Purpose: This study aims to analyse brand image (BI)–service quality (SQ)–patient satisfaction (PS)–loyalty in healthcare by understanding BI and SQ modelled as multidimensional constructs in Indian healthcare. Furthermore, the mediating effect from BI to loyalty through SQ and PS is examined. Design/methodology/approach: Analysis of survey data of 210 patients from Indian hospitals reveals that BI directly affects SQ, PS and loyalty, that SQ directly influences PS, that PS directly influences loyalty of patients and that PS and BI are significant determinants of loyalty. Findings: Our findings suggest that BI has both a direct and indirect (through SQ and PS) impact on loyalty of patients. Moreover, the mediation of BI to loyalty through SQ and PS is partial and complementary mediation. Practical implications: By understanding the relationship between BI, SQ, PS and loyalty, managers will be able to better understand the mechanism to enhance loyalty. As BI impacts loyalty indirectly through SQ and PS, managers need to improve quality, which will enhance satisfaction of patients and thus help in the formation of loyal patients. Originality/value: This study shows how the mediating effect of SQ and PS can be used to improve patient loyalty by building positive BI.