The Relationship Between the Customer Relationship Management and Patients Loyalty to Hospitals

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1 Global Joural of Health Sciece; Vol. 8, No. 3; 2016 ISSN E-ISSN Published by Caadia Ceter of Sciece ad Educatio The Relatioship Betwee the Customer Relatioship Maagemet ad Patiets Loyalty to Hospitals Shadi Hajikhai 1, Seyed Jamaledi Tabibi 1 & Leila Riahi 1 1 Departmet of Health care Services Maagemet, Faculty of Medical Scieces, Sciece ad Research Brach of Tehra, Islamic Azad Uiversity, Tehra, Ira Correspodece: Seyed Jamaledi Tabibi, Professor, Departmet of Health care Services Maagemet, Faculty of Medical Scieces, Sciece ad Research Brach of Tehra, Islamic Azad Uiversity, Hesarak, Tehra, Ira. Tel: [email protected] Received: February 26, 2015 Accepted: Jue 4, 2015 Olie Published: Jue 25, 2015 doi: /gjhs.v83p65 URL: Abstract Backgroud ad Aim: Customer Relatioship Maagemet (CRM) with its various compoets has bee cosidered as a tool causig customers' loyalty. The preset study aims to ivestigate the relatioship betwee the various compoets of customer relatioship maagemet ad patiets' loyalty to the place of their treatmet. Methods: This cross sectioal ad descriptive-aalytical study was coducted amog urses ad hospitalized patiets i ipatiet wards i selected hospitals i Usig the stratified radom samplig method, 224 valid ad reliable researcher-drafted questioaires were completed for CRM by urses ad 359 questioaires were completed by patiets for patiets' loyalty i the studied wards. Data were aalyzed usig the SPSS 20 software. Results: There was o statistically sigificat relatioship betwee the level of patiets' loyalty ad orgaizatioal idicators, iformatio techology ad kowledge maagemet (P Value>0.05). However, there was a statistically sigificat relatioship betwee loyalty ad the dimesios of the service process (P Value=0.04), huma resources (P Value=0.002) ad CRM (P Value=0.038). The stregth of these relatioships were 34, 40 ad 36 percet, respectively all of which were positive. Coclusio: Customer Relatioship Maagemet is a tool for improvig ifluecig factors o patiets satisfactio ad loyalty. Therefore, attempts to implemet customer relatioship maagemet as a process for improvig hospitals performace ad improvig commuicatio betwee service providers i hospitals ad customers leadig to ehace patiets loyalty should be take ito accout by maagers ad policy makers i the health sectors. Keywords: CRM, orgaizatio ad maagemet, patiets, hospitals 1. Backgroud Attractig ad maitaiig customers have log bee believed to be of mai aspects of activities i every orgaizatio. New forms of competitio ad structural chages i trasactioal processes have led to the creatio of patters for log term commuicatio betwee stakeholders i market (Šebja, Bobek, & Tomic, 2014). However, the competitio has icreased i various busiesses due to the diversificatio of customers demads. Ideed, may busiesses try to build effective commuicatio with customers i order to cosider their eeds. I additio, they foud out that maitaiig curret customers is cheaper tha attractig ew oes. To do so, Customer Relatioship Maagemet (CRM) systems have bee implemeted i may cases (Choi et al., 2013; Lee, 2012; Tohidi & Jabbari, 2012). Thus, attractig ad maitaiig customers ad creatig loyalty amog them i orgaizatios are cosidered as aims of the establishmet of the CRM (Ngai, 2005). Is said that CRM, as a ew term, was widespread sice the mid-1990s (Choi et al., 2013; Ngai, 2005). This system is a marketig techique ad a ivestmet approach through which a orgaizatio ca uderstad customers ad ifluece customers behavior. All this is doe through providig customized services for each group of customers ad a sigificat relatioship i order to acquire more customers, retai customer, icrease customers loyalty ad improve customers profitability (Choi et al., 2013; Kig & Burgess, 2008; Kostojoh, Johso, Paule, & McKiie, 2011; Lee, 2012). 65

