Marketing Mix and Customer Loyalty in Hermina Galaxy Hospital ^†

Abstract

The purpose of the study was to determine customer perceptions of the marketing mix and customer loyalty of the executive outpatient polyclinic at Hermina Galaxy Hospital. Descriptive research included 98 respondents who use health services. The results of the research on product, price, people, place, promotion, process and physical evidence as well as customer loyalty concluded that the highest percentage of the price element is 96.9%. This is the customer’s motive in choosing service products according to customer abilities where 84% of the respondents agreed. In all, 80% of the respondents were satisfied with the services provided by the hospital so that customers carry out reuse.

1. Introduction

Marketing is an activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings which have value for customers, clients, partners, and the general public [1]. Hospitals need planning so that their goal of providing optimal services can be achieved. The marketing plan consists of several marketing-mix decisions. The marketing mix is a set of marketing tools used by the company to achieve its marketing goals in the target market. It is hoped that this marketing mix can improve patient assessment of a service product [2].

Customer loyalty is a loyalty that is shown by regular buying behavior over a long period of time through a series of customer decisions. To create customer loyalty, hospitals need to manage demand to be inelastic—in other words, making patients more sensitive to the services provided compared to the prices offered by adjusting the marketing mix, paying attention to service quality, conducting intensive promotions, and conducting relationship marketing.

Previous research stated that the decline in the number of visits by service users illustrates that there is disappointment from service users, and there is an imbalance between the conditions that occur and the desired and expected conditions. Patients cannot be provided with or provided good services. In this study, it is illustrated that the elements of the product marketing mix in the form of a specialist doctor who is less varied can lead to a decrease in the number of visits due to the unavailability of the product expected by the patient [3].

From the results of the daily report of the executive poly-executive of Hermina Galaxy Hospital, it is known that the number of visits that experience ups and downs is still one of the challenges faced by the marketing unit of Hermina Galaxy Hospital [4]. In January 2022, the number of poly-executive visits was 6934, it decreased in February 2022 to 5562, and again it increased in March 2022 to 6553. Such increases and decreases are sometimes accompanied by various problems such as complaints about long waiting times and delayed doctor practice hours. Hence, the hospital needs to include patient perceptions in determining the marketing-mix policy implemented by the hospital.

2. Research Methodology

This research using qualitative descriptive method, in that it aimed to find out the description of the marketing mix and customer loyalty to the health services of the Hermina Galaxy Hospital poly-executive. The population in this study was poly-executive outpatients from April who were treated at Hermina Galaxy Hospital, totaling 6369 patients. The sampling technique using the Slovin formula obtained 98 patients. This study used primary data obtained through a questionnaire, from which it collected data by providing a list of questions that were distributed to 98 respondents of outpatient poly-executives. The collected data were then processed and checked for completeness to ensure that all questions were filled out completely. In calculating the data, a code for each answer was provided to facilitate data processing. This research using a Likert scale for each answer (likert scale: strongly agree: 4, agree: 3, disagree: 2, strongly disagree; 1). Data analysis utilized a spreadsheet with the aim of describing the characteristics of the variable dimensions of the marketing mix of product, price, people, place, promotion, process, physical evidence, and customer loyalty.

3. Research Result

3.1. Respondent’s Description

This characteristic was used to determine the diversity of the respondents based on gender, age, occupation, income, and how many visits were made by the respondents using the Outpatient Poly-Executive Hospital of Hermina Galaxy Hospital. This was expected to provide a fairly clear picture of the condition of the respondents and their relation to the problem and research objectives. The following is the number and percentage of respondents’ characteristics (

Table 1. Distribution of respondents based on individual characteristics.

Characteristics of Respondents		n = 98	%
Gender	Male	26	27
	Female	72	73
Age	20–35 years	59	60
	36–45 years	29	30
	46–65 years	10	10
Jobs	Private Employees	43	44
	housewife	25	26
	student	9	9
	PNS/TNI/POLRI	2	2
	Entrepreneur	7	7
	etc.	12	12
Salary	Less than IDR 1,000,000	12	12
	IDR 1,000,000–IDR 2,000,000	12	12
	More than IDR 2,000,000	74	76
Visits	1 time	13	13
	2 times	8	8
	3 times	9	9
	>3 times	68	70

).

Table 1 shows five components of the characteristics of outpatient poly-executive respondents.

