The trust-commitment challenge in service quality-loyalty relationships.

Purpose: The purpose of this paper is to develop and empirically test a model to examine service quality, satisfaction, trust and commitment as loyalty antecedents in a private healthcare service.

Design/methodology/approach: The approach was tested using structural equation modelling, involving 175 patients from a private Portuguese healthcare unit, using a revised Service Quality Assessment Scale (SQAS) scale for service quality evaluation.

Findings: The scale used to evaluate service quality is valid and meaningful.