Patient satisfaction mediates the influence of trust, service quality and hospital sharia compliance on patient loyalty in Sharia hospitals in Riau province from an Islamic perspective

This study seeks to assess patient satisfaction by examining the impact of trust, service quality


Introduction
Currently, the health services and social activities industry is growing the fastest, reaching 14.06% yoy in Indonesia (Annur, 2021).The government has anticipated the rapid growth of health services in particular by issuing various regulations and legislation aimed at encouraging investment and making business conditions and hospital services better.According to the World Health Organization (2023), this condition has positive implications for the increasing need for quality hospital services.A hospital is an organization that, through organized professional medical personnel and permanent medical facilities, provides medical services, continuous care, diagnosis and treatment suffered by patients (American Hospital Association, 2016).The National Health System states that hospitals have the main function of providing health in the form of healing and recovery for sufferers and providing services that are not limited to care within the hospital but provide outpatient services, as well as care outside the hospital (Adisasmito, N/D).According to Djono (2020), based on data, the ratio of the number of beds to the number of residents (bed to population ratio) in Indonesia is 1.21:1,000.This means that per 1,000 residents, only 1.21 hospital beds are available.Currently, with a population of around 260 million people, in Indonesia, there are around 310,000 treatment beds in hospitals (Djono, 2020).
Seeing this condition, the opportunity to establish a hospital in Indonesia is still wide open.Hospitals as health service facilities continue to experience growth both in terms of hospital population, number of beds, and level of service.Many entrepreneurs have entered the hospital industry sector because they see the increasing number of patients and also the need for better quality care.The need for more complete health services is indicated by the large number of patients from Indonesia who go abroad for treatment.Hospitals as one of the health service facilities are carried out by strengthening the active involvement of the community and improving the quality of health facilities through accelerating accreditation and clinical pathways.They have a very strategic role in efforts to accelerate the level of health of the Indonesian people (Gani & Budiharsana, 2018).In this case, the Indonesian government has made efforts to improve quality.services that are promotive, preventive, curative and rehabilitative.In order to anticipate changes in disease epidemiology, changes in organizational structure, developments in science and technology, socio-economic changes in society and services that are more effective, friendly and able to meet the needs of the community.
According to the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2020 concerning the Classification and Licensing of Hospitals (Peraturan Menteri or PERMEN No.3/2020), the grouping of hospitals is based on administration, namely Central Government Hospitals, Regional Government Hospitals and Private Hospitals.Hospitals established by the central government and regional governments must be in the form of Technical Implementation Units from agencies tasked with the health sector.Meanwhile, hospitals established by the private sector must be in the form of a non-profit legal entity with the aim of profit in the form of a limited liability company or a limited liability company whose business activities are only engaged in the hospital sector.Based on the type of services provided, hospitals are categorized as general hospitals and special hospitals.According to the Directorate General of Health Services, Indonesian Ministry of Health ( 2021), the number of hospitals in Indonesia from 2016-2020 has increased as in Table 1 below:  1 above, it can be interpreted that in 2020, there were 2,985 hospitals recorded in Indonesia, consisting of 2,449 General Hospitals and 536 Special Hospitals.A total of 1,058 hospitals belong to the Central, Provincial, Regency/City Government, TNI/POLRI and 1,927 hospitals belong to the private sector.If we look at hospital accreditation, there are 2,484 hospitals (83.2%) that have been accredited with a distribution of 908 government hospitals (36.6%) and 1,576 private hospitals (63.4%), so there are 503 (16.9%) hospital has not been accredited, so there has not been an assessment of service quality standards.Judging from the level of hospital accreditation is as follows: Primary 26%, Basic 8.4%, Intermediate 15.5%,Primary 13.4%, Plenary 36.5%, and JCI International accreditation only 0.2%.The highest level is Plenary, and apparently, only 36.5% of hospitals in Indonesia have achieved it.The Indonesian Health Policy (2019) states that the phenomenon of health problems that have occurred in Indonesia for several years shows that there is poor service in various regions in Indonesia.
For example: allegations of malpractice committed by health service workers which result in patients suffering material losses, physical disabilities and even death show that the quality of health services in hospitals is still low (Indonesian Health Policy,2019).This has an impact on the phenomenon that many Indonesian people prefer to seek treatment abroad (Muhammad, 2023;Effiana,2023), such as Singapore because the health services are the best in the world.According to Effiana (2023), there are several different reasons underlying this, in general, the public's reason is dissatisfaction with existing services in Indonesia, and the pull factor in the form of more complete services in the destination country is also quite influential.This trend occurs because a quality health service system will have a major impact on the quality of life of people in a country (Muhammad, 2023).Indonesia is also the largest contributor to the health tourism sector abroad.On average, Indonesians spend 11.5 billion US$/year to undergo treatment abroad (Katadata Publication Team, 2019).According to the latest data, service quality that is not yet optimal is the reason around 600 thousand to 1 million Indonesians still choose foreign hospitals for treatment.As a result, the country lost a potential income of up to IDR 161 trillion (Purnajati,2023).
According to the results of research by Patients Beyond Borders in the Katadata Publication Team (2019), Malaysia and Singapore are the main destinations for patients from Indonesia for treatment.During 2016-2017, the health tourism sector brought in profits of 4.3 billion US$ for Thailand and around 3.5 billion US$ for Singapore.In fact, the number of patients from abroad in Thailand reached 2.5 million patients and in Singapore reached 850 thousand patients, while Malaysia reached 0.158 billion US$, with a total of 583,000 patients.Then, there is the phenomenon of many Riau residents seeking treatment abroad, according to the Riau Islands Provincial Government (Provinsi Kepulauan Riau or Kepri), through the Public Health Service in Riau Islands, they spend around IDR 300 billion per year for treatment abroad, such as Singapore and Malaysia (Jauhari, 2023).Based on various descriptions related to the phenomenon of health problems that occur in Indonesia, and especially in Pekanbaru, Riau Province, the Indonesian government is expected to continue to improve the health system in Indonesia related to the overall quality of the health care system, health care professionals such as doctors and nurses, health equipment, staff hospitals, hospital costs, and so on (Rizaty, 2022).
Starting from various health problem phenomena in the form of controversies such as those in the theoretical and practical realms, researchers interested in conducting studies on good loyalty must be supported by all elements of the Sharia Hospital.One of them is providing trust and professional service quality as well as hospital sharia compliance and providing a good sense of satisfaction which will play a role in patient loyalty.Patient Loyalty is the customer's (patient) perception of maintaining a deeply held commitment to repurchase or re-support a product or service even though the influence of the situation and marketing efforts have the potential to cause the customer to switch, telling others about the product or service (Heskett et al., 1994).According to Kotler and Keller (2012), loyalty is a firmly held commitment to repurchase a chosen product or service in the future.One way this is reflected in the desire to recommend service providers to other people.Patient Loyalty cannot be separated from Trust, where according to Mowen and Minor quoted by Sumarwan (2011) trust is the knowledge possessed by consumers regarding an object, its attributes and benefits.According to Ding Mao in Putra (2017), the belief that someone's words or promises can be trusted and someone will fulfil their obligations in an exchange relationship".Building trust in long-term relationships with customers is an important factor in creating customer loyalty.This trust cannot simply be acknowledged by other parties/business partners, but must be built from the start and can be proven.
According to Prasaranphanich (2011), when consumers trust a company, they will prefer to make repeat purchases and share valuable personal information with the company.Trust is also supported by the quality of service in a company.According to Kotler and Keller (2016), service quality is the totality of features and characters of a product or service that has the ability to satisfy stated or implied needs.In companies operating in the service sector, the quality of the service people really take into account when choosing which service brand to choose.In this case, companies operating in the service sector, especially Sharia hospitals, must be really thorough and have company operational standards related to service to consumers based on professional service quality and Sharia compliance.The concept of Sharia compliance in Indonesia was initially developed in the banking industry, Sharia banking which is regulated in Law of the Republic of Indonesia Number 21 of 2008 concerning Sharia Banking.Sharia banks are banks that carry out their business activities based on Sharia principles in Islam with a profit-sharing system and the absence of usury and have general characteristics inherent in the banking industry, namely an industry that prioritizes trust, togetherness values, brotherhood, and avoidance of speculative elements in every transaction ( Rizkiyani, 2021).
The concept of sharia compliance is compliance with the Fatwa of the Indonesian Ulema Council (Majelis Ulama Indonesia or MUI) -National Shari'ah Council (Dewan Syariah Nasional or DSN) because the MUI -DSN Fatwa is an embodiment of sharia principles and rules which must be operationally adhered to in sharia banking (Sutedi,2009).In this context, sharia compliance can be interpreted as compliance with Islamic sharia law in organizational governance and operations, company specifications, standards or regulations.Thus, a Sharia-compliant hospital is a place where health services are provided in accordance with Sharia principles.Therefore, the implementation of maqasid sharia in Sharia hospitals should be implemented correctly and well, especially in relation to business operational systems and internal control systems.Furthermore, this article is entitled: "Patient Satisfaction Mediates the Influence of Trust, Service Quality and Hospital Sharia Compliance on Patient Loyalty in Sharia Hospitals in Riau Province from an Islamic Perspective".

