Kyaw Zin Htoo, MMM-43 1st Batch

YANGON UNIVERSITY OF ECONOMICS
DEPARTMENT OF COMMERCE
MASTER OF MARKETING MANAGEMENT PROGRAMME
MARKETING MIX ON PATIENT SATISFACTION AND

LOYALTY AT MA HAR MYAING HOSPITAL
KYAW ZIN HTOO
MMM (1st BATCH)
AUGUST, 2023
MARKETING MIX ON PATIENT SATISFACTION AND
LOYALTY AT MA HAR MYAING HOSPITAL
A thesis submitted as a partial fulfillment towards the requirements for the degree of
Master of Marketing Management (MMM)
Supervised By: Submitted By:
Dr. Thynn Thynn Myint Kyaw Zin Htoo

Professor Roll No. 43
Department of Commerce MMM (1st Batch)
Yangon University of Economics 2020-2023
AUGUST, 2023
ACCEPTANCE
Accepted by the Board of Examiners of the Department of Commerce, Yangon

University of Economics, in partial fulfilment for the requirements of the Master Degree,
Master of Marketing Management.
BOARD OF EXAMINERS
---------------------------
(Chairman)
Dr. Tin Tin Htwe
Rector
Yangon University of Economics
---------------------------- ----------------------------
(Supervisor) (Examiner)
Dr. Thynn Thynn Myint Dr. Tin Tin Htwe
Professor Professor / Head
Department of Commerce Department of Commerce
Yangon University of Economics Yangon University of Economics
---------------------------- -----------------------------
(Examiner) (Examiner)
Dr. Aye Thu Htun Dr. Phu Pwint Nyo Win Aung
Professor Associate Professor
Department of Commerce Department of Commerce
Yangon University of Economics Yangon University of Economics
AUGUST, 2023
ABSTRACT
The primary aims of this study are to investigate the impact of Ma Har Myaing
Hospital's marketing mix on patient satisfaction and to examine the influence of patient
satisfaction on loyalty towards Ma Har Myaing Hospital. This study employs both
descriptive and quantitative research approaches. This study utilizes both primary and
secondary data sources. The sample size for this study was determined using the Yamane
Formula, resulting in a random selection of 341 outpatients. A structured questionnaire is
employed as a means of gathering primary data through internet channels. The findings
suggest that out of the seven elements of the marketing mix, namely product, pricing,
promotion, people, and physical evidence, there is a notable impact on patient satisfaction.
The findings of the study indicate that the element of people is the most influential
determinant of patient happiness. Additionally, it has been observed that customer pleasure
exerts a substantial influence on customer loyalty. Ma Har Myaing Hospital should
enhance the human element by implementing customer service training programs for all
service providers. Additionally, it is imperative for the program to offer educational and
skill-enhancing training sessions that are tailored to address the current pandemic and
emerging diseases. In order to enhance patient care, it is imperative to provide a
comprehensive range of services that cater to the diverse needs of patients, encompassing
both general nursing care and specialized medical interventions. In order to enhance client
attraction, it is advisable to establish a competitive pricing strategy by conducting a
comprehensive analysis of service prices offered by competing hospitals. Moreover, it is
imperative to enhance the digital marketing efforts on social media platforms such as
Facebook. In conclusion, it is recommended that Ma Har Myaing Hospital prioritize the
implementation of additional ventilation systems in order to effectively address the issue of
stench.
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ACKNOWLEDGEMENTS
Firstly, I would like to express my sincere gratitude to Professor Dr. Tin Tin Htwe,
the Rector of Yangon University of Economics, for her permission to write this MMM
thesis.
I also thankful to Professor Dr. Tin Tin Htwe, Head of the Department of
Commerce, Yangon University of Economics for her kind permission and enthusiastic
support for this study.
Furthermore, my deepest appreciation is extended to my beloved supervisor
Professor Dr. Thynn Thynn Myint, Program Director of Master of Marketing Management
Programme, for the continuous support of this study, for her patience, motivation,
enthusiasm, and immense knowledge. Her guidance helped me to finish this study.
My special thanks go to my MMM professors, colleagues, friends, and classmates

for their encouragement, support and knowledge sharing during my studies. Last but not
least, I would like to thank officials of Mahar Myaing Hospital, Hospital’s Medical
Officers, Staffs and its customers for supporting my thesis.
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TABLE OF CONTENTS
Page
ABSTRACT i
ACKNOWLEDGEMENTS ii
TABLE OF CONTENTS iii
LIST OF TABLES v
LIST OF FIGURES vi
CHAPTER 1 INTRODUCTION 1
1.1 Rationale of the Study 2
1.2 Objective of the Study 3
1.3 Scope and Method of the Study 3
1.4 Organization of the Study 4
CHAPTER 2 THEORETICAL BACKGROUND 5
2.1 Patient Satisfaction 5
2.2 Patient Loyalty 5
2.3 Service Marketing Mix 6
2.4 Related Theories 10
2.5 Previous Studies 14
2.6 Conceptual Framework of the Study 16
CHAPTER 3 PROFILE AND MARKETING MIX OF MA HAR MYAING

HOSPITAL 19
3.1 Profiles of Ma Har Myaing Hospital 19
3.2 Marketing Mix of Ma Har Myaing Hospital 20
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CHAPTER 4 4.1 ANALYSIS OF PATIENT SATISFACTION AND
LOYALTY TOWARDS MA HAR MYAING
HOSPITAL 25
4.1 Research Design 25
4.2 Reliability Test 26
4.3 Profile of the Respondents 27
4.4 Patient Perception on Marketing Mix 28
4.5 Analysis on the Effect of Marketing Mix on

Patient Satisfaction 39
4.6 Analysis on the Effect of Patient Satisfaction on

Patient Loyalty 41
CHAPTER 5 CONCLUSION 42
5.1 Findings and Discussions 42
5.2 Suggestions and Recommendations 44
5.3 Needs for Further Research 45
REFERENCES
APPENDIX A
APPENDIX B
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LIST OF TABLES
Table No. Description Page No.
3.1 Products and Services of Ma Har Myaing Hospital 21
4.1 Reliability Test 26
4.2 Demographic Data of the Respondents 27
4.3 Mean Rating Scale 28
4.4 Product of Ma Har Myaing Hospital 29
4.5 Price 30
4.6 Place of Ma Har Myaing Hospital 31
4.7 Promotion of Ma Har Myaing Hospital 32
4.8 People 33
4.9 Physical Evidence 34
4.10 Process 35
4.11 Summary of Overall Mean Value 36
4.12 Patient Satisfaction 37
4.13 Patient Loyalty 38
4.14 Effect of Marketing Mix on Patient Satisfaction 39
4.15 Effect of Patient Satisfaction on Patient Loyalty 41
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LIST OF FIGURES
Figure No. Description Page No.
2.1 Conceptual Framework of Influence of Services

Marketing Mix (7 Ps.) and Subjective Norms
on
Customer’s Satisfaction 14
2.2 Conceptual Framework of Healthcare Marketing Mix and

Patient Satisfaction in Clinics 15
2.3 Conceptual Framework of Factors Impacting on

