Brand equity in hospital marketing

Available online at www.sciencedirect.com

Journal of Business Research 61 (2008) 75 – 82

Brand equity in hospital marketing ☆ Kyung Hoon Kim a , Kang Sik Kim b , Dong Yul Kim c , Jong Ho Kim d,⁎, Suk Hou Kang e a

Changwon National University, South Korea Changwon Joongang Hospital, South Korea c Korean Economy and Management Development Institute, South Korea Department of Business Administration, College of Business, Chosun University, 375 Seosuk-Dong, Gwang Ju, South Korea e Hanyang University, Hak Il Moon, LG Electronics, South Korea b

d

Accepted 1 May 2006

Abstract Health care marketers face unique challenges around the world, due in part to the role the health care field plays in contributing to public welfare. Hospital marketing in Korea is particularly challenging since Korean law prohibits hospitals from running any advertising. As a result, Korean hospitals depend heavily on customer relationship management (CRM). This study identifies five factors that influence the creation of brand equity through successful customer relationships: trust, customer satisfaction, relationship commitment, brand loyalty, and brand awareness. An empirical test of the relationships among these factors suggests that hospitals can be successful in creating image and positive brand equity if they can manage their customer relationships well. © 2007 Elsevier Inc. All rights reserved. Keywords: Brand equity; Influencing factors of brand equity; Hospital image; Customer relationship management (CRM); Hospital marketing

1. Introduction Brand equity is one of the most important concepts in business practice as well as in academic research. This is because successful brands can allow marketers to gain competitive advantage (Lassar et al.,1995), including the opportunity for successful extensions, resilience against competitors' promotional pressures, and the ability to create barriers to competitive entry (Farquhar, 1989). Branding plays a special role in service firms because strong brands increase trust in intangible products (Berry, 2000), enabling customers to better visualize and understand them. They reduce customers' perceived monetary, social, or safety risks in buying services, which is an obstacle to evaluating a service correctly before purchase. Also, a high level of brand equity increases consumer satisfaction, repurchasing intent, and degree of loyalty. Research in this area includes Kohli et al.'s (2001) study of reliability and brand equity, Pappu and Quester's ☆

This study was supported in part by research funding from Chosun University in 2004. ⁎ Corresponding author. Tel.: +82 62 230 6840; fax: +82 62 225 5944. E-mail address: [email protected] (J.H. Kim). 0148-2963/$ - see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jbusres.2006.05.010

(2006) study of satisfaction and brand equity, and RossWooldridge et al.'s (2004) study of brand equity and brand image. Medical institutions and hospitals in Korea are limited in their ability to increase brand loyalty because they are not legally permitted to run any commercial advertising. Customer relationship management (CRM) is their only viable option for raising brand equity (Kim et al., 2005). Hausman (2004) notes that to raise brand loyalty and brand equity and satisfy customers' needs, medical institutions can enhance their marketing activities by increasing patients' benefits and doctors' independence. Fok et al. (2003) discuss the relationship between organizational adoption and use of quality management programs and CRM systems in health care settings vis-àvis other organizational settings. However, not many studies have investigated structural relationships among brand equity, the factors that influence brand equity, and hospital image. That is the purpose of the study presented here, as well as to identify which factors are influential in building customer relationships. The study is presented in the following manner. First, we draw from the research literature to identify the brand equity factors that influence the building of successful customer relationships in hospitals. Second, we construct a research

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model that explains the relationships of those factors to brand equity and hospital image. Third, we generate research hypotheses and empirically test them. Finally, we discuss the practical and theoretical implications of the results. 2. Literature review

tomers who have confidence in a company will continue to buy its products or services that satisfy them. Francken and Van Raaij (1981) noted that satisfaction is determined by the perceived discrepancy between the actual and the desired situation and by perceptions of internal and external barriers that block the attainment of the desired situation. Moreover, if people do not attain their expectations, they will become dissatisfied.