Trust (X1)
Patient trust in the hospital.Hospitals that do not provide optimal health services cause the public's trust in hospital facilities to decrease.According to Mowen and Minor in Priansa (2017), trust is all the knowledge possessed by consumers and all the conclusions made by consumers about objects, attributes and benefits.According to Rousseau et al in Priansa (2017), trust is a psychological area which is concerned with accepting what is based on expectations of good behaviour from other people.Providing maximum service to patients is one of the characteristics of an Islamic hospital, one of which is providing Islamic services.Islamic hospitals serve everyone regardless of skin colour, religion or social strata.Islam teaches us to always respect other people, in this case respecting and serving patients (customers), where the Prophet Muhammad SAW provided an example to his people.In the context of moral perfection, the Prophet Muhammad SAW had akhlakul karimah (good and praiseworthy morals) that need to be emulated and applied in everyday life and in carrying out duties.In this case, Sharia hospitals should strive to be able to implement the values of trust which means trustworthy or trustworthy in the form of responsibility, true promises and transparency (Tasmara, 2001).
In this case, the values of trust can be applied as an effort to prioritize satisfactory service quality in Sharia hospitals, in line with Islamic values, as in practising the pillars of Islam (Sulistiadi et al.,2020).This is in line with QS An-Nisa/4:58, Allah SWT says: "Indeed, Allah commands you to convey a message to those who are entitled to receive it, and (orders you) when you determine a law between people so that you determine it fairly." From various previous descriptions, it can be concluded that patient trust in the services provided will make the patient feel comfortable and safe in the facilities provided by the hospital.This also means that the better the service provided by the hospital to its patients, the stronger the patient's confidence in seeking treatment at the hospital, this is in accordance with Norhermaya and Soesanto (2016).Building customer trust is one way to create and retain customers.According to Danesh, Nasab, Ling and Widiyanto (2012) stated that customer trust is the foundation of business which is a way to create and retain consumers (Laely, 2016).The research findings of Diza et.al. (2016) confirm that trust has a positive and significant influence on customer satisfaction variables.Sahangamu et.al. (2015) proves that there is a significant and positive influence of trust on customer satisfaction.Gul's (2014) research also proves that the trust variable has a significant influence on satisfaction.Customers who are increasingly dissatisfied indicate that customers have low trust in the company, such as Leninkumar (2017) who found that there is a significant positive relationship between customer satisfaction and customer trust.According to Maharani (2010), there are four indicators in the trust variable, including reliability, honesty, care and quality.These four elements are important issues to increase consumer confidence and are also needs and requirements to meet customer expectations (Arianto,2018) Thus, this research follows that conducted by Kantsperger and Kunz (2010) regarding the dimensions of trust consisting of benevolence and credibility.
Therefore, the following hypothesis can be made: Hypothesis 1 (H1): Trust has a positive and significant effect on patient loyalty at Sharia Hospitals in Pekanbaru City, Riau Province Hypothesis 4 (H4): Trust has a positive and significant effect on patient satisfaction at Sharia Hospitals in Pekanbaru City, Riau Province Service Quality (X2) Davis (1994) explains in Tjiptono & Diana (2003), that quality is an uncertain condition related to products, services, people, processes and the environment to achieve results that meet expectations.Gaspersz (2011) describes products or services with features that are intended to meet customer expectations.Industry and service companies are businesses that are usually classified as being in the service sector and whose main product is services (Zeithaml et.al., 2018).According to Hizam et al. (2021).executives, one of the most critical challenges facing businesses today is improving service quality.Service quality has a direct effect on customer loyalty.Nurhadi (2018) states that the concept of service according to Islam has 6 principles, namely the Principle of Helping One Another (Ta'awun), the Principle of Providing Convenience (At-taysir), and the Principle of Equality (Musawah), the Principle of Mutual Love (Muhabbah), the Principle of Meekness (Al-layin), and the Principle of Family (Ukhuwah).
Islam emphasizes the validity of a service that has good intentions as follows:(1).Service is provided according to customer expectations with maximum satisfaction; (2).There is a difficulty in providing services but consumers do not know about it; and (3).The occurrence of service delivery errors will have implications for customers feeling dissatisfied with the work results of service officers (Nurhadi,2018).The culture of work as a servant serving in Islam which refers to the characteristics of the Prophet Muhammad SAW include shiddiq (righteousness, whether in words or deeds), istiqamah (consistent), fathanah (extraordinary intelligence), tabligh (conveying, namely conveying commands and prohibitions), and amanah (trusted) (Nurhadi, 2018;Masan, 2015).For companies operating in the service sector that provide services, these characteristics are very important issues to attract consumers to use the products and services offered (Kasmir, 2015).Service is also the key to success for companies in carrying out service marketing activities (Adiwiyoto, 2017).In providing services to consumers, each party must work professionally and skillfully.This professional and skilled nature is described in QS Al-Isra/17:84, Allah SWT says: "Say: Each one works according to his form (talent), your Lord knows better the one who gets the better way."In the verse above it is stated that every person does good deeds and acts according to his ability.This means that a person must work diligently and devote all his skills.This research was conducted in an Islamic hospital so the approach taken was to use the sharpening knife of Islamic economics.Islamic economics is said to be a human economy because Islamic economics is implemented and aimed at human benefit (Hulwati,2009).This can be realized with the basic values or principles of Islamic economics, namely the values developed by Yusuf Qardhawi including uluhiyyah, insaniyyah, akhlaqiyyah, and washatiyyah, while Syed Nawab Haider Naqvi added Islamic economic values, namely ikhtiyah and masuliyyah (Djakfar,2007).Service Quality is the patient's perception of the service expected from the hospital.Meanwhile, there are five dimensions of service quality that will be studied, namely admission, medical service, overall service, discharge process and social responsibility, (Aagja and Garg, 2010).Based on current knowledge, it can be concluded that service quality is a method for service providers to provide superior and exemplary service to customers to differentiate themselves from competitors.
Therefore, the following hypothesis can be made: Hypothesis 2 (H2): Service Quality has a positive and significant effect on patient loyalty at Sharia Hospitals in Pekanbaru City, Riau Province Hypothesis 5 (H5): Service Quality has a positive and significant effect on patient satisfaction at Sharia Hospitals in Pekanbaru City, Riau Province

