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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
b
Changwon Joongang Hospital, South Korea
c
Korean Economy and Management Development Institute, South Korea
d
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
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 (2006) study of satisfaction and brand equity, and Ross-

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' promotion-
al 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
☆ The study is presented in the following manner. First, we
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: jhakim@chosun.ac.kr (J.H. Kim).
0148-2963/$ - see front matter © 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.jbusres.2006.05.010
Wooldridge 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 manage-
ment programs and CRM systems in health care settings vis-à-
vis 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.
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
76 K.H. Kim et al. / Journal of Business Research 61 (2008) 75–82
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
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 dimen-
sion 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 en-
vironment 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-
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 per-
ceived 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.
2.1.3. Relationship commitment
Commitment is a key characteristic associated with success-
ful marketing relationships (Morgan and Hunt, 1994a,b). Ac-
cording 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 relation-
ship 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 multidi-
mensional construct that consists of brand loyalty, brand aware-
ness, 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 multi-
loyalty, 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 pre-
miums, brand loyalty, perceived quality, and brand awareness.
 K.H. Kim et al. / Journal of Business Research 61 (2008) 75–82
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 decision-
making 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 re-
searchers discuss brand equity based on two dimensions: con-
sumer perception and consumer behavior. Aaker (1991) suggests
measuring brand equity through price premium, loyalty, per-
ceived 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
Fig. 1. Research model.
77
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 re-
search 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, in-
cluding Ambler's (1997) study of brand equity and trust, Pappu
78 K.H. Kim et al. / Journal of Business Research 61 (2008) 75–82

Table 1 service, and so on. Based on research of Anderson et al. (1994)

Types of hospitals and Oliver (1997), we measured customer satisfaction with
Type of hospitals Frequency a Percentage medical treatment and administrative services using satis-
Medium or small hospital 361 73 faction with the diagnosis, satisfaction with the services, and
General hospital 66 13 understanding of customer needs. Drawing from the discussions
General special hospital 71 14 of Dwyer et al. (1987), Ganesan (1994), and Morgan and Hunt
(including university hospital)
(1994a,b) that organizations should be committed to building and
Total 498 100
a
maintaining harmonious relations with customers, the construct
Missing cases were excluded in this table.
of relationship commitment was measured by variables such as
the structure of customer management, harmonious brand
and Quester's (2006) study of satisfaction and brand equity, awareness maintenance, attachment to the hospital, the impor-
Kim et al.'s (2003b) study of CRM effect, CRM, and brand tance of the hospital, and positive opinion about the hospital.
loyalty, Krishnan and Hartline's (2001) study of brand equity in Brand loyalty was measured by a reference to the hospital
service, Kim et al.'s (2003a) study of brand equity's influencing advantages, its recommendations, and the first considerations
factors, brand loyalty, sensation quality, and brand image, and when choosing a hospital. For brand awareness, we proposed
Berry's (2000) study of service brand equity, we generated the associative relationships among the four consumer-based dimen-
following eight hypotheses: sions and identified six statements from Yoo et al. (2000).
With regard to brand equity, Park and Srinivasan (1994) have
H1. Trust influences brand loyalty positively.
identified product-specific measures of customer-based equity.
H2. Trust influences brand awareness positively. Martin and Brown (1991) used empirical measurement scales of
customer-perceived brand equity. For this research, we adopted
H3. Customer satisfaction influences brand loyalty positively.
brand equity measurement from those studies, conceptualizing it
H4. Customer satisfaction influences brand awareness positively. as having five dimensions: perceived quality, perceived value,
image, trustworthiness, and commitment. To develop a better
H5. Relationship commitment influences brand loyalty positively.
scale, we examined the previous research and used the following
H6. Relationship commitment influences brand awareness five components to measure brand equity: performance, social
positively. image, price/value, trustworthiness, and identification/attachment.
H7. Brand loyalty influences brand equity positively.
Table 2
H8. Brand awareness influences brand equity positively. Demographic characteristics of sample
Item Frequency a Percentage
Based on additional past research, including Ross-Wool-
Gender Male 228 42.9
dridge et al.'s (2004) study of brand equity and company image Female 304 57.1
and Javalgi et al.'s (1992) study of hospital image, we generated Total 532 100
the following hypothesis: Age 20–29 112 21.1
30–39 164 30.8
H9. Brand equity influences hospital image positively. 40–49 125 23.5
50–59 102 19.2
Finally, based on research that includes Flavian et al.'s (2005) More than 60 29 5.4
study of consumer trust and company image and Kandampully Total 532 100
and Suhartanto's (2000) study of relationships between cus- Education Middle school 44 8.3
tomer satisfaction and company image, we generated our last High school 193 36.6
Being in college 62 11.7
three hypotheses:
College graduate 213 40.3
Postgraduate school 16 3.1
H10. Trust influences hospital image positively. Total 528 100
Career Self-employed 55 10.4
H11. Customer satisfaction influences hospital image positively. Employee 174 33.1
H12. Relationship commitment influences hospital image Official 17 3.2
Professional 63 12.0
positively. Housewife 116 22.1
Student 39 7.4
3.3. Measurement Other 62 11.8
Total 526 100
Income per month Less than 200 million 243 49.6
The constructs used in our research model were measured
in Korean won 200–300 million 158 32.3
using five-point Likert scales. The construct of trust, based 300–400 million 66 13.5
primarily on the research of Doney and Cannon (1997), was 400–500 million 12 2.4
measured by variables such as fast service, convenience in More than 500 million 11 2.2
making appointments with doctors, reliable service, ease of Total 490 100
a
changing appointments, keeping appointments on time, honest Missing cases were excluded in this table.
 K.H. Kim et al. / Journal of Business Research 61 (2008) 75–82 79