Customer Satisfaction and Customer Loyalty
toward
Medical Aesthetic Clinics 16
2.4 Conceptual Framework of the Study 17
3.1 Organizational Structure of Ma Har Myaing Hospital 20
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CHAPTER (1)
INTRODUCTION
The health care sector is characterized by a dynamic nature, wherein organizations

encounter ongoing marketing problems and possibilities due to the swiftly evolving
operational landscape and increasing demand for services (Lancioni, 2005). Patient
satisfaction is the major indicator utilized in the assessment of service quality when
determining patient views (Cunha & Suresh, 2015). Hospitals offer a range of health
services, encompassing outpatient services, inpatient services, and emergency services that
encompass both medical services and medical support. The establishment of customer
satisfaction yields several advantages, such as fostering amicable interactions between the
company and its clientele, laying a solid foundation for recurring purchases, and cultivating
consumer loyalty.
Customer loyalty is a form of loyalty that emerges as a result of previous
experiences. Customer loyalty refers to the inclination of customers to consistently
patronize a particular company's physical retail establishment. Loyalty is exemplified by
the inclination of customers to engage in repeated utilization of goods or services, as well
as their voluntary endorsement of these products or services to other consumers. Kotler
(2000) is a reference to the work of Philip Kotler, a prominent figure in the field of
marketing Lovelock (2001) posits that loyalty is characterized by consumers exhibiting
favorable attributes towards a product or manufacturer (or service provider) through
frequently recurring purchasing behaviors. The marketing mix plays a crucial role in
exerting influence over consumers' purchasing decisions regarding a company's product or
service. Effective marketing plays a pivotal role in surpassing competitors and attaining
organizational objectives through the integration of marketing operations, strategic pricing,
and the fulfillment of market demands and desires. The significance of marketing has
increased for hospitals as they seek to enhance their standing in a progressively competitive
healthcare marketplace.
The marketing mix element serves as a strategic strategy employed by firms to
effectively manage and influence consumer satisfaction. According to Simanungsong et al.
(2018), service providers who possess a comprehensive comprehension of the components
comprising the marketing mix can exert an impact on both prospective and existing
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consumers. This influence can manifest in the form of client loyalty, hence facilitating the
continuity of business relationships. Kotler (2011) posits that the product Marketing Mix
encompasses four key elements, namely product, price, place, and promotion. Conversely,
service marketing incorporates three more indications, namely people, process, and
physical proof.
Ma Har Myaing Hospital was established in 1998 and has since gained a prominent
reputation as a highly regarded healthcare facility in the lower region of Myanmar. The
hospital is situated in the central part of San Chaung, a metropolitan region inside the city,
and has a capacity of 70 beds. Patient happiness and loyalty are crucial factors for the
success of every hospital. This study aims to examine the impact of the marketing mix on
Ma Har Myaing hospital.
1.1 Rationale of the Study
In the contemporary business landscape, numerous entities operate within the same
sector, offering comparable or closely aligned goods and services. Consequently, hospitals
must engage in competitive strategies in order to expand and ensure their continued
existence. It is imperative for healthcare providers to possess an understanding of patients'
perceptions regarding the quality of healthcare. As the financial responsibility for
healthcare expenses continues to rise, patients are assuming a greater role in the decision-
making process regarding their healthcare options. The implementation of service
marketing strategies in hospitals enables the establishment of stronger patient connections
and facilitates the cultivation of enduring relationships, hence fostering patient loyalty over
an extended period. Therefore, it is crucial to possess an appropriate marketing mix in order
to effectively promote the services inside the medical industry. Hospitals are increasingly
adopting a consumer-centric approach, wherein patients have elevated expectations for
high-quality medical treatment and are demanding services of superior quality at affordable
pricing. Consequently, it is imperative for the hospital to possess the capability to adapt the
marketing mix in accordance with the preferences and demands of patients. By delivering
superior satisfaction to patients in comparison to rival firms, an organization can effectively
cultivate contentment through the implementation of an effective marketing mix, so
resulting in overall patient satisfaction.
The significance of patient satisfaction in hospitals lies in its ability to foster patient
loyalty and generate positive word-of-mouth referrals. The identification of key factors that
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influence patients' inclination to seek more medical treatments is crucial in order to devise
and implement effective strategies aimed at fostering patient loyalty. A significant level of
satisfaction is likely to result in a substantial rise in patient loyalty. Enhanced patient loyalty
stands as the primary catalyst for long-term organizational effectiveness.
There is a growing prevalence of health issues in contemporary times. This is the

reason why individuals possess a heightened sense of health consciousness. As a result, the
increasing significance of quality products and services in relation to health is evident.
Myanmar boasts a significant number of both private and state healthcare facilities,
encompassing hospitals of all types. Public hospitals employ a cost-sharing mechanism. As
a consequence, public hospitals are unable to provide optimal service quality.
Consequently, individuals are increasingly dependent on private healthcare facilities.
The emergence of numerous private hospitals has led to a significant increase in

competition within the healthcare industry. At present, the city of Yangon is home to a total
of 42 privately owned hospitals. Consequently, private healthcare facilities endeavor to
enhance their service provision. Organizations are employing several strategies to both
attract and retain clients, utilizing an appealing marketing mix. Therefore, a significant level
of competition arises within the healthcare industry. The commercial competitiveness of
Ma Har Myaing Hospital has increased. Despite having been formed for a considerable
duration and having already attained a market position, Ma Har Myaing Hospital must
prioritize the maintenance of consumer loyalty. Consequently, Ma Har Myaing Hospital
should undertake further measures to enhance customer satisfaction and foster customer
loyalty. Hence, the primary objective of this study is to examine the impact of the service
marketing mix on patient happiness and loyalty in the context of Ma Har Myaing Hospital.
1.2 Objective of the Study
The main objectives of this study are
(i) To explore the effect of marketing mix of Ma Har Myaing Hospital on patient
satisfaction
(ii) To analyse the effect of patient satisfaction on patient loyalty towards Ma Har
Myaing Hospital
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1.3 Scope and Method of the Study
The primary objective of this study is to examine the impact of the marketing mix
on patient satisfaction and loyalty specifically within the context of Ma Har Myaing
Hospital. This study employs both descriptive and quantitative research approaches.
This study utilizes both primary and secondary data sources. In order to obtain
primary data, a structured questionnaire on a 5-point Likert scale is utilized. According to
the Yamane Formula (1967), a sample size of 341 outpatients was randomly selected from
a total population of 2326 outpatients. The collection of primary data is scheduled to take
place in July 2023. The data is subjected to linear regression analysis. Secondary data
sources encompass several types of information, such as the records of Ma Har Myaing
Hospital, previously published papers, earlier research papers, pertinent textbooks, and
overseas studies accessed through internet portals.
1.4 Organization of the Study
This research has five distinct chapters. Chapter one of this article presents the
introduction of the study, the motivation behind doing the study, the objectives of the
investigation, the scope and methodology employed in the study, and the organization of
the document. Chapter two encompasses a comprehensive exploration of the theoretical
underpinnings. In Chapter three, an analysis is provided on the profile and marketing mix
of Ma Har Myaing Hospital. In Chapter four, an analysis is conducted on the subject of
Patient Satisfaction and Loyalty towards Ma Har Myaing Hospital. Chapter five provides a
comprehensive account of the research findings, subsequent discussions, proposed
proposals, recommendations, and the imperative for more investigation.
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CHAPTER (2)
THEORICAL BACKGROUND
This chapter presents theories that are related to this study. Literature review of
influencing factors are then described. Moreover, this chapter includes the previous studies
and conceptual framework of the study.
2.1 Patient Satisfaction
According to Kotler (2000), satisfaction can be understood as an individual's

emotional response of either pleasure or disappointment, which arises from the comparison
between a product's perceived performance or outcome and the individual's expectations.
Furthermore, according to Yi (1990), customer satisfaction is a comprehensive result that
arises from the perception, appraisal, and psychological responses associated with the
consumption experience of a particular product or service. According to Fournier and
Mick (1999), customer satisfaction holds a pivotal position within the marketing
concept. It is frequently observed that mission statements are formulated with a focus
on satisfaction, marketing plans and incentive programs are devised to achieve satisfaction
as an objective, and consumer communications prominently showcase accolades for
satisfaction accomplishments in the marketplace. Ensuring consumer happiness is an
essential prerequisite for healthcare professionals. The significance of satisfaction is
evident in the decision-making process of patients and institutional healthcare service
buyers (Woodside et al., 1989).
Patient satisfaction not only has a favorable effect on patient retention and consumer
loyalty, but it also plays a role in influencing the rates of patient compliance with physician
advise (Calnan, 1988). A patient who is content with their experience has the potential to
become a genuine champion for the private hospital, so providing a significant word-of-
mouth endorsement (Winsted, 2000).
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2.2 Patient Loyalty
According to Reichheld (1996), one of the most crucial components in all corporate
strategies is the preservation of customer loyalty. Customer loyalty refers to the ongoing
purchase behavior of customers towards a specific company's products or services (Griffin,
1996). According to Reichheld (1996), customers who are satisfied with a firm's products
or services are more likely to engage in positive word-of-mouth activities to promote that
company.
According to Griffin (1996), customer loyalty may be classified into four primary
categories: intention to repurchase, frequency of purchases, product recommendations, and
participation in product-related activities. Therefore, these characteristics appear to serve
as indications of the presence of a sense of loyalty from one side towards the other. Based
on these factors, loyalty can be defined within the context of relationship marketing as the
enduring commitment to consistently purchase or endorse a preferred product or service in
the future, regardless of situational influences and marketing efforts that may prompt
switching behavior (Oliver, 1997). From this standpoint, loyalty can be quantified in two
ways. Firstly, it can be measured directly by examining purchase behavior, specifically by
observing a higher frequency of purchases or a consistent pattern of purchasing a particular
product or service compared to others. Secondly, loyalty can be measured indirectly by
assessing the attitude or intention to repurchase, as suggested by Yi and Jeon (2003).
2.3 Service Marketing Mix
There are many factors that can effect on the patient satisfaction and patient loyalty.
In this study, service marketing mix (7Ps) are analysed to find out which factors effect on
patient satisfaction.
(a) Product
The term "product" can be defined as the comprehensive range of supplementary

