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Hospital Customer Competition Issues are being addressed through Confirmation Factor Analysis on Experiential Marketing, Brand Trust, and Loyalty
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Nikma Fitriasari2
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Endy Wira Pradana1
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Kumoro Asto Lenggono3
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Authors Info & Affiliations
Abstract
Introduction
The post-COVID-19 pandemic has caused an epidemiological transition that has pushed the pace of development of the health service system even further. Issues and revolutions in the health service industry have made all health service industry providers compete with each other to get service users with competitive advantages in the potential global health market. The hospital has improved revenue sustainability while promoting quality assurance practices. These healthcare industry managers have become adept at introducing business practices into business operations to increase the market for hospital customers. Exploratory factor analysis on important marketing dimensions such as experiential marketing, brand trust, and patient loyalty is very much needed in the issue of competition in the health service industry in hospitals.
Materials and Methods
This research was quantitative research with a survey approach to outpatients with a sample size of n=255 patients according to Lemeshow (1997). Identification of loading factor analysis includes experiential marketing variables, brand trust, and loyalty. Data analysis used IBM SPSS Statistics 26
Results
The research results showed 1) an important loading factor on the experiential marketing variable is the Think dimension indicator (0.845), 2) an important loading factor on the brand trust variable is the brand characteristic dimension (0.945) and 3) an important loading factor on variable loyalty is Repeat Purchase (0.925)
Conclusion
Dimension of brand trust is the most important dimension in the issue of competition in the health service industry in hospitals. Strengthening and expanding hospital branding as a promotion strategy to add positive value to the reputation of patient and community services at the hospital.
1. INTRODUCTION
In the hospital health services industry, patients are customers. The era of Medical Technologies 4.0 is marked by digital transformation in the healthcare industry and technical developments in services that focus on patient satisfaction and comfort [1]. Trend Patient Center Care (PCC) has become one of the key service focuses of health service quality [2]. It is hoped that the experiences felt by patients while in the hospital can create a positive perception trend. Creating a positive perception in the minds of customers is one of the important factors that companies must carry out in the marketing process to create product or service success. The COVID-19 pandemic and the Epidemiological Transition are driving the pace of increasingly advanced health system development [3]. Digital marketing optimism and the revolution in the health service industry have made all health service industry providers compete with each other to gain a competitive advantage amidst the potential digital-based world health market [4]. Conditions of competition that are quite tight in the health industry require public service organizations to always try to provide the best service continuously to create loyalty. Nowadays, loyalty can be achieved by marketing which must focus more on creating and maintaining trust in the customer's relationship with the brand. Brand characteristics play a role in creating customers' decisions to trust a brand. Patient loyalty has an impact on the level of hospital visits, the more patient visits to the hospital, the more it affects the level of hospital income. The advantage of patient loyalty is that it can create higher profitability and a more stable financial base. Satisfaction, trust, and loyalty are key factors that influence customer satisfaction, customer repurchase, and customer commitment to an organization [5]. One of the important factors that the hospital industry must take into account in the marketing process to produce a successful product or service is the creation of a favorable customer perception. To create loyalty, public service organizations such as hospitals must always strive to achieve excellence in every aspect of their functions because of the very tight competitive conditions in the health sector. In today's environment, marketers must concentrate on developing and maintaining trust in their clients' relationships with brands so that loyalty can be achieved. Brand characteristics have a role in determining customer decisions regarding trust.
Most human populations are increasing rapidly. The entire world is leading to increasing pressure on healthcare delivery settings. Indonesia experienced two important events in the history of the health service system, the COVID-19 pandemic and the epidemiological transition [6]. Competition within the healthcare industry is having an impact on several relational perspectives, with many studies reporting the impact of increased competition. The healthcare industry has unique market characteristics compared to other industries [7]. The government's role in the health service industry is closely related to the safety of the lives of health service users. Apart from that, industrial drivers are not only from the government, but also from the private sector which continues to grow along with very high business potential as an implication of lifestyle and awareness. Moreover, health services are in synergy with the national health insurance program or universal health coverage [8, 9].