2 Global Joural of Health Sciece Vol. 8, No. 3; 2016 There are several factors ifluecig customers loyalty such as employee satisfactio, employee loyalty ad the quality of services (Arab, Tabatabaei, Rashidia, Forushai, & Zarei, 2012; Caruaa, 2002; Tabibi, Kakhai, Gohari, & Shahri, 2009). Nowadays, the umber of health care ceters has icreased alog with the icreased competitio i the health care idustry. This has resulted i establishig the customer relatioship maagemet system i order to meet diverse demads of customers. Due to the itesifyig competitio amog health care ceters, services tailored to customers are provided through aalyzig their eeds by the ceters (Choi et al., 2013; Trepper, 2000). The CRM for health care service providers is a approach through which they lear whatever related to their patiets, their viewpoits ad expectatios i order to make relatioship with them, provide timely iformatio ad follow up their related results so that they ca carry out corrective measures, icrease customer loyalty ad gai more profit (Hug, Hug, Tsai, & Jiag, 2010). Also, CRM is a way to maximize patiets satisfactio through idetifyig patiets eeds ad providig high quality health care services based o patiets prefereces (Choi et al., 2013). A favorable relatioship betwee health care providers ad patiets ot oly ehaces patiets satisfactio but also improves the quality of health (Almuawar & Ashari, 2012; Beak, 2008). The importace of this issue is to the extet that issues related to CRM such as the provisio of care to uisured idividuals, medical/ hospital iteractios ad customers satisfactio have bee categorized amog 9 high priority factors i hospitals (Hug et al., 2010). 2. Objective Most of the past attempts by hospitals related to the implemetatio of the CRM have bee wrogly directed ad supported (Youg, 2007). It is therefore ecessary to ivestigate ad prioritize affairs required for establishig ad implemetig CRM. This study aims to ivestigate the relatioship betwee the dimesios of CRM i hospital wards ad patiets' loyalty i order to help maagers idetify ifluetial dimesios of this techique o patiets ad their loyalty. 3. Methods This cross sectioal ad descriptive-aalytical study coducted i 2014 aimed to ivestigate the relatioship betwee customer relatioship maagemet ad patiets' loyalty. The study was coducted i 34 ipatiet wards i selected hospitals affiliated to Tehra Uiversity of medical scieces. Nurses (N=429) ad patiets (N=4127) i ipatiet wards i the studied hospitals were the populatio of this study. I order to determie the sample size, at first the Morga's table ad stratified radom samplig method were used ad the total umber of sample for all hospitals were calculated (S=583) (S Nurse = 224 & S Patiets =359). I each hospital, the umber of urses ad patiets were determied i terms of wards ad this umber of sample size proportioal to the umber of urses ad patiets was distributed. Two questioaires icludig the CRM questioaire ad the patiet loyalty questioaire were used to gather data. The CRM questioaire was a researcher-drafted oe cosistig of two parts. The first part icluded demographic iformatio of participats ad the secod part was cosisted of 42 questios i 5 areas - orgaizatioal idicators (9 questios), service-providig process (9 questios), huma resources (12 questios), iformatio techology (6 questios) ad kowledge maagemet (6 questios). This questioaire was desiged based o the 5-poit Likert scale cosistig of very high (5 poit), high (4 poit), moderately (3 poit), low (2 poit) ad very low (1 poit). The validity of the questioaire which was based o the collective judgmet of scholars ad experts ad by usig the cotet validity idex (CVI) was calculated to be 84%. Also, i order to assess the reliability of the questioaire, the Crobach's alpha was calculated to be 96%. As to measure patiets loyalty, the questioaire used by Tabibi et al. (Tabibi et al., 2009) was used which cosisted of 5 questios; that validity ad reliability the Crobach's