<![CDATA[Patient loyalty is a strategic indicator for hospitals, particularly in mental health services where continuity of care is essential. This study analyzed the effect of brand image and service quality on outpatient loyalty mediated by patient satisfaction at RSJD Atma Husada Mahakam, a type A psychiatric referral hospital in East Kalimantan, Indonesia. An explanatory quantitative survey with a cross-sectional design was conducted among 200 outpatients selected using purposive sampling. Data were collected using a structured Likert-scale questionnaire measuring brand image, service quality, patient satisfaction, and patient loyalty. Data were analyzed using descriptive statistics, Pearson correlation, and partial least squares structural equation modeling (PLS-SEM) with SmartPLS. The measurement model met validity and reliability criteria, with AVE values ranging from 0.546 to 0.649 and composite reliability values ranging from 0.902 to 0.924. The structural model showed that brand image positively affected patient satisfaction (beta = 0.318; t = 3.934; p < 0.001) and loyalty (beta = 0.210; t = 2.920; p = 0.004). Service quality positively affected satisfaction (beta = 0.515; t = 7.648; p < 0.001) and loyalty (beta = 0.273; t = 4.042; p < 0.001). Patient satisfaction also had a positive effect on loyalty (beta = 0.408; t = 4.794; p < 0.001). Indirect effect testing confirmed that satisfaction significantly mediated the influence of brand image (beta = 0.130; t = 2.715; p = 0.003) and service quality (beta = 0.210; t = 4.113; p < 0.001) on loyalty. The findings indicate that strengthening service quality, maintaining a positive hospital image, and systematically managing patient satisfaction are central strategies for building outpatient loyalty in psychiatric hospital services.]]>
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