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Running Head: HOSPITAL BRAND EQUITY 1
Bis1200_20coursework
Product_20table
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Task.docx
Master thesis proposal
Hospital Brand Equity: the role of doctor reputation
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Institution:
CHAPTER I
INTRODUCTION
HOSPITAL BRAND EQUITY 2
1.1 Research questions
The primary aspect of concern for this study is;
What is the role of doctor reputation in Hospital Brand Equity?
This is the main subject of concern which this research is out to solve. However, it
naturally leads to the cropping up of a host of other subsidiary questions which are
more or less prerequisites to the primary research question;
Does doctor reputation influence Trust positively?
Does doctor reputation influence Customer Satisfaction positively?
Does Customer Satisfaction influence Trust positively?
Does trust influence Relationship Commitment positively?
Does relationship Commitment influence Brand Loyalty positively?
Does trust influence Brand Awareness positively?
Does customer Satisfaction influence Brand Awareness positively?
Does brand Loyalty influence Brand Equity positively?
Does brand Awareness influence Brand Equity positively?
1.2 Background to the study
This research is integrating two separate frameworks. The management
framework based on Torres et al (2009) postulations and the marketing framework
based on Kim et al (2008) postulations. The hospital is regarded as a managerial
platform and then again as a marketing entity. These two conceptual frameworks are
overlapping. One leads to or depends on the other. On one hand the hospital is
HOSPITAL BRAND EQUITY 3
regarded as a platform where management comes into play in order to coordinate the
efforts of the staff members and hospital assets so as to realise all the set objectives
explicitly. On the other hand, the hospital is regarded as a marketing entity where
there are limited patients who are willing and able to seek services from it and thus
the hospital needs to direct its efforts towards luring the patients to seek its services
specifically and to remain loyal.
Hospitals have over the years been primarily centers for the provision of
health care. They have grown by and by and have covered almost every locality in
most urban centers. This springing up of hospitals has led to a new turn of events in
the health care industry. Hospitals are engaging each other in cut throat competition
in an effort to survive in the ever dwindling market. They have turned to employing
marketing skills in conjunction with their professionalism in health care so as to win
the hearts of the ‘limited’ patients. This has led to hospitals seeking affiliations with
highly reputable doctors so as to build on their brand equity; which begs the question,
“What is the role of doctor reputation in Hospital Brand Equity?”
The fact that there is a dilemma in the role which the reputation of doctors
play in building Hospital Brand Equity is the key motivation to this study. Among
many services provided, going to hospital puts customers in one the most difficult
positions to choose from. This is more so considering its risk is related to customer’s
health. Which means brand equity plays an important role for hospitals, however, in
many countries it is legally not allowed to increase hospital brand equity through
HOSPITAL BRAND EQUITY 4
advertising (Kirmani and Zeithaml, 1993). Under this rule, hospitals are considering
leaning on doctor reputation as a counter attack mechanism. Does doctors’ reputation
really have a positive impact in Hospital Brand Equity?
In the modern world, the pace of life becomes faster and faster, time seems to be
a scarcity even more. People confront the situation of making different choices almost
every minute, what to eat, what to wear, where to go, whom to meet, which to buy,
among others. Need is the reason. Thanks to the information we receive voluntarily or
passively, we form a certain kind of value system that helps us make all these
decisions. Most of the decisions that we make are involving other parties, a shop for a
product, a person for a communication, a hospital for a treatment etc. People always
want to make the right decisions to save time and enjoy the fulfilment of need, but
how? Experience tells us to make the right choice for many circumstances, but what
about the things we haven’t experienced. A new product, a new service, there are so
many new things waiting for us to try out, but how do we choose quickly and
correctly? Brand is a fast way to help us match a product or a service to our needs, it
is the gate to understand the things we haven’t experienced, and it is the name which
helps us to distinguish good or bad in those things we have experienced. Customer is
god, said by Lance Arrington (1991), companies and firms should focus on customer
need to form competitive advantages. Customers learn a company first through its
brand (Keller, 1993), the effectiveness of brand communication is important; brand
equity is a key to competitive advantage, business survival and success. Brand equity
HOSPITAL BRAND EQUITY 5
became more and more popular among marketers and researchers (Cobb-Walgren et
al., 1995).