Sharia Compliance (X3)
Chairman of the Indonesian Islamic Health Effort Council (Majelis Upaya Kesehatan Islam Seluruh Indonesia or MUKISI), Masyhudi (2023) stated that Sharia Hospitals are obliged to monitor the worship obligations of patients, especially Muslims.For Muslims, practicing the Shari'a in a kaffah manner is a consequence of faith that must be upheld as stated in QS Al-Baqarah/2:208, Allah SWT says: "O you who believe, enter Islam (peace) completely and do not follow the devil's steps!Indeed, he is a real enemy for you."A sharia hospital is a hospital that carries out all its activities, both patient care and management, based on the principles of maqashid al-syari'ah.Maqashid al-syariah are the secrets and final goals that Syar'i wants to realize in every law he has established (Busyro, 2019: 6-7).The implementation of maqasid sharia in health services can be seen from compliance with Islamic laws in the management of hospitals or other health services (Ernawati, 2019).The implementation of life in the world, including caring for sick patients according to sharia, should be the reference for every Muslim as in QS Al-Jasiyah/13:18, Allah SWT says: "Then We made you above a sharia (regulation) of affairs (that religion), then follow the Shari'a." In this case, sharia hospitals that have been sharia certified by DSN-MUI in their operations must meet sharia management standards and sharia service standards.In sharia services, sharia hospitals have 3 (three) Mandatory Sharia Quality Indicators, namely;(1).Accompanying patients who are dying with talqin, (2).Reminding patients and families of prayer times; and (3).Inserting catheters according to gender.Then, the Syariah Minimum Service Standards (Standar Pelayanan Minimal or SPM) indicators as follows: (1).Islamic (leaflets or spiritual books) ;(2).Installation of an EKG according to gender;(3).Wearing a breastfeeding hijab;(4).Wearing a hijab in the operating room;and (5).Scheduling elective operations that do not conflict with prayer times.Furthermore, the Hospital Sharia Compliance has 6 (six) dimensions, namely consisting of the 6 latest Sharia Service Standards published by MUKISI and in collaboration with DSN-MUI (Admin-Mukisi, 2018).According to Admin-Mukisi (2018) Therefore, the following hypothesis can be made: Hypothesis 3 (H3): Sharia Compliance has a positive and significant effect on patient loyalty at Sharia Hospitals in Pekanbaru City, Riau Province Hypothesis 6 (H6): Sharia compliance has a positive and significant effect on patient satisfaction at Sharia Hospitals in Pekanbaru City, Riau Province.

Patient Satisfaction (Y2)
Having good trust from patients in hospital services and facilities will give rise to patient satisfaction with the hospital itself.
According to Zeithaml and Bitner (2003), satisfaction is a need that is fulfilled by consumers so that they give a good response.
Satisfaction is an assessment related to the features of a product or service, which ranks consumer pleasure in relation to fulfilling consumer consumption needs (Zeithaml, and Bitner (2003).Kotler (2000) states that customer satisfaction is a customer's feeling of pleasure or dissatisfaction resulting from comparing a product's perceived performance (or outcome) in relation to his/her expectations.If the performances fall short of expectations, the customer is dissatisfied.If the performances match the expectations, the customer is satisfied.If the performances exceed expectations, the customer is highly satisfied or delighted.Customer satisfaction will provide many benefits and the impact in the long term will be more profitable for a company (Lovelock & Wright, 2002).
A high level of satisfaction can make customers more loyal and can show good company performance (Kotler and Keller, 2012).Andaleeb and Conway (2006) state that knowing better patient satisfaction will be very helpful in making more effective policies to improve service quality.Meanwhile Lovelock. and Wright (2002) state that customer satisfaction provides many benefits for companies, and the level of customer satisfaction is greater.Satisfaction is the perception of customers (patients) who compare their expectations before making a transaction with what they receive after making the transaction (Kotler and Armstrong, 2012).The patient satisfaction indicator is a development of the research results of Merkouris et.al (2003), and includes indicators regarding satisfaction with services that comply with sharia principles as follows: (1).Patients are satisfied with services that are in accordance with sharia principles; (2).Patients are satisfied with the skills and competence of doctors, nurses and employees; (3).Patients are satisfied with the speed of exam inations with modern equipment.Patients are satisfied with the relatively cheap cost of treatment; and (4).Patients are satisfied with the comfort of this hospital.
Therefore, the following hypothesis can be made:

Patient Loyalty (Y1)
Customer loyalty is needed by a company to be able to survive and be able to compete with other companies.Customer satisfaction can influence customer loyalty, but to be loyal there is a customer's interest in returning to using a company's products or services.
According to Kotler et. al (2010), retaining all existing customers will be more profitable than charging customers because the cost of attracting a new customer can be five times the cost of retaining one.existing customers.In the banking services sector, it was found that consumer loyalty is strongly influenced by customer satisfaction (Keisidou, et.al, 2013).Then, service quality can be measured using 5 (five) dimensions, namely: empathy, tangibility, responsiveness, assurance and reliability.These five dimensions show a positive relationship with consumer satisfaction (Lau et al., 2000;Chodzaza and Gombachika, 2013).The results of research in Sharia hospitals show that the implementation of Sharia principles can provide satisfaction to patients, thereby generating loyalty to Sharia hospitals.Here are some of the results of the research: Research conducted by SarI ( 2023) results shows that Islamic services have a significant influence on satisfaction among patients at Islamic Hospital.Islam III Surabaya.Hospitals have a Sharia concept which can be seen in the aspects of service in Sharia hospitals in five dimensions, including Rabbaniyah (surrendering everything to Allah SWT), akhlaqiyyah (character and character), waqi'iyyah (truth of facts), and insaniyyah (in line with human nature).
Loyalty is the customer's (patient's) perception of maintaining a deeply held commitment to repurchase or re-support a product or service even though the influence of the situation and marketing efforts have the potential to cause the customer to switch, telling others about the product or service (Heskett et al, 1994).Patient loyalty has the following indicators: (1).Attitude to always carry out transactions at the hospital of choice continuously; (2).Convey positive things about the hospital to other people; (3).Avoid the attitude of switching to another hospital; (4).Recommending hospitals to other parties; and (5).Making certain hospitals the main choice for consultations on health problems.These indicators refer to Kwong and Candinegara (2014) and Heskett et al. (1994) and have been adapted to conditions in Indonesia, the indicators have been condensed into 2 (two) as follows: (1).I will always seek treatment at the hospital this, and not switch to other hospitals; and (2).I will invite my family to seek treatment at this hospital and recommend this hospital to others.