There are 3 important variables that influence each other outpatient services in competition for hospital service providers, namely experiential marketing, brand trust, and patient loyalty [10]. One marketing concept that aims to form loyal customers through experiential marketing is that marketers must look at the emotional side of customers to gain loyalty.
The relationship between experiential marketing and customer loyalty is reaffirmed by several other studies that the higher value of experiential marketing can increase customer loyalty. However, dimensional analysis of the 3 important components in building customer/ patient loyalty is very important to identify as a strategy finding in increasing and maintaining loyalty amid competitive issues in the health service industry, considering the impact of implementing experiential marketing and receiving service value on comfort, satisfaction, and loyalty customer. In the current era even the digitalization of business in the application of experiential marketing is very closely related to customers on an ongoing basis [11].
This study aimed to explore factor loading as a confirmatory factor analysis on important dimensions [12] in experiential marketing, brand trust, and patient loyalty in hospitals which are the basis for management to create programs and policies in the global competition of the hospital industry for maintaining reputation and creating feelings of greater customer trust.
2. MATERIALS AND METHODS
2.1. Study Design
The research design is quantitative research with a survey approach on outpatients using a non-probability sampling technique using convenience sampling with consideration of a population that is easy to obtain and can provide this information [13]. Anyone who can provide good information by accidentally meeting the researcher can be used as a sample if the person is seen as suitable as a data source. The experiential marketing variable in this research is measured by five indicators, namely sense, feel, think, act, and exogenous relate. Brand trust dimensions include brand characteristics, Company characteristics, and Consumer-brand characteristics. Dimensions of patient loyalty Repeat Purchase, Pay More. Retention, and Advocate [14].
2.2. Population and Sample
This study used a population of all outpatients from 2017-2021, amounting to 250,000 patient visits. The sample used non-probability sampling with a convenience sampling technique of 255 respondents referring to the Lemeshow formula [15]. Convenience sampling provides equal opportunity for each visitor to be selected as a sample to provide the required information.
2.3. Procedure
Data collection for this study was carried out by distributing questionnaires in the hospital outpatient unit. The questionnaire in this research consists of indicators on the experiential marketing variable, brand trust variable, and loyalty variable. Ethical approval of respondents was carried out after receiving an explanation of the aims and benefits of the research by signing informed consent. The respondent criteria included outpatients who are at least 18 years old, have stable general conditions, are able to communicate well, and are not in acute condition or experiencing pain.
2.4. Data Analysis
Inferential statistical analysis is used to test the dimensions of each variable expressed as a loading factor. In this study, data were analyzed using IBM SPSS Statistics 26 approach [16].
3. RESULTS
The measurement results in Table 1 show that all the dimension values of the loading factor indicators contribute to describing the experiential marketing variables. The highest indicator of the loading factor contribution value on the experiential marketing variable is the think dimension of 0.845. The diversity of experiential marketing variables can be represented by the think dimension with an important contribution of 84.5%. The lowest indicator contributes to the sense dimension loading factor value of 0.770. The diversity of experiential marketing variables can be represented by the sense dimension at 77%. The contribution of the sense dimension in measuring experiential marketing variables is 77%. The think dimension is the most dominant and important in measuring experiential marketing variables.
| Variable | Dimensions | Loading Factors |
|---|---|---|
| - | Senses | 0.770 |
| - | Feel | 0.838 |
| Experiential marketing | Think | 0.845 |
| - | Act | 0.798 |
| - | Relate | 0.823 |
| Variable | Dimensions | Loading Factors |
|---|---|---|
| - | Brand Characteristics | 0.945 |
| Brand trust | Company Characteristics | 0.928 |
| - | Consumer Brand Characteristics | 0.920 |
The results of the measurement values in Table 2 shows the values of all dimensions of the loading factor indicators showing the contribution of the image to the brand trust variable. The highest and most important value of the loading factor dimension is found in the brand characteristic indicator of 0.945. The diversity of brand trust variables can be represented by the brand characteristic dimension of 94.5%. The contribution of the brand characteristic dimension in measuring the brand trust variable is 94.5%. The smallest dimension loading factor value is found in the consumer brand characteristic dimension of 0.920. The diversity of brand trust variables can be represented by the consumer brand characteristic dimension of 92%. The contribution of the consumer brand characteristic dimension in measuring the brand trust variable is 92%. The brand characteristic dimension is the most dominant and important in measuring the brand trust variable.
