Patient Participation and Citizenship in Outpatient Processes: A Service Logistics Study

Background: Outpatient departments operate as interconnected service nodes through which patient and information flows must be coordinated across multiple handoffs. However, the role of patient value co-creation in shaping perceived outpatient process performance remains underexplored. Methods: This study examined how patient citizenship behavior (VCC_C) and participation behavior (VCC_P) are associated with patient satisfaction (SAT) across four outpatient processes and the overall outpatient pathway of a Thai university hospital. A process-level design was used, combining a cross-sectional survey of 400 patients with PLS-SEM, bootstrapping, multi-group analysis, Kruskal-Wallis tests, IPMA, and semi-structured interviews. Results: Across all processes, VCC_C showed greater explanatory importance for SAT than VCC_P and was strongly associated with VCC_P, indicating a citizenship-dominant pattern. Structural associations were statistically stable across processes, whereas satisfaction levels varied by operational context, with medication dispensing outperforming diagnosis and treatment. IPMA identified feedback and tolerance as high-importance, lower-performance priorities, whereas helping and advocacy emerged as strengths. Conclusions: Interpreted through a service logistics perspective, the findings suggest that queue visibility, handoff coordination, process transparency, and feedback management are important priorities for outpatient service improvement efforts.