Research and Methodology
The research design used is explanatory research and causality with a survey method, because this research is research that has cause and effect or research that explains the causal relationship between variables through hypothesis testing (Effendiet.al., 2012).
Population is a generalization area consisting of objects/subjects that have certain quantities and characteristics determined by researchers to be studied and then conclusions drawn (Sugiyono, 2015).According to Burhan (2011), the research population is the totality of research objects which can be humans, animals, plants, air, symptoms, event values, life attitudes and so on, so that these objects can be sources of research data.The population in this study were all inpatients at the Islamic private hospital in Pekanbaru City, the number of which is not known with certainty.The sampling technique in this research is the accidental sampling method.Accidental sampling is sampling carried out by chance, that is, anyone who meets the researcher by chance can be used as a sample (Sugiyono, 2015).

Method of Collecting Data
Data collection methods include: (1).Primary data was carried out by distributing questionnaires to inpatients at Islamic hospitals in the city of Pekanbaru.By visiting hospitals that have given research permission, questionnaires are distributed directly to hospital patients who are undergoing treatment or who have returned home.Primary data is planned to be collected over a period of three months; and (2).Secondary data in the form of data relating to patients such as data on the number of outpatient and inpatient visits.Obtained from 3 (three) hospitals in Pekanbaru City, which were the research objects, consisting of Ibnu Sina Islamic Hospital, RSIA Zaenab, and RS Tabrani: Research data comes from survey results and documentation.The Likert scale is used in the proposed questionnaire to determine the extent to which respondents provide their opinions on a predetermined scale.Data were analyzed using partial least squares structural equation modelling (SEM-PLS).PLS data analysis aims to test the results of modifications to several research models to provide an overview of the variables studied (Garson, 2016).Next, the conceptual framework of this research is described in Figure 1 as follows  (1).Gender of Respondents consists of 40% men, while 50% women, and the rest do not fill in.This shows that gender in this research is not a limitation in making respondents' conclusions;(2).Respondents' ages consisted of: 17-30 years old, 50%; 25% of patients aged 30-45 years, 9.6% of patients aged 45-60 years, and 8.40% of patients aged 60-75 years and over;(3).The education level of respondents consisted of: high school graduates as many as 40%; 20% Diploma graduates; Bachelor graduates as much as 25%; and 5% Master's graduates;(4).The patient's marital status consists of: unmarried status, 30%; married status as much as 60%; as well as widower and widow status as much as 5%;(5).Respondent Demographics based on Religion consists of 97% of patients who are Muslim, Christian religion as much as 2%,and patients who are Hindu are 1%; and (6).Respondent demographics based on patient income level are IDR 1-5 million 50% income level; the income level is IDR 5-10 million as much as 30%, patient income level of IDR 10-15 million by 15%,and patients whose income level is IDR 15-20 million is 5%.

Descriptive Statistical Analysis
Referring to respondents' answers related to trust, service quality, sharia compliance, satisfaction and loyalty towards Islamic Hospital are as follows: i.
Public trust in the Islamic Hospital in Pekanbaru has an average respondent answer value of 3.96, meaning good...This can be seen from several aspects, namely because of the expertise, trust, and physical attractiveness of the Islamic Hospital.
According to Mowen and Minor in Donni (2017), Trust is all the knowledge possessed by consumers and all the conclusions made by consumers about objects, attributes and benefits; ii.
The quality of service to the community has an average score of respondents' answers in the 4.05 category, meaning good.This can be seen from several aspects, namely the facilities and physical attractiveness of the Islamic Hospital.Several researchers and academics view service quality as an antecedent of customer satisfaction (Parasuraman et.al., 1985;McDougall and Levesque, 2000); iii.
Shariah Compliance at Islamic hospitals in Pekanbaru is in the good category with.It has an average value of respondents' answers of 3.55.Sharia compliance, satisfaction and loyalty towards hospitals that comply with sharia, obtained results in the good category.This is because the three Islamic Hospitals have implemented health services with sharia principles in accordance with maqasid sharia in terms of hospital governance.Ibn Ashur (1973) in Musolli ( 2018) provides an interesting definition that maqasid sharia is the value or wisdom that is of concern to sharia' in all sharia content, whether detailed or global.In this case, the three Islamic Hospitals in Pekanbaru have characteristics, namely that the hospitals comply with Sharia compliance, making them different from other hospitals.iv.
The average value of respondents' answers to satisfaction was 3.99.Public satisfaction with the services of the Islamic Hospital in Pekanbaru is in a good category.This can be seen from several aspects, namely because of trust and the physical attractiveness of the Islamic Hospital.According to Kotler (1988), satisfaction is a person's level of satisfaction after comparing the perceived performance or results compared to his expectations.So, satisfaction or dissatisfaction is the conclusion of the interaction between expectations and experience after using the services or services provided; And v.
The average value of respondents' answers to the loyalty statement was 3.72, meaning that the value was included in the good category.It can be seen that public satisfaction with the Islamic Hospital in Pekanbaru is in a good category and has a positive impact on customer (patient) perceptions thereby increasing patient loyalty.Kotler and Keller (2012) define loyalty as a firmly held commitment to repurchase a chosen product or service in the future.

Measurement Model Analysis
This research uses convergent and discriminant validity tests with the construct to be measured.Convergent validity of the measurement model with reflexive indicators is assessed based on the correlation between item scores/component scores estimated with PLS software.An individual reflexive measure is said to be high if it correlates more than 0.70 with the construct being measured.According to Chin (1998) in Ghozali (2006), for research in the initial stages of developing a measurement scale, a loading value of 0.5 to 0.6 is considered sufficient.In this research, a loading factor limit of 0.50 will be used.Table 4 shows that the factor loading value (convergent validity) of each item is more significant than 0.5.so that each item in the variables of trust, service quality, sharia compliance, satisfaction and customer loyalty all have valid test results, and all constructs meet the reliable criteria.This shows that it can be concluded that Cronbach's Alpha and Composite Reliability values above 0.70 as well as AVE values above 0.50 as the recommended criteria.Thus, it can be concluded that all items in each variable have carried out their measurement function properly and correctly with the Smart PLS measuring instrument.5 above, the data used in this research is reliable.The reliability threshold value is 0.70 (Ghozali & Latan,2015).Thus, Table 5 shows that each variable has a Cronbach's Alpha and Composite Reliability value greater than 0.70 so that the items used in this research are reliable.

