The patient’s voice: unpacking the role of participation in hospital re-preference**

This study aims to examine the effects of perceived service quality and patient participation on patients’ re-preference behavior toward the same hospital, specifically investigating the mediating role of patient participation. Research data were collected from 757 adult inpatients at a university hospital in Konya, Turkey, using the Perceived Service Quality Scale, Hospital Re-preference Scale, and Patient Participation Scale. Analysis conducted via Structural Equation Modeling revealed that perceived service quality has a statistically significant and positive effect on the intention to re-prefer the hospital (ß=0.72, p < 0.001), explaining 52.3% of the variance in re-preference behavior. Perceived service quality was also found to significantly predict patient participation (ß=0.54, p < 0.001), while participation itself directly influences re-preference intention (ß=0.52, p < 0.001). Most importantly, bootstrapping results (95% CI [0.07, 0.14]) confirmed that patient participation plays a significant partial mediating role in the relationship between service quality and hospital re-preference. These findings contribute to healthcare management literature by demonstrating that while service quality is a fundamental driver, active patient engagement acts as a critical mechanism that strengthens long-term institutional loyalty. Practically, the study suggests that hospital managers should transition from passive service models to collaborative, patient-centered approaches to enhance patient retention and competitive advantage.