Brand equity has been studied by many scholars in the last decades. Branding
is important especially for service firms, service is intangible product, customer
perceives monetary, social, and safety risks in buying services, because it is not easy
to evaluate service before purchase, Berry (2000) tests strong brands increase trust in
intangible product, branding help customers better understand and visualize services.
Brand equity and customer relationship have been studied in many fields,
however in hospital market it still remains rather new, Kim, Kim, Kim, Kim, & Kang,
(2008) investigates structural relationships among brand equity and its factors,
(Torres, Vasquez-Parraga, & Barra 2009) points out the relationship among patient
loyalty, satisfaction, trust, relationship commitment and doctor reputation. Yet neither
academically nor practically, has the relationship between doctor reputation and
hospital brand equity been revealed. Thus, the purpose of this research is to shade
light on these controversial issues once and for all.
1.3 Objectives
1.3.1 Broad objective
To find out the role of doctor reputation in Hospital Brand Equity
This is the main objective of this study. It is broad and naturally answers or
requires the answering of other minor objectives. As stipulated by The Marketing
Accountability Standards Board (MASB), Hospital Brand Equity functions to
distinguish one hospital’s service as unique from those of others. This study majorly
HOSPITAL BRAND EQUITY 6
aims at finding out the roe that the reputation of a doctor plays in making the services
of a particular hospital unique from those of the others.
1.3.2 Specific Objectives:
According to Philip, Wong , Armstrong and Saunders (2008) a service provider’s
reputation carries with it the knowledge of the needs and wants of the consumers
targeted and hence causes the delivery of the desired satisfactions. This implies that
the reputation of a doctor plays a role in satisfying the clients. If and when one gets
satisfied with something, he tends to build trust in it. Bearing this in mind, this
research aims at;
To find out whether doctor reputation influence Trust positively.
To find out whether doctor reputation influence Customer Satisfaction
positively.
To find out whether Customer Satisfaction influence Trust positively.
Philip, Wong, Armstrong and Saunders (2010) stipulate that companies build strong
Relationship Commitment so as to create value for their clients as well as for their
selves. This suggests that it increases brand loyalty. The fact that it creates value for
their clients suggests that the clients build trust in it and hence this research aims at;
To find out whether trust influence Relationship Commitment positively.
To find out whether Relationship Commitment influence Brand Loyalty
positively.
HOSPITAL BRAND EQUITY 7
There are very many brands that are coming up every very often. With the hastily
rising force of globalization, the difference between marketing within a hospital's
local country and marketing in outside markets is fading very rapidly. Bearing this in
mind, hospitals should move with speed to reorganise their marketing tactics to meet
the test of the overall marketplace on top of maintaining their competitive edge within
local markets (Joshi and Mohan, 2005) . Hospitals are thus embracing the aspects of
building trust and customer satisfaction so as to enhance brand awareness and loyalty.
Therefore this research aims at;
To find out whether trust influence Brand Awareness positively.
To find out whether customer Satisfaction influence Brand Awareness
positively.
To find out whether brand Loyalty influence Brand Equity positively.
To find out whether brand Awareness influence Brand Equity positively.
CHAPTER II
2. Literature review
2.1 Overview
The relationship between doctor and patient is of prime significance in the
general health service. It is an exclusive connection which relies on trust as well as
confidence linking the parties involved for the delivery of excellent health care.
Efficient communication between the doctor and patient is a vital clinical utility in
constructing a curative doctor-patient association, which is the engine and fuel of
HOSPITAL BRAND EQUITY 8
medicine. Much dissatisfaction from patients and numerous complaints are as a result
of the collapse in the relationship between doctor and patient (Ha, Anat, &
Longnecker, 2010). Torres et al., (2009) investigated the bond between patient
commitment, patient loyalty, patient trust and patient satisfaction as directed to
doctors.
2.2 Doctor reputation
A hospital is a professional service provider; doctors are the main assets of
hospitals. Torres et al., (2009) researches on the relationship among doctor reputation,
patient satisfaction, trust, commitment and loyalty, showed that patient satisfaction
and trust are affected by doctor reputation. A good doctor reputation increases patient
satisfaction and trust in a doctor. This leads to the formulation of this research’s prime
hypothesis that;
The doctor reputation plays a major role in enhancing Hospital Brand Equity.