Structural Model Test
The structural model is a model that describes the cause-and-effect relationship between latent variables which is built based on the substance of the theory (Ghozali & Latan,2015).The PLS structural model was validated by calculating R2 and path coefficients by comparing the t-statistics on the Smart PLS output with the t-table.First, test the direct relationship between service quality and perceived value.on customer loyalty.Then, there is a direct influence of service quality and perceived value on customer satisfaction.After that, there is a direct influence of customer satisfaction on customer loyalty.The results of the structural model testing are shown in Figure 2    Based on the analysis results that can be seen in Table 6 above, it shows that: (1).The coefficient value of SAT -> LOY is 0.409 with a calculated t value of 7.131.This value is greater than the t table of 1.96.These results prove the significant effect of SAT -> LOY; (2).The SC -> LOY coefficient value is 0.322 with a calculated t-value of 5.546.This value is greater than the t table of 1.96.These results prove the significant effect of SC -> LOY; (3).The SC -> SAT coefficient value is 0.326 with a calculated t value of 5.13.This value is greater than the t table of 1.96.These results prove the significant influence of SC -> SAT; (4).The coefficient value of SQ -> LOY is -0.063 with a calculated t value of 0.881.This value is smaller than the t table of 1.96.These results prove there is NO effect of SQ -> LOY; (5).The coefficient value of SQ -> SAT is 0.361 with a calculated t value of 4.298.This value is greater than the t table of 1.96.These results prove the significant influence of SQ -> SAT; (6).The coefficient value of TRUST -> LOY is 0.195 with a calculated t value of 3.253.This value is greater than the t table of 1.96.These results prove the significant effect of TRUST -> LOY; and (7).The TRUST -> SAT coefficient value is 0.202 with a calculated t-value of 2.857.This value is greater than the t table of 1.96.These results prove the significant effect of TRUST -> SAT.
Furthermore, the indirect test can be seen in table 7 as follows:.Based on the analysis results which can be seen in Table 7 above, the SC -> SAT-> LOY coefficient value is 0.133 with a calculated t value of 3.925.This value is greater than the t table of 1.96.These results prove the significant effect of SC -> SAT -> LOY which means a significant mediation effect.Based on the analysis results that can be seen in Table 7 above, the coefficient value of SQ -> SAT -> LOY is 0.148 with a calculated t value of 3.985.This value is greater than the t table of 1.96.These results prove the significant influence of SQ -> SAT -> LOY, which means the mediation effect.Based on the analysis results which can be seen in the table above, it shows the coefficient value of TRUST -> SAT -> LOY is 0.083 with a calculated t value of 2.573.This value is greater than the t table of 1.96.These results prove the significant effect of TRUST -> SAT ->; LOY which means a significant mediation effect.

Discussion of Results
Based on the results of the Structural model estimation test, it can be concluded as follows

H1: The influence of trust on Loyalty to the Islamic Hospital in Pekanbaru City.
Based on the results of the analysis which can be seen in Table 7 above, the coefficient value of trust in customer loyalty for Islamic hospitals is 0.195 with a calculated t value of 3.253.This value is greater than the t table of 1.96.These results prove the significant influence of trust on customer loyalty at Islamic Hospitals in Pekanbaru City.Mowen and Minor (2013) stated that consumer trust is all the knowledge possessed by consumers and all conclusions made by consumers about objects, attributes and benefits and this trust arises as a result of: i.
Benevolence, how much someone trusts the seller to behave well towards consumers.It means. is how the hospital management or Islamic hospital administrators in Pekanbaru City are truly serious about working and providing services to hospital patients without looking at the patient's background, thus creating a sense of trust in the patient towards the Islamic hospital in terms of curing illnesses; ii. Ability, a current assessment of what a person can do.In this case, how is the management or management of the Islamic hospital in Pekanbaru City able to convince patients and provide guarantees of satisfaction and safety when they are in the Islamic hospital environment so that it will create patient loyalty towards the Islamic hospital; iii.Integrity, is how much confidence a person has in the Hospital's honesty in maintaining and fulfilling the agreement that has been made with the Patient.What this means is how the management of the Islamic hospital in Pekanbaru City is able to provide confidence that this Islamic hospital is one of the best solutions in providing healing to patients so that patients who enjoy the hospital facilities feel comfortable and calm, the hospital management already has ISO standards and standards.sharia that has been determined by the certification body that has been determined by DSN-MUI; iv.Willingness to depend, the consumer's willingness to depend on the seller in the form of accepting risks or negative consequences that may occur.What this means is that the trust that patients given to the hospital so that the patient can recover in the hospital is very large because the management of the Islamic hospital in the city of Pekanbaru City is managed professionally so that the patient feels confident and happy to seek treatment at the Islamic hospital to cure the disease experienced by him.patient.So it can be concluded that consumer trust is the willingness of one party to accept risks from another party based on the belief and hope that the other party will act as expected, even though both parties do not know each other.
According to Imam Al-Qusairi, in Tasman (2002), trust is possessed by shadiq people, honest people.Honest behaviour is behaviour that is followed by an attitude of trustworthy responsibility for what one does or integrity.An attitude of trust is closely related to the way one maintains one's principles and is then responsible for implementing these principles while maintaining balance and creating beneficial values.which is appropriate.Carrying out the mandate as well as possible is the characteristic of a professional.Services can be said to be reliable if the agreement that has been expressed is achieved accurately.This precision and accuracy will grow consumer trust in service providers.In this context, Allah SWT also wants each of His people to keep the promises they have made.
As in QS An-Nahl/ 16:91, Allah SWT says: "And keep the agreement with Allah when you promise and do not cancel (your) oaths after confirming them, while you have made them." In this case, health service providers, especially Islamic hospitals, should always provide optimal, professional service so as to provide excellent service to patients who need maximum recovery and treatment and also Islamic hospital managers are also expected to be kept away from negative attitudes that damage the performance of Islamic hospitals itself so that it will be detrimental to the individual and the organization.This is in accordance with Norhermaya and Soesanto (2016), where forming customer trust is one way to create and retain customers.According to Danesh, Nasab, and Ling (2012) who state that customer trust is the foundation of business which is a way to create and retain consumers (Laely, 2016).Diza et.al., 2016) stated that trust has a positive and significant influence on customer satisfaction variables.Sahangamu, Mananeke, and Sepang (2015) prove that there is a significant and positive influence of trust on customer satisfaction.Gul's (2014) research also proves that the trust variable has a significant influence on satisfaction.Customers who are increasingly dissatisfied indicate that customers have low trust in the company, such as Leninkumar (2017) who found that there is a significant positive relationship between customer satisfaction and customer trust.

