Abstract
This study investigates the development of patient loyalty by applying the four stages of the loyalty model within the context of Indonesia, a developing country. It examines the influence of service quality on patient satisfaction, as well as the subsequent impact of satisfaction on trust, commitment, and behavioral intention. Additionally, the study explores the mediating roles of trust and commitment in shaping patients' behavioral intentions toward loyalty. Data were collected through an online questionnaire using purposive sampling from 212 individuals who had been hospitalized for at least two days and subsequently discharged. The data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with the assistance of SmartPLS 4 software. The results indicate that both the physical environment and personnel quality significantly and positively affect patient satisfaction. In contrast, the technical quality dimension failed to meet validity and reliability standards due to its conceptual overlap with the other two dimensions. Patient satisfaction was found to significantly enhance both trust and commitment, which, in turn, positively mediate the relationship between satisfaction and behavioral intention. This study contributes to the advancement of loyalty theory within healthcare services, particularly in the context of developing countries like Indonesia. It also offers empirical insights from Greater Jakarta, identifying key factors that influence patient loyalty in private hospitals. These findings not only extend existing loyalty models but also provide practical guidance for hospital management and policymakers seeking to improve patient retention in urban healthcare environments.