services that a supplier can incorporate into their product offering. This is done with the
intention of distinguishing their offering from that of their competitors, as seen by both
potential consumers and distributors. According to Kotler and Keller (2012), The healthcare
sector, encompassing hospitals and palliative care, has experienced significant growth in
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recent years. Numerous studies indicate that hospitals are poised to experience growth and
emerge as very influential sectors in many developing nations. There is a lack of
adequate marketing efforts within the healthcare industry. The researchers reached the
conclusion that hospitals generally lack a well-established marketing department, allocate
insufficient funds to their marketing efforts, fail to effectively utilize strategic
planning tools, and demonstrate limited awareness of the notion of branding within the
healthcare industry (McCarthy, 1964). The health care facility in question has been a
prominent subject of discourse over the course of the previous decade. According to
Naidu (1993), products can serve as effective tools inside the sector to enhance
profitability.
(b) Price
In their seminal work, Farley and Hogan (1990) expounded upon the significance
of price as a critical area of specialization in the context of reducing hospital costs. Hospitals
that prioritize specialization often aim to decrease their pricing strategies in order to attract
and retain patients. Additionally, they should strive to effectively integrate with other
components of the marketing mix. The authors additionally assert that pricing within the
healthcare industry is not primarily driven by the pursuit of maximum profitability, but
rather by the objective of providing patients with high-quality services at a fair cost.
According to Marlowe (1989), pricing is an essential element of an effective

marketing mix. In order to achieve success, it is imperative that individuals collaborate
harmoniously with the many components of the marketing mix. While price is a significant
component of the marketing mix, its application as an administrative tool in the healthcare
sector is considerably restricted. The individual made reference to the organizational
framework and operational procedures within the healthcare sector, the inherent limitations
in healthcare expertise, and the challenges associated with accurately assessing expenses.
The report provides an overview of both the healthcare industry and industries outside of
healthcare.
According to Lovelock (2001), price is a vital component of the services marketing

mix. Several academics have claimed that price is the sole component of the marketing mix
plan that generates income for the firm, while all other elements are associated with
expenses. The pricing strategy within the service sector exhibits a notable level of
complexity, mostly attributed to the substantial similarity observed among various service
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groups and the shared nature of service delivery and operational systems (Kotler, 2011).The
role of costs is of considerable importance in determining the pricing of healthcare services.
Merely focusing on cost coverage is deemed inadequate given the hospital's imperative to
fulfill its financial goals and achieve profitability. Hospital pricing strategy is often
influenced by consumer price elasticity, in addition to considering costs. The concept of
price elasticity of demand quantifies the degree to which the amount sought of a certain
service is influenced by variations in its price. The segmentation strategy is based on the
understanding that distinct consumer groups will assign varying levels of value to a service,
hence necessitating the use of diverse pricing techniques. According to Booms and Bittner
(1981).
(c) Place
The construction of a hospital facility holds significant importance. Before

establishing a hospital, it is imperative to do a thorough analysis of the target customer base
and assess the healthcare needs of the community. This entails evaluating several
geographical locations, engaging in comprehensive planning, and ultimately determining
the most suitable spot for the hospital. Additionally, the hospital should develop effective
positioning strategies to ensure its success in the chosen location (Reddy & Campbell,
1993). In their study, Leonard and Kent (2008) provided an explanation about the
significance of branding within a hospital setting, specifically highlighting its influence on
client purchasing behavior when associated with branding. Kyung et al. (2008) have
identified that the establishment of strong customer ties in certain regions and locations
contributes to the development of brand creation.
According to Sreenivas et al. (2013), it is imperative for hospitals to provide both

convenient accessibility for patients and sufficient protection from pollutants. It is
imperative for any hospital to endeavor towards ensuring the availability and accessibility
of its services to its intended consumer base. In order to enhance the distribution of
healthcare accessibility, the involvement of various stakeholders such as physicians,
hospital managers, donors, government entities, insurance companies, and employers is
necessary. Therefore, hospitals are required to make three significant distribution decisions.
The elements encompassed within this category are physical access, which pertains to the
various channels, locations, and facilities available; time access, which refers to the
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temporal availability of resources; and promotional access, which involves the means by
which individuals are made aware of and encouraged to utilize those resources.
(d) Promotion
Promotion is a strategic approach employed by an organization to directly engage

with its target audience. The execution of this process is accomplished by utilizing the five
components of the promotion mix, which encompass advertising, sales promotion, personal
selling, public relations, and direct marketing (Ennew, 1998). Petit and McEnally (1985)
emphasized that the promotion mix primarily encompasses the channels utilized by
healthcare and industrial sectors to attain the promotional marketing objectives of an
organization.
The promotion and communication strategy is a crucial element of the services

marketing mix strategy, enabling hospitals to effectively convey information about their
health services to customers (Lovelock, 2001). The initial step for hospital administrators
entails assessing the requirements of consumers within the specific context in which the
hospital operates. Subsequently, they must select appropriate communication tools that
align with the aforementioned environment, taking into consideration the hospital's
resources and objectives related to profitability and growth. Promotion affords firms the
ability to establish differentiation at both the corporate and brand levels.
(e) People
Individuals have a vital role within service businesses, particularly in the context of
service delivery, where they engage in contacts with clients. The significance of personnel,
specifically customer contact workers, has been emphasized in service marketing as
essential elements in the provision of a service of superior quality and in enhancing total
customer satisfaction (Booms & Bitner, 1981).
The current state of people's involvement in service delivery exhibits significant

variations across different service contexts. However, the healthcare sector is an area where
healthcare professionals are widely recognized as being of significant importance. There is
a prevalent argument that the total quality of service provided by organizations, such as
health services, is influenced by various factors, one of which is the nature of the customer-
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provider relationship. Storbacka et al. (1994) classified routine and critical interactions as
routine and critical episodes. Customer connections encompass several forms of
interactions, which vary in terms of their content, frequency, duration, and regularity. The
physician possesses considerable autonomy in fulfilling client demands, and the assessment
of the relationship primarily relies on the dimensions of expertise and trustworthiness
(Avlonitis & Indounas, 2005). The evaluation of experience qualities pertaining to medical
services can only be conducted during or subsequent to the consumption of those services.
The evaluation of credence traits poses challenges, particularly in the context of post-
consumption of medical services (Ojasalo, 1999).
In the healthcare sector, the individual serves as the primary product, distinguishing
it from other industries. When patients contemplate healthcare, the physician is often the
foremost professional that comes to mind. The patient perceives medical treatment through
the lens of the individuals responsible for its delivery (Booms & Bitner, 1981).
(f) Physical Evidence
In their seminal work, Zeithaml and Bitner provided a comprehensive definition of

the concept in question. Physical evidence refers to the setting in which a service is provided
and the space where interactions between the company and the consumer take place. It also
encompasses any tangible items that aid in the execution or communication of the service.
The customer takes into account several crucial criteria while making a purchase, including
cleanliness, well-maintained facilities, comfortable seating arrangements, and ease of travel
(Woodside et al., 1989).
According to Richard and Allaway (1993), the presence of high-quality facilities

