The impact of service quality and marketing on financial performance in the hospital industry: an empirical examination

Service quality and service marketing have both been studied extensively in relation to service organizations. In this paper we examine these areas simultaneously in terms of their impact on financial performance in the hospital industry. Drawing from the literature in the quality and service marketing areas, the area of service quality is represented in terms of the constructs of quality context and quality outcomes. Quality context (QC) describes the environment related to quality practices within a hospital which generally encourages and enhances service quality while quality outcomes (QO) comprises of specific clinical and patient satisfaction outcomes of the hospital. The area of marketing is represented in terms of the constructs of marketing orientation and market/product development outcomes. Market orientation (MO) is a well accepted, albeit complex, construct within the marketing literature. Generally, market orientation can be thought of as the process of effectively collecting, disseminating, and responding to information in order to enhance the marketing function within the hospital. Such information generally relates to market trends, customers, and competitors. Market/product development outcomes (MPD) refer to specific outcomes in relation to product innovation and market segmentation that are general indicators of the marketing effectiveness of the hospital. Although the evidence in the literature suggests that both service quality and marketing are independently related to organizational performance, the precise nature of the relationships among the variables described above is not clearly understood.Based on theoretical considerations, we propose a framework linking the above-mentioned constructs to the financial performance (FP) of an organization. Since QC and MO are theorized to be multidimensional constructs we use the technique of structural equations modeling (SEM) to test the model. Data were collected for the study from hospitals in a five-state region in the US. The results show that the constructs related to both service quality and marketing impact on financial performance. However, the results do not support the proposed framework of relationships. Instead, the results support a sequential chain of relationships among the constructs where MO mediates the effect of QC on QO, and MPD mediates the effect of QO on FP. Implications of these results for the hospital industry as well as for future research in the area are offered.