaction, and loyalty by facility size are found in the emergency department. Next week's article will examine the causes of these variations.

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