and services tends to significantly appeal to consumers. According to Baron and Harris
(1995), the physical environment of a service, namely the manmade aspects, has a
significant impact on customers' impressions of their service experience. The
environmental aspects of the service encompass various factors, such as the prevailing
ambient conditions (e.g., temperature, air quality, noise levels, background music), the
arrangement and utilization of the physical space (including equipment, layout, and
furnishings), and the presence of any visual cues, symbols, or artifacts.
In addition, the utilization of light, windows, and art contributes to the facilitation
of the healing process. According to a study conducted by Ulrich in 1984, it was observed
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that patients who were situated in rooms with windows offering views of natural scenes
exhibited reduced consumption of pain relief medication and experienced shorter durations
of hospitalization, in contrast to patients with windows seeing a brick building wall.
(g) Process
Laing and McKee (2000) conducted an examination of the various processes

implemented by different hospitals and their correlation with hospital marketing. Based on
the findings of the study, it can be inferred that there is a positive correlation between the
level of standardization in hospital procedures and the overall satisfaction of both
consumers and patients. The process is a vital component of the enlarged marketing mix in
services, and it should be considered as a separate strategic aspect. The influence of the
process on the first consumer decision to purchase a service and its impact on the level of
customer satisfaction has been noted by Collier (1991).
It is important to acknowledge that the process consists of three primary elements:

the flow of operations, which can be either standardized or customized; the number of steps
involved, which can range from simple to complex; and the level of customer participation.
The process refers to the specific methods, techniques, and sequence of actions through
which a service is supplied. It is categorized within the realm of operating systems. The
customer's firsthand experience of the delivery process, or the operational flow of the
service, provides customers with tangible evidence upon which they can evaluate the
service (Zeithaml et al., 2006).
2.4 Related Theories
There are three main theories applied in this study. Those theories are service
marketing mix, equity theory of consumer satisfaction, and Hirschman’s (1970) exit-voice
theory.
(a) Services Marketing Mix Model, (The 7 Ps)
The marketing mix strategy is widely regarded as a fundamental topic within the
field of marketing theory (Zeithaml & Bitner, 2000). In recent years, there has been a
growing critique of the widely accepted interpretation of this idea, as proposed by
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McCarthy (1964), which emphasizes the 4Ps framework encompassing product, price,
promotion, and place. Consequently, various alternative marketing mix techniques have
been proposed to cater to varied marketing settings.
In a previous study conducted by Booms and Bitners (1981), it was contended that
the conventional marketing mix model, consisting of the 4Ps, is insufficient for effectively
marketing both commodities and services. Services and products can be distinguished based
on their inherent features, including intangibility, inseparability, heterogeneity, and
perishability. The seminal research conducted by Booms and Bitner in 1981 expanded upon
the conventional marketing mix for services, originally consisting of the 4Ps, by introducing
three additional components: people, physical proof, and processes.
The concept of service refers to the act of providing assistance or performing duties
for others. It The marketing mix, also referred to as the 7Ps, encompasses several elements
that are crucial in the field of marketing. These elements are People, Price, Promotion,
Process, Product, Place, and Physical proof. The marketing mix is a significant marketing
element that is strategically organized to influence the target market. It is utilized in
conjunction with a range of marketing instruments to execute and accomplish marketing
objectives within the appropriate target market (Palmer, 2012).
The inclusion of personal, physical assets, and procedures in the marketing mix,
resulting in the formation of the 7Ps, led services marketing theorists to explore a distinct
realm of management theory and practice that is distinct from the marketing of tangible
items (Lovelock, 2001).
(b) Equity Theory of Consumer Satisfaction
Satisfaction is said to be present in accordance with the principles of the Equity

Theory, whereby customers perceive a fair ratio between their output and input (Oliver &
Swan, 1989). Equity models are conceptual frameworks that are drawn from the Equity
Theory proposed by Adams (1963). These models are grounded in the concept of input-
output ratio, which is considered to be a significant determinant of satisfaction (Oliver &
Swan, 1989). Based on the hypothesis proposed by Oliver and DeSarbo (1988), it is posited
that individuals engaged in a trade will perceive equitable treatment, leading to satisfaction,
when they perceive a fair ratio between their outputs and inputs. The perception of equitable
treatment by an individual can be influenced by several aspects, such as the cost incurred,
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the rewards obtained, the time and effort invested during the transaction, and the
individual's past transactional experiences (Woodruff et al., 1983). This suggests that the
comparative baseline can manifest in several manners. This idea exhibits resemblances to
the Comparison Level idea, which proposes that the criteria employed by consumers to
evaluate their pleasure may extend beyond mere expectations. The equity models of
consumer happiness exhibit distinct characteristics compared to other models. These
models assess pleasure in relation to other individuals involved in a transaction, taking into
account the outcomes experienced by all parties involved.
According to Erevvels and Leavitt (1992), the utilization of equity models can offer
a more comprehensive understanding of consumer happiness in scenarios that may not be
adequately represented by conventional satisfaction models. For instance, they can be
particularly valuable in modeling scenarios where the level of contentment with the
counterparty is seen a crucial component of the transaction.The principle of equity relies
on the individual perspectives of each party involved in the exchange. When an individual
becomes aware of their involvement in an unfair relationship, they experience anguish. The
underlying premise of equity theory posits that individuals possess the capacity to assess
and juxtapose their respective ratios of outcomes to inputs with those of another individual
with whom they share a relational connection (Walster, Walster, & Bersheid, 1978).
(c) Hirschman’s Exit-Voice Theory
Hirschman's (1970) Exit, Voice, and Loyalty (EVT) model aimed to delineate the
many courses of action that individuals inside an organization can pursue when faced with
a situation of "slack". Hirschman's model primarily centered around economic conditions,
but it has been extended to encompass organizational conditions. In this context, slack is
conceptualized as the dynamic of decline that occurs when a business is not functioning at
its optimal level. According to the paradigm, individuals faced with slack have two primary
options for responding - voice or escape. In the Hirschman paradigm, exit and voice are
two interrelated components that complement each other. The term "exit" refers to the act
of voluntarily departing from an organization, whereas "voice" pertains to the act of
expressing one's concerns over issues within an organization. Hirschman's theoretical
framework posits that the utilization of the voice function is often more effective in
addressing issues of inefficiency or complacency compared to the option of leave.
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However, Hirschman argues that the promotion of voice as a preferred course of action
necessitates the development of loyalty among individuals involved (Hirschman, 1970).
The decision to raise one's voice is often motivated by loyalty, as conceptualized in
academic discourse.The concept of loyalty has been further explored in subsequent
scholarly works through its association with the concept of quiet.
According to Gehlbach (2006), it has been acknowledged that the EVL model
encompasses the concept of silence as a dynamic phenomenon when comprehended
accurately. The author characterized this phenomenon as contingent upon the level of
bargaining power existing between the organizational leadership and its members. The
concept of quiet can be observed through two distinct manifestations: apathy and enforced
silence. A member characterized by apathy demonstrates a passive acceptance of the
existing state of affairs, adheres to established regulations, exhibits productivity, and lacks
motivation to actively participate or express their opinions. The individuals exhibit a
preference to remain within the corporate organization, opting to continue their
employment voluntarily. These individuals exhibit a type of allegiance that is mostly
characterized by their choice to remain silent. The loyalty being discussed in this context
differs greatly from Hirschman's first conceptualization of loyalty as the essential precursor
to expressing one's opinions or concerns.
When an organization is functioning at its peak efficiency, its members actively

participate in the productive endeavors of the organization and collaborate with
management to achieve the business's objectives. Similarly, when effective management is
in place, it cultivates a sense of loyalty among individuals. However, in situations where
there is a lack of effective means for expressing constructive opinions within an
organization, and if members are unable to leave voluntarily, a phenomenon known as
imposed silence can arise (Gehlbach, 2006). An individual who is compelled to remain
silent acquiesces to the prevailing state of affairs due to necessity.
According to Kassing (2002), latent disagreement can be equally or even more