2.1. Influencing factors of brand equity A review of the literature reveals five factors that influence the creation of successful brand equity in hospital marketing: (1) trust, (2) customer satisfaction, (3) relationship commitment, (4) brand loyalty, and (5) brand awareness. Past research has identified these as the most important factors related to brand equity and relationship management. Each factor is discussed in turn below. 2.1.1. Trust Doney and Cannon (1997) define trust as the perceived credibility and benevolence of a target party. 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. Through various studies, we have categorized trust into the following four categories: (1) the known intentions of each party in a transaction (Moorman et al., 1992); (2) the necessity of the parties to believe each other when something occurs that can affect the future of the relationship (Anderson and Weitz, 1989); (3) the establishment of the relations that can create the desired state (Dwyer et al., 1987); and (4) belief in each other's words, promises, and actions in the regular conduct of business (Schurr and Ozanne, 1985). Understanding exchange partners leads to the formation of trusted business relationships. If trust is formed, the relationship between company and customer has the potential to be mutually beneficial. In the health care context, trust can create an exchange environment in which a hospital can provide better care to its patients, or customers, while becoming or remaining profitable. Built on management capability, trust is a standard that hospitals and their employees offer patients. When patients complain about service, the hospital and its employees must do their best to respond to the complaints and thereby maintain or rebuild trust. 2.1.2. Customer satisfaction Satisfaction results from customers' good experiences. According to (Westbrook 1981), satisfaction is “a state of recognition to feel appropriate or inappropriate experience for the sacrifice adequately,” or an “emotional response which is not only affected by the whole market, but also affected by products' characteristics, service, and seller when shopping or doing similar behavior.” Oliver (1997) discusses satisfaction as “a general psychological state which is about the expectation for feelings and experience from shopping behavior.” Various studies note that when products or services exceed than customers' expectations, the repurchase rate is high. Cus-

2.1.3. Relationship commitment Commitment is a key characteristic associated with successful marketing relationships (Morgan and Hunt, 1994a,b). According to Berry and Parasuraman (1991), relationships are built on the foundation of mutual commitment. As noted by Rusbult (1983), commitment level has been found to be the strongest predictor of the voluntary decision to remain in a relationship. It follows, then, that the investigation of antecedents of the likelihood of relationship dissolution can also be viewed as the study of the determinants of relationship commitment. The streams of research in the medical literature on patient– physician relationships in general (including patient–physician roles, patient–physician communication styles, and patient satisfaction) have not focused on improving the knowledge of what motivates patients to continue relationships with their physicians (Barksdale et al., 1997). 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). Clearly, this suggests that patient commitment should be linked to empowering patient–physician relationships (Ouschan et al., 2006). 2.1.4. Brand loyalty Aaker (1991, 1996) argues that brand equity is a multidimensional construct that consists of brand loyalty, brand awareness, and other proprietary brand assets. Yoo et al. (2000) suggest that brand equity can be created by reinforcing those dimensions. Oliver (1999, p. 34) defines brand loyalty as “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.” Chaudhuri (1997) has proposed that brand loyalty is the preference of a customer to buy a single brand, or to buy a particular brand name in a product class regularly. The consumer repurchases the brand and resists switching to another. Jacoby et al. (1974) stated that brand loyalty differs from brand attitude and habit, although the latter can indicate brand loyalty. Brand attitude is a consumer's feelings or behavior toward a brand. Jacoby et al. (1977) found that brand loyalty can be a separate construct from brand attitude, but that multiloyalty, or loyalty toward more than one brand, involves attitudes that can be more comprehensive. A high level of brand loyalty indicates a tendency to buy only a signal brand in a product category, not a multi-loyalty purchase intention. Aaker (1991) proposes measuring brand equity through price premiums, brand loyalty, perceived quality, and brand awareness.

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2.1.5. Brand awareness Brand awareness includes consumer recognition, recall, top-of-mind awareness, knowledge dominance, and recall performance of brands, as well as brand attitude. Keller (1993) states that when people form information about a brand, the level of involvement resolves the strength of the brand association in their minds. Brand awareness influences consumer decisionmaking by affecting the strength of this brand association. Keller argues further that positive brand image and brand awareness have significant influence on marketing activities related to a product brand. Pitta and Katsanis (1995) also point out several dimensions of brand awareness coupled with brand association, indicating that people can generate more information about a product by recalling its brands even though they are unable to get a full picture of the product. Moreover, brand associations involving attributes, benefits, and attitudes can be stored in consumers' minds after brand awareness is in their memory (Keller, 1993; Pitta and Katsanis, 1995). 2.2. Brand equity Brand equity can be thought of as a mix that includes both financial assets and associations. Actually, brand equity can be viewed as the value added to the product (Keller, 1993), or the perceived value of the product in consumers' minds. Mahajan et al. (1990) claim that customer-based brand equity can be measured by the level of consumers' perceptions. Several researchers discuss brand equity based on two dimensions: consumer 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