The measurement results in Table 3 show that all loading factor dimension values describe the loyalty variable. The highest loading factor value is found in the repeat purchase dimension of 0.925. The diversity of Loyalty variables can be represented by the repeat purchase dimension of 92.5%. The contribution of the repeat purchase dimension in measuring the loyalty variable is 92.5%. The lowest loading factor value is found in the advocate dimension at 0.850. This means that the diversity of Loyalty variables can be represented by the advocate dimension by 85%. The contribution of the advocate dimension in measuring the Loyalty variable is 85%. In conclusion, the repeat purchase dimension has the largest loading factor value, namely 0.925. This shows that the repeat purchase dimension is the most dominant and important in measuring the loyalty variable.
| Variable | Dimensions | Loading Factors |
|---|---|---|
| Loyalty | Repeat Purchase | 0.925 |
| PayMore | 0.881 | |
| Retention | 0.860 | |
| Advocate | 0.850 |
4. DISCUSSION
4.1. Think Factor Loading Analysis on Experiential Marketing
Experiential marketing is an approach to providing information that is more than just information about the services offered and can help customers differentiate services from other similar service providers [17]. The think dimension in experiential marketing has the most important indicators compared to the exogenous dimensions of sense, feel, act, and relate. This illustrates that the thinking dimension is related to customers' intellectual abilities and creativity in assessing service quality [18]. Hospitals can strengthen the thinking dimension by building positive experiences of health services provided by hospitals to customers through medical and non-medical personnel.
The highest dimension is in think which shows that the majority of respondents agree that doctors in outpatient units motivate patients to get well soon. In practice, doctors in outpatient units use empathy and sympathy as a form of excellent service [19]. Excellent service is a form of caring by providing the best service, facilitating the fulfillment of needs, and creating customer satisfaction so that they are loyal to the company. The effectiveness of service excellent training on employee performance [20]. The emergence of negative comments, especially in electronic media, regarding customer experiences when receiving services at hospitals is a sign that the management team needs to pay attention to service excellence activities. The hospital marketing management team provides regular training on service excellence for its employees, especially in the outpatient unit.
Training on service excellence and service quality for employees can have an impact on promotion and marketing for hospitals [21]. One thing that makes the thinking dimension as part of marketing successful is using marketing surprises that have positive value [22]. The surprise in question is that customers get more than they asked for, more fun, or even more than they expected. Marketing surprises to patients in hospitals is the ability to provide a positive experience without discriminating between patient statuses so that the impression that the hospital is not friendly to general patients disappears.
Strong patient expectations can make customers feel happy with the services provided. The think dimension has an intriguing marketing campaign by arousing customer curiosity and contributing to the marketing platform [23]. Sometimes what attracts one person can be boring to another, depending on the customer's level of knowledge, likes, and experience.
The think dimension is a type of experience to invites customers to think creatively [24]. The think dimension needs to be utilized further by hospital marketing management through cognitive experiences that involve customers in creative and intelligent thinking, and educate customers by thinking about something that influences the re-evaluation of the company, industry, products, and services. The patient's intellectual abilities and creativity need to be empowered in providing assessments of health services while the patient is receiving treatment. Marketing through thinking is a cognitive experience that engages customers in creative and intelligent thinking, educating customers by thinking about something that influences the re-evaluation of companies, industries, products, and services. The majority agree that health workers in outpatient services motivate patients to get well soon. This is through patient-centered service practices that use empathy and sympathy as basic capital in fostering patient motivation [25].
