Beyond the standard: Rethinking Likert scale use in measuring patient satisfaction at public health center in Indonesia

Background: Patient satisfaction surveys in Indonesian public health centers use a four-point Likert scale mandated by the Regulation of the Minister of State Apparatus Empowerment and Bureaucratic Reform (PERMENPAN-RB), which may restrict sensitivity and accuracy. Internationally, broader Likert scales commonly five or seven-point—are widely used to obtain more nuanced responses and have been shown to improve reliability, validity, and cross-cultural comparability of patient-reported outcomes. Aligning Indonesian practices with these standards enhances measurement precision and facilitates benchmarking against global indicators. Accurate measurement of patient satisfaction is critical for benchmarking health service quality worldwide. This study aimed to develop a predictive model that generates scores on a seven-point Likert scale based on responses originally measured using a four-point format. Design and Method: This cross-sectional study surveyed 200 outpatients from 2 Public Health Centers (Puskesmas) in Padang City, measuring satisfaction with four- and seven-point Likert scales simultaneously. Regression analysis developed a predictive model converting four-point scores into seven-point equivalents. Results: The seven-point scale produced higher satisfaction and performance scores. A strong correlation ( r = 0.7573) and significant regression model ( p = 0.0001) were found, with Y = 33.96 + 0.656X, explaining 57.3% of the variance. Conclusion: The seven-point scale provides a more accurate measure of patient satisfaction. The regression model enables conversion of existing four-point data, supporting more precise assessment of patient satisfaction and service quality, and informing evaluation and policy decisions.