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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). 2.3. Hospital image Boulding (1956) pointed out that image is built up as a result of all past experience of the possessor of the image. Kotler (1984) notes that image is the idea of the total impression of a person or thing. Kotler andClarke (1987) point out that hospital consumers' idea of hospital image is not absolute but relative. According to Javalgi et al. (1992), a hospital's image can be used to help it improve its competitive position through strategic marketing activities. Hospital patients are able to form a specific thought about any hospital within a rapid time (Elbeik, 1986; Turow, 1985). They usually form an image of a hospital from their own medical examination and treatment experiences. Good hospital image is built by patients' trust in the treatment and by knowledge of the hospital, which can improve a consumer's tendency to select that hospital in the future. 3. Research design 3.1. Research model Drawing from the literature review, we constructed a research model for this study to explain the relationships among brand equity, hospital image, and the influencing factors for building successful customer relationships: trust, satisfaction, relationship commitment, brand loyalty, and brand awareness. Based on this research model, which is shown in Fig. 1, we came up with twelve hypotheses regarding the influences among these relationships. 3.2. Hypotheses Based on the previous discussion and past research, including Ambler's (1997) study of brand equity and trust, Pappu

Fig. 1. Research model.

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Table 1 Types of hospitals Type of hospitals

Frequency a

Medium or small hospital General hospital General special hospital (including university hospital) Total

361 66 71

73 13 14

498

100

a

Percentage

Missing cases were excluded in this table.

and Quester's (2006) study of satisfaction and brand equity, Kim et al.'s (2003b) study of CRM effect, CRM, and brand loyalty, Krishnan and Hartline's (2001) study of brand equity in service, Kim et al.'s (2003a) study of brand equity's influencing factors, brand loyalty, sensation quality, and brand image, and Berry's (2000) study of service brand equity, we generated the following eight hypotheses: H1. Trust influences brand loyalty positively. H2. Trust influences brand awareness positively. H3. Customer satisfaction influences brand loyalty positively. H4. Customer satisfaction influences brand awareness positively. H5. Relationship commitment influences brand loyalty positively. H6. Relationship commitment influences brand awareness positively.

service, and so on. Based on research of Anderson et al. (1994) and Oliver (1997), we measured customer satisfaction with medical treatment and administrative services using satisfaction with the diagnosis, satisfaction with the services, and understanding of customer needs. Drawing from the discussions of Dwyer et al. (1987), Ganesan (1994), and Morgan and Hunt (1994a,b) that organizations should be committed to building and maintaining harmonious relations with customers, the construct of relationship commitment was measured by variables such as the structure of customer management, harmonious brand awareness maintenance, attachment to the hospital, the importance of the hospital, and positive opinion about the hospital. Brand loyalty was measured by a reference to the hospital advantages, its recommendations, and the first considerations when choosing a hospital. For brand awareness, we proposed associative relationships among the four consumer-based dimensions and identified six statements from Yoo et al. (2000). With regard to brand equity, Park and Srinivasan (1994) have identified product-specific measures of customer-based equity. Martin and Brown (1991) used empirical measurement scales of customer-perceived brand equity. For this research, we adopted brand equity measurement from those studies, conceptualizing it as having five dimensions: perceived quality, perceived value, image, trustworthiness, and commitment. To develop a better scale, we examined the previous research and used the following five components to measure brand equity: performance, social image, price/value, trustworthiness, and identification/attachment.

H7. Brand loyalty influences brand equity positively. H8. Brand awareness influences brand equity positively.