• Gender

From research result the gender of the majority of the respondents was female for 72 respondents (73%) while the number of male respondents was 26 respondents (27%); the most users of executive outpatient polyclinics are women. Previous research conducted by Andespa stated that there is a real relationship between gender differences and consumer buying interest [5]. Hermina Galaxy Hospital, formerly known as a special hospital for mothers and children, has superior products in the form of maternal and child health facilities. This explains why women had the highest percentage of visits.

2.

Age

From research result the majority of the respondents were aged 20–35 years, which included 59 respondents (60%); respondents aged 36–45 years included 29 respondents (30%), and respondents aged 46–65 years included as many as 10 respondents (10%). This shows that the age of respondents who used the most executive outpatient poly-services were between the ages of 20 and 35 years and between the ages 36 and 45 years. Age can affect a person’s voting power. With a different age range, the needs of each individual are different. For most respondents whose ages range from 20 to 35 years, this can happen because the type of superior services provided are maternal and child services.

3.

Jobs

From research result the majority of respondents’ occupations were private employees for as many as 43 respondents (44%), household workers for as many as 25 respondents (26%), other jobs for as many as 12 respondents (12%), students/students for as many as 9 respondents with a percentage of 9%, self-employed for as many as 7 respondents (7%) and 2 (2%). This shows that the majority of respondents using executive outpatient poly-services were private employees and housewives. The results of a person’s type of work can affect the choice of service. Purchasing power is strongly influenced by a person’s ability to achieve good service desired. A person’s ability is very closely related to the type of work one has.

4.

Salary

Table 1 shows a person’s income can affect the choice of service. Purchasing power is strongly influenced by one’s ability. The higher the amount of income owned, the higher the expected expectations.

5.

Number of Repeat Visits

The number of visits by the majority of the respondents was >3 times for as many as 68 respondents (70%), 1 visit for as many as 13 respondents (13%), 3 visits by 9 respondents (9%), and 2 visits by 8 respondents (8%). The number of repeated visits by respondents using executive outpatient poly-services was more than 3 times. From the research result find the number of repeat visits made by patients illustrates the patient’s loyalty to the services obtained; this is proven for the respondents who received health services more than three times, with a percentage of 70%

3.2. Marketing-Mix Element

• Product

From the research result find the product element is an element that can influence consumers in choosing a health service. It includes products or services produced and offered by the company to consumers with the aim of meeting consumer needs, as well as patients’ perceptions of aspects of product elements in the Executive Outpatient Clinic of HG Hospital (

Table 2. Executive outpatient product elements (n = 98).

No	List of Questions	SS		S		TS		STS		Amount
	Product	n	%	n	%	n	%	n	%
1	Specialist as needed	42	43	56	57	0	0	0	0	98
2	Support services as needed services	29	30	69	70	0	0	0	0	98
3	can be used every day	36	37	62	63	0	0	0	0	98
4	Availability and completeness of drugs	18	18	75	77	5	5	0	0	98
5	Many and various specialist doctors	43	44	55	56	0	0	0	0	98
	TOTAL	168	34	317	65	5	1	0	0

).

Table 2 contains the assessment of product elements in executive outpatients at HG Hospital. Here, 65% of the respondents said they were satisfied especially with the availability and completeness of drugs, 34% of the respondents were very satisfied, especially with many and varied specialist doctors, and 1% of the respondents disagreed, especially on the availability and completeness of drugs. In this element, the statement of agreement from the respondent is the highest percentage, which is 65%, and the statement of disagreement from the respondent is the smallest percentage, which is 1%.

Products are goods or services produced and offered by companies to consumers with the aim of meeting consumer needs. In executive outpatient health services, the products offered are in the form of medical examinations carried out by specialists and sub-specialists in accordance with the conditions experienced by patients. Various sub-specialists, the completeness of drugs, and the completeness of the supporting examination tools are also relevant. Meeting the needs provided by the hospital can increase patient interest in choosing products that suit their needs and make patients happy with the products or services received. When the patient feels happy and satisfied with the product, the patient will tend to reuse the product offered when the need reappears.

2.

Price

The price element is the amount that consumers must pay to receive the product in the form of goods or services needed. The price of the product has a huge impact on the overall marketing strategy used. In determining the price, you must be able to see whether the price is in accordance with the intended consumer [6]. From the research result Patient’s perception of the aspect of tariff elements in the Executive Outpatient Clinic of HG Hospital is also a factor (

Table 3. Elements of price outpatient executive (n = 98).

No	List of Questions	SS		S		TS		STS		Amount
	Price	n	%	n	%	n	%	n	%
1.	Price according to the ability of the patient	8	8	90	92	0	0	0	0	98
2.	Easy payment method	20	20	75	77	3	3	0	0	98
	TOTAL	28	14	165	84	3	2	0	0

).