When a hospital is affiliated with a highly reputed doctor, say for instance Benny
Carson, the brand name of that hospital is enhanced, just like John Hopkins Hospital
in this case.
A person’s reputation represents third-party experiences with a relationship
partner (Einwiller, 2003), or secondhand rumors that produce one’s general beliefs
about the subject of the rumors (McKnight & Chervany, 2001). Reputation is most
often analyzed in individual level. It is a mechanism for evaluating risk of interaction;
Dalton and Croft (2003) suggest such risk evaluating is important for any social
HOSPITAL BRAND EQUITY 9
exchange. Accordingly, this issue can be transferred into doctor reputation easily; and
doctor reputation can be treated as a mechanism for patients to evaluate risk of
interacting with the hospital. That is to say, doctor reputation gives ability to
anticipate future outcome of the service. Positive doctor reputation signals of high
level of trustworthiness and low level of risk, and therefore can play a role of catalyst
in making a decision to revisit and recommend to others. In business literature
reputation is linked to both customer satisfaction and trust. It can positively and
directly influence satisfaction (Andreassen, 1994) A person’s reputation affects
others’ trust in that person (Casalo, Flavi_an, & Guinalı´u, 2007). Doctor’s reputation
has a role in how patients gain trust in their hospitals. Patient satisfaction and trust are
affected by doctor reputation. A good doctor reputation increases patient satisfaction
and trust in a doctor (Torres et al., 2009). Thus leading to the formulation of
hypotheses regarding doctors’ reputation and customer satisfaction considering the
research question that;
Doctor reputation influence Customer Satisfaction positively.
A highly reputed doctor is more likely to instil the notion of total satisfaction on the
patients he treats as compared to the lowly regarded doctors.
The reputation of a doctor plays a major part in how patients grow trust in their
providers of medical service. Mechanic & Meyer (2000) established that relationships
in the medical field are usually initiated on the foundation of recommendations of
friends and family, consequently trust primarily may be founded on reputation.
HOSPITAL BRAND EQUITY 10
Satisfaction of the patient along with trust is influenced by the reputation of the doctor
(Torres et al., 2009). The reputation a person’s in business is related to trust and
customer satisfaction. The latter can also be affected by the corporate image (Bloemer
& de Ruyter, 1998; LeBlanc & Nguyen, 1996). The reputation of a person’s
influences the trust of others’ towards that person (Casalo, Flavian, & Guinaliu,
2007), predominantly in relationships that are long-term which incorporate historical
events that represent reliability (Anderson & Weitz, 1989). It is also possible to
establish trust at the start of a relationship (Einwiller, 2003). These lead to the
formulation of this research’s hypothesis regarding doctors’ reputation and trust in the
research questions that;
Doctor reputation influence Trust positively.
When a patient is poised to receives treatment from a highly reputable doctor, he or
she is more likely to develop confidence and trust in the treatment that he is about to
receive.
2.3 Factors related to doctor reputation and brand equity
Kim et al., (2008) discussed from a customer relationship management
perspective about brand equity in hospital marketing, the results have shown trust,
customer satisfaction, relationship commitment all have positive influence on brand
loyalty and brand awareness, and brand awareness has strong positive influence on
hospital brand equity. In addition, patient satisfaction and trust are affected by doctor
reputation. A good doctor reputation increases patient satisfaction and trust in a
HOSPITAL BRAND EQUITY 11
doctor. Torres et al., (2009) researched on the process of patient loyalty formation, the
factors doctor reputation, trust, customer satisfaction and relationship commitment
and the result has revealed a sequential process from trust to satisfaction to
relationship commitment and finally to building loyalty. These lead to the
construction of a model that explain the relationships among doctor reputation, brand
equity and the influencing factors for building successful brand equity: trust,
satisfaction, relationship commitment, brand loyalty, and brand awareness:
Based on researches, the factors related to doctor reputation and brand equity
are as follows:
RelationshipCommitment
Trust
BrandLoyalty
CustomerSatisfaction
DoctorReputation
BrandEquity
Brand Awareness
HOSPITAL BRAND EQUITY 12
(1) Trust.
(2) Customer satisfaction.
(3) Relationship commitment.
(4) Brand loyalty.
(5) Brand awareness.
Each factor is discussed in turn below.