H2: The influence of Service Quality on Patient Loyalty at Sharia Hospitals in Pekanbaru City
Based on the results of the analysis which can be seen in Table 7 above, it shows that the coefficient value of service quality on customer loyalty is -0.063 with a calculated t value of 0.881.This value is smaller than the t table of 1.96.These results prove that there is no significant influence of service quality on patient loyalty at the Islamic Hospital in the city of Pekanbaru.In the hospital industry, Naidu (2009) found that the relationship between healthcare quality and patient satisfaction was significant.A patient is satisfied when the quality of hospital services meets their expectations and requirements, as a result, the greater the patient's satisfaction (Chahal and Kumari, 2010).Therefore, the strategy that must be carried out by Islamic hospitals is to build customer satisfaction, which will ultimately build customer loyalty.However, patients have their rights and choices, and if they are not satisfied with their hospital, then they have the opportunity to switch to another hospital (Kessler and Mylod, 2011).
In addition, there is no consensus regarding the relationship between service quality and patient satisfaction in the hospital industry, as many researchers in the healthcare industry focus more on measuring technical and functional quality rather than patient satisfaction (Bell, 2004;Gill and White, 2009), and patient satisfaction.patient outcomes are continuously measured as a proxy for assessing the quality of patient care (Turris, 2005).Research results from Aagja and Garg (2010) show that a reliable and valid scale called public hospital service quality (PubHosQual) was developed in relation to admission.The purpose of hospital admission here is how the administration of this Islamic hospital can make it easier to provide One solution for administrative services for patients is the Sharia hospital services based on the Self Admission Platform (SAP) Cente.What this SAP machine means is that if every patient wants to consult a doctor or go to a doctor for treatment, they can use the SAP without having to wait in a very long queue which is done manually.Excellent health services are how Islamic hospital managers can provide health information, treatment information, and so on in a professional manner, supported by modern equipment in order to improve health services to patients who will seek treatment at Islamic hospitals.
Furthermore, the concept of service in Islam can be used as a reference as stated in the words of Allah SWT in QS Al-Baqarah/2:267 as follows."O you who believe, spend (in the way of Allah) some of the good results of your efforts and some of what you bring out of the earth for you and do not choose the bad and then make a living from it ..........".This verse emphasizes that Islam pays great attention to quality service, providing the good, and not the bad.Thorik G and Utus H (2006) explain that quality service is not just delivering or serving but also understanding, comprehending and feeling.Therefore, the benchmark for service quality in Islam is called sharia standardization which is used as an assessment standard, namely: i.
Responsiveness and keeping commitments -as mentioned in QS Al Mā'idah/5:1, Allah SWT says: "O you who believe, fulfill your promises...".Also professional in work, as mentioned in QS Al-Insyirah / 94:7, Allah SWT says: "So when you have finished (with one matter), keep working hard (on other matters." ii. Reliability -as exemplified by the Prophet Muhammad SAW in QS Al Ahzāb/ 33:21, Allah SWT said: "Indeed there is in the Messenger of Allah a good role model for you (namely) for those who hope for (the mercy of) Allah and (the coming of) the day the end of the world and those who remember Allah a lot." iii.
Assurance can be provided in the form of security, comfort, honesty and so on.This is in accordance with the word of Allah in QS Asy-Syu'ara' /26:181-182, Allah SWT says: "Perfect the measure and do not harm others and weigh with the right scales.", and behave gently as the word says.Allah SWT in QS Ali Imrān/3:159.

iv.
Empathy -The form of attention taught by Islam must be based on faith in order to serve Allah SWT.This is in accordance with QS Al-Nahl/ 16:90, Allah SWT says: "Indeed, Allah commands (you) to act justly and do good deeds, to give to your relatives, and Allah forbids evil deeds, evil and enmity.He teaches you so that you can learn from it." v.
Physical abilities (tangible), for example, being polite in dressing as in QS Al-A'raf/ 7:26, Allah SWT says "O son of Adam, indeed We have sent down to you clothes to cover your private parts and beautiful clothes to adorn you."On the other hand, the Islamic concept teaches that when providing services from the business you run, whether in the form of goods or services, do not give bad or low-quality ones, but rather provide quality ones to other people.This is related to QS An-Nahl/ 16:91, Allah SWT says: "And keep your promise to Allah when you promise and do not break the oath after it has been pledged."This means the ability to provide services in accordance with the promises offered.The assessment of service quality is seen from the hospital's capabilities related to timeliness of service, time to process registration, time to start treatment or examination, and conformity between expectations and actual time for patients.

H3: The effect of Sharia Compliance on Patient Loyalty at the Sharia Hospital in Pekanbaru City
Based on the results of the analysis which can be seen in Table 7 above, the coefficient value of sharia compliance on Islamic Hospital patient loyalty is 0.322 with a calculated t value of 5.546.This value is greater than the t table of 1.96.These results prove the significant influence of Islamic Hospital Sharia compliance on patient loyalty.In the governance of an organization, compliance means following specifications, standards, or regulations set by authorities.Specifications, standards or regulations can be in the form of policies, work procedures, and the existence of an internal control system based on Sharia compliance, and Sharia Hospital Certification standards.Sharia Hospital Certification Standards are published to provide a reference for implementing maqasid sharia in the hospital health service system.Sharia standards only mention aspects that contain critical Sharia control points in addition.
Things that are normative and that do not contain sharia values in their documentation and implementation are not included in sharia hospital certification standards.
Research by Ismail et.al. (2018) confirms that the assessment elements related to the implementation of sharia compliance consist of document reviews, patient surveys and facility surveys which are also in accordance with the assessment methodology by KARS hospital accreditation carried out by assessors from DSN-MUI and MUKISI related to sharia compliance.This research is in line with Zailani et al (2016) which proves that the satisfaction of Muslim medical tourists depends on the role of doctors and hospitals; Meanwhile, nurses' halal practices are not related to it.So it can be concluded that sharia compliance is a rule in religion that must be followed and obeyed as in QS Ash Shura/ 42:13, Allah SWT says: "He gave a will to Noah and what We have revealed to you (Muhammad) and what We have willed to Abraham, Moses and Jesus, namely, uphold the religion (faith and piety) and do not be divided in it...", and QS Al Jatsiyah/45:18, Allah SWT says: "Then, We made you (Muhammad ) follow the Shari'a (rules) of that religion, so follow (the Shari'a) and do not follow the wishes of people who do not know."These verses show that Allah SWT has ordered His servants to uphold His religion and forbids disputes over it which could result in division and destroy unity.Then, these verses show that we must adhere firmly and obey the Shari'a of Allah SWT as taught by the Prophet Muhammad SAW to his people, and not follow the desires of people who do not know the Shari'a of Allah SWT.

Fourth Hypothesis (H4): The Influence of Trust on Patient Satisfaction at Sharia Hospitals in Pekanbaru City
Based on the analysis results that can be seen in Table 7 above, the trust coefficient value for patient satisfaction is 0.202 with a calculated t-value of 2.857.This value is greater than the t table of 1.96.These results prove the significant influence of trust on patient satisfaction at Islamic hospitals in the city of Pekanbaru.Patient trust in the services provided will make the patient feel comfortable and safe in the facilities provided by the hospital.Customer satisfaction will provide many benefits and the impact in the long term will be more profitable for a company (Lovelock,2002).A high level of satisfaction can make customers more loyal and can show good company performance (Kotler,2011) so analyzing patient satisfaction levels is an important thing to do in order to achieve patient-oriented health services.
According to Andaleeb et al. (2006) knowing better patient satisfaction will really help in making more effective policies to improve service quality.Meanwhile, Lovelock (2002) stated that customer satisfaction provides many benefits for companies, and the level of customer satisfaction is greater.Highly satisfied customers will spread positive word of mouth and will become a walking, talking advertisement for a company, which will lower the costs of attracting new customers.In the Islamic view, giving a good belief so that it results in satisfaction is a good deed and is approved by Allah SWT.As QS An-Nahl/16:105, Allah SWT says: "Indeed, those who invent lies are only those who do not believe in the verses of Allah, and they are liars.";and QS An-Nisa/4:58, Allah SWT says: "Indeed, Allah orders you to convey trust to those who are entitled to receive it, and (orders you) when you determine a law between people so that you determine it fairly.Indeed, Allah will give you the best teaching."The meaning of these two verses is that we as followers of the Prophet Muhammad SAW must be able to act fairly, without committing injustice, because if we can act as a trust (fair) it is closer to piety.And fear Allah, indeed, Allah is most careful in what we do.