alpha was calculated to be 86%. The researcher distributed the CRM questioaire amog urses workig i morig, eveig ad ight shifts i 34 ipatiet wards i the studied hospitals. Also, the patiets loyalty questioaire was distributed amog the hospitalized patiets at the poit of discharge i these 34 wards. The SPSS 20 software ad descriptive ad iferetial statistical methods were used to aalyze data. Descriptive statistics were used to draw the frequecy distributio tables ad iferetial statistics were used to determie differeces ad the relatioship betwee variables. The Kolmogorov-Smirov test (KS-test) was used to assess the ormality of the scores distributio. Also, Pearso's ad Spearma's test were performed to assess the betwee variables. To address ethical ad legal issues, a letter of permissio was issued by the relevat uiversity. Also, the participats were give sufficiet explaatios ad they were assured that the 66

3 Global Joural of Health Sciece Vol. 8, No. 3; 2016 questioaires iformatio will be kept cofidetial. 4. Results Amog the urses, 96% were female, 50% were married ad 96% had a Bachelor of Sciece degree i ursig; 88% were ursig experts ad 9% were head urses. The average age of the urses was 30.54±5.1 years ad the average years of work experiece amog them was 6.8±4.8 years. Amog the patiets, 52% were female, 85% were married, 18% had college degrees, 43% were housewives, 41% were salaried employees i the public ad private sectors, 62% were over the age of 40. Amog the 93% of those covered by the health isurace, 73% had basic health isurace ad 27% of them were covered by complemetary health isurace, besides the basic health isurace. Amog the 34 studied wards, the mea score of loyalty was 3.43; the mea score of orgaizatioal idicators was 3.39; the mea score of service process was 3.48; the mea score of huma resources was 3.77; the mea score of iformatio techology was 3.44; the mea score of the kowledge maagemet was 3.34 ad the mea score of CRM was The highest attaiable score was 5. The Kolmogorov-Smirov test showed that all the scores of loyalty, orgaizatioal idicators, service- providig process, huma resources, iformatio techology, kowledge maagemet ad the customer relatioship maagemet were ormally distributed. Table 1. Results of Kolmogorov-Smirov ormality test for the variables of loyalty ad CRM ad its 5 areas i the studied hospitals Variable Kolmogorov- Smirov Statistics Df Sig. Loyalty Orgaizatioal idicators Service providig process Huma resources Iformatio techology Kowledge maagemet CRM Mea Table 2. The betwee the customer relatioship maagemet ad its compoets ad patiets loyalty i the studied hospitals Loyalty Orgaizatio al idicators Pearso's decisio criterio Pearso's decisio criterio Loyalt y Orgaizatio al Idicators Service- Providi g Process Huma Resource s Iformatio Techology Kowledg e Maagem et CRM * 0.40 * * ** Service- Pearso's **

4 Global Joural of Health Sciece Vol. 8, No. 3; 2016 providig process Huma resources Iformatio techology Kowledge maagemet CRM decisio criterio Pearso's decisio criterio Pearso's decisio criterio Pearso's decisio criterio Pearso's decisio criterio * Correlatio is sigificat at the 0.05 level ; ** Correlatio is sigificat at the 0.01 level ** 0.63 ** 0.86 ** ** ** ** The fidigs of Table 2 idicates that there was o statistically sigificat relatioship betwee the level of patiets' loyalty ad orgaizatioal idicators, iformatio techology ad kowledge maagemet (P Value>0.05). However, there was a statistically sigificat relatioship betwee loyalty ad the dimesios of the service-providig process (P Value=0.04), huma resources (P Value=0.002) ad the CRM (P Value=0.038). The assessmet of the betwee the CRM compoets with each other ad with CRM also idicates that there is also a sigificat relatioship betwee all these compoets. This is while the dimesios of orgaizatioal idicators ad the service-providig process showed the highest with CRM (90 percet) ad the dimesio of huma resources showed the lowest with CRM (86 percet). 