Associated Factors of Satisfaction on the Referral Services among Clients in a Department of Health-Retained Hospital

Authors

Al Jr R. Dela Mide

Graduate School of Allied Health Sciences, University of the Visayas (Philippines)

Joan P. Bacarisas

Graduate School of Allied Health Sciences, University of the Visayas (Philippines)

Article Information

DOI: 10.51584/IJRIAS.2026.11050203

Subject Category: Nursing

Volume/Issue: 11/5 | Page No: 2468-2479

Publication Timeline

Submitted: 2026-05-14

Accepted: 2026-05-20

Published: 2026-06-16

Abstract

This study assessed the factors associated with satisfaction in referral services at a Department of Health–retained hospital in Surigao City, Philippines. Using a quantitative descriptive-predictive design, data were collected from referred clients through consecutive sampling with the use of a structured questionnaire measuring demographic characteristics and key dimensions of satisfaction, including admission, treatment, communication, time, customer service, and discharge processes. Findings revealed that clients were generally satisfied, with higher ratings in procedural aspects such as admission and discharge, and comparatively lower ratings in communication and customer service. Regression analysis identified treatment, communication, and customer service as significant predictors of overall satisfaction, while most demographic characteristics showed no significant predictive relationship. The study concludes that clinical competence must be complemented by effective interpersonal engagement to achieve comprehensive client satisfaction. The results support the Confirmation-Disconfirmation Theory, emphasizing that meeting patients’ relational expectations is central to delivering excellence in referral services.

Keywords

Client Satisfaction, Referral Services, Communication

Downloads

References

1. Abere, T. M., Atnafu, D. D., & Mulu, Y. (2021). Self-referral and associated factors among patients attending adult outpatient departments in Debre Tabor General Hospital, North West Ethiopia. BMC Health Services Research, 21(1), 607. [Google Scholar] [Crossref]

2. Adhikary, G., Shawon, M. S. R., & Ali, M. W. (2023). Factors influencing patients’ satisfaction at different levels of health facilities. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196643 [Google Scholar] [Crossref]

3. Alemu, M. E., Worku, W. Z., & Berhie, A. Y. (2023). Patient satisfaction and associated factors towards surgical service among patients undergoing surgery at referral hospitals in Western Amhara Regional State, Ethiopia. Heliyon, 9(3). [Google Scholar] [Crossref]

4. Alharbi, T. S., Alothman, F. A., Alhussaini, M. A., & Alqahtani, A. M. (2020). Patient satisfaction and its determinants in outpatient clinics: A cross-sectional study. Journal of Patient Experience, 7(6), 1363–1370. https://doi.org/10.1177/2374373520951678 [Google Scholar] [Crossref]

5. Alomar, D., Almashmoum, M., Eleftheriou, I., Whelan, P., & Ainsworth, J. (2024). The impact of patient access to electronic health records on health care engagement: Systematic review. Journal of Medical Internet Research, 26, e56473. https://www.jmir.org/2024/1/e56473/ [Google Scholar] [Crossref]

6. Asamrew, N., Endris, A. A., & Tadesse, M. (2020). Level of patient satisfaction with inpatient services and its determinants: A study of a specialized hospital in Ethiopia. Journal of Environmental and Public Health, 2020(1), 2473469. [Google Scholar] [Crossref]

7. Asamrew, N., Endris, A. A., & Tadesse, M. (2020). Level of patient satisfaction with inpatient services and its determinants: A study of a specialized hospital in Ethiopia. Journal of Environmental and Public Health, Article ID 2473469. https://doi.org/10.1155/2020/2473469 [Google Scholar] [Crossref]

8. Bontia, A. A. I., & Babsa-Ay, J. D. (2024). Factors affecting waiting time of patients referred to specialty clinics from a family medicine clinic in a tertiary government hospital: A retrospective chart review. Acta Medica Philippina, 58(13), 39. [Google Scholar] [Crossref]

9. Carenzo, L., Costantini, E., Greco, M., Barra, F. L., Rendiniello, V., Mainetti, M., ... & Cecconi, M. (2020). Hospital surge capacity in a tertiary emergency referral centre during the COVID‐19 outbreak in Italy. Anaesthesia, 75(7), 928-934. [Google Scholar] [Crossref]

10. Carini, E., Villani, L., Pezzullo, A. M., Gentili, A., Barbara, A., Ricciardi, W., & Boccia, S. (2021). The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: Updated systematic literature review. Journal of Medical Internet Research, 23(9), e26189. https://doi.org/10.2146/26189 [Google Scholar] [Crossref]

11. Cartier, Y., Fichtenberg, C., & Gottlieb, L. M. (2020). Implementing Community Resource Referral Technology: Facilitators And Barriers Described By Early Adopters: A review of new technology platforms to facilitate referrals from health care organizations to social service organizations. Health Affairs, 39(4), 662-669. [Google Scholar] [Crossref]