Table 3 contains the assessment of the price element in executive outpatients at HG Hospital. It shows that 84% of the respondents agreed, especially on the tariff according to the patient’s ability, 14% of the respondents said they are very satisfied, especially with the easy payment method, and the lowest percentage is 2%. Respondents expressed their disagreement, especially on the easy payment method. In this element, the statement of agreement from the respondent was the highest percentage, which is 84%, and the statement of disagreement from the respondent was the smallest percentage, which is 2%. The price of a product is a very important component in marketing a product because the price is the benchmark for determining the profits and survival of the company. In addition, prices help in shaping product perceptions in the eyes of consumers [6]. It can be concluded that the rates set by HG Hospital are in accordance with the selected target market. This can be seen from the 92% of the respondents who agreed that the rates set were in accordance with the patient’s ability.

3.

Promotion

A good promotion can increase brand awareness and sales by delivering clear information in the form of visual and audiovisual communication [6]. From the research result Patients’ perceptions of aspects of promotional elements in the Executive Outpatient Clinic of HG Hospital are also crucial (

Table 4. Elements of promotion outpatient executive (n = 98).

No	List of Questions		SS			S		TS		STS		Amount
	Promotion		n	%	n	%	n		%	n	%
1.	There are promotions in the form of websites and Instagram	2	5	26	70	71	3		3	0	0	98
2.	Pamphlets and brochures are easy to obtain		8	8	56	57	34		35	0	0	98
3.	There is clear information regarding the type of inspection in the brochure/leaflet/website/Instagram.		9	9	85	87	4		4	0	0	98
4.	Outdoor promotions (such as banners/signs/directions) are quite effective		9	9	64	65	25		25	0	0	98
5.	Promotion in the form of IGLIVE with specialist doctors is quite effective		23	24	69	70	6		6	0	0	98
	TOTAL	74	15		344	70	72	15		0	0

).

Table 4, detailing the assessment of promotion elements in executive outpatients of HG Hospital, shows that 70% of the respondents agreed that there was clear information about the type of examination in brochures/leaflets/websites/Instagram, 15% of the respondents stated that they strongly agreed that there was promotion in the form of a hospital website and Instagram, and 15% of the respondents disagreed that outdoor promotions (such as banners/signs/directions) were quite effective. In this element, the statement of agreement from the respondents was the highest percentage, which is 70%. Marketing communication is useful for providing information, persuading, and reminding consumers directly or indirectly about the products and brands being sold [2].

Hospitals can use various promotional tools in marketing their products, such as websites, Instagram, and official hospital applications. Promotion can also be achieved by using brochures distributed to patients within the hospital area. Brochures can be in the form of information on the doctor’s practice schedule and available services. Social media is one of the widely used promotional media, especially Instagram because it has one feature that can allow users to interact with other users, namely Instagram live. With this feature, hospitals can make promotions by broadcasting health seminars with available specialist doctors.

4.

Place

Location includes the various activities of the company to make the products produced or sold affordable and available to the target market. From the research result patient’s perception of the location element aspect in the Executive Outpatient Clinic of HG Hospital is crucial (

Table 5. Elements of Place Outpatient Executive (n = 98).

No	List of Questions	SS		S			TS		STS		Amount
	Place	n	%	n	%	n		%	n	%
1.	The location can be reached from any direction	31	32	67	68	0		0	0	0	98
2.	Distance to residence near	33	34	55	56	9		9	1	1	98
3.	Public transportation is easy to find	6	6	66	67	25		26	1	1	98
4.	Fast mileage time	26	27	65	66	6		6	1	1	98
5.	There are other hospitals around HG Hospital	9	9	83	85	5	5	1	1		98
	TOTAL	105	21	336	69	45	9	4	1

).

Table 5 details the assessment of the Place element (location) in executive outpatients at HG Hospital. Here, 69% of the respondents agreed that there were other hospitals around HG Hospital, 21% of the respondents stated that they strongly agreed regarding distance to close residence, 9% of the respondents said they did not agree that transportation facilities were generally easy to obtain, and 1% of the respondents stated that they strongly disagreed on several questions. In this element, the statement agreeing from the respondents was the highest percentage, which was 69%, while the statement strongly disagreed was the lowest percentage, which was 1%.

The results of this study are in line with previous studies that stated that the location factor had a significant influence on hospital patient satisfaction [7]. The location of the hospital being close to community settlements and having considerable access are factors that patients consider in choosing a hospital.