The impression of doctors in the hospital outpatient unit, through patient perceptions as proven by the results of the questionnaire, has given a positive impression of the relationship and communication between doctors and patients. The form of communication between doctors and patients includes affective observation in identifying and understanding the patient's emotional experience as well as cognitive abilities such as perspective to understand the patient's experience [26]. Adequate information needed while patients receive health services from administrative officers and health workers is very necessary to maintain satisfaction and comfort with health services.
4.2. Factor Loading Analysis of Brand Characteristic Dimensions on Brand Trust
The results of measuring the highest brand characteristic dimension indicators show that the hospital's performance has a good reputation and is competent in handling patients, both official and general. Hospitals can describe patient beliefs and behavior by conducting assessments before using health services. Brand trust is a customer's desire to trust a brand with the risks involved. This is due to the hope that the brand has promised to provide positive results for customers and is built based on brand reputation, brand predictability, and brand competence of the service being promoted [27]. Hospital marketing branding has won the trust of patients by providing the best care. The experience felt by the patient can give a positive impression by spreading health service branding through word of mouth of the patient's experience. Healthcare branding that is perceived by patients as consumers can run parallel to the service delivery process [28].
In the results data, respondents stated that the strength of the brand characteristic also describes the hospital's reputation for being competent in providing health services to official and general patients. This is in line with the vision, namely to be a hospital of pride for service patients, families, and the general public. Branding carried out as a matter of pride for the family and the general public has provided positive results. The brand trust variable which influences customer loyalty can be a guide for hospital management teams as a marketing strategy effort to improve the hospital's reputation [29]. Support by experiential marketing variables that influence customer loyalty can be a guide for the management team as a marketing strategy effort by increasing experiences that gives a positive impression to customers [30].
Efforts to improve the brand characteristic reputation of this hospital lie in one form of marketing strategy that can be used in digital marketing [31]. In this digital era, many customers seek information first through social media and bring different perceptions based on what they read and watch. Social media also can be used to build a hospital's image by providing correct and positive information regarding the hospital. Data supporting the benefits of social digital media is presented in Indonesia, the most frequently used social media, namely YouTube, is at the top with 93.8%, WhatsApp at 87.7%, Instagram at 86.6%, Facebook at 85.5%, and Twitter at 63.6%. Report data for 2020 and 2021, the top five social media rankings are still occupied by the same platforms [32]. In 2021, Instagram rose from fourth to third position, replacing Facebook, which was in third position in 2020. Instagram's various features can be interesting marketing media such as stories, reels, and IGLive. These features can strengthen relationships, develop group identity, leverage community intelligence, and motivate customer action [33]. Content characteristics can be content that is educational, entertaining, persuasive, storytelling, sharing, and content that is easy to find [34].
At this time, Instagram still doesn't make it easy for customers to get information such as doctor schedules and services. Videos in the form of close activities of medical personnel in hospitals with patients have also not been conceptualized and published as part of marketing. Interaction on social media between hospitals and patients is also not optimal, such as the use of the question feature on IG stories and talk shows via IGlive, considering that there is an influence of IG posts on promotions on consumer purchasing behavior [35]. The use of hospital Instagram can begin to be improved again in terms of concept, graphics, and operations. Increasing competition between hospitals can be a motivation to increase brand trust through brand characteristics for hospitals, especially outpatient service units. Utilizing digital marketing as a marketing effort and optimizing broad coverage in this digital era, such as using hospital Instagram, Facebook, and YouTube, can be the main choice for strengthening brand trust [36]. The quality of service felt by patients is a reflection of brand loyalty which plays an important role in patient satisfaction and must be a priority for the quality of health services that is worthy of being maintained [37].
