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立 政 治 大 學
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N a tio na
l C h engchi U ni ve rs it y
CHAPTER 3 – RESEARCH MODEL AND HYPOTHESES
The service-profit chain uses a linear method to explain relationships between internal service quality (i.e. employee value) and external service value (i.e. customer value).
In this study, we will extend the service-profit chain by integrating service triangle concept. The service triangle emphasizes the relationships among three stakeholders:
the firm, the customer, and the employee. The external service value should be not only affected by employees’ value, but also by the interactions among three stakeholders. Thus, we will develop our research framework according to that shown in Figure 3-1and examine it in context of e-Health services. Details about this framework are described below.
Figure 3-1 Research Framework
3.1 The Delivery of Firms’ Business Value
In general, firms advertise their business value to customers through mass communication, speeches, brochures and/or newsletters (Teboul 2006). Therefore, since hospitals have the potential to increase their business value to potential customers through service marketing of e-Health, we propose that:
H1: Business value of hospital is positively related to patient value in e-Health services.
Business Value of Hospital
Physicians’
Value
Case Managers’
Value
Patients’
Value
Patients’
Retention
Internal Service Quality External Service Value
H2 H3
H4
H1
H5 H6
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國立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
However, any campaign for a new service must be targeted equally towards employees as well as external customers, because employees play an essential part in promoting the service (Teboul 2006); companies need to ensure that employees fully understand the value of their roles and are willing to act as required. Therefore, it is necessary to sell the service to employees before any external marketing takes place--this is known as internal marketing. Through rules or communications, firms offer incentives among service providers to get employees to adopt the marketing concept of customer orientation and to encourage them to become part of the company's team (Joseph 1996). It is important to first enhance the employees’ value before attaining further business value.
Although services mostly depends on the experience from front-line service providers, it is still necessary for backstage employees to prepare products and components or process information (Teboul 2006). Thus, in relation to e-Health, we propose that hospitals convey business value to both physicians (backstage staffs) and case managers or nurses (front-line staffs) through internal marketing.
H2: Business value of hospital is positively related to physician value in the context of e-Health service.
H3: Business value of hospital is positively related to case manager value in the context of e-Health service.
3.2 The Delivery of Employee Value
Back-stage activities exist to support the front stage (Teboul 2006); therefore, front-line and backstage employees act in a cooperative relationship and should be observed as a team. For example, a restaurant waiter cannot accept meal orders without backup support from employees in the kitchen. Furthermore, we predict that backstage employees who have acquired high value from the service will be more willing to cooperate with front-line employees. In context of e-Health, case managers who receive better support from physicians will be more able to deliver services to patients and will thus hold a higher value for the e-Health service and themselves. We hypothesize that:
H4: Physician value is positively related to case mangers value in the context of e-Health service.
On the other hand, service marketing is not just for the front-line employees; it is just as important that these employees deliver service quality to ultimate consumers
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國立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
(Joseph 1996). Customers today are strongly value oriented, so while the firm may advertise value through mass communication, brochures or newsletters, the front-line employees are ultimately the ones who directly interact with the customers and prove that they offer quality service. For this reason, we believe that the extent of value held by the front-line employees directly affects the value that is delivered to customers.
Teboul (2006) believed that the relationship between frontline staff and customers becomes predominant. In e-Health service, patients were shown real service content through a caring and FAQ process from case managers. Consequently, we propose that case managers’ value has a positive relationship with patient value.
H5: Case manager value is positively related to patient value in the context of e-Health service.
3.3 The Delivery of Customer Value and Retention
Customers who have already experienced the service have some power over the business-customer relationship, because they can decide whether or not to repurchase or advocate the service (Teboul 2006). In fact, when referrals are added to the economics of customer retention and repeat purchases of related products, the lifetime value of a loyal customer may be astronomical (Heskett 1994). According to Reichheld and Sasser’s (1990) estimation, a 5% increase in customer loyalty can increase profit from 25% to 85%. However, a customer’s intention to stay with a particular business is usually determined by the value they receive in relation to the total costs. In terms of e-Health, the quality of healthcare received and medical outcome may influence a patient’s intention to remain loyal. Based on this, we hypothesize that there is a positive relationship between patients’ value and patient retention in the context of e-Health services.
H6: Patient value is positively related to patient retention in the context of e-Health services.
The above hypotheses can be tested empirically by calculating the significant path coefficients. In the following section, we will elaborate on the methodology which is going to be used in this study.
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國立 政 治 大 學