5.

People

Health workers have an important role in the patient’s assessment of a service because they are directly related to patients. From the research result patient’s perception of the aspect of resource elements in the Executive Outpatient Clinic of HG Hospital is vital (

Table 6. Elements of people outpatient executive (n = 98).

No	List of Questions	SS		S		TS		STS		Amount
	People	N	%	n	%	n	%	n	%
1.	Medical personnel provide clear information about the patient’s illness	19	19	79	81	0	0	0	0	98
2.	Pharmacists explain well about the drugs that must be taken	23	23	75	77	0	0	0	0	98
3.	The explanation given by the administrative staff is quite clear	23	23	75	77	0	0	0	0	98
4.	Medical staff are responsive in dealing with patient complaints.	17	17	81	83	0	0	0	0	98
5.	The attitude of the paramedics in serving is friendly and polite	27	28	67	68	4	4	0	0	98
	TOTAL	109	22	377	77	4	1	0	0

).

Table 6 contains the assessment of the people (HR) element in outpatients at HG Hospital. Here, 77% of the respondents agreed, especially on responsive medical officers in dealing with patient complaints, 22% of the respondents strongly agreed, especially on the attitude of paramedics being friendly and polite, and 1% of the respondents did not agree especially on the attitude of the paramedics being friendly and polite. In this element, the statement of agreement from the respondent was the highest percentage, which is 77%, while the statement of disagreement was the lowest percentage, which is 1%. The attitude and behavior of officers who are good, friendly, polite, and responsive in providing services can provide a sense of satisfaction for patients. This is in line with the opinion in a study conducted by Saragih, which states that HR greatly affects the quality of services provided. HR must be trained to realize the importance of giving patients satisfaction in meeting their needs [7].

6.

Process

Service systems and processes in a company must run well starting from the patient reception system to the service system for sending the patient home. From the research result patient’s perception of the process elements in the Executive Outpatient Clinic of HG Hospital is important (

Table 7. Elements of process outpatient executive (n = 98).

No	List of Questions	SS		S		TS		STS		Amount
	Process	n	%	n	%	n	%	n	%
1.	Easy and fast registration procedure	20	21	66	67	12	12	0	0	98
2.	Payment procedure is easy and fast	17	17	77	79	4	4	0	0	98
3.	Paramedics serve patients responsively and skillfully	22	22	74	76	2	2	0	0	98
4.	Medical personnel carry out checks in a timely manner	16	16	58	59	24	25	0	0	98
5.	Patients are treated by doctors who are in accordance with the diagnosis of the disease or patient complaints	21	21	77	79	0	0	0	0	98
	TOTAL	96	20	352	72	42	8	0	0

).

Table 7, containing the assessment of process elements in executive outpatients at HG Hospital, shows that 72% of the respondents agreed on easy and fast payment procedures and that patients were treated by doctors in accordance with the diagnosis of disease or patient complaints, 20% of the respondents stated that they strongly agreed that paramedics served patients responsively and skillfully, and 8% of the respondents did not agree, especially for medical personnel carrying out examinations on time. In this element, the statement of agreement from the respondent was the highest percentage, which is 72%, while the statement of disagreement was the lowest percentage, which is 8%. The service process that takes place quickly, accurately, and responsively can increase patient satisfaction. This is in line with the results of research conducted by Saragih that HR greatly affects the quality of services provided [7]. However, in this element, there are still shortcomings, especially at the point where medical personnel carry out examinations in a timely manner, which can have an impact on decreasing patient interest in visiting or moving to other health service facilities.

7.

Physical Evidence

Physical evidence in the marketing mix is an element that is able to state that the service exists and is recognized by the wider community. The hospital has physical evidence covering the condition of the room starting from the examination room, waiting room, bathroom, cleanliness, and others. From the research result patients’ perceptions of aspects of physical evidence elements in the Executive Outpatient Clinic of HG Hospital are crucial (

Table 8. Elements of physical evidence outpatient executive (n = 98).

No	List of Questions	SS		S		TS		STS		Amount
	Physical Evidence	n	%	n	%	n	%	n	%
1.	Neat and clean appearance of medical and paramedical personnel	27	28	71	72	0	0	0	0	98
2.	There is a waiting area at the outpatient polyclinic.	30	31	68	69	0	0	0	0	98
3.	Room cleanliness inspection is kept neat and clean	30	31	68	69	0	0	0	0	98
4.	The toilets at HG Hospital are clean and odorless	19	19	77	79	2	2	0	0	98
5.	There are canteen facilities and a prayer room at RSU Hermina Galaxy	25	26	71	72	2	2	0	0	98
	TOTAL	131	27	355	72	4	1	0	0

).