12. Chen, J., Liu, Y., & Wang, H. (2024). Evaluating service quality in public hospitals using SERVQUAL: A cross-sectional study in China. International Journal of Health Care Quality Assurance, 37(2), 85–98. https://doi.org/10.1108/IJHCQA-09-2024-0090 [Google Scholar] [Crossref]

13. Coyne, I. (2025). Effective health communication to reduce avoidable readmission: Enhancing understanding for patients and families. Journal of Clinical Nursing. https://pmc.ncbi.nlm.nih.gov/articles/PMC11907237/ [Google Scholar] [Crossref]

14. Cui, J., Du, J., Zhang, N., & Liang, Z. (2025). National patient satisfaction survey as a predictor for quality of care and quality improvement – Experience and practice. Patient Preference and Adherence, 19, 193-206. [Google Scholar] [Crossref]

15. Department of Health. (2019). Universal Health Care Act (RA 11223). Manila: DOH. [Google Scholar] [Crossref]

16. Escobar, E. R., Pathak, S., & Blanchard, C. M. (2021). Screening and referral care delivery services and unmet health-related social needs: a systematic review. Preventing Chronic Disease, 18, E78. [Google Scholar] [Crossref]

17. Espiritu, A. I., & San Jose, M. C. Z. (2021). A call for a stroke referral network between primary care and stroke-ready hospitals in the Philippines: A narrative review. The Neurologist, 26(6), 253–260. https://doi.org/10.1097/NRL.0000000000000357 [Google Scholar] [Crossref]

18. Flores, K. J. A., Garcia, M. C. U., & Pacete-Estrera, K. R. R. (2025). Factors affecting patient referral to periodontists from general dental practitioners in the City of Manila: A descriptive cross-sectional study. Acta Medica Philippina, 59(12), 60. [Google Scholar] [Crossref]

19. Garcia, M. R., & Dela Cruz, J. P. (2023). Communication quality and patient experience during referral processes in tertiary hospitals in the Philippines. Philippine Journal of Nursing Practice, 6(1), 22–34. [Google Scholar] [Crossref]

20. Guddu, D. K., & Demissie, D. B. (2022). Patient satisfaction with referral service and associated factors among public hospitals in and around Addis Ababa, Central Ethiopia. SAGE Open Medicine, 10, 20503121221089443. https://doi.org/10.1177/20503121221089443 [Google Scholar] [Crossref]

21. Habte, B. M., Alemayehu, A. M., & Tesfaye, T. S. (2020). Patient satisfaction with referral services in Ethiopian hospitals. BMC Health Services Research, 20(1), 1–10. https://doi.org/10.1186/s12913-020-05120-7 [Google Scholar] [Crossref]

22. Hussain, A., Khan, M., & Rahman, S. (2023). Applying confirmation–disconfirmation theory to patient satisfaction: A systematic review. International Journal of Health Care Quality, 41(3), 201–214. [Google Scholar] [Crossref]

23. Jamal, F., Ahmadini, A. A. H., Hassan, M. M., Sami, W., Ameeq, M., & Naeem, A. (2024). Exploring critical factors in referral systems at different health‐care levels. World Medical & Health Policy, 16(4), 729-744. [Google Scholar] [Crossref]

24. Kim, Y. J., & Park, S. H. (2024). Determinants of patient satisfaction in hospital referral pathways: Testing a modified disconfirmation model. Health Services Management Review, 39(1), 57–68. [Google Scholar] [Crossref]

25. Laurito, A. A. (2022). Assessment of Referral System on Maternal Services in Cagayan De Oro City. medRxiv, 2022-03. [Google Scholar] [Crossref]

26. Lopez, R. A. (2024). Nursing coordination and its influence on referral outcomes in public hospitals. Journal of Nursing Administration and Management, 12(2), 88–99. [Google Scholar] [Crossref]

27. Marshall, N., Butler, M., Lambert, V., Timon, C. M., Joyce, D., & Warters, A. (2025). Health literacy interventions and health literacy-related outcomes for older adults: a systematic review. BMC Health Services Research, 25. https://doi.org/10.1186/s12913-025-12457-7 [Google Scholar] [Crossref]

28. Melesse, D., Tesfu, M., & Mantefard, B. (2022). Level of clients’ satisfaction and associated factors with the service of out-patient department in Dilla University Referral Hospital, Southern Ethiopia, 2021. Advances in Public Health, 2022(1), 6451755. [Google Scholar] [Crossref]

29. Mendoza, D. J., & Valdez, R. F. (2021). Barriers to effective referral systems in Philippine rural health units. Philippine Health Research Journal, 25(4), 310–322. [Google Scholar] [Crossref]

30. Mohammed, H. T., & Huebner, L. A. (2020). Assessing patient satisfaction and experience with an electronic referral process. Quality Management in Healthcare, 29(1), 20–29. [Google Scholar] [Crossref]

