Primary healthcare centers in Surabaya, Indonesia: Improving the efficiency of outpatient services by increasing e-health capability and service quality

Abstract

Primary health services are experiencing a rise in the use of digital transformation tools, such as e-health, to enhance their efficiency and effectiveness. However, existing studies offer limited explanations of how e-health capabilities translate into sustained service performance in public primary healthcare settings. This study examines the influence of e-health capability on outpatient service performance by considering outpatient service quality as a mediating mechanism and waiting time as an operational factor. Two hundred and three outpatients from Surabaya, Indonesia's health centers, participated in this quantitative explanatory study. We used PLS-SEM, or Partial Least Squares, to evaluate the data. The research demonstrates that the efficiency and effectiveness of outpatient services are significantly improved through the use of e-health capabilities. Structural analysis reveals that improvements in e-health capability enhance service performance both directly and indirectly via outpatient service quality, with the latter exerting the strongest influence on performance outcomes. Additionally, no moderating effects were found, although wait times have a substantial detrimental impact on service performance. These findings indicate that primary healthcare digital transformation can only reach its full potential by integrating technology capabilities with improved service quality and operational efficiency. This research offers valuable policy recommendations for enhancing the long-term performance of primary healthcare systems and for strengthening the Capability-Quality-Performance model.