Table 8 shows the assessment of elements of physical evidence in executive outpatients of HG Hospital. From the research result, 72% of the respondents agreed that the toilets were clean and odorless, 27% of the respondents stated that they smelled, 27% of the respondents strongly agreed that there was a waiting area in the outpatient poly and that the waiting room and the examination area were kept neat and clean, and 1% of the respondents stated that they did not agree that there were canteens and prayer rooms at HG Hospital. In this element, the statement of agreement from the respondent was the highest percentage, which is 72%, while the statement of disagreement was the lowest percentage, which is 1%. Clean, good, and appropriate supporting facilities are an aspect that cannot be separated from patient satisfaction. Well-available physical facilities can make patients receiving services more comfortable and satisfied.

8.

Overall Marketing Mix

Marketing mix is a marketing strategy used to achieve organizational and consumer goals. Marketing mix is a tool that can be used by marketers that consists of various elements of a marketing program that require consideration so that the implementation of the marketing strategy and set goals can run successfully and according to plan [2]. From the research result patient Perception of Executive Outpatient Services at HG Hospital is crucial (

Table 9. Overall marketing-mix elements outpatient executive.

No	Elements	Good		Not Good
		n	%	n	%
1.	Product	56	57.1	42	42.9
2.	Price	95	96.9	3	3.1
3.	Promotion	73	74.5	25	25.5
4.	Place	77	78.6	21	21.4
5.	People	94	95.9	4	4.1
6.	Process	71	72.4	27	27.6
7.	Physical Evidence	94	95.9	4	4.1

).

From Table 9 it shows that research result on the price element with a percentage of 96.9% has been implemented well, and it further illustrates that the price set by HG Hospital is correct and in accordance with the intended target market. However, the product element with a percentage of 42.9% is still the element with the most respondents’ dissatisfaction, which illustrates that the product offered is still less than optimal.

3.3. Customer Loyalty

Customer loyalty includes behavior (customer retention) where customers repurchase a certain brand of goods at this time, rather than choosing a competing brand instead or using their current service instead of choosing another service [8]. From the research result Patient Perceptions of Satisfaction of Executive Outpatients at HG Hospital is crucial (

Table 10. Customer loyalty (n = 98).

No	List of Questions	SS		S		TS		STS		Amount
	Customer Loyalty	n	%	n	%	n	%	n	%
1.	Are you satisfied with the services provided by medical, paramedical and non-medical personnel?	13	13	82	84	3	3	0	0	98
2.	If there are friends or relatives who need health services, you will recommend and return to the HG Hospital as the first choice.	13	13	76	78	8	8	1	1	98
	TOTAL	26	13	156	80	11	6	1	1

).

Table 10, containing the executive outpatient loyalty of HG Hospital, shows 80% of the respondents agreed about the satisfaction of the services provided, 13% of the respondents strongly agreed about the satisfaction of the services provided and will recommend HG Hospital to others, 6% of the respondents disagreed about recommending HG Hospital, and 1% of the respondents strongly disagreed about recommending HG Hospital. In this element, the statement of agreement from the respondent was the highest percentage, which is 80%, while the statement strongly disagrees was the lowest percentage, which is 1%.

Based on these results, the majority of patients were satisfied with the services provided by medical and nonmedical officers. Patient satisfaction was used as an indicator of the extent to which customers are happy with the products or services received. With this indicator, the hospital can provide an evaluation of existing services to be further improved in the future. Customer satisfaction is a comparison between expectations that become expectations of the perception of the experience (felt/accepted) [9]. Patient satisfaction makes patients loyal to the hospital. Patients reuse existing products and recommend them to others [10].

4. Conclusions

Based on the research result of 98 executive outpatient respondents at HG Hospital, the following conclusions can be drawn:

• The entire marketing-mix strategy was carried out in accordance with the intended target market with the highest percentage on the price element of 96.9%. In addition, the price (tariff) mix element was still one of the patient’s motives in choosing a product or service, especially on tariff points according to the patient’s ability, where the respondents agreed as much as 84%
• The majority of the respondents agreed or were satisfied with the services provided, which was equal to 80%. This satisfaction can increase the patient’s assessment of the hospital. The percentage of satisfaction shows that patients tend to reuse because the hospital can meet the needs and desires of patients.