harmful than overt dissent, and it may serve as a precursor to member withdrawal if the
opportunity arises in the future. Similar to how damaging opposition can erode the
effectiveness of a corporation, the imposition of silence can also have similarly detrimental
consequences. At a conceptual level, silence and imposed quiet are distinct phenomena.
While silence can be interpreted as a manifestation of passive loyalty, imposed silence
refers to the condition of passive resistance towards managerial decisions. The phenomenon
14
of enforced silence occurs when organizational management deliberately seeks to stifle the
expression of individual voices.
When a member is denied the opportunity to speak their opinions or depart a

situation, it leads to a state of imposed quiet. However, it is important to note that
management may occasionally misinterpret this silence as an indication of loyalty. The
utilization of quiet as a means of survival, or as a first step towards departure in situations
where departure is possible, is not adequately addressed in Hirschman's paradigm and has
recently gained recognition in scholarly literature as a significant aspect. The
comprehension of the correlation between loyalty and silence holds equal significance to
the research conducted on the correlation between voice and exit. This thesis aims to expand
the existing theoretical framework of silence by incorporating insights from related
disciplines that have considered the concept of quiet. By incorporating silence as a fourth
dimension, this study seeks to enhance the original EVL model proposed by Gehlbach
(2006).
2.5 Previous Studies
The study conducted by Alnaser et al. (2017) examined the impact of the Services
Marketing Mix (7 Ps) and subjective norms on customer satisfaction in Islamic banks in
Palestine. The researchers conducted an analysis on the correlation between the elements
of the services marketing mix, including product, price, place, promotion, people, process,
and physical proof, and customer satisfaction. Furthermore, the researchers also
investigated the impact of subjective standards on customer satisfaction within the context
of Islamic Banks in Palestine. The current study's sample comprises 150 individuals who
are customers of banking institutions. The participants were instructed to complete the
questionnaire at their own convenience. The conceptual framework proposed by Alnaser et
al. (2017) is visually depicted in Figure 2.1.
15
Figure (2.1) Conceptual Framework of Influence of Services Marketing Mix (7 Ps.)
and Subjective Norms on Customer’s Satisfaction
Source: Alnaser et al. (2017)
The present study employed a structural equation model to investigate both the
measurement model and the structural model. The study's findings indicate a statistically
significant and positive correlation between the seven components of the marketing mix
and consumer happiness. Additionally, the findings indicate that subjective standards serve
as a moderating factor in the relationship between the seven Ps and customer satisfaction
within the context of Islamic banking.
The objective of the study conducted by Siripipatthanakul et al. (2021) was to

conduct a comprehensive analysis of the healthcare marketing mix and its impact on patient
satisfaction within clinic settings. The researchers obtained the survey responses from a
sample of 200 individuals who were patients at various clinics. The selection of participants
was conducted using a simple random sampling method. The conceptual framework
proposed by Siripipatthanakul et al. (2021) is depicted in Figure 2.2.
16
Figure (2.2) Conceptual Framework of Healthcare Marketing Mix and Patient
Satisfaction in Clinics
Source: Siripipatthanakul, et al. (2021)
Siripipatthanakul et al. (2021) employed regression analysis as a methodological

approach to ascertain the associations between variables. The researchers discovered that
the healthcare marketing mix in clinics consists of seven elements, commonly referred to
as the 7Ps. These elements are people, product (services), procedure, physical evidence,
price, location, and process.
The study conducted by Khumnualthong (2015) sought to examine the various

elements that influence customer satisfaction and consumer loyalty towards medical
aesthetic clinics located in Bangkok. The present study was formulated with a quantitative
research approach. The survey questionnaire served as the research tool for data collection
in this study. The data were acquired from a sample size of 400 individuals. The data
underwent examination utilizing descriptive and inferential statistical methods. The
conceptual framework of Khumnualthong (2015) is illustrated in Figure 2.3.
17
Figure (2.3) Conceptual Framework of Factors Impacting on Customer Satisfaction
and Customer Loyalty toward Medical Aesthetic Clinics
Source: Khumnualthong (2015)
The findings indicated that there was a notable beneficial impact on Customer
Satisfaction from three distinct factors: Promotion, People, and Physical Evidence.
However, the four components, namely Product, Price, Place, and Process, did not exhibit
such behavior. The findings of the study also indicated that there exists a very weak
although statistically significant association between customer pleasure and customer
loyalty.
2.6 Conceptual Framework of the Study
Based on the theoretical background, and previous studies, the conceptual

framework of the study is developed. Figure (2.4) presents the conceptual framework of the
study.
18
Figure (2.4) Conceptual Framework of the Study
Source: Own Compilation, 2023
The analysis of the service marketing mix (7Ps) for hospitals is conducted based on
prior studies. Thus, the present study examines seven influential components, specifically
the service marketing mix (7Ps), as depicted in Figure 2.4. The objective of this study is to
examine the correlation between the service marketing mix and patient happiness.
Moreover, it examines the impact of patient satisfaction on patient loyalty.
Working Definition
Product: The term "product" in the context of this study refers to the comprehensive
healthcare services offered by Ma Har Myaing Hospital. These services encompass round-
the-clock availability, utilization of state-of-the-art medical equipment, possession of an in-
house laboratory, and provision of a wide range of essential medical services.
Price: In the context of this study, the term "price" refers to the provision of medical services
at a fair and transparent cost, with a competitive pricing structure that offers value for
money in terms of quality.
Place: The role of Ma Har Myaing Hospital in this study pertains to the establishment of a
convenient location for the hospital, provision of home care, implementation of telehealth
services, and the formation of well-coordinated teams.
19
Promotion: The promotion of Ma Har Myaing Hospital in this study encompasses the
utilization of pamphlets or brochures, engaging Facebook marketing strategies, a diverse
range of promotional packages, as well as tailored packages.
People: The individuals comprising the study sample from Ma Har Myaing Hospital include
doctors who possess exceptional knowledge and experience, nurses who possess qualified
abilities, qualified supporting staff, as well as practitioners who demonstrate commitments
and politeness.
Process: The present study examines the operational procedures of Ma Har Myaing
Hospital, focusing on the establishment of a streamlined booking and billing process, the
provision of an adequate number of service counters, the availability of a suitable number
of medical officers (MOs), the implementation of advanced booking systems, and the
integration of a cohesive medical team.
Physical Evidence: The physical evidence of Ma Har Myaing Hospital, as discussed in this
study, encompasses several key aspects. Firstly, it includes a well-designed layout that is
conducive to efficient operations and patient flow. Additionally, the hospital maintains
clean and comfortable treatment rooms, waiting areas, and toilets, ensuring a hygienic
environment for patients and staff alike. Adequate ventilation and lighting are also seen,
contributing to a pleasant and healthy atmosphere within the hospital premises. Lastly, the
presence of a 24/7 medicine sales counter further enhances the accessibility and
convenience of pharmaceutical services for patients.
20
CHAPTER (3)
PROFILE AND MARKETING MIX OF MA HAR MYAING

HOSPITAL
In this chapter, profile of Ma Har Myaing Hospital is presented. In addition, it

presents the organizational structure of the Ma Har Myaing Hospital. Finally, it describes
the marketing practices of the hospital.
3.1 Profiles of Ma Har Myaing Hospital
Ma Har Myaing Hospital is one of the first and foremost hospitals to first operate
and run a private hospital in Yangon, Myanmar. Ma Har Myaing was first founded in 1998
and is considered as one of the most well-known and reputed hospital in lower Myanmar.
The hospital is a 70 bedded hospital located in the heart of San Chaung, a metropolitan area
of the city. Ma Har Myaing Hospital stands with its motto, “Health is wealth, and our aim
is your satisfaction”. Ma Har Myaing has four groups of shareholders and all are private
owner.
The vision of Ma Har Myaing Hospital is to become the first choice of customers
in the health care industry and the leader in providing the best customer service in the
country. Ma Har Myaing’s mission is to provide a sustainable implementation of high-
quality patient-focused approach. Ma Har Myaing has four main core values which are
Service, Technology, Teamwork and Development. Regarding the service sector, Ma Har
Myaing values the customer feedback and advice to provide cost effective and efficient
service. In Technology concern, it has seen that trying to get and use advanced technology
and equipment in order to be in line with international standard in all services. Team work
is one of the factors to increase organization efficiency, therefore Ma Har Myaing is trying
to improve employees’ attitudes and build co-ordination among them and practice team
work performance. On the other hand, Ma Har Myaing practiced learning organization to
improve the continuous professional development of the employees.
21
3.1.1 Organizational Structure of Ma Har Myaing Hospital
To deliver good health service, Ma Har Myaing Hospital sets up its organizational
structure thoroughly. Figure (3.1) presents the organizational structure of Ma Har Myaing
Hospital.
Figure (3.1) Organizational Structure of Ma Har Myaing Hospital
Board of Directors
Operation Director
Clinical and Operation and Ancillary Support