2.3.1. TRUST
Trust is defined as the perceived credibility and benevolence of a target party
(Doney and Cannon, 1997). Customer trust relies on interactions involving reliability,
durability, and integrity between at least two parties who mutually believe that one’s
actions are devoted to the interest and benefit of the other party in the relationship
(Peppers & Rogers, 2004). Accordingly, the first dimension focuses on the objective
believability of an exchange partner, as in an expectancy that one can rely on the
partner's word or written statement. The second dimension is the extent to which one
partner is genuinely interested in the other's welfare and motivation to seek joint
gains. In the health care context, if trust is formed, patient would rely on doctor’s
word and doctor is truly interested in patient’s welfare to benefit mutually.
Considering this, an hypothesis related to the research question that links trust and
relational commitment can be drawn that;
HOSPITAL BRAND EQUITY 13
Trust influence Relationship Commitment positively.
When one trusts a particular phenomenon, he or she is more likely to develop
relational commitment to the phenomenon as compared to when there is no trust.
Sharma & Patterson (1999) have found that trust precedes commitment in
business-to-customer relationships. More specifically, Torres et al., (2009) tested trust
in doctors to patient’s relationship commitment.
Mayer, Divan, & Schoorman (1995) described the trust of a patient as being
present when a patient is ready to admit his susceptibility to a trustee’s conduct. This
readiness is founded on the basis that the patient permitted the trustee to carry out a
tremendously significant act for him and anticipated to get a positive comeback from
the trustee, all though it may be hard to examine and manage the trustee’s comeback.
Doney & Cannon (1997) disclose that this trust comes from an exhibition of
dependability and generosity by the trustee which can be known by us. This
knowledge definitely increases the awareness of the trustee’s brand and hence the
formulation of the research hypothesis that;
Trust influence Brand Awareness positively.
When one trusts something it is more likely that he and those around him shall be
more aware of the brand.
Nevertheless, Kristof, Gaby & Dawn (2001) suggested that the degree of the
trust is influenced by the height of reliance on and tribute that the user shows towards
the provider of the service. Berry, Parish, Janakiraman, Ogburn-Russell, Couchman,
& Rayburn (2008) recount trust in doctors to the relationship commitment of the
HOSPITAL BRAND EQUITY 14
patient’s so as to “advance our comprehension of the relationship between the patient
and the physician
2.3.2. CUSTOMER SATISFACTION
Customer satisfaction involves both customers’ expectations and perceptions
of received services (Zeithaml & Bitner, 2002). Customers' good experiences create
satisfaction, many studies states that when products or services exceed customers'
expectations, they intend repurchasing. Customers who have confidence in a company
will continue to buy its products or services that satisfy them. If people do not obtain
their expectations, they will become dissatisfied. Customer satisfaction has been
found to affect trust in service encounters (Selnes, 1998; Flavian, Guinalı´u, &
Gurrea, 2006) by increasing customer trust (Singh & Sirdeshmukh, 2000). This draws
the hypothesis in view of the research questions that;
Customer Satisfaction influence Trust positively.
When one is satisfied by something, he is more likely to trust in it.
According to Kim et al., (2008), customer satisfaction can affect brand
awareness of a hospital. Regarding relationships in health services, Leisen and Hyman
(2004) and Torres et al., (2009) tested the relationship between customer satisfaction
and customer’s trust in medical service provider. Bearing this in mind, a hypothesis
answering a research question is formulated as;
Customer Satisfaction influence Brand Awareness positively.
HOSPITAL BRAND EQUITY 15
When one is satisfied by a product, it is more likely that he and those around him shall
be more aware of the product’s brand.
Howard & Sheth (1969) proposed that customer satisfaction can be described by
appraisal as well as customer comparison. They postulated that the satisfaction of
customer was a single type of cognition state that assessed response founded on
purchase appropriateness following the making of the purchase. The satisfaction of
the customer has been established to influence service reception by improving or
raising customer trust (Flavian, Guinaliu, & Gurrea, 2006; Roman, 2003). The
association may engage a process of triumphant transactions, customers getting
satisfied, customers progressively relying on a provider of a service and also
customers progressively trusting the root of the satisfaction (Ravald & Gronroos,
1996; Torres et al., 2009). Cardozo (1965) said that customer satisfaction guide to
repeated purchase conduct and buying of further products offered by the same
provider. Concerning associations in health care services, Leisen & Hyman (2004)
examined the association between customer’s trust and customer satisfaction in heath
care service providers.