5. Discussio The results of the study showed that there is a statistically sigificat differece betwee the level of loyalty amog male ad female i the studied populatio (P Value=0.02). However, there is o statistically sigificat betwee demographic features icludig marital status, age, the status of isurace ad the type of isurace, the level of educatio ad the status of employmet with patiets' loyalty. This issue idicates that the perceptio amog patiets i various groups i the studied populatio is early the same. There is o statistically sigificat relatioship betwee the level of patiets' loyalty ad orgaizatioal idicators, iformatio techology ad kowledge maagemet. However, there is a statistically sigificat ad positive relatioship betwee loyalty ad the dimesios of the service-providig process, huma resources ad the CRM. There is also sigificat relatioship betwee CRM ad all its compoets; while the dimesios of 68

5 Global Joural of Health Sciece Vol. 8, No. 3; 2016 orgaizatioal idicators ad the service-providig process showed the highest with the CRM. I other words, there is a sigificat relatioship betwee customer relatioship maagemet ad patiets loyalty, however, o relatioship was observed i the areas of orgaizatioal idicators, iformatio techology ad kowledge maagemet. It may be cocluded that patiets ca well uderstad the two areas of huma resources ad service-providig process ad express their opiio i this regard. However, the areas of orgaizatioal idicators, iformatio techology ad kowledge maagemet are ot observable ad uderstadable for patiets. There are strog s betwee customer relatioship maagemet ad its dimesios (orgaizatioal idicators, the service-providig process, huma resources, iformatio techology ad kowledge maagemet). Cosistet with these results, Foss also regarded the cooperatio amog various sectios, as oe of the compoets of orgaizatioal idicators, as a ecessary approach for customer relatioship maagemet (Foss, Stoe, & Ekici, 2008). Dewhurst et al. stated i their study that iformatio techology has facilitated ad icreased the relatioship with customers i various ways ad has eabled orgaizatios for persoalizatio (Dewhurst, Martíez Lorete, & Dale, 1999). I a study o success factors i customer relatioship maagemet i hospitals coducted by Hug et al. cosidered the existece of kowledge maagemet i hospitals as a ecessary compoet for the success of CRM (Hug et al., 2010). I this regard, Hussai et al. also ackowledged the importace of huma resources ad the way of providig services (Hussai et al., 2014). The results of the Pearso's test show that there is a sigificat betwee customer relatioship maagemet ad patiets' loyalty to the medical ward. Cobelas et al. cocluded that whe a hospital meets a patiet's eeds at a higher level tha he/she expects, the this patiet will ot chage the hospital (Cobelas et al., 2001). Adeleke (Adeleke & Amiu, 2012) itroduced three factors of 'the quality of services', 'customer satisfactio' ad 'the perceptio of participatio' as three mai factors of customer loyalty. The customer relatioship maagemet is a tool creatig these three factors, so these fidigs are cosistet with those of this study. Also, Galbreath ad Rogers have cosidered 'customizatio', 'customized commuicatio' (persoalizatio for the idividual customer) ad 'providig after sales support services' as the three mai goals of customer relatioship maagemet (Galbreath & Rogers, 1999). Paazie stated that the improvemet i customer services, cost reductio as well as customer retetio ad loyalty are the basic aims of implemetig CRM i hospitals (Paazie, 2011). The results of this study are also cosistet with those of the curret study. Furthermore, i a study coducted by Gbadeya, stated that CRM has had a sigificat impact o the quality of hospital services i Nigeria which i tur creates patiet satisfactio ad loyalty (Gbadeya, 2010). A sigificat relatioship betwee the compoet of service-providig processes ad