Medical Affair Business Service
Development
Source: Ma Har Myaing Hospital, 2023
Based on the data presented in Figure 3.1, it can be observed that there are a total of
eight departments. Each department is designated a department head at its highest level.
Under the supervision of the designated authority, each individual in charge is
systematically recruited to fulfill medical and administrative responsibilities, as well as
oversee the personnel. The department of clinical and medical affairs assumes
responsibility for the administration of medical therapies. The department of operation and
business development assumes responsibility for administrative tasks, marketing activities,
and customer service initiatives. Conversely, the ancillary support service department is
accountable for managing human resources, information technology, pharmacy and
procurement, as well as finance-related matters.
3.2 Marketing Mix of Ma Har Myaing Hospital
This section provides an overview of the marketing mix employed by Ma Har

Myaing Hospital. This study aims to analyze the service marketing mix, sometimes known
as the 7Ps. The service marketing mix encompasses seven key elements, sometimes referred
to as the 7 P's. These elements are product, price, place, promotions, people, process, and
physical evidence.
22
3.2.1 Product
The primary components of a hospital's offerings consist of the products and

services provided by Ma Har Myaing Hospital. The hospital frequently undergoes shaping
processes influenced by the requirements or desires of its primary users, with the aim of
establishing itself as a comprehensive or central institution within its local community or
medical network. The services provided by Ma Har Myaing Hospital encompass a diverse
array of medical provisions, spanning from fundamental healthcare essentials to urgent
medical interventions. Table 3.1 displays an overview of the products and services offered
by Ma Har Myaing Hospital.
Table (3.1) Products and Services of Ma Har Myaing Hospital
Sr. No Available Products and Services

1. Outpatient Service
2. Inpatient Service
3. Accident and Emergency Service
4. Operating Theatre
5. Laboratory Service
6. Imaging Service
7. Medical Check-Up Center
8. Medical Oncology Center
9. Hemodialysis Center
10. Counselling Center
11. High Dependency Center
12. Ambulance Service
Source: Ma Har Myaing Hospital, 2023
Based on the data presented in Table 3.1, it can be observed that Ma Har Myaing
Hospital offers a total of 14 distinct products and services to cater to the needs of its patients.
The organization provides a comprehensive range of medical services to its clientele,
encompassing both outpatient and inpatient care. These services are delivered by a team of
highly skilled professionals, consisting of 12 specialized departments and a roster of over
80 experts. The hospital employs a centralized medical record system. The facility offers a
comprehensive healthcare system that operates around the clock, providing continuous
medical services. Additionally, the facility possesses its own laboratory that operates 24/7.
Ma Har Myaing Hospital provides round-the-clock home visit services and facilitates
23
ambulance services for emergency situations. Ma Har Myaing is also facilitating
communication with international hospitals on behalf of patients who want specialized
medical care in foreign nations.
Generally, the service offering in Ma Har Myaing Hospital comprises of the

following levels:
1. Core Level - Ma Har Myaing Hospital provides basic treatment facilities and
services like diagnostic services, emergency services, causality services etc. Core
Products of MHM are Urology, Nephrology, and Orthopedic.
2. Expected level – Ma Har Myaing Hospital maintains cleanliness, fast service and
hygiene level in the hospital.
3. Augmented level – Ma Har Myaing Hospital sets dress code for staff, air
conditioning of the hospital, use of state of art technology, services of renewed
consultants.
3.2.2 Price
Ma Har Myaing Hospital caters to consumers in the medium range and has a pricing
approach that is cost-effective. A diverse range of prices is available, including reasonable
rates for patients who may find certain services financially challenging. Ma Har Myaing
actively engages in a monthly Corporate Social Responsibility (CSR) initiative, wherein
two financially disadvantaged patients are selected to receive full sponsorship for their
medical expenses. Ma Har Myaing offers a diverse range of package packages and discount
programs tailored to each specialization, providing a more affordable alternative to the
regular pricing.
The mean expense for a single session of therapy with a specialized consultant is
from 15,000 MMK to 20,000 MMK, while the cost for a single instance of on-call treatment
ranges from 20,000 MMK to 25,000 MMK. Ma Har Myaing Hospital aims to enhance
healthcare accessibility and affordability by providing a wide range of medical services at
a reasonable cost.
3.2.3 Place
Ma Har Myaing Hospital is recognized as one of the pioneering private healthcare

facilities in Yangon, Myanmar, having established itself as a leading institution in the
24
region. The hospital is situated in the central part of San Chaung, a bustling metropolitan
region, and has a capacity of 70 beds. The location of the establishment is in close proximity
to a bus-stop station, rendering it conveniently accessible by public transportation. The
hospital offers well-maintained and ample automobile parking facilities, which are
accompanied by round-the-clock security services. The hospital is situated in close
proximity to the city area and in close proximity to the Government Specialist Hospital,
facilitating convenient transfers for patients with complex medical conditions or those
involved in legal matters.
In addition, the hospital offers home services to patients, so eliminating the

necessity for them to physically visit the hospital premises. In addition, the platform
provides telehealth services and facilitates the provision of ambulance services in
emergency situations.
3.2.4 Promotions
Ma Har Myaing employs both direct marketing and indirect marketing strategies.
Facebook is currently recognized as a prominent marketing platform that serves as a direct
method for connecting with customers. Another marketing strategy is engaging in direct
touch with patients and their attendants through telephone calls to inform them about
promotional packages. Currently, Ma Har Myaing primarily emphasizes a range of
packages, including check-up packages, labor packages encompassing both LSCS and
normal birth, pre-employment check-ups, annual check-ups, and Urology packages, among
others.
Ma Har Myaing utilizes several marketing strategies, such as distributing brochures,

employing vinyl advertisements, and engaging in word-of-mouth marketing to reach out to
consultants and promote their product. Additionally, it produces outpatient department
(OPD) pamphlets aimed at promoting the selection of suitable specialists by patients.
Additionally, the healthcare facility offers round-the-clock emergency consultation services
with medical professionals at the emergency unit, providing patients with the convenience
of selecting from a diverse range of specialists. In addition to its core medical services, the
hospital offers a range of supplementary services, including reception assistance, telephone
25
operator support, room reservation facilitation, ambulance booking coordination, medical
examination provision, business partnership facilitation, and cost-effective advertising
opportunities.
3.2.5 People
In order to identify appropriate physicians and healthcare workers who possess the
necessary qualifications and align with the hospital's requirements, Ma Har Myaing
employs proficient recruiters. Recruiters meticulously examine the credentials of medical
experts in order to identify candidates who possess the necessary willingness and cultural
compatibility to effectively operate inside a hospital setting. The organization conducts
interviews with candidates in order to evaluate their compatibility with the company's
culture for the specific position, and thereafter selects only the most qualified individuals
for further consideration. The primary focus of Ma Har Myaing is to employ physicians and
specialists who possess strong interpersonal skills and are adept at interacting with
individuals. Furthermore, the hospital ensures adequate staffing for each department
through a comprehensive assessment of individuals' skills and professional background.
3.2.6 Process
Ma Har Myaing Hospital offers comprehensive patient care services, encompassing