H5: The influence of Service Quality on Patient Satisfaction at Sharia hospitals in Pekanbaru City
Based on the results of the analysis which can be seen in Table 7 above, the coefficient value of service quality on Islamic hospital patient satisfaction is 0.361 with a calculated t value of 4.298.This value is greater than the t table of 1.96.These results prove the significant influence of service quality on Sharia hospital patient satisfaction.Quality is something that for service providers is something that must be done well.The superiority of a service product can be seen from the uniqueness and quality provided by the service, whether it meets the expectations and desires of customers (Hery & Aris,2015).Bates and Hoffman (1999) in Sukoco and Nilowardono (2009) state that service quality is the customer's assessment of the service provision process, thus evaluating service quality means evaluating the process.In the context of the service industry, the use of standard quality management techniques aims to discover, measure and analyze the determinants of service quality.Islamic Hospital is related to how hospitals can provide good and professional services to hospital patients.
This starts from the side of Islamic hospital workers, including having skills and serving patients using the 3 S (Senyum, Sapa, Salam) or Greetings, Smiles and Greetings.On the other hand, what needs to be considered is the adequate facilities of the Islamic hospital, where there is access to a place that makes it easier for patients to seek treatment at an Islamic hospital so that it will create a feeling of satisfaction when seeking treatment and visiting an Islamic hospital.According to Nizar and Soleh (2012), consumer satisfaction is an emotional response to experiences related to the product or service purchased.According to Zeithaml and Bitner in Priansa (2017) the definition of consumer satisfaction or dissatisfaction is the difference between expectations.The connection with hospital patient satisfaction is that when patients come to the hospital they feel that they are not burdened by the pain they are experiencing, meaning that patients visit an Islamic hospital with professional service that emotionally reduces the pain the patient experiences so that the patient feels satisfied with the service and facilities.Islamic hospitals will also be profitable for Islamic hospital management because it will provide satisfaction in managing the Islamic hospital.
In the Islamic view, satisfaction is the same as being fair.Fairness here is that no one party feels disadvantaged, either from the side of the service provider, namely the Islamic hospital or the recipient of the service, namely the hospital patient.This is found in QS Al-Maida/ 5: 8, where Allah SWT says: "O believers!Be upholders of justice, witnesses for Allah, even against yourselves or against your parents and relatives."Based on the explanation of the verse above, it is Allah SWT's command to believers to carry out all matters carefully, honestly and sincerely, both in worldly matters and religious matters.The concept of being fair has also been concretely expressed in this verse.

H6: Sharia Compliance Influences Patient Satisfaction at Sharia Hospitals in Pekanbaru City
Based on the results of the analysis which can be seen in Table 7 above, the coefficient value of Islamic hospital sharia compliance on patient satisfaction is 0.326 with a calculated t value of 5.13.This value is greater than the t table of 1.96.These results prove the significant influence of Islamic hospital Sharia compliance on patient satisfaction.Sharia compliance means implementing maqasid sharia in the governance of business operational systems.Reference and standard systems are required to ensure compliance.Thus, the Sharia Hospital Certification standard was published to provide a reference for implementing maqasid sharia in the hospital health service system.Sharia Hospital Certification Standards consist of five chapters which are details of maqasid sharia, and each chapter is divided into two groups, namely:(1).Sharia management standards; and (2).Sharia service standards.This will be a reference and guideline for any hospital to be certified as a Sharia Hospital in the future.
Sharia standards mention aspects containing critical Sharia control points in addition.Things that are normative and that do not contain sharia values in their documentation and implementation are not included in sharia hospital certification standards.From these standards, assessment elements are determined to assess the level of compliance.The assessment elements consist of document reviews, patient surveys and facility surveys which are also in accordance with the assessment methodology by KARS hospital accreditation.The assessors who conducted the survey came from DSN-MUI and MUKISI (Ismail et.al., 2018).Satisfaction is a positive response from customers which is shown by things such as feelings of pleasure, and fulfilment of expectations regarding performance and service.According to Kotler (2005), satisfaction is a person's feeling of happiness or disappointment which comes from a comparison between his impression of the performance or results of a product and his expectations.If performance meets expectations, customers will feel satisfied, and vice versa.With Sharia compliance followed by hospital managers, it will automatically provide satisfaction for patients who use health services.
Customer satisfaction is also expected to be a benchmark for the performance of employees or doctors who work at Islamic hospitals in Pekanbaru City.Patient satisfaction with the services provided by employees will become a distinctive characteristic of other hospitals that are not based on Islam.From an Islamic perspective, the benchmark for assessing customer satisfaction is Sharia standards.Customer satisfaction in the view of Sharia is the level of comparison between expectations for products or services that should be in accordance with sharia and the reality received.As a guideline for determining the level of satisfaction felt by consumers, a goods or services company must look at the company's performance in relation to the nature of honesty.According to Lastri, et.al (2022), in muamalah fiqh, being honest is of course very necessary in setting selling prices, being honest in producing products, and being honest in setting selling prices means considering the values of truth and the benefit of humanity.However, doing business to gain short-term profits by ignoring truth and general benefits will plunge oneself into the abyss of destruction now or in the future (Lastri et.al, 2022).

H7: Satisfaction Mediates Public Trust and Influences Loyalty to Sharia Hospitals in Pekanbaru City
Based on the analysis results which can be seen in Table 7 above, it shows that the trust coefficient value is mediated by satisfaction with loyalty of 0.083 with a calculated t value of 2.573.This value is greater than the t table of 1.96.These results prove the significant influence of satisfaction mediating public trust on loyalty, which means the mediating influence is significant.Satisfaction remains the main benchmark for Islamic hospital patients regarding their trust and loyalty to the hospital.The patients have felt satisfied with the services and facilities provided starting from a welcome reception to incoming patients, providing information to patients who outpatient or inpatient services, all types of services provided to cure a patient up to the overall service system.throughout the hospital.
The study of patient satisfaction must be understood as something that has many dimensions or variables that influence it (Linder Pelz in Kwinsky and Steiber, 1996)).Patient satisfaction is a very subjective thing, difficult to measure, and can change, and there are many influencing factors, as many dimensions in human life.This subjectivity can be reduced and can even become objective if enough people have the same opinion about something.Thus, to study patient satisfaction, a fairly valid research instrument is used, accompanied by good research methods (Suryawati, 2004).According to Merkouris, et al., (1996), measuring patient satisfaction can be used as a tool for evaluating the quality of health services; evaluation of intervention consultations and the relationship between health and illness behaviour; making administrative decisions; evaluating the effects of service organizational changes; staff administration; marketing function; and professional ethical formation.After the patient feels satisfied with the hospital service, patient loyalty will arise towards the Islamic hospital in Pekanbaru.The simplified meaning of patient loyalty is a desire that is born on the basis of the process provided by the Islamic hospital, thus making the patient desire to recover at the hospital they choose.