loyalty was observed. Arab et al. have reported the process quality as oe of the dimesios ifluecig loyalty (Arab et al., 2012). Kessler ad Mylod (Kessler & Mylod, 2011) also stated that the process of service provisio plays a importat role i the patiets' perceptio of the quality of services which is cosistet with the results of the curret study. Also, a sigificat relatioship was observed betwee the compoets of huma resources ad loyalty. Ayimbillah Atiga et al. (Ayimbillah Atiga, Abekah-Nkrumah, & Ameyaw Domfeh, 2011) cosidered the lack of opportuity to ask persoal questios, limited time spet with physicia ad the behavior of physicia as the mai reasos for patiet dissatisfactio with hospitals. Arab et al. (Arab et al., 2012) also proved that a strog positive relatioship exists betwee the score of patiet loyalty ad the dimesio of iteractive quality (the quality of iteractio betwee staff ad patiets). The results of these two studies are also cosistet with those of the curret study. Despite the sigificat relatioship betwee CRM ad patiet loyalty, there is o sigificat relatioship betwee three compoets (KM, OI, IT) with patiet loyalty. The cause should be sought i objectives ad fuctios of these three compoets i hospitals. These three compoets, ulike the other two compoets (HR, SP), are ot tagible ad uderstadable for hospitalized patiets, but patiets have a direct ad uderstadable relatioship with huma resources ad service-providig processes. Hussai et al. (Hussai et al., 2014) also ackowledged the ifluece of huma resources ad the way of providig health services o patiets. These three compoets ca be cosidered as factors supportig ad stregtheig two compoets (HR, SP). Also, Kaufma i a report o the impact of iteret ad iformatio techology o diabetes treatmet stated that they ca be applied as effective tools for better treatmet of more umber of patiets (Kaufma, 2010). Choi et al. i their study metioed that there is a sigificat relatioship betwee the quality of iformatio ad the quality of services with cosumers' perceived beefit ad satisfactio; Cosequetly the perceived beefit ad satisfactio have 69

6 Global Joural of Health Sciece Vol. 8, No. 3; 2016 cosiderable impact o idividual ad orgaizatioal performace (Choi et al., 2013). Bahadori et al. also emphasized the importace of orgaizatioal structures o the improvemet of quality ad services for patiets satisfactio (Bahadori, Yaghoubi, Javadi, & Rahimi, 2015). Ideed, these three compoets are cosidered as tools for huma resources i hospitals. 6. Coclusio Customer relatioship maagemet ca be applied to ehace patiets' loyalty; while, two areas of huma resources ad service-providig process ca directly affect patiet loyalty, three areas icludig orgaizatioal idicators, iformatio techology ad kowledge maagemet are cosidered as factors ifluecig patiet loyalty to medical wards idirectly. I order to improve customer relatioship maagemet, all its areas should go further i the same directio. I additio, huma resources ad their fuctios are cosidered as the most importat dimesios of patiet satisfactio ad loyalty. It ca therefore be cocluded that i order to implemet CRM, firstly maagers should focus o huma resources ad service-providig processes. However, i log terms, they should kow that improvemets i these two dimesios requires strog support by kowledge maagemet, iformatio techology ad appropriate orgaizatioal structures. Limitatios The lack of a hospital i which the CRM has bee completely implemeted is a limitatio of this study, so that each hospital had take steps i achievig the CRM, so ipatiet wards i participatig hospitals were selected for the settig of the study. Refereces Adeleke, A., & Amiu, S. A. (2012). The determiats of customer loyalty i Nigeria's GSM market. Iteratioal Joural of Busiess ad Social Sciece, 3(14), Almuawar, M. N., & Ashari, M. (2012). Improvig customer service i healthcare with CRM 2.0. arxiv preprit arxiv: Arab, M., Tabatabaei, S. G., Rashidia, A., Forushai, A. R., & Zarei, E. (2012). The