<![CDATA[The Service Profit Chain (SPC) describes a sequence from internal service quality and employee satisfaction to service value, patient satisfaction and loyalty, and organizational performance. Evidence for each link in hospitals has not been mapped systematically by pathway. To synthesize empirical evidence on employee satisfaction, service quality, patient satisfaction, and patient loyalty within the SPC framework. A systematic literature review following PRISMA 2020 was conducted using 34 queries across web-indexed sources on 21 September 2026. Thirty-seven reports were included: 31 empirical studies, 5 systematic reviews/meta-analyses, and 1 conceptual analysis. Empirical studies were appraised using three criteria adapted from MMAT 2018 and synthesized narratively. Asia contributed 74.2% of empirical studies, yet only 3 of 23 Asian studies (13.0%) included the employee side. No study measured all SPC components. Service quality was positively associated with patient satisfaction in 15 studies and patient satisfaction with loyalty in 14 studies. Employee-side relationships with patient outcomes were positive in 7 studies, although outcome measures varied. Only 3 studies examined loyalty and organizational performance, with inconsistent findings. Evidence is most consistent on the patient side, whereas the internal employee link and organizational performance link remain under-tested. A hospital SPC adaptation should incorporate trust as a mediator, employee well-being as an internal construct, contextual moderators, and feedback from performance to internal investment.]]>