31. Mohammed, S., Chattu, V. K., & Saidu, I. (2022). Factors affecting patient satisfaction in hospitals: Evidence from developing countries. International Journal of Environmental Research and Public Health, 19(14), 8391. https://doi.org/10.3390/ijerph19148391 [Google Scholar] [Crossref]

32. Mulugeta, H., Wagnew, F., & Dessie, G. (2024). Determinants of patients' satisfaction with health-care services: the role of patient demographics and individual factors. Journal of Patient Experience. https://pmc.ncbi.nlm.nih.gov/articles/PMC12883968/ [Google Scholar] [Crossref]

33. Niu, Y., Sun, J., Zhu, K., Xu, B., Zhang, Y. P., & Peng, M. (2025). The Critical Role and Effects of Patient-Centered Communication in Psychotherapy: A Narrative Review. Psychology research and behavior management, 18, 1657–1671. https://doi.org/10.2147/PRBM.S528343 [Google Scholar] [Crossref]

34. Oliver, R. L. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions. Journal of Marketing Research, 17(4), 460–469. [Google Scholar] [Crossref]

35. Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1), 12–40. [Google Scholar] [Crossref]

36. Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1991). Refinement and reassessment of the SERVQUAL scale. Journal of Retailing, 67(4), 420–450. [Google Scholar] [Crossref]

37. Republic Act No. 11223. (2019). An Act institutionalizing universal health care for all Filipinos, prescribing reforms in the health care system, and appropriating funds therefor. Official Gazette of the Republic of the Philippines. https://www.officialgazette.gov.ph/2019/02/20/republic-act-no-11223/ [Google Scholar] [Crossref]

38. Reyes, J. L., Santos, R. P., & Aquino, M. H. (2023). Referral system delays and patient satisfaction in tertiary public hospitals in Luzon. Asian Journal of Public Health Studies, 8(1), 55–70. [Google Scholar] [Crossref]

39. Santos, L. E., Robles, M. A., & Dizon, C. R. (2022). Documentation and communication gaps in interfacility referrals in government hospitals. Philippine Journal of Public Health, 64(2), 101–112. [Google Scholar] [Crossref]

40. Seyed-Nezhad, M., Ahmadi, B., & Akbari-Sari, A. (2021). Factors affecting the successful implementation of the referral system: A scoping review. Journal of Family Medicine and Primary Care, 10(12), 4364–4375. [Google Scholar] [Crossref]

41. Tan, E. A. (2025). Improving Emergency Referrals in a Philippine Tertiary Hospital: A Quality Improvement Initiative. Cureus, 17(6). [Google Scholar] [Crossref]

42. Tan, E. A. (2025). Improving emergency referrals in a Philippine tertiary hospital: A quality improvement initiative. [Journal Name]. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/40688850/ PubMed+1 [Google Scholar] [Crossref]

43. Tantengco, O. A., & Velayo, C. (2023). Twin reversed arterial perfusion sequence: A review of cases in the Philippines from 2000 to 2022. Placenta and Reproductive Medicine, 2. https://www.hksmp.com/journals/prm/article/view/365 [Google Scholar] [Crossref]

44. Tessema, T. T., Tadesse, T. A., & Alemayehu, D. S. (2021). Client satisfaction and associated factors in healthcare services: A systematic review. Healthcare, 9(11), 1443. https://doi.org/10.3390/healthcare9111443 [Google Scholar] [Crossref]

45. Tsegay, L., Abebe, S., & Nigatu, T. (2021). Patient satisfaction with referral services and associated factors in Ethiopia. PLOS ONE, 16(9), e0257250. https://doi.org/10.1371/journal.pone.0257250 [Google Scholar] [Crossref]

46. Villaflor, K., & Pineda, N. M. (2024). Waiting time, discharge processes, and patient satisfaction in DOH-retained facilities. Journal of Hospital Administration in the Philippines, 18(1), 73–85. [Google Scholar] [Crossref]

47. Wang, H., Li, Y., & Chen, T. (2022). The impact of hospital service quality on patient satisfaction and loyalty: A systematic review. Frontiers in Public Health, 10, 907345. https://doi.org/10.3389/fpubh.2022.907345 [Google Scholar] [Crossref]

48. World Health Organization. (2020). Referral systems: Key strategies for strengthening health services. WHO. [Google Scholar] [Crossref]

49. Zhang, Q., & Zhang, T. (2023). Applying the SERVQUAL model to patient satisfaction in healthcare: A systematic review. BMC Health Services Research, 23(1), 1157. https://doi.org/10.1186/s12913-023-1157-8 [Google Scholar] [Crossref]

50. Zhou, W., Zhang, Y., & Chen, L. (2025). Length of stay and patient satisfaction: Evidence from a Chinese tertiary hospital using SERVQUAL dimensions. Scientific Reports, 15, 139–150. https://doi.org/10.1038/s41598-025-90176-z [Google Scholar] [Crossref]

Metrics

Views & Downloads

Similar Articles