Table 2 Demographic characteristics of sample Item

Based on additional past research, including Ross-Wooldridge et al.'s (2004) study of brand equity and company image and Javalgi et al.'s (1992) study of hospital image, we generated the following hypothesis:

Gender

Age

H9. Brand equity influences hospital image positively. Finally, based on research that includes Flavian et al.'s (2005) study of consumer trust and company image and Kandampully and Suhartanto's (2000) study of relationships between customer satisfaction and company image, we generated our last three hypotheses:

Education

H10. Trust influences hospital image positively. H11. Customer satisfaction influences hospital image positively.

Career

H12. Relationship commitment influences hospital image positively. 3.3. Measurement The constructs used in our research model were measured using five-point Likert scales. The construct of trust, based primarily on the research of Doney and Cannon (1997), was measured by variables such as fast service, convenience in making appointments with doctors, reliable service, ease of changing appointments, keeping appointments on time, honest

Income per month in Korean won

a

Male Female Total 20–29 30–39 40–49 50–59 More than 60 Total Middle school High school Being in college College graduate Postgraduate school Total Self-employed Employee Official Professional Housewife Student Other Total Less than 200 million 200–300 million 300–400 million 400–500 million More than 500 million Total

Missing cases were excluded in this table.

Frequency a

Percentage

228 304 532 112 164 125 102 29 532 44 193 62 213 16 528 55 174 17 63 116 39 62 526 243 158 66 12 11 490

42.9 57.1 100 21.1 30.8 23.5 19.2 5.4 100 8.3 36.6 11.7 40.3 3.1 100 10.4 33.1 3.2 12.0 22.1 7.4 11.8 100 49.6 32.3 13.5 2.4 2.2 100

K.H. Kim et al. / Journal of Business Research 61 (2008) 75–82 Table 3 Reliability analysis Constructs

Number of questions

Alpha

Trust Customer satisfaction Relationship commitment Brand loyalty Brand awareness Brand equity Hospital image

6 4 6 4 3 5 7

0.86 0.85 0.88 0.90 0.73 0.77 0.81

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Guangju, 95 in Daejon, 96 in Taegu, and 31 in Gyeongnam. 498 people provided information about what types of hospital they used. There were 361 respondents (73%) who had visited a medium or small hospital, 71 (14%) who had visited a general special hospital (including a university hospital), and 66 (13%) who had visited a general hospital. Table 1 shows these results. Table 2 shows the respondents' demographic characteristics, including gender, age, education, occupation, and monthly income. 4.2. Reliability analysis

Finally, the concept of hospital image used in this research was drawn from Boulding (1956), Kotler (1984), and Coates (1996) and consisted of high-quality hospital service, excellent facilities, comfortable environment, a long history of the hospital, low fees, proper attitudes of doctors, and the most advanced medical equipment. 3.4. Sample design and analysis method The study collected data from hospital customers of five cities, including Seoul, and one province in Korea. The data collection for the pilot study was conducted in March 2006. To secure high levels of reliability and validity, 50 questionnaires were collected from patients of hospitals located in Gyeongnam province. After the pilot test, data were randomly selected from hospital customers in Korea in spring 2006. Out of 600 questionnaires disbursed to customers, 552 responses came back. Out of those, 20 were not complete enough to be used for further analysis. Thus, 532 questionnaires were ultimately used for the study. This relatively high response rate of almost 89% was attained with help from the Korean Medical Association. 4. Data analysis, testing, and results 4.1. Sample characteristics The 532 respondents were well dispersed throughout South Korea: 139 lived in Seoul or nearby, 119 in Pusan, 52 in

To analyze the reliability of questionnaire items used in this study, Cronbach's alpha was used, with the following results: trust 0.86, customer satisfaction 0.85, relationship commitment 0.88, brand loyalty 0.90, brand awareness 0.73, brand equity 0.77, and hospital image 0.81. Thus, alpha ranged from 0.7 to 0.9, which is a satisfactory level (Nunnally, 1978; Kim, 1998). Table 3 summarizes these results. 4.3. Validity analysis Confirmatory factor analyses were performed to check the validity of measures used in this study. CFA on trust with six variables produced the following results: chi-square: 38.72, p = 0.0; RMR = 0.042; GFI = 0.94. CFA on customer satisfaction with four variables produced the following results: chi-square: 38.72, p = 0.0; RMR = 0.027; GFI = 0.96. CFA on relationship commitment with six variables produced the following results: chi-square: 282.07, p = 0.0; RMR = 0.057; GFI = 0.90. CFA on brand loyalty with four variables produced the following results: chi-square: 27.62, p = 0.0; RMR = 0.017; GFI = 0.97. CFA on brand awareness with three variables produced the following results: chi-square: 38.72, p = 0.0; RMR = 0.027; GFI = 0.96. CFA on brand equity with five variables produced the following results: chi-square: 385.20, p = 0.0; RMR = 0.052; GFI = 0.88. Finally, CFA on hospital image with seven variables produced the following results: chi-square: 300.14, p = 0.0; RMR = 0.056; GFI = 0.88. Thus, the validity of the data used in