effect of service quality o patiet loyalty: A study of private hospitals i Tehra, Ira. Iraia Joural of Public Health, 41(9), 71. Ayimbillah Atiga, R., Abekah-Nkrumah, G., & Ameyaw Domfeh, K. (2011). Maagig health care quality i Ghaa: a ecessity of patiet satisfactio. It J Health Care Qual Assur, 24(7), Bahadori, M., Yaghoubi, M., Javadi, M., & Rahimi, Z. A. (2015). Study of relatioship betwee the orgaizatioal structure ad market orietatio from the viewpoit of urse maagers. J Educ Health Promot, 4, Beak, H. (2008). Research ad study o performace aalysis of hospital CRM system ad its improvemet [dissertatio]. Seoul, Korea: Yosei Uiversity. Caruaa, A. (2002). Service loyalty: The effects of service quality ad the mediatig role of customer satisfactio. Europea Joural of Marketig, 36(7/8), Choi, W., Rho, M. J., Park, J., Kim, K.-J., Kwo, Y. D., & Choi, I. Y. (2013). Iformatio system success model for customer relatioship maagemet system i health promotio ceters. Health care Iformatics Research, 19(2), Cobelas, C., Cooper, C., Ell, M., Hawthore, G., Keedy, M., & Leach, D. (2001). Quality maagemet ad the Emergecy Services Ehacemet Program. J Qual Cli Pract, 21(3), Dewhurst, F., Martíez Lorete, A. R., & Dale, B. G. (1999). Total quality maagemet ad iformatio techologies: a exploratio of the issues. Iteratioal Joural of Quality & Reliability Maagemet, 16(4), Foss, B., Stoe, M., & Ekici, Y. (2008). What makes for CRM system success Or failure? Joural of Database Marketig & Customer Strategy Maagemet, 15(2), Galbreath, J., & Rogers, T. (1999). Customer relatioship leadership: a leadership ad motivatio model for the 70

7 Global Joural of Health Sciece Vol. 8, No. 3; 2016 twety-first cetury busiess. The TQM magazie, 11(3), Gbadeya, R. (2010). Customer Relatioship Maagemet ad Hospital Service Quality i Nigeria. Africa Research Review, 4(2). Hug, S.-Y., Hug, W.-H., Tsai, C.-A., & Jiag, S.-C. (2010). Critical factors of hospital adoptio o CRM system: Orgaizatioal ad iformatio system perspectives. Decisio support systems, 48(4), Hussai, M., Kha, M. S., Wasim, A., Sabih, S., Saleem, S., & Mushtaq, A. (2014). Ipatiet satisfactio at tertiary care public hospitals of a metropolita city of Pakista. J Pak Med Assoc, 64(12), Kaufma, N. (2010). Iteret ad iformatio techology use i treatmet of diabetes. It J Cli Pract Suppl(166), Kessler, D. P., & Mylod, D. (2011). Does patiet satisfactio affect patiet loyalty? It J Health Care Qual Assur, 24(4), Kig, S. F., & Burgess, T. F. (2008). Uderstadig success ad failure i customer relatioship maagemet. Idustrial Marketig Maagemet, 37(4), Kostojoh, S., Johso, M., Paule, B., & McKiie, T. (2011). CRM fudametals. Spriger. Lee, E. W. (2012). Data miig applicatio i customer relatioship maagemet for hospital ipatiets. Healthc Iform Res, 18(3), Ngai, E. (2005). Customer relatioship maagemet research ( ): A academic literature review ad classificatio. Marketig Itelligece & Plaig, 23(6), Paazie, V., Adjei, M.. (2011). Customer Relatioship Maagemet i the Health care Idustry i Ghaa; a Case Study i Ashati Regio ad the Upper West Regio (Master Thesis), Iulea Uiversity of Techology., Swede. Šebja, U., Bobek, S., & Tomic, P. (2014). Orgaizatioal Factors Ifluecig Effective Use of CRM Solutios. Procedia Techology, 16, Tabibi, S., Kakhai, M., Gohari, M., & Shahri, S. (2009). The Relatioship Betwee Services Quality ad patiet's loyalty i Tehra Public ad Private Hospitals: Hospital J, 8(3-4), 35. Tohidi, H., & Jabbari, M. M. (2012). CRM i Orgaizatioal Structure Desig. Procedia Techology, 1, Trepper, C. (2000). CRM: customer care goes ed-to-ed. Iformatio Week, 60. Youg, T. (2007). Hospital CRM: uexplored frotier of reveue growth? Healthc Fiac Maage, 61(10), Copyrights Copyright for this article is retaied by the author(s), with first publicatio rights grated to the joural. This is a ope-access article distributed uder the terms ad coditios of the Creative Commos Attributio licese ( 71