Abstract
The aim of this study was to investigate the impact of patient satisfaction with a dentist on their loyalty to that dentist in Saudi Ministry of Health dental clinics. Retrospective data were recruited from the patient experience program (Press Ganey Survey) during the first half of 2022. Descriptive statistical analysis, Pearson correlation coefficient (r), and multiple linear regression models were used to assess the impact on loyalty to that dentist. Among the 964 respondents who submitted their responses to the survey, the highest mean satisfaction score was for the item concerning the good listening of the dentist to the patient (3.86 of 5; 77.2%). There was a highly significant correlation between each item related to the dentist and the likelihood of the patient to recommend a certain dentist to others “that is, patient loyalty” (P < .001). The highest predictor of patient loyalty to his dentist was the dentist's explanation of the treatment options to his patient (t: 8.632, P < .001). Dentists have a crucial role to play in boosting patient satisfaction and thereby patient loyalty.
Keywords: patient experience, patient-centered care, patient satisfaction, Saudi Arabia, Press Ganey
Introduction
Every healthcare facility's intrinsic value is determined by the patient in terms of its quality, perfection, institutional integration, and professional work. 1 As the quality of care, professional staff and basic environmental requirements are important contributing factors for better patient compliance and healthier outcomes. Hence, the patient's, healthcare provider's relationship, communication and professionalism are considered as the most important elements that distinguish today's dentists toward better patient's satisfaction levels. 2 Loyalty is the process of keeping the patient as long as possible. 3 Loyalty refers to a commitment to repurchase or patronize a preferred product or service in the future. 4
A patient's potential to return is known as their behavioral intention. It is a relatively accurate predictor of future patient's intent and behavior to return back and visit the same dentist. Hence, Loyalty is demonstrated by returning to the distributor and recommending intention.5–7 Loyal patients not only make repeated visits, but can also influence their friends, relatives, and other community groups, although they may not necessarily become repeat visitors. 8
Numerous research studies have established an association between patient experience and health service provider loyalty throughout the years. 9 Several studies argue that patient satisfaction is necessary to earn their loyalty.9–11 Because of the great interest of the Saudi Arabian health administration of providing healthy life to the Saudi population as one of the Sustainable Development Goals. Hence, the importance of the patient experience as a quality indicator of the healthcare service provided to the population. Moreover, to the best of our knowledge, no previous research has been held in Saudi Arabia concerning patient loyalty to dental healthcare providers. So, we conducted the current research to investigate the impact of patient satisfaction scores with certain dental healthcare providers on their loyalty to those dentists in Saudi Ministry of Health dental clinics.
Methods
The patient experience program in the Saudi Ministry of Health (MOH) uses a survey designed and administered by Health.Links/Press Ganey. The Press Ganey Survey questionnaire is a standardized self-administered questionnaire used to determine patient experience with healthcare services provided by different specialties, including dental services. The survey is usually shared with patients through their registered mobile phones within a couple of days after their visit to the dental clinic, inviting them to participate by providing feedback after explaining the survey objectives and ensuring them of the confidentiality of the information they will provide through the questionnaire. Questions are written in both Arabic and English languages.
This study recruited retrospective data from the patient experience program. The data concerned Saudi patients who visited all MOH specialized dental clinics (n = 29) throughout the Kingdom of Saudi Arabia during the first half of 2022.
The dental healthcare provider section (dentist domain) of the Press Ganey questionnaire consists of 5 questions (items) included in the dentist domain. The fifth question is about the likelihood that the patient will recommend their dentist to others.
The questionnaire asks patients to rate their experience on a 5-point Likert scale (1, very poor; 2, poor; 3, fair; 4, good; and 5, very good). No questions are mandatory in the Press Ganey questionnaire, so the patient is free to answer the questionnaire completely or partially. We recruited all completed surveys submitted from MOH-specialized dental clinics throughout the Kingdom of Saudi Arabia, while excluding incomplete questionnaires.
Statistical Analyses
Data were managed and edited using Microsoft® Excel® (Microsoft® Office 2016, Microsoft® Corp, Redmond, WA, USA). Statistical analyses were performed using Statistical Package for the Social Sciences (IBM SPSS Statistics 25, Armonk, NY, USA).
Descriptive statistical analysis was carried out to evaluate the section on patient satisfaction with dental healthcare provider (dentist domain) of the Press Ganey questionnaire. Pearson correlation coefficient (r) and multiple linear regression models were used to assess the effect of patient satisfaction with the dental healthcare provider on the loyalty to that dentist (significance at the 0.01 level).
Results
A total of 964 patients, who visited MOH-specialized dental centers, submitted a complete Press Ganey survey during the first half of 2022. The descriptive findings of patient satisfaction with the dentist domain of the Press Ganey survey are presented in Table 1. The highest mean satisfaction score was for the item concerning the good listening of the dentist to the patient (3.86 of 5; 77.2%).
Table 1.