Table 4 Correlation matrix

Y1 Y2 Y3 Y4 Y5 Y6 Y7 Y8 Y9 X1 X2 X3 X4 X5 X6 X7

Y1

Y2

Y3

Y4

Y5

Y6

Y7

Y8

Y9

X1

X2

X3

X4

X5

X6

X7

1.00 0.69 0.60 0.67 0.36 0.09 0.57 0.48 0.49 0.48 0.46 0.59 0.56 0.65 0.59 0.69

1.00 0.66 0.57 0.43 0.14 0.57 0.43 0.51 0.47 0.52 0.57 0.52 0.57 0.51 0.70

1.00 0.63 0.46 0.23 0.56 0.46 0.43 0.42 0.42 0.45 0.43 0.50 0.59 0.52

1.00 0.44 0.13 0.46 0.57 0.48 0.49 0.50 0.61 0.54 0.66 0.68 0.63

1.00 0.59 0.51 0.44 0.54 0.28 0.39 0.38 0.31 0.34 0.32 0.42

1.00 0.21 0.23 0.44 0.14 0.16 0.09 0.06 0.13 0.10 0.12

1.00 0.37 0.45 0.37 0.41 0.38 0.39 0.45 0.40 0.61

1.00 0.51 0.44 0.38 0.54 0.52 0.41 0.45 0.43

1.00 0.42 0.50 0.42 0.43 0.44 0.38 0.49

1.00 0.64 0.60 0.61 0.48 0.45 0.49

1.00 0.59 0.57 0.47 0.44 0.52

1.00 0.79 0.60 0.45 0.60

1.00 0.58 0.47 0.56

1.00 0.74 0.73

1.00 0.62

1.00

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Fig. 2. The results of hypothesis testing.

this study was deemed good enough to be used for further analysis. 4.4. Hypothesis testing A structural equation model by LISREL 8.53 (Jöreskog and Sörbom, 2002) was used to test the research hypotheses constructed in this study. The correlation matrix of data is shown in Table 4. Fig. 2 shows the results of the hypothesis testing. Trust was found to positively influence brand loyalty (γ11 = 0.23, t-value = 2.22) and brand awareness (γ21 = 0.19, t-value = 2.26). Customer satisfaction was found to positively influence brand loyalty (γ12 = 0.41, t-value = 4.85) and brand awareness (γ22 = 0.27, t-value = 3.93). Relationship commitment was found to posiTable 5 Testing of hypotheses Hypotheses

LISREL tcoefficient value

Results

H1: Trust and brand loyalty H2: Trust and brand awareness H3: Customer satisfaction and brand loyalty H4: Customer satisfaction and brand awareness H5: Relationship commitment and brand loyalty H6: Relationship commitment and brand awareness H7: Brand loyalty and brand equity H8: Brand awareness and brand equity H9: Brand equity and hospital image H10: Trust and hospital image H11: Customer satisfaction and hospital image H12: Brand awareness and hospital image