Conclusions
Based on research findings and discussion, it can be concluded that the direct influence of independent variables on loyalty is: trust has a positive and significant effect on patient loyalty, then service quality has no significant effect on patient loyalty, hospital sharia compliance has a positive and significant effect on loyalty.Then the direct influence of independent variables on satisfaction is: Trust has a positive and significant effect on satisfaction, service quality has a positive and significant effect on satisfaction, and sharia compliance has a positive and significant effect on satisfaction.Next is the influence of the mediation of satisfaction on the relationship between the independent and dependent variables, namely; satisfaction mediation has a positive and significant effect on the relationship between trust and patient loyalty, satisfaction mediation has a positive and significant effect on the relationship between service quality and loyalty, and satisfaction mediation has a positive and significant effect on the relationship between hospital sharia compliance and patient loyalty.And finally, patient satisfaction has a positive and significant effect on patient loyalty.
The results of this research are expected to provide the following contributions:(1).This research provides a theoretical contribution that Trust has a positive and significant effect on loyalty to the Islamic Hospital in Pekanbaru City.The results of this research are supported by Sahangamu et.al (2015) who prove that there is a significant and positive influence of trust on customer satisfaction.Gul's (2014) research also proves that the trust variable has a significant influence on satisfaction.Customers who are increasingly dissatisfied indicate that customers have low trust in companies such as Leninkumar (2017) who found that there is a significant positive relationship between customer satisfaction and customer trust;(2).This research provides a theoretical contribution that Service Quality does not have a significant effect on Sharia Hospital Loyalty in the city of Pekanbaru City.The results of this research are supported (Mihaela, 2013;Hafeez, and Muhammad, 2012;Luarn and Lin, 2003).
In Rafidah's (2017) research, service quality influences customer satisfaction in Sharia banking in the city of Jambi.Hospital Sharia Compliance has a positive and significant effect on loyalty to Islamic Hospitals in Pekanbaru City.According to Zailani et al (2016) in their research titled Predicting Muslim medical tourists' satisfaction with Malaysian Islamic friendly hospitals, the results of their research prove that the satisfaction of Muslim medical tourists depends on the role of doctors and hospitals; meanwhile, nurses' halal practices are not related to it.This study also shows that Muslim medical tourists' attitudes only play a mediator role between hospital halal practices and Muslim medical tourists' satisfaction.Trust has a positive and significant effect on satisfaction at the Islamic Hospital in Pekanbaru City.The results of this research are supported by Moniharapon and Ogi (2016) where trust has a positive and significant effect on the customer satisfaction variable.Sahanggamu et.al. (2015) proves that there is a significant and positive influence of trust on customer satisfaction.Gul's (2014) research also proves that the trust variable has a significant influence on satisfaction.Customers who are increasingly dissatisfied indicate that customers have low trust in the company.Leninkumar's (2017) research results found that there is a significant positive relationship between customer satisfaction and trust.Service quality has a positive and significant effect on patient satisfaction, and Sharia Compliance has a positive and significant effect on patient satisfaction.Satisfaction can mediate trust in loyalty to Sharia hospitals, and researchers want to see the indirect influence on patient loyalty.Satisfaction can mediate service quality on loyalty to Sharia hospitals in Pekanbaru City where researchers want to see the indirect influence on patient loyalty in Sharia hospitals.Satisfaction can mediate hospital Sharia compliance on patient loyalty where researchers also want to see the indirect effect on Sharia hospital patient loyalty.Next, satisfaction has a positive and significant effect on loyalty to Islamic hospitals in Pekanbaru City.
This research has been carried out in accordance with scientific procedures but still has limitations, and in order for future research to be more comprehensive, among others: the variables used for this research are few, namely only 5 variables, therefore in future research we can add other variables related to loyalty Then, the variable questionnaire used by researchers is considered to be still imperfect, therefore in future research the questionnaire can be perfected, and it is also hoped that new methods can be used, with new research objects.
Hypothesis 7 (H7): Satisfaction mediates the influence of Trust on patient Loyalty positively and significantly at Sharia Hospitals in Pekanbaru City, Riau Province Hypothesis 8 (H8): Satisfaction mediates the influence of Service Quality on patient loyalty positively and significantly at Sharia Hospitals in Pekanbaru City, Riau Province Hypothesis 9 (H9): Satisfaction mediates the influence of Hospital Sharia Compliance on Patient Loyalty positively and significantly at Sharia Hospitals in Pekanbaru City, Riau Province.Hypothesis 10 (H10): Satisfaction influences loyalty to Sharia Hospitals in Pekanbaru City, Riau Province.

Figure 2 :
Figure 2: Direct Effect Test Results; Source: Processed Primary Data 2023 Based on Figure 2 above, the following will explain the testing of each hypothesis.Hypothesis Testing The structural model (inner model) is a structural model for predicting causal relationships between latent variables (Gozali & Latan, 2015).To predict the existence of a causal relationship in SEM-PLS using SmartPLS 3.0 M3 as follows:

Table 1 :
Development of the Number of General Hospitals Based on Implementation in Indonesia 2016 -2020 , the dimensions and indicators of variable 6 Sharia Service Standards are as follows: i. Hospital Sharia Compliance as follows: Sharia Standards for Hospital Access and Service Continuity (Standar Syariah Akses RS dan Kontinuitas Pelayanan or SSARK); ii.Sharia Standards for Patient Assessment (Standar Syariah Asesmen Pasien or SSAP); iii.Sharia Standards for Patient Services and Care (Standar Syariah Pelayanan dan Asuhan Pasien or SSPAP); iv.Sharia Standards for Drug Services (Standar Syariah Pelayanan Obat or SSPO); and v. Sharia Standards for Spiritual Services and Guidance (Standar Syariah Pelayanan dan Bimbingan Kerohanian or SSPBK); and *6).Sharia Standards for Communication and Education (Standar Syariah Komunikasi dan Edukasi or SSKE).

Table 2 below : Table 2 :
Demographics of Patient Respondents from 3 (three) Islamic Hospitals in Pekanbaru City Based on Table on the Demographics of Respondents from Islamic Hospital Patients in Pekanbaru City as follows:

Table 3 :
Recapitulation of Respondents' Responses to Trust, Service Quality, Hospital Sharia Compliance, Satisfaction and Loyalty to Islamic Hospitals Referring to Table of descriptive analysis to see the condition and general description of the data used in the research, and the results are as follows:

Table 5 :
Reliability Analysis

Table 6 :
Direct Effect (Result For Inner Weights)