2.3.3. RELATIONSHIP COMMITMENT
Berry and Parasuraman (1991) believe relationships are built on the
foundation of mutual commitment. Relationship commitment involves an enduring
desire to keep an identified relationship mainly because it is considered valuable to
HOSPITAL BRAND EQUITY 16
the involved parties (Garbarino & Johnson, 1999).To attain the trust and satisfaction
of patients, physicians need to establish a relationship that meets patients'
expectations in term of being supportive and actively involving them in decision-
making (Montaglione, 1999). Customer commitment has been shown to be crucial in
the formation of customer loyalty (Oliver, 1999; Fullerton, 2003), particularly when
commitment is based on shared values and customer sympathy with the service
provider. More specifically, recent studies on hospital marketing have underscored the
importance of the effects of relationship commitment on the loyalty of a patient to a
hospital (Kim et al., 2008; Torres et al., 2009). In this regard, a hypothesis tackling a
research question in this study is formulated as;
Relationship Commitment influence Brand Loyalty positively.
When one is more relationally committed to a product or service, he is more likely to
develop loyalty to that brand.
Moorman, Zaltman, and Deshpande (1992) described relationship
commitment as a lasting wish to uphold a valued association. A valued association is
present when the association is regarded as important. ‘Lasting wish to uphold’
generally means that a dedicated partner requires the relationship to last for an
indefinite period and is ready to work at upholding it. Morgan & Hunt (1994)
described commitment as a trade partner trusting that a continuing relationship with a
counterpart is so significant as to merit utmost effort to uphold it. They regard
relationship commitment as key to all relational interactions amid the service
HOSPITAL BRAND EQUITY 17
providers and the customers. Certainly, previous studies on health care marketing
have highlighted the significance of the influences of relationship commitment
towards the loyalty that a patient has regarding a hospital (Kim et al., 2008); (Torres
et al. 2009).
2.3.4. BRAND LOYALTY
Loyalty is ‘‘a deeply held commitment to rebuy or repatronize a preferred
product/service consistently in the future, thereby causing repetitive same-brand or
same brand-set purchasing, despite situational influences and marketing efforts having
the potential to cause switching behavior’’ (Oliver, 1999, p34). Aaker (1991, 1996)
argues that brand equity is a multidimensional construct that consists of brand loyalty,
brand awareness, and other proprietary brand assets. Aaker (1991) also proposes
measuring brand equity through price premiums, brand loyalty, perceived quality, and
brand awareness.
Oliver (1997) stated true loyalty includes both behavioral and attitudinal
components. Behavioral loyalty alone reflects repeated purchase and has to be
accompanied by attitudinal loyalty to adequately represent what customer loyalty is.
Customer commitment is what distinguishes true loyalty from repeated purchase or
spurious loyalty (Jacoby & Kyner, 1973; Amine, 1998). True loyalty may generate
word-of-mouth communication which can attract new patients and produces
HOSPITAL BRAND EQUITY 18
potentially positive cognitive and affective attitudes toward the hospital. Thus
considering the research question of this study that links brand loyalty and brand
equity, a hypothesis is formulated as;
Brand Loyalty influence Brand Equity positively.
When one is more loyal to a given brand, it is more likely that the brand shall enjoy
higher levels of brand equity from him and the people around him.
Loyalty is an intensely detained commitment to re-patronize or re-buy a favorite
product and / or service constantly in the future, thus leading to recurring same brand-
set or same-brand buying, in spite of situational pressures and marketing powers
having the possibility to cause alternative deeds (Oliver, 1999). True loyalty can
produce word-of-mouth contact which can lure new patients as well as make
potentially positive attitudes toward the healthcare service provider (Torres et al.,
2009). Detailing how the doctor patient loyalty is created needs investigative the past
history of customer loyalty. Three major antecedents that explain the course that
patients pursue in getting loyal to their health providers are satisfaction, commitment
and trust with the doctors. A major antecedent on the healthcare service provider’s
part is reputation. The existence and improvement of these attributes would not only
produce but also uphold the procedure of creating patient loyalty (Torres et al., 2009).