4.3. Loading Factor Analysis of Repeat Purchase Dimensions on Loyalty
Loyalty is a deep customer commitment to re-subscribe or re-purchase selected products or services consistently in the future [38]. The results of measuring the repeat purchase dimension for outpatient unit patients are the highest in the loyalty variable. The repeat purchase dimension indicator relates to customer behavior to carry out repeated maintenance regularly. This illustrates the patient's ability to make 2 types of purchases made by patients, namely trial purchases and repeat purchases. Trial purchase is the initial stage of a customer investigation to evaluate the product by trying it directly [39].
Hospital marketing management strategies must be able to maintain repeat patient purchases by maintaining ongoing monitoring of evaluation and quality of hospital services. The role of marketing management to customers is very much needed in increasing customer repeat purchase behavior [40, 41]. Increasing loyalty programs for customers is needed to increase customer satisfaction [42]. Open criticism and suggestions from both patients and health workers and staff must be responded quickly in the health service system so that increasing patient satisfaction and loyalty can be achieved [43]. The majority of respondents also agreed that they would continue to use hospital services if necessary and make the hospital their first choice. Meanwhile, when it comes to repurchase, that is, if they try to buy a product and it turns out to be satisfactory or more satisfying, the customer will want to buy again. There is an influence of the program to maintain loyalty with the process of repeat purchases [45].
Respondent data also showed that as many as 105 people (41%) had made more than 10 repeat visits to the hospital outpatient unit. This shows that 41% of respondents were old patients who had passed the trial purchase stage and had experience in the outpatient unit. This shows that the impact of service quality and brand trust influences patient comfort and patient loyalty [44]. Apart from that, the mediating role of brand trust and brand loyalty on the effects of social media marketing on the service and trust of customers [46].
5. THEORETICAL AND PRACTICAL IMPLICATIONS
Theoretically, this research provides a significant contribution to the knowledge that an important dimension in strategic experience modules (SEMs) in Experiential Marketing by Schmitt (1999) is the think dimension [47]. Patient involvement through experience in assessing the quality of health services greatly influences the evaluation of customer or patient experience in forming strong relationships in the hope of gaining trust in the hospital service industry. Second, the current research contributes to the literature which shows that the brand characteristic dimensions of brand trust have important technical value in trusting the product and service provided to patients. The impact of increasingly high competition between hospitals can be a motivation to improve brand characteristics as the main brand trust for hospitals, such as digital marketing as a marketing effort for broad coverage in the digital era [48]. Third, factor loading analysis of the repeat purchase dimension has an important effect on patient loyalty [49].
The patient's ability to receive services at the hospital continuously needs to be maintained through the consistent quality of patient service satisfaction on an ongoing basis and being open to suggestions and constructive criticism [50]. The research results support general hospital modeling which states that service quality, patient trust, and loyalty are in building patient-based justice [51]
CONCLUSION
The brand characteristic dimension of brand trust is the most important in the issue of competition for health services in hospitals. Strengthening and expanding hospital branding can be a marketing strategy and create a reputation for health services to the public and patients. The brand expansion carried out can help and make it easier for hospitals to promote product services and service quality which will increase patient loyalty.
AUTHORS CONTRIBUTION
N.F., T.H.: Study conception and design; E.W.P.: Data collection; K.A.L.: Analysis and interpretation of results. All authors reviewed the results and approved the final version of the manuscript.
LIST OF ABBREVIATIONS
| PCC | = Patient Center Care |
| SPSS | = Statistical Program for Social Science |
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
The researcher has obtained ethical permission number: 75/EC/KEPK-S2/03/2022 from the Health Research Ethics Committee, Faculty of Medicine, Brawijaya University, East Java, Indonesia.
HUMAN AND ANIMAL RIGHTS
All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or research committee and with the 1975 Declaration of Helsinki, as revised in 2013.
AVAILABILITY OF DATA AND MATERIAL
The data supporting the findings of the article are available at: https://dialnet.unirioja.es/servlet/articulo? codigo=8957053 and https://repository.ub.ac.id/view/ divisions/pasca=5Fmmrs/2023.type.html.