Table 3 Guangju, 95 in Daejon, 96 in Taegu, and 31 in Gyeongnam. 498

Reliability analysis people provided information about what types of hospital they
Constructs Number of questions Alpha used. There were 361 respondents (73%) who had visited a
Trust 6 0.86 medium or small hospital, 71 (14%) who had visited a general
Customer satisfaction 4 0.85 special hospital (including a university hospital), and 66 (13%)
Relationship commitment 6 0.88 who had visited a general hospital. Table 1 shows these results.
Brand loyalty 4 0.90
Table 2 shows the respondents' demographic characteristics,
Brand awareness 3 0.73
Brand equity 5 0.77 including gender, age, education, occupation, and monthly
Hospital image 7 0.81 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
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.

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
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 1.00
Y2 0.69 1.00
Y3 0.60 0.66 1.00
Y4 0.67 0.57 0.63 1.00
Y5 0.36 0.43 0.46 0.44 1.00
Y6 0.09 0.14 0.23 0.13 0.59 1.00
Y7 0.57 0.57 0.56 0.46 0.51 0.21 1.00
Y8 0.48 0.43 0.46 0.57 0.44 0.23 0.37 1.00
Y9 0.49 0.51 0.43 0.48 0.54 0.44 0.45 0.51 1.00
X1 0.48 0.47 0.42 0.49 0.28 0.14 0.37 0.44 0.42 1.00
X2 0.46 0.52 0.42 0.50 0.39 0.16 0.41 0.38 0.50 0.64 1.00
X3 0.59 0.57 0.45 0.61 0.38 0.09 0.38 0.54 0.42 0.60 0.59 1.00
X4 0.56 0.52 0.43 0.54 0.31 0.06 0.39 0.52 0.43 0.61 0.57 0.79 1.00
X5 0.65 0.57 0.50 0.66 0.34 0.13 0.45 0.41 0.44 0.48 0.47 0.60 0.58 1.00
X6 0.59 0.51 0.59 0.68 0.32 0.10 0.40 0.45 0.38 0.45 0.44 0.45 0.47 0.74 1.00
X7 0.69 0.70 0.52 0.63 0.42 0.12 0.61 0.43 0.49 0.49 0.52 0.60 0.56 0.73 0.62 1.00
80 K.H. Kim et al. / Journal of Business Research 61 (2008) 75–82