2.3.5. BRAND AWARENESS
Aaker (1991) defines it as the ability of a potential buyer to recognize or recall
a brand as a member of a certain product category. Keller (1993) further states brand
HOSPITAL BRAND EQUITY 19
awareness has two dimensions: brand recall and brand recognition. Brand recognition
is the basic step of brand communication, where the firm communicates the products’
attributes to customers until the brand name is associated to brand name. In hospital
marketing, word-of-mouth communication which generated by true loyalty could help
build brand recognition. Brand recall means customer’s memory brings back brand
name when it is under certain circumstances. Aaker (1991) states brand awareness is a
sign of quality and commitment, helping consumers become familiar with a brand and
consider it at the point of choice. Moreover recent studies on hospital marketing have
underscored the importance of the effects of brand awareness on the brand equity of a
hospital (Kim et al., 2008). These postulations lead to the formulation of another one
of this research’s hypothesis that;
Brand Awareness influence Brand Equity positively.
When one is more aware of a given brand, it is more likely that the brand shall enjoy
higher levels of brand equity from him and the people around him.
2.4. Brand equity
Aaker (1991) defines brand equity as a set of assets (or liabilities) linked to a
brand’s name and symbol which adds to the value provided by a product or service to
a firm and/or that firm’s customers. Keller (1993) states brand equity can be seen as
the value added to the product, or the perceived value of the product in consumers'
minds. Several researchers discuss brand equity based on two dimensions: consumer
HOSPITAL BRAND EQUITY 20
perception and consumer behavior. Aaker (1991) suggests measuring brand equity
through price premium, loyalty, perceived quality, and brand associations. Viewing
brand equity as the consumer's behavior toward a brand, Keller (1993) proposes
similar dimensions: brand awareness and brand knowledge. Thus, past studies tend to
identify brand equity as a multidimensional construct consisting of brand loyalty,
brand awareness, brand knowledge, customer satisfaction, perceived equity, brand
associations, and other proprietary assets (Aaker, 1991, 1996; Blackston, 1995; Cobb-
Walgren et al., 1995; Na, 1995). Other studies tend to regard brand equity and other
brand assets, such as brand knowledge, brand awareness, brand image, brand loyalty,
perceived quality, and so on, as independent but related constructs (Keller, 1993;
Kirmani and Zeithaml, 1993). Keller (1993) claims, a positive customer based brand
equity can lead to better revenue, higher price, lower cost, higher profit, and
consumer’s willingness to seek new channels, more effective marketing
communication etc. In hospital marketing, Kim et al., (2008) has suggested hospital
can succeed in creating positive brand equity by managing relationships with their
customers well.
3. Methodology
3.1. Overview
HOSPITAL BRAND EQUITY 21
A research framework will be designed to test the previously mentioned
hypothesized relationships among doctor reputation, trust, customer satisfaction,
relationship commitment, brand loyalty, brand awareness and brand equity in the
hospital market. This research employs the use of Structural equation modelling.
Statistical data shall be collected and used to test as well as to estimate causal
assumptions (Sewall, 1921)
3.2 study design
A cross-sectional study will be used to test the strength of association between the
variables. It is the study design of choice because it is inexpensive, takes a short time,
and offers more feasibility (Punch, 2005)
3.3 Study Area
Due to the practical necessity and restraint of research capability, the research will be
conducted in one city in China. Subjects are taken from the patients in Xi’an region.
The sample size will contain 200 patients. A standardized questionnaire will be placed
on the internet, it consisted of items for measuring the dimensions of brand equity,
and overall brand equity, as well as demographic questions. The research shall
therefore majorly concentrate and collect first hand information from the Chinese city
of Xi’an. Being that the questionnaire shall also be placed on the internet; the research
shall also collect information from the wide world (Punch, 2005)
.
3.4 Target population
HOSPITAL BRAND EQUITY 22
The targeted population for this study shall be the patients. They are the consumers
for healthcare services. They are the best placed to tell whether or not the reputation
of doctors in the health care industry affects the Hospital Brand Equity. A directly
affected target population should be chosen (Punch, 2005). The people in Xi’an City
of China fall sick just like all the people all over the globe. They go out in pursuit of
medical care. They are faced with the dilemma of choosing the best health care centre
to visit for treatment from the host of health care centres in the city. This puts them in
a position to be able to weigh the different degrees of Hospital Brand Equity that the
numerous health centres have. They are the spectators and participants in the brawl
against hospitals. Being that there are a number of both highly and lowly reputed
doctors in the City, the habitants of the City are a very good source for answering the
question of whether or not the reputation of doctors has a hand in the Brand Equity of
Hospitals.