the entire treatment process from admission to discharge, as well as post-therapy follow-
up. The hospital prioritizes the promptness and precision of the services rendered. Processes
are formulated through the use of a blueprint, which establishes a prescribed framework for
the execution and implementation of a service. Within a hospital setting, the operational
procedure can be categorized into four distinct phases: the joining phase, intensive
consuming period, detachment phase, and feedback phase.
Upon arrival at the hospital, patients are greeted by the personnel in a kind manner
and are inquired about their desired course of treatment. Subsequently, the customer service
representatives present a comprehensive roster of doctors that are now accessible for
selection. Following this, the customer service representatives proceed to coordinate the
necessary treatment. When a patient requires admission, the customer staff assists in
facilitating the admission procedure, which includes tasks such as collecting the deposit and
providing the hospital registration number. Nurses and healthcare aides are prepared to
26
provide assistance to patients. The intensive consumption phase encompasses the processes
of diagnosis, treatment, and provision of knowledge for future activities. The process of
detachment can be facilitated with the guidance and recommendations provided by medical
professionals. The staff members provide assistance and support throughout all stages of
the detachment processes. To enhance convenience in service provision and cater to client
needs, the integration of new computer systems and the implementation of a digital token
system for the sale of pharmaceuticals have been introduced.
3.2.7 Physical Evidence
Ma Har Myaing Hospital ensures the provision of enough equipment and drugs, as
well as maintaining a conducive atmosphere and physical environment. Physical symbols,
like as emblems, uniforms, and equipment, exhibit variations in their display among
different units. Furthermore, the hospital places significant emphasis on the provision of
specialized treatment, with a particular focus on maintaining high standards of hygiene,
cleanliness, and enough illumination across the entire facility. Furthermore, Ma Har
Myaing Hospital implements effective ventilation and air conditioning systems to mitigate
unpleasant odors and enhance overall comfort.
The hospital provides round-the-clock ambulance services, as well as emergency

department facilities consisting of four beds and one isolation room. The facility has the
capacity to accommodate up to 70 individuals requiring inpatient care. In addition, there is
a single ambulance vehicle on standby to address emergency situations.
27
CHAPTER (4)
ANALYSIS OF PATIENT SATISFACTION AND LOYALTY

TOWARDS MA HAR MYAING HOSPITAL
This chapter presents the research design followed by reliability test. Then,
demographic data and customer perceptions towards the influencing factors are presented.
Finally, it presents the regression results.
4.1 Research Design
satisfaction on loyalty towards Ma Har Myaing Hospital. To calculate sample population,
sampling formula of Yamane (1965) is used and it is shown in the following:
= 341
The variables in this formula are:
n = the sample size
N = the population of the study
e = the margin error in the calculation
This study employs descriptive and qualitative research methodologies. The total number
of outpatients at Ma Har Myaing Hospital is 2326. The Yamane Formula is employed for
the computation of sample population. A sample size of 341 outpatients was obtained using
the simple random sampling approach.
A structured questionnaire utilizing a 5-point Likert scale was devised and implemented
through the use of a Google form in order to gather primary data online. The data were
taken on June 2023. The collected data is analyzed using the SPSS software, and the
28
regression approach is utilized to determine the relationship between the variables.
Secondary data sources encompass several types of information, such as the records of Ma
Har Myaing Hospital, previously published papers, earlier research papers, pertinent
textbooks, and overseas studies accessed through internet portals..
4.2 Reliability Test
Reliability refers to the degree of stability or consistency exhibited by the variable inside
the structured questionnaire. The development of questions involves the utilization of a 5-
point Likert scale. Cronbach (1951) provided a range of Alpha values that were categorized
as excellent (0.93–0.94), strong (0.91–0.93), reliable (0.84–0.90), robust (0.81), fairly high
(0.76–0.95), high (0.73–0.95), good (0.71–0.91), relatively high (0.70–0.77), slightly low
(0.68), reasonable (0.67–0.87), adequate (0.64–0.85), moderate (0.61–0.65), satisfactory
(0.58–0.97), acceptable (0.45–0.98), sufficient (0.45–0.96), not satisfactory (0.4–0.55), and
low (0.11) in terms of their quality. The findings of the reliability assessment conducted
using Cronbach's Alpha are displayed in Table 4.1.
Table (4.1) Reliability Test
Sr. No. Variable No. of Items Cronbach’s Alpha
1 Product 10 .919
2 Price 7 .925
3 Place 10 .901
4 Promotion 7 .928
5 People 10 .947
6 Physical Evidence 10 .933
7 Process 10 .949
8 Patient Satisfaction 10 .966
9 Patient Loyalty 8 .954
Source: Survey Data, 2023
According to Table (4.1), Cronbach’s Alpha values for all variables show that all
the scores are greater than 0.7. Therefore, the findings have good reliability.
4.3 Profile of the Respondents
29
This section presents the profiles of 341 respondents who finished and returned the
structured questionnaire. Gender, marital status, age, educational level, job and income are
all part of the respondents' profiles. In the Table (4.2), profiles of the respondents are
expressed by frequency and percentage.
Table (4.2) Demographic Data of the Respondents
Sr. Item Category No. of Percent

No Respondents
Total 341 100.0
Male 183 53.7
1 Gender Female 158 46.3
Single 205 60.1

2 Marital Status Married 136 39.9
Under 18 3 0.9
18-20 6 1.8
21-25 27 7.9
26-30 57 16.7
3 Age(Years) 31-35 92 27.0
36-40 75 22.0
41-45 48 14.1
46-50 18 5.3
Above 50 15 4.4
Undergraduate 15 4.4
4 Education Level Graduate 198 58.1
Post Graduate 128 37.5
Company Employee 211 61.9
Government Staff 27 7.9
5 Job Student 22 6.5
Business Owner 61 17.9
Retired 20 5.9
Below 300,000 26 7.6
300,000-500,000 48 14.1
500,001-700,000 28 8.2
6 Salary(MMK)
700,001-900,000 31 9.1
900,001-100,000 24 7.0
Above 1,000,000 184 54.0
According to the Table (4.2), majority of the respondents male patients. In addition,
They are aged between 31 and 35. A large majority of the respondents are married and
30
working as company employees. In addition, majority of the respondents occupy bachelor
degree. In accordance with income, the majority of the respondents earn above 1,000,000
MMK.
4.4 Patient Perception on Marketing Mix

The 7Ps marketing mix (product, price, location, promotion, employee process, and
physical evidence) and patient satisfaction are necessary to compete with similar businesses
and different products, so it is the main element that needs to be maintained and improved
so that consumers always feel satisfied.
Primary data are collect by using structured questions with Five-point Likert scale
(1=Strongly Disagree, 2=Disagree, 3=Neutral, 4=Agree, and 5=Strongly Agree) was used
to find out the importance of factors influencing on satisfaction and loyalty. The mean rating
scale is presented in Table (4.3).
Table (4.3) Mean Rating Scale

No. Score Range Mean Rating
1 1.00 -1.80 Strongly Disagree
2 1.80 -2.60 Disagree
3 2.61-3.40 Neutral
4 3.41- 4.20 Agree
5 4.21-5.00 Strongly Agree
Source: Best, 1977
According to Table (4.4), Best (1977) identified mean rating scale in order to
interpret the survey data. He classified five ranges by specifying score range and mean
rating. In this study, Best (1977) mean score rating is applied.
(a) Patient Perception on Product

Patient perception is crucial for the success of the business. Patient perception
describes how patients see a business or product in light of their interactions and
experiences. Patient perception is the opinions, feelings, and beliefs patients have about
medical products or services. Patient Perception on Product of Ma Har Myaing Hospital is
presented in Table (4.4).
31
Table (4.4) Product of Ma Har Myaing Hospital
Sr. Mean Std.
Product
No. Score Dev
1. Having attractive service 3.36 0.94
2. Having Up-to-date medical equipment 3.47 0.89
3. Offering 24/7 medical services 3.84 0.96
4. Developing new services 3.65 0.93
5. Having own laboratory service 3.77 0.89
6. Offering many kinds of core services for health care 3.73 0.82
7. Offering variety of packages (OG, Uro, Surgery) 3.82 0.83
8. Arranging various Check-up Programs (couple, pre- 3.65 0.89
employment etc.)
9. Offering Tele-medical service 3.60 0.93
10. Providing home medical service for elders 3.65 0.88
Overall Mean 3.65
Based on the data presented in Table 4.4, it is evident that the respondents hold a
favorable perception of the 24/7 medical services provided by Ma Har Myaing Hospital.
This good sentiment may be attributed to the hospital's provision of a round-the-clock
medical system and an in-house laboratory that operates continuously throughout the day.
Furthermore, the participants indicated that Ma Har Myaing Hospital offers a diverse
selection of packages, including OG, Uro, and Surgery. This is because the services given
by Ma HM Hospital encompass a wide spectrum, ranging from urgent care to essential
medical requirements. The average score of 3.65 indicates that a majority of the participants
hold a favorable view of the products provided by Ma Har Myaing Hospital.
(b) Patient Perception on Price