Descriptive Results of Patient Satisfaction With the Dentist Domain of Press Ganey Survey (n = 964).
| Dentist domain items | Very poor [1] N (%) |
Poor [2] N (%) |
Fair [3] N (%) |
Good [4] N (%) |
Very good [5] N (%) |
Mean of satisfaction score (% of 5) |
|---|---|---|---|---|---|---|
| 1. How well the dentist listened to you | 145 (15.0) | 47 (4.9) | 104 (10.8) | 172 (17.9) | 496 (51.5) | 3.86 (77.2%) |
| 2. Explanations the dentist gave you about your problem or condition | 141 (14.6) | 70 (7.3) | 99 (10.3) | 156 (16.1) | 498 (51.7) | 3.83 (76.6%) |
| 3. Dentist's efforts to include you in decisions about your care | 157 (16.3) | 73 (7.6) | 99 (10.3) | 167 (17.4) | 468 (48.5) | 3.74 (74.8%) |
| 4. Explanation of your options for treatment | 167 (17.3) | 68 (7.1) | 118 (12.2) | 143 (14.8) | 468 (48.5) | 3.70 (74%) |
| 5. Likelihood of your recommending this dentist to others | 192 (19.9) | 74 (7.7) | 90 (9.3) | 139 (14.4) | 469 (48.7) | 3.64 (72.8%) |
Table 2 shows the results of the Pearson correlation coefficient (r) analysis between patient satisfaction scores of each item of the dentist domain and loyalty to that dentist. There was a highly significant correlation between each item of the dentist domain (the dentist listens to the patient, the dentist explains the problem to the patient, the dentist's efforts to include the patient in his decisions, the dentist explains the available options of treatment to his patient) and the “likelihood of the patient to recommend a certain dentist to others” (P < .001).
Table 2.
Results of Pearson Correlation Coefficient (r) Analysis Between Patient Satisfaction Mean Scores of Each Item of the Dentist Domain and the Likelihood of Your Recommending This Dentist to Others.
| Dentist domain items | Mean | ±SD | Correlation coefficient | P value |
|---|---|---|---|---|
| How well the dentist listened to you | 3.86 | 1.47 | 0.871** | .000** |
| Explanations the dentist gave you about your problem or condition | 3.83 | 1.48 | 0.866** | .000** |
| Dentist's efforts to include you in decisions about your care | 3.74 | 1.51 | 0.882** | .000** |
| Explanation of your options for treatment | 3.70 | 1.54 | 0.897** | .000** |
**Correlation is significant at the 0.01 level (2-tailed).
Multiple linear regression analysis (Table 3) was conducted to predict the dentist's related determinants of the likelihood of the patient recommending a certain dentist to others (ie, patient's loyalty to a dentist). The highest predictor of patient loyalty to his dentist was the dentist's explanation of the treatment options to his patient (t: 8.632, P < .001). The “dentist's efforts to include the patient in decisions about his care” was not statistically significant as a predictor (t: 2.358, P = .019).
Table 3.
Results of Multiple Linear Regression Analysis for Patient Satisfaction Mean Scores of Each Item of the Dentist Domain, and the Likelihood of Your Recommending This Dentist to Others.
| Predictors | Standard error | Confidence interval (95%) | t | P value | |
|---|---|---|---|---|---|
| Lower bound | Upper bound | ||||
| How well the dentist listened to you | 0.158 | 0.552 | 1.171 | 5.461 | .000** |
| Explanations the dentist gave you about your problem or condition | 0.177 | 0.228 | 0.925 | 3.249 | .001** |
| Dentist's efforts to include you in decisions about your care | 0.188 | 0.074 | 0.813 | 2.358 | .019 |
| Explanation of your options for treatment | 0.164 | 1.097 | 1.743 | 8.632 | .000** |
** Regression is significant at the 0.01 level.
Discussion
The modern patient has a wide range of options due to recent developments in dental care and the numerous specializations that have developed over the years. Hence, it is crucial to understand the criteria a patient uses to select their dental care providers. 12 The selection of a dentist for dental care is affected by a variety of factors and varies depending on the population. 13
One effective way to achieve loyalty is through trust, where trust is patient awareness of the expectations of the service provider's performance based on the experience and confidence embodied in an attitude. Hence, loyalty will be generated by creating trust. 14
The cornerstone of patient loyalty is trust. Certain reassuring traits, like the capacity to listen, a sense of carefulness, and the quality of care, might strengthen trust. Loyalty is both a continuous structure and an interpersonal interaction subjected to varying components. 15
Current work revealed a high prevalence of patient satisfaction with the dentists working in the Saudi Arabian MOH-specialized dental centers, especially regarding dentists who listened well to their patients (77.2%). This satisfaction was followed by patient satisfaction regarding the dentist's explanations of the problem or condition to patients (76.6%). Such findings agreed with those of Fernandez et al, 12 who stated the reputation of the dentist was the main factor in choosing a particular dentist for dental care in different University hospitals in Riyadh, Saudi Arabia. Similarly, Alshareef et al, 16 found that patients appear to be impacted by how dentists interact with them and treat them. Additionally, it has been demonstrated in that study that the way dentists interact with their patients affects how frequently patients visit the dentist, known as patient loyalty. 16
It has been concluded that the development of loyalty is a complicated, and diverse phenomenon. 15 Whether trust is built alone or reinforced by traits like listening skills, thoroughness, and level of care hence, trust is crucial. 15 This is confirmed by the statement of Samohyl et al, 17 “Dental technology, psychosocial elements, and interaction are all part of the multifaceted idea of the quality of communication between dentists and patients.”