0.23 0.19 0.41

2.22 2.26 4.86

Supported Supported Supported

0.27

3.93

Supported

0.36

7.27

Supported

0.50

10.68

Supported

0.15 0.54 0.28 0.29 0.21

1.71 5.17 9.26 2.88 2.66

Not supported Supported Supported Supported Supported

0.12

2.61

Supported

tively influence brand loyalty (γ13 = 0.36, t-value = 7.27) and brand awareness (γ23 = 0.50, t-value = 10.68). Hospital brand loyalty did not have a positive influence on brand equity (β31 = 0.15, t-value = 1.71), although hospital brand awareness did (β32 = 0.54, t-value = 5.17). Hospital brand equity was found to positively influence hospital image (β43 = 0.28, t-value = 9.26), as were trust (γ41 = 0.29, t-value = 2.88), customer satisfaction (γ42 = 0.21, t-value = 2.66), and relationship commitment (γ43 = 0.12, t-value = 2.61). Thus, all of the research hypotheses except H7 were supported (see Table 5). Structural equations drawn from the tested model are shown in Table 6. We found the following statistics regarding the model fit index of the tested model: chi-square value (3775.40, p-value = 0.0), GFI (0.90), NNFI (0.87), and RMR (0.05). Therefore, GFI was 0.90, which means the model fit was good enough. The RMR, which represents the average value across all standardized residuals, was 0.05. 4.5. Results Results from the research hypothesis testing suggest the following information. First, the study found that trust, customer satisfaction, and relationship commitment all had a positive influence on brand loyalty and brand awareness. This

Table 6 Model fitting index Chi-square with 66 degrees of freedom Root mean square residual (RMR) Goodness of fit index (GFI) Adjusted goodness of fit index (AGFI) Normed fit index (NFI) Non-normed fit index (NNFI) Comparative fit index (CFI) Incremental fit index (IFI)

3775.40 (p = 0.0) 0.05 0.90 0.83 0.90 0.87 0.91 0.91

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suggests that hospital managers and staffs should take care of patients well enough to allow them to gain trust in the hospital, feel satisfied with it, and create a high level of relationship commitment to it. Second, the study found that brand awareness significantly influenced brand equity positively, but that brand loyalty did not. This finding may mean that people in Korea have chosen their hospitals based upon geographic proximity. Third, brand equity had a significant positive influence on hospital image, which suggests that hospital managers should pay more attention to managing their brand equity in order to construct a positive image. And fourth, trust, customer satisfaction, and relationship commitment also had a significant positive influence on hospital image.

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With hospital management in Korea facing the challenge of not being allowed to use any commercial marketing approaches, such as advertising, the hospitals must depend heavily on wordof-mouth communication and customer relationship management (CRM). This study shows that they can succeed in creating positive brand equity and image if they can manage relationships with their customers well. Finally, we must recognize the limitations of this study. First, there have not been many studies in hospital brand equity, so that and other related measures used in this study could suffer from lack of validity and reliability. Second, results of LISREL analysis can be interpreted in many ways. Future studies can be benefited from using other analytic techniques to further understand relationships among constructs studied in this research.

5. Implications References Eleven of the twelve research hypotheses generated for this study were found to be supported. Trust, customer satisfaction, and relationship commitment all had a positive influence on brand loyalty, brand awareness, and hospital image. Brand awareness had a positive influence on brand equity, and brand equity on hospital image. However, brand loyalty was not found to significantly influence brand equity, which again means that only H7 was not supported. Practical implications drawn from these findings are discussed below. First, hospitals in Korea should focus their marketing efforts on customers with a high level of trust in their service. They should invest resources to create and maintain this high level of trust for their medical service in the hope that it will lead to positive brand equity and hospital image. They must strive to find ways to bolster customer satisfaction as much as possible for its influence on brand loyalty, brand awareness, and hospital image. Customers with a high level of relationship commitment will boost brand equity and hospital image, so hospitals should create and maintain strong customer relationships in order to increase customers' commitment. They must remember the importance of creating brand awareness in order to create positive brand equity and hence cultivate hospital image. Finally, hospital managers must learn how to connect their brand loyalty to brand equity. Based on the practical implications mentioned above, we propose the following integrated marketing communication program to enhance hospital image in Korea. This IMC program consists of two stages. The objective of the first stage is to create a strong brand equity for hospitals through the implementation of training, educational and public relations programs to increase the level of customer trust, satisfaction, and relationship commitment. A reward system and recognition for medical staff with excellent customer satisfaction should be implemented. Medical staff and top management should be trained to acquire relationship-building skills to establish strong commitment from customers. More advanced management techniques should be used to relate hospital loyalty to brand equity. The objective of the second stage is to create positive hospital image with strong brand equity by launching brand equity awareness programs for all hospital workers, educating them on the important relationship between brand equity and hospital image.

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