Impact of medical environment, service quality, and perceived value on pediatric outpatient family loyalty: A multicenter mediation cross-sectional study

Objective This study aimed to explore the impact of outpatient satisfaction on loyalty in pediatric families, identify and analyze key factors in the satisfaction evaluation system that influence patient loyalty, and provide empirical evidence for hospitals to formulate targeted strategies to improve outpatient loyalty. Methods A total of 608 family members of pediatric outpatients at six hospitals in Hubei Province used a validated, reliable, and valid satisfaction scale. Descriptive statistics, multiple linear regression analysis, and mediation effect tests were used to analyze the factors influencing pediatric outpatient loyalty and the mediating role of overall satisfaction. Results The patient loyalty rate was 90.3%. The average scores for the seven dimensions, ranked from high to low, were service attitude satisfaction (4.67 ± 0.60), medical environment satisfaction (4.58 ± 0.62), service skill satisfaction (4.56 ± 0.65), patient loyalty (4.55 ± 0.66), service efficiency satisfaction (4.50 ± 0.72), overall patient satisfaction (4.49 ± 0.69), and perceived value (4.48 ± 0.70). Satisfaction with service skills, service efficiency, and perceived value were significantly related to loyalty ( p  < 0.05). Overall satisfaction mediated the relationship between satisfaction with the five antecedents and loyalty, with an effect size ranging from 0.47 to 0.59, accounting for 61%-78% of the total effect ( p  < 0.001). Conclusion Family members of pediatric outpatients in Hubei Province have a high level of loyalty, but there is still room for improvement. To enhance loyalty, hospitals should focus on improving satisfaction with service skills, service efficiency, perceived value, service attitude, and the medical environment, thereby improving overall satisfaction and fostering patient loyalty. Trial registration: Medical Ethics Committee of Wuhan Children's Hospital; registration number: 2025R126-E01.