Identify Key Drivers of Patient Dissatisfaction: Applying Importance-Performance Mapping Analysis (IPMA)

Anita Sevira Santoso; Ferdi Antonio

doi:10.37034/jems.v8i1.290

Authors

Anita Sevira Santoso Universitas Pelita Harapan
Ferdi Antonio Universitas Pelita Harapan https://orcid.org/0000-0002-1319-3732

DOI:

https://doi.org/10.37034/jems.v8i1.290

Keywords:

Patient Dissatisfaction, Clinical Problems, Management Problems, Relational Problems, IPMA

Abstract

This study aims to identify the key factors contributing to patient dissatisfaction in six general hospitals operated by security institutions in East Java using the Importance–Performance Mapping Analysis (IPMA). Patient dissatisfaction generally arises from three categories of issues—clinical, management, and relational problems that influence patients’ experiences during hospitalization. Using a purposive sampling method, data were collected from 130 inpatients who had previously submitted complaints. The analysis indicates that clinical issues, particularly indicators related to the adequacy of pain management and the appropriateness of hospital meals (CPQY4 and CPQY5), fall within the high-importance and low-performance quadrant, making them the primary priorities for service improvement. Meanwhile, several indicators within the management and relational problem categories, such as RPCN2 and MPET4, demonstrate high performance but have a low impact on dissatisfaction, suggesting that these aspects are functioning well but are not the principal determinants of patient dissatisfaction. The implementation of this study includes recommendations to enhance clinical competence through integrated training programs, regular medical audits, and the refinement of complaint-handling procedures to ensure a more proactive and responsive approach. Additionally, strengthening interpersonal communication, improving inter-unit coordination, and conducting routine evaluations using IPMA are proposed to help hospitals more accurately target improvement priorities and support the development of patient-centered healthcare services.

References

WHO. (2021). World Health Statistics. In Pharmacognosy Magazine, 75(17). World Health Organization.

Janerka, C., Leslie, G. D., & Gill, F. J. (2023). Development of patient-centred care in acute hospital settings: A meta-narrative review. In International Journal of Nursing Studies, 140. https://doi.org/10.1016/j.ijnurstu.2023.104465

Gillespie, A., & Reader, T. W. (2016). The Healthcare Complaints Analysis Tool: development and reliability testing of a method for service monitoring and organisational learning. BMJ Quality & Safety, 25(12), 937–946. https://doi.org/10.1136/bmjqs-2015-004596

Fiano, F., Sorrentino, M., Caputo, F., & Smarra, M. (2022). Intellectual capital for recovering patient centrality and ensuring patient satisfaction in healthcare sector. Journal of Intellectual Capital, 23(3), 461–478. https://doi.org/10.1108/JIC-04-2020-0116

Wulandari, A. R. C., Rachmawaty, R., Ilkafah, I., & Erfina, E. (2021). Patient satisfaction towards healthcare quality in Indonesian Public Hospital. Enfermeria Clinica, 31. https://doi.org/10.1016/j.enfcli.2021.09.006

Becker, G., & Newsom, E. (2003). Socioeconomic Status and Dissatisfaction with Health Care among Chronically Ill African Americans. American Journal of Public Health, 93(5). https://doi.org/10.2105/AJPH.93.5.742

Head, K. J., Forster, A. K., Harsin, A., & Bartlett Ellis, R. J. (2023). Identifying sources of patient dissatisfaction when seeking care for a chronic and complex disease. Patient Experience Journal, 10(2). https://doi.org/10.35680/2372-0247.1803

O’dowd, E., Lydon, S. E., Lambe, K., Vellinga, A., Rudland, C., Ahern, E., Hilton, A., Ward, M. E., Kane, M., Reader, T., Gillespie, A., Vaughan, D., Slattery, D., & O’connor, P. (2022). An analysis of complaints about hospital care in the Republic of Ireland. International Journal for Quality in Health Care, 34(2). https://doi.org/10.1093/intqhc/mzac037

Kemenkes.go.id. (2023). Laporan Kinerja Kementerian Kesehatan Republik Indonesia.