Fig. 2. The results of hypothesis testing.

this study was deemed good enough to be used for further tively influence brand loyalty (γ13 = 0.36, t-value = 7.27) and
analysis. brand awareness (γ23 = 0.50, t-value = 10.68).
Hospital brand loyalty did not have a positive influence on
4.4. Hypothesis testing brand equity (β31 = 0.15, t-value = 1.71), although hospital brand
awareness did (β32 = 0.54, t-value = 5.17). Hospital brand equi-
A structural equation model by LISREL 8.53 (Jöreskog and ty was found to positively influence hospital image (β43 = 0.28,
Sörbom, 2002) was used to test the research hypotheses con- t-value = 9.26), as were trust (γ41 = 0.29, t-value = 2.88), cus-
structed in this study. The correlation matrix of data is shown in tomer satisfaction (γ42 = 0.21, t-value = 2.66), and relationship
Table 4. commitment (γ43 = 0.12, t-value = 2.61). Thus, all of the
Fig. 2 shows the results of the hypothesis testing. Trust was research hypotheses except H7 were supported (see Table 5).
found to positively influence brand loyalty (γ11 = 0.23, t-value = Structural equations drawn from the tested model are shown
2.22) and brand awareness (γ21 = 0.19, t-value = 2.26). Custom- in Table 6. We found the following statistics regarding the
er satisfaction was found to positively influence brand loyal- model fit index of the tested model: chi-square value (3775.40,
ty (γ12 = 0.41, t-value = 4.85) and brand awareness (γ22 = 0.27, p-value = 0.0), GFI (0.90), NNFI (0.87), and RMR (0.05).
t-value = 3.93). Relationship commitment was found to posi- Therefore, GFI was 0.90, which means the model fit was good
enough. The RMR, which represents the average value across
Table 5 all standardized residuals, was 0.05.
Testing of hypotheses
Hypotheses LISREL t- Results 4.5. Results
coefficient value
H1: Trust and brand loyalty 0.23 2.22 Supported Results from the research hypothesis testing suggest the
H2: Trust and brand awareness 0.19 2.26 Supported following information. First, the study found that trust,
H3: Customer satisfaction 0.41 4.86 Supported customer satisfaction, and relationship commitment all had a
and brand loyalty positive influence on brand loyalty and brand awareness. This
H4: Customer satisfaction 0.27 3.93 Supported
and brand awareness
H5: Relationship commitment 0.36 7.27 Supported
Table 6
and brand loyalty
Model fitting index
H6: Relationship commitment 0.50 10.68 Supported
and brand awareness Chi-square with 66 degrees of freedom 3775.40 (p = 0.0)
H7: Brand loyalty and brand equity 0.15 1.71 Not supported Root mean square residual (RMR) 0.05
H8: Brand awareness and brand equity 0.54 5.17 Supported Goodness of fit index (GFI) 0.90
H9: Brand equity and hospital image 0.28 9.26 Supported Adjusted goodness of fit index (AGFI) 0.83
H10: Trust and hospital image 0.29 2.88 Supported Normed fit index (NFI) 0.90
H11: Customer satisfaction and 0.21 2.66 Supported Non-normed fit index (NNFI) 0.87
hospital image Comparative fit index (CFI) 0.91
H12: Brand awareness and hospital image 0.12 2.61 Supported Incremental fit index (IFI) 0.91
 K.H. Kim et al. / Journal of Business Research 61 (2008) 75–82
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.
5. Implications
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 relation-
ship commitment. A reward system and recognition for medical
staff with excellent customer satisfaction should be implemen-
ted. Medical staff and top management should be trained to
acquire relationship-building skills to establish strong commit-
ment 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 im-
portant relationship between brand equity and hospital image.
81
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 word-
of-mouth communication and customer relationship manage-
ment (CRM). This study shows that they can succeed in creating
positive brand equity and image if they can manage relation-
ships 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 under-
stand relationships among constructs studied in this research.
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