3.5 Inclusion and exclusion criteria
The inclusion criterion is well articulated so as to collect data from the right
population and in an ethical manner (Cohen, Mannion and Morrison, 2000). The
population which shall be specifically included in this study are the people who seek
health care services from health care centres and are over 18 years of age. These are
people who are grown up enough. They are capable of authentically choosing right
from wrong. They are not easily manipulated by unreasonable information. These
HOSPITAL BRAND EQUITY 23
people are also most likely footing their own healthcare bills. This make them feel the
pinch of any dissatisfaction resulting from poor healthcare services. They are thus the
best source of information (Punch, 2005).
The inclusion criterion also stipulates that the population to be considered
viable for the research should also be willing to participate in the study (Cohen,
Mannion and Morrison, 2000). They are required to append their signature in that
effect. Any questionnaires which shall be filled without the respondent’s consent shall
be considered null and void for the research. These kinds of respondents are most
often than not blatant lies. They are made as a result of aspects like force or peer
pressure which is not good for an authentic research.
The exclusion criterion is employed to lock out those who are not considered
viable to take part in the research study (Punch, 2005). These are deemed to provide
unreliable information which shall compromise the effectiveness of the research.
They are the children who are below 18 years of age. These are considered as not
mature enough to give satisfactory information for effective determination of the
research question.
The exclusion criterion also locks out the people who did not consent to
participate in the study (Cohen, Mannion and Morrison, 2000). If one is not willing to
take part in the study, he should not be compelled to do the contrary. He would end up
doing it grudgingly and offer extremely non reliable information.
3.6 Sampling technique and sample size
HOSPITAL BRAND EQUITY 24
Patients in comprehensive care clinic meeting the inclusion criteria will be selected
from the general public using systematic random sampling method until the required
sample size is obtained (Cohen, Mannion and Morrison, 2000). The sampling interval
is: K=Sampling frame (N)/Sample size (n/). The sample size will be determined by
the formula:
n= Z²P(1-P)
d²
n = sample size,
Z = Z statistic for a level of confidence, (for 95% confidence Z= 1.96)
P = expected prevalence or proportion (50%) and
d = precision (in proportion of one; if 5%, d = 0.05)
n= (1.96)2x 0.5x 0.5/ (0.05)2 = 384
3.7 Research instrument and Data collection techniques
The population in the inclusion criteria are the major sources of data apart from the
recorded literature from which I shall seek information. These people are very
dependable sources of data if the data is collected correctly (Cohen, Mannion and
Morrison, 2000). I shall make it my personal duty and responsibility to see to it that
the data is suitable and dependable. The core mode of collecting data that I shall
employ is;
- Using questionnaires
HOSPITAL BRAND EQUITY 25
The chief instrument that I am going to employ in this research study is the
personally prepared questionnaire. I have individually written up the questionnaire so
as to increase its efficiency to the subject of my research (Cohen, Mannion and
Morrison, 2000). The instrument (questionnaire) shall not need the correspondent to
disclose his or her personal identity. Generally speaking, correspondents feel more
comfortable to tell the truth incognito (Cohen, Mannion and Morrison, 2000. I have
made most of the parts of the questionnaire ‘ticking’ affair. The correspondents are
only required to tick the appropriate choice in most parts. This serves to make simpler
the effort of the correspondents. Majority of the people do not fancy doing too much
writing or have limited time to spare (Punch, 2005). In addition, I have also made
short the questions and strictly to the point. This shall serve to evade forcing the
respondents to read a lot of literature. I have as well used basic simple language. This
shall be understandable by every single individual who comprehends Basic English. I
have finally left a space at the foot of the questionnaire which shall directs or allow
the respondents to provide whatever data they consider pertinent to the subject which
is not tackled by the questionnaire.
Using the questionnaires, I will also manage to get to a wide range and
enormous number of the respondents through the internet (Cohen, Mannion and
Morrison, 2000). This broadens the scope of the study. It in turn shall lead to a more
decisive resolution.