Price perception is the perceived worth of a product or service in the consumer's
mind. It is one of the leading variables in the consumer's buying process. Patient perception
on price of Ma Har Myaing Hospital is presented in Table (4.5).
32
Table (4.5) Price
Sr. Mean Std.
Price
No. Score Dev
1. Offering services in fair prices 3.56 0.94
2. Setting reasonable charges in Ma Har Myaing Hospital 3.67 0.93
3. Offering value for money in terms of quality 3.51 0.85
4. Being cheaper than those of other private hospitals 3.45 1.04
5. Having price transparency by listing prices of each service 3.47 0.96

6. Charging premium price for new services 3.55 0.88
7. Setting competitive price for ordinary medical services 3.61 0.91
Overall Mean 3.54
Based on the findings presented in Table 4.5, a significant proportion of the

participants said that the fees charged by Ma Har Myaing Hospital are deemed reasonable.
This perception can be attributed to the hospital's deliberate focus on catering to middle-
class clientele, as well as its adoption of an inexpensive pricing approach. Additionally,
there exists a diverse spectrum of pricing options, encompassing affordable rates tailored
to accommodate individuals who may have financial constraints. Furthermore, the
participants expressed that Ma Har Myaing Hospital establishes a competitive pricing
structure for standard medical services by providing several specialized packages and
discounts that are priced lower than the prevailing market rates. The collective average
score of 3.54 indicates that a significant proportion of the participants hold a favorable view
regarding the pricing supplied by Ma Har Myaing Hospital.
(c) Patient Perception on Place

Place in marketing mix means service delivery. Place is the element of
the marketing mix that ensures that the product is distributed and made conveniently
available for patients. Patient perception on place of Ma Har Myaing Hospital is presented
in Table (4.6).
33
Table (4.6) Place of Ma Har Myaing Hospital
Sr. Mean Std.
Place
No. Score Dev
1. Being easy and convenient to go to Ma Har Myaing 3.95 0.86
Hospital
2. Arranging large parking lot 3.16 1.03
3. Not long waiting time at the waiting area 3.34 0.99
4. Being reachable by (bus, taxi etc.) 3.94 0.92
5. Having many schedules of doctors 3.79 0.78
6. Offering emergency service for providing immediate 3.71 0.85

treatment
7. Providing home medical service 3.58 0.91
8. Having 24 hours ambulance service to provide emergency 3.66 0.84

assistance
9. Offering Telehealth service 3.63 0.92
10. Having well-organized teams for home service and 3.65 0.90
telehealth service
Overall Mean 3.64
Based on the data shown in Table 4.6, a significant proportion of the participants
indicated that accessing Ma Har Myaing Hospital is facilitated by its favorable location,
which is perceived as both easy and convenient. Furthermore, the participants indicated that
Ma Har Myaing Hospital is accessible through many modes of transportation, such as buses
and taxis. The hospital offers a variety of doctor schedules, allowing respondents to
conveniently visit the hospital at their preferred time. The average score of 3.64 indicates
that a significant proportion of the participants hold a favorable view of the distribution
channels for location or service provided by Ma Har Myaing Hospital.
(d) Patient Perception on Promotion

Promotion is considered as public relations, advertising, and the whole media plan
use to launch a product or service are all included. To reach the target audiences, marketers
34
frequently combine the aspects of placement and promotion. Patient perception on
promotion of Ma Har Myaing Hospital is presented in Table (4.7).
Table (4.7) Promotion of Ma Har Myaing Hospital
Sr. Mean Std.
Promotion
No. Score Dev
1. Printing Leaflets or brochures for the clinic information 3.54 0.89
2. Having attractive Facebook marketing of Ma Har Myaing 3.37 1.08
Hospital
3. Offering various promotional packages 3.45 0.94
4. Having OPD booklets to promote various specialist 3.60 0.91
5. Offering attractive promotion packages 3.45 1.02
6. Doing attractive Digital marketing of Ma Har Myaing 3.34 1.07
Hospital
7. Offering customized package. 3.47 0.93
Overall Mean 3.46

Based on the data shown in Table 4.7, it is evident that a significant proportion of
the participants indicated that Ma Har Myaing Hospital provides outpatient department
(OPD) booklets as a means to facilitate the selection of various specialists by patients.
Furthermore, the participants said that Ma Har Myaing Hospital employs several means of
disseminating clinic information, such as the utilization of vinyl banners, booklets, and
word-of-mouth advertising, as well as the provision of leaflets or brochures to potential
clients. Furthermore, individuals have the option to avail themselves of the personalized
package. The collective average score of 3.46 indicates that a majority of the participants
hold a favorable view regarding the promotions provided by Ma Har Myaing Hospital.
(e) Patient Perception on People

People is the healthcare personals who deliver healthcare service to patients. People
play a crucial role in service organizations, especially during the service delivery process
when the peoples have interactions with patients. Patient perception on people is presented
in Table (4.8).
35
Table (4.8) People
Sr. Mean Std.
People
No. Score Dev
1. Having excellent doctors with knowledge and expertise 3.74 0.82
2. Treating all the patients alike by doctors 3.70 0.85
3. Having qualified staff and nurses 3.64 0.88
4. Showing commitments by Practitioners and they are 3.66 0.86
available.
5. Having reliable and polite doctors 3.62 0.92
6. Showing concern and competence of doctors and nurses 3.56 0.92
7. Having adequate number of people for service delivery. 3.59 0.91
8. Showing courteous and kindness of staff 3.58 0.89
9. Setting a clean, tidy and neatly pressed uniforms 3.57 0.88
10. Setting ID badge for all staff 3.66 0.90
Overall Mean 3.63

participants express agreement with the notion that the doctors at Ma Har Myaing Hospital
possess exceptional knowledge and expertise. This sentiment is attributed to the hospital's
practice of appointing renowned medical professors in relevant fields, as well as its history
of evaluating doctors' patient treatment approaches. Moreover, the participants assert that
physicians provide equal treatment to all patients due to the expectation set by Ma Har
Myaing Hospital for medical personnel to approach every patient with both respect and
fairness. The collective average score of 3.63 indicates that a majority of the participants
hold a favorable impression of healthcare personnel at Ma Har Myaing Hospital.
(f) Patient Perception on Physical Evidence

The physical evidence element of the marketing mix refers to the physical
environment experienced by the patient. This could mean the design and layout of hospital.
Patient perception on physical evidence is presented in Table (4.9).
36
Table (4.9) Physical Evidence
Sr. Mean Std.
Physical Evidence
No. Score Dev
1. Having comfortable, clean and free of bad smells of the 3.47 0.93
treatment room, waiting area and toilet
2. Having Good layout 3.49 0.95
3. Arranging good ventilation and lighting 3.62 0.90
4. Placing clear Signs and logos of the Hospital 3.65 0.91
5. Having ambulance car 3.77 0.81
6. Having own laboratory room 3.81 0.81

7. Having enough examination rooms 3.62 0.83
8. Having a large emergency room 3.55 0.81
9. Having enough rooms for patients 3.62 0.83
10. Placing 24/7 medicine sales counter 3.75 0.91
Overall Mean 3.64
Based on the data presented in Table 4.9, a significant proportion of the participants
indicated that Ma Har Myaing Hospital possesses its own dedicated laboratory facility,
hence obviating the necