Reconfiguring Care Practices Through Technology-Supported Services: Pathways to Outpatient Satisfaction in Urban and Rural Public Hospitals.

Abstract

IntroductionThis study examines how technology-supported services contribute to the reconfiguration of care practices and how these processes shape pathways to outpatient satisfaction in public hospitals. Rather than treating digital technologies as standalone solutions, this study analyzes the pathways linking structural conditions, care processes, and technology-supported services to outpatient satisfaction, with particular attention to differences between urban and rural public hospitals.MethodsA cross-sectional survey was conducted among 2,084 outpatients attending five public hospitals (two city-level and three rural-level) in East Kalimantan, Indonesia. Patient-reported experiences of care were analyzed using an extended structure-process-outcome framework. In this framework, technology-supported services were incorporated as a process-related component. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to estimate direct and indirect pathways to general patient satisfaction, with subgroup analyses for urban and rural hospitals.ResultsCare processes, particularly caring attitudes and emotional support, were central determinants of outpatient satisfaction across settings. Structural factors showed both direct and mediated effects, with professional competence more influential in urban hospitals and environment and facilities more salient in rural hospitals. Technology-supported services had a significant direct effect on satisfaction and mediated the relationship between structural capacity and patient experiences, though their relative importance varied by context.ConclusionBy conceptualizing technology-supported services as embedded care practices rather than standalone tools, this study provides new evidence on the pathways linking care practices to outpatient satisfaction in public hospitals.