HOSPITAL BRAND EQUITY 26
The questionnaire bears questions that need the respondents to give their age
and marital status. This gives the research a picture of the level of maturity of the
respondent and hence the degree to which his response can be relied upon (Cohen,
Mannion and Morrison, 2000). It also requires the respondent’s education level which
hence shows the level of comprehension of the respondent. Another question is the
employment status of the employee which shows whether or not the respondent
personally feels the pinch of spending his hard earned money or the money he spends
on health care service is provided for by a third party (Punch, 2005).
There is a minimum of two questions in the questionnaire for each of the
relational factors as in the research question to enhance the effectiveness of the
collection of reliable data (Punch, 2005). The questions are also not leading questions.
The respondents are supposed to reason by themselves and provide answers for the
questions in the questionnaire without undue influence from the nature or structure of
the questions themselves (Cohen, Mannion and Morrison, 2000).
I shall commence by searching for information in the recorded literature. This
provides the general research question background (Cohen, Mannion and Morrison,
2000). It gives a base and foundation on which the research shall be made around. At
last I will employ the use of questionnaires for research data collection.
There are a host of risks to the process of collecting data (Punch, 2005). These
may cause the collection of incorrect information which shall eventually lead to the
making of erroneous conclusions. The risks are principally:
HOSPITAL BRAND EQUITY 27
- respondents lying Intentionally
- barriers in Language and accents
- respondents illegible handwriting
- experts postulating contradicting views
These risks may generate a huge threat to the valid nature of the study (Cohen,
Mannion and Morrison, 2000). So as to restrain these challenges, I am going to
employ a host of counter measures. I will collect information from numerous
respondents so as to dilute off the data from the respondents who are lying
intentionally (Punch, 2005). I will also tape record the interviews so as to look for a
third party’s aid in situations where the accent or the language is a barrier to efficient
communication. I shall also use third parties to enable me in interpreting what
illegible handwritings are conveying. So as to sort out the issue of the contradicting
views postulated by the experts, I will use the gathered evidence which I shall have
from the other sources of information.
3.8 Data analysis
Each collected data will be cleaned, checked for completeness, coded and
analyzed with EPI-info program (Cohen, Mannion and Morrison, 2000). Relevant
tables and figures will be used to display results. Range and mean will be analyzed
and appropriate tables, graphs and percentage will be displayed (Fielding, 2004).
3.9 Ethical consideration
HOSPITAL BRAND EQUITY 28
To cater for ethical issues relating to the study; Permission to carry out the
research study will be sought from all the related bodies of authority including the
concerned authorities at the study area (Kellett, 2005a). Informed consent will be
sought from all the study participants. Confidentiality, anonymity and privacy will be
fully guaranteed.
Some people may argue that the process of collecting data from a certain class
of individuals in the community is not ethical (Cohen, Mannion and Morrison, 2000).
They claim that handing questionnaires to, conducting observations or carrying out
interviews with these people is ignorance of ethics. These elite people in the society
may include politicians, religious leaders, police officers among others. I strongly
disagree with this since the ethical attribute of these activities is entirely based on the
approach by which they are carried out. I will carry out these activities with extreme
respect as well as professionalism. This will get rid of all aspects of immorality in
data collection.
3.10 Validity and Reliability
The instrument of research will be tested for reliability by use of the
Cronbach’s coefficient alpha estimate. In case all the values for all dimensions will be
ranging say between 0.90 and 0.97, which in essence exceeds the least alpha of 0.70
(Hair, Black, Babin, Anderson, & Tatham, 2010), then the measures of the constructs
will be deemed reliable. The Pearson correlations will be calculated so as to identify
the correlations that exist between the variables. In addition to that, the mean score of
HOSPITAL BRAND EQUITY 29
the several items for a construct will be calculated because a solitary construct in the
prepared questionnaire will be measured by numerous items, and the result will be
used in a supplementary analysis like a regression analysis and correlation analysis
(Wang & Benbasat, 2007). In accordance to Field (2005), the coefficient of
correlation must not go further than 0.8 so as to evade multicollinearity. If the
uppermost correlation coefficient will be less than 0.8, then there will be no
multicollinearity dilemma in this research.
HOSPITAL BRAND EQUITY 30
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