In the current research, the correlation between patient satisfaction with the items of the dentist domain in the Press Ganey survey and patient loyalty to a dentist revealed highly significant correlation levels (P < .001) of all items. This finding elucidates the importance of the dentist as the main pillar providing high-quality dental healthcare to patients. Furthermore, many predictors of the patient's likelihood to recommend a dentist to other patients are presented through our results of the multiple linear regression analysis. The explanation of the treatment options to the patient was the most important predictor, followed by how well the dentist listened to the patient (P < 0.001). The previously mentioned predictors suggest a high reputation and trust of Saudi patients toward their dentists.
Our results confirmed the results of Susanti et al, 8 whose data analysis demonstrated that patient loyalty was significantly positively affected by patient satisfaction (P < .001). This implies patient loyalty increases with patient satisfaction and vice versa. One determinant of patient loyalty is his pleasure. 18
The results of this study are in accordance with research conducted by Hasan and Putra, 19 and Lestariningsih et al, 20 who demonstrated there is a strong link between patient loyalty and satisfaction in public hospitals in Indonesia. Establishing a positive relationship between the hospital and the patient supports the patient's decision concerning follow-up visits. Satisfaction can also promote patient loyalty and word-of-mouth referrals that are advantageous to the hospital. Our results showed a very high correlation between the dentists’ personality and attitude toward their patients (P < .001). This result is in agreement with a prior research, which showed a high level of satisfaction that was related to the dentist's personality and consideration for the patient's needs. 21 Also, the study of Balhaddad et al, 22 in a dental college in Dammam, Saudi Arabia, revealed that 85.9% of the patients reported the professionalism of their dental care providers, while 86.6% of the participants in the same study stated their dentists were respectful and caring of their patients’ requirements. Additionally, 86.2% of participants were given a thorough overview of their treatment plans. However, only 6% to 8% of the participants were dissatisfied with the communication of their dentist. 22
Current work revealed that the most important determinants of Saudi patients’ loyalty to their dentists in the MOH sector were the dentist attitude of explaining treatment's options and listening to the patients. While, the lowest determinant was involving the patient in the treatment decision. This is in agreement with the findings of Gerard et al, 15 explored characteristics that build and maintain patients’ loyalty to their doctors in French general practice, where the 2 primary determinants of the overall score in their model were “response to patient inquiries and patient contact time,” and the least reliable indicators were the practitioner's knowledge of the patient's history of illness and the healthcare provider's follow up. 15 These results are corresponded to ours where we proved that, patient loyalty and patient satisfaction are related in that, when clients are satisfied to the fullest extent possible, this results in deep emotional bonds and a long-term commitment to the institution. 23 Besides serving as a key component in determining how well services are evaluated, patient satisfaction serves as an indicator of quality of service by monitoring how patients react after receiving care. 8
Limitations
Despite the fact that the Press Ganey Survey is a patient-reported survey that is commonly used to assess patient satisfaction with healthcare in various nations, there are significant and well-known limits to the use of such data. 24 Nonresponse and incomplete response bias are a couple of these limitations. 25 Additionally, this predesigned standardized survey lacks demographic information such as gender and age that could have an impact on the satisfaction scores. We recommend either adding demographic data to the Press Ganey survey or creating a more comprehensive questionnaire for evaluating patient experience. Moreover, enhancing the responses pathway could be technically achieved and by promotional campaigns to highlight the importance of patients’ participation to improve the provided healthcare services. Additionally, we recommend further research into potential predictors for other pertinent aspects impacting patient loyalty to dentists, such as care quality and other satisfaction indicators.
Conclusions
The establishment of loyalty is a complex and multifaceted phenomenon. Trust is essential, whether it exists on its own or is supported by qualities like attentiveness, accuracy, and level of care. Physicians and dentists have a crucial role to play in boosting patient satisfaction and trust. Creating a close association between patients and dentists can boost patient satisfaction and loyalty.
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval: Ethical approval (No. 22-42 M) was obtained from the Central Institutional Review Board (IRB) in the MOH, Saudi Arabia.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs: Mervat M. El Dalatony https://orcid.org/0000-0002-2399-439X
Mohammed S. Aldossary https://orcid.org/0000-0002-0380-7905
Statement of Informed Consent: Informed consent for patient information to be published in this article was not obtained because this study used retrospective data, using electronic Press Ganey survey, which has no personal information.
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