Determinants of patient satisfaction in the emergency department: A Structural Equation Modeling–Partial Least Squares (SEM-PLS) analysis

Abstract

Background: Patient satisfaction is an important indicator of hospital service quality. In emergency departments (EDs), patient experiences occur under high urgency and uncertainty. At Lahat Regional General Hospital, quality indicators have shown favorable performance, while complaints remain related to waiting time, staff communication, service certainty, and facility comfort, suggesting a gap between internal quality indicators and users’ experiences.

Objective: To analyze the associations of demographic characteristics and SERVQUAL dimensions on patient satisfaction in the Emergency Department of Lahat Regional General Hospital.

Methods: A quantitative cross-sectional study was conducted in the Emergency Department of Lahat Regional General Hospital from March to May 2026. A total of 395 adult patients were recruited using convenience sampling after completing their ED care and meeting the eligibility criteria. The instrument was a performance-only adaptation of SERVQUAL consisting of 20 service-quality items and 3 satisfaction items. Data were analyzed using SPSS and SmartPLS 4. SEM-PLS assessment included outer loading, AVE, Composite Reliability, Cronbach’s Alpha, Fornell–Larcker, VIF, R², f², Q² Predict, SRMR, and 5,000-subsample bootstrapping.

Results: Tangibles (β=0.230; p<0.001), reliability (β=0.241; p=0.001), assurance (β=0.241; p<0.001), and empathy (β=0.202; p=0.001) were positively and significantly associated with patient satisfaction. Responsiveness (β=0.095; p=0.072), age (β=−0.032; p=0.610), sex (β=−0.026; p=0.672), and education (β=0.149; p=0.069) did not show significant associations. The model yielded R²=0.730, Q² Predict=0.691, and SRMR=0.055. Reliability and assurance had the same highest path coefficient (β=0.241), whereas tangibles had the largest effect size (f²=0.125). Based on the path coefficient, followed by the effect size, reliability was identified as the most dominant factor associated with patient satisfaction.

Conclusion: Patient satisfaction in the Emergency Department was significantly influenced by tangibles, reliability, assurance, and empathy. Reliability was the strongest determinant, indicating that improving service consistency, accuracy, adherence to standard operating procedures, and dependable healthcare delivery should become priorities for quality improvement initiatives.