Service quality, patient trust, and outpatient satisfaction under waiting pressure: an organizational perspective

Purpose This study examines how outpatient service quality affects patient satisfaction through patient trust and whether perceived waiting pressure acts as a boundary condition shaping this relationship, from an organizational service delivery perspective. Design/methodology/approach A cross-sectional survey of 345 adult outpatients in medical centers, regional hospitals, and clinics in Taiwan was conducted. Service quality was conceptualized as interaction, process, and environmental quality. Structural equation modeling and a first-stage moderated mediation approach were used for analysis. Findings Service quality is positively associated with outpatient satisfaction, both directly and indirectly through patient trust. Patient trust partially mediates this relationship. While perceived waiting pressure negatively affects trust, it positively moderates the relationship between service quality and trust, indicating that high-quality service plays a stronger trust-building role under higher waiting pressure. Practical implications The findings suggest that maintaining high service quality – particularly in staff interactions and process management – can buffer the negative effects of waiting pressure and enhance patient trust and satisfaction, especially in high-pressure outpatient environments. Social implications By showing how organizational service practices can mitigate the negative effects of waiting pressure, this study highlights the role of healthcare organizations in fostering patient trust and supporting patient-centered care. Originality/value By integrating service quality, patient trust, and satisfaction within a moderated mediation framework, this study conceptualizes waiting pressure as a critical boundary condition that reshapes how service quality translates into patient trust, rather than solely a service deficiency.