Physician Competence and Patient Satisfaction: A Systematic Literature Review

Technical Summary: Physician Competence and Patient Satisfaction

Problem Statement
Patient satisfaction has emerged as a primary indicator for evaluating the quality of hospital healthcare services, shifting the global focus from purely disease-centered treatment to patient-centered experiences. While clinical outcomes remain vital, the extent to which healthcare services meet patient expectations, needs, and preferences is increasingly critical. Among the various determinants of satisfaction, Physician Competence is identified as a highly influential factor. However, existing literature presents several limitations:

• Conceptual Fragmentation: Many studies utilize general service quality frameworks (e.g., SERVQUAL) without comprehensively integrating multidimensional physician competency models (e.g., ACGME, JCI).
• Contextual Gaps: Research is predominantly conducted in public or private commercial institutions, with a scarcity of empirical evidence regarding faith-based healthcare organizations, specifically Islamic hospitals (e.g., Muhammadiyah and Aisyiyah in Indonesia) that integrate medical professionalism with spiritual care.
• Methodological Constraints: The field is dominated by cross-sectional designs and simple correlational analyses, which limit the ability to explain underlying causal mechanisms or longitudinal changes. Furthermore, few studies have integrated physician competency theory, service quality theory, and patient satisfaction theory into a unified conceptual framework.

Methodology
This study employs a Systematic Literature Review (SLR) to synthesize and critically evaluate existing research on the relationship between Physician Competence and patient satisfaction. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, alongside procedures proposed by Kitchenham (2004) and Snyder (2019).

• Search Strategy: A comprehensive search was conducted across seven databases (Scopus, Web of Science, PubMed, ScienceDirect, ProQuest, SpringerLink, and Google Scholar) using keywords such as "physician performance," "medical competency," "patient satisfaction," and "service quality."
• Inclusion Criteria: Articles published between January 2015 and June 2026, available in full text, published in reputable national or international journals, and directly addressing physician performance, service quality, or patient satisfaction in hospital settings.
• Quality Assessment: Eligible studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Studies were scored on a binary system (0–6), with only those demonstrating moderate to high quality (scores of 3–6) retained for synthesis.
• Data Synthesis: A thematic analysis approach was used to group findings into major themes, identifying patterns, theoretical perspectives, and research gaps.
• Final Sample: After screening 315 records and removing duplicates and irrelevant studies, 9 studies were included in the final qualitative synthesis. These studies were predominantly quantitative, utilizing Structural Equation Modeling (SEM) and Partial Least Squares (PLS-SEM).

Key Results
The synthesis of the 9 included studies reveals the following:

• Multidimensional Competence: Physician Competence is conceptualized not merely as clinical expertise but as a multidimensional construct including communication skills, professionalism, patient-centered care, continuous learning, and teamwork.
• Direct Influence: There is a consistent, significant positive effect of physician performance on patient satisfaction. Key dimensions driving this relationship include:
  • Communication Skills: Effective interpersonal communication, active listening, and clear explanations of diagnoses and treatment plans significantly improve inpatient satisfaction.
  • Professionalism: Integrity, accountability, and ethical conduct foster trust and loyalty.
  • Reliability and Punctuality: Specific operational aspects, such as doctor punctuality and effective complaint handling, directly impact satisfaction levels.
• Mediating Role of Service Quality: Perceived service quality acts as a crucial mediating mechanism. Physician Competence influences patient satisfaction largely by enhancing the perceived quality of the service process (responsiveness, empathy, assurance). Patients evaluate services based on their interactions with providers, where competence translates into positive service perceptions.
• Theoretical Alignment: The findings align with Expectancy Disconfirmation Theory (satisfaction results when performance exceeds expectations), Donabedian's Healthcare Quality Theory (competence as a process quality leading to outcome satisfaction), and SERVQUAL theory.

Significance and Contributions
The authors posit that this review provides a foundational evidence base for developing integrated conceptual frameworks in healthcare management and human resource development. The significance of the work lies in:

1. Clarifying the Mechanism: It explicitly identifies perceived service quality as the bridge linking physician competency to patient satisfaction, moving beyond simple correlation to explain how competence influences outcomes.
2. Strategic HR Implications: The findings suggest that enhancing physician competencies through continuous professional development, communication training, and leadership support is a strategic investment. This approach can simultaneously improve clinical service quality, patient satisfaction, organizational sustainability, and healthcare system effectiveness.
3. Identifying Research Gaps: The review highlights specific areas requiring future investigation, including:
   • The need for more research in Islamic healthcare institutions.
   • The necessity of longitudinal study designs to establish causal relationships.
   • The development of integrative models that combine physician competency dimensions with service quality constructs using advanced analytical methods (SEM/PLS-SEM).
   • The exploration of moderating variables such as health insurance status, patient class, and cultural background.

The paper concludes that while the relationship between Physician Competence and patient satisfaction is well-established, future research must address contextual and methodological limitations to fully optimize patient-oriented healthcare services.