Hauff, S., Richter, N. F., Sarstedt, M., & Ringle, C. M. (2024). Importance and performance in PLS-SEM and NCA: Introducing the combined importance-performance map analysis (cIPMA). Journal of Retailing and Consumer Services, 78, 103723. https://doi.org/10.1016/j.jretconser.2024.103723

García-Fernández, J., Fernández-Gavira, J., Sánchez-Oliver, A. J., Gálvez-Ruíz, P., Grimaldi-Puyana, M., & Cepeda-Carrión, G. (2020). Importance-Performance Matrix Analysis (IPMA) to Evaluate Servicescape Fitness Consumer by Gender and Age. International Journal of Environmental Research and Public Health, 17(18), 6562. https://doi.org/10.3390/ijerph17186562

Machado, M. D. D. S., & Bertucci Ramos, P. H. (2023). ThinkBox: Consumer buying behavior: IPMA – the technique that deepens the analysis and suggests management strategies. RAUSP Management Journal, 58(4), 363–369. https://doi.org/10.1108/RAUSP-10-2023-275

Sekaran, U., & Bougie, R. (2016). Research Methods For Business: A Skill Building Approach (7th Editio). Wiley Online Library.

Memon, M. A., Ting, H., Cheah, J. H., Thurasamy, R., Chuah, F., & Cham, T. H. (2020). Sample size for survey research: Review and recommendations. Journal of Applied Structural Equation Modeling, 4(2). https://doi.org/10.47263/jasem.4(2)01

Hair, J. F., & Ringle, C. M. (2022). A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM). Sage Publication.

Ali, N., & Dzandu, M. D. (2023). A paradigm shift for medical health care to focus on a service-value approach to achieve greater patient satisfaction. Journal of Health Organization and Management, 37(2), 133–157. https://doi.org/10.1108/JHOM-06-2022-0180

Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis. Healthcare, 11(5), 639. https://doi.org/10.3390/healthcare11050639

Youkta, K., & Paramanik, R. N. (2025). Assessing women’s satisfaction with childbirth services in Bihar: implications for healthcare revisit intentions. Journal of Social and Economic Development. https://doi.org/10.1007/s40847-025-00431-2

Wider, W., Tan, F. P., Tan, Y. P., Lin, J., Fauzi, M. A., Wong, L. S., Tanucan, J. C. M., & Hossain, S. F. A. (2024). Service quality (SERVQUAL) model in private higher education institutions: A bibliometric analysis of past, present, and future prospects. Social Sciences & Humanities Open, 9, 100805. https://doi.org/10.1016/j.ssaho.2024.100805

Singh, P., & Sidhu, A. S. (2023). Measuring Patient’s Expectations and Realisations Using SERVQUAL: A Review of Oncology Services in Punjab, India. Asian Pacific Journal of Cancer Prevention, 24(10), 3327–3334. https://doi.org/10.31557/APJCP.2023.24.10.3327

Jaya, I. G. N. T., Kosasih, Yuliaty, F., Paramarta, V., & Fitriana. (2025). Implementation Of Lean Hospital As An Effort To Improve Health Services In The Emergency Unit Of The Hospital. MORFAI JOURNAL, 5(1), 189–193. https://doi.org/10.54443/morfai.v5i1.2543

Palupi, I., & Rosa, E. M. (2025). The analysis study of the impact of service quality to patient satisfaction in regional general hospital in Indonesia: A comprehensive systematic. Journal of Public Health and Development, 23(3), 312–325. https://doi.org/10.55131/jphd/2025/230324

Katsaliaki, K. (2022). Evaluating patient and medical staff satisfaction from doctor–patient communication. International Journal of Health Care Quality Assurance, 35(1), 38–55. https://doi.org/10.1108/IJHCQA-03-2022-0033

Sitorus, P., Daeli, W., & Suryadi, B. (2023). Hubungan Komunikasi Teraupetik Perawat Dengan Tingkat Kepuasan Pasien. NAJ : Nursing Applied Journal, 2(1), 23–32. https://doi.org/10.57213/naj.v2i1.100

Çakmak, C., & Uğurluoğlu, Ö. (2024). The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye. Cancer Control, 31. https://doi.org/10.1177/10732748241236327

Serrano, C. I., Shah, V., & Abràmoff, M. D. (2018). Use of Expectation Disconfirmation Theory to Test Patient Satisfaction with Asynchronous Telemedicine for Diabetic Retinopathy Detection. International Journal of Telemedicine and Applications, 2018, 1–14. https://doi.org/10.1155/2018/7015272

Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging Patients in Decision-Making and Behavior Change to Promote Prevention. Studies in Health Technology and Informatics, 240. https://doi.org/10.3233/978-1-61499-790-0-284

Edgman-Levitan, S., & Schoenbaum, S. C. (2021). Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Israel Journal of Health Policy Research, 10(1), 21. https://doi.org/10.1186/s13584-021-00459-9

Wasim, A., Sajan, M., & Majid, U. (2023). Patient-centered care frameworks, models and approaches: An environmental scan. Patient Experience Journal, 10(2), 14–22. https://doi.org/10.35680/2372-0247.1806