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. Service quality proved to be a multidimensional construct and relevant to build satisfaction. The path satisfaction→trust→loyalty was validated, whereas the path satisfaction→commitment→loyalty was not statistically supported.

Research Limitations/implications: The revised SQAS scale showed good internal consistency in healthcare context. Further trust-commitment antecedents must be examined in a private healthcare landscape to generalise the findings.

Practical Implications: Healthcare quality managers must explore the service quality dimensions to generate satisfaction among their patients. Developing trust generates positive patient attitudes and loyalty.

Originality/value: This study explores using the SQAS scale in a private healthcare context. The authors provide further evidence that service quality is an antecedent and different from satisfaction. All the measures used proved to be valid and reliable. Trust and commitment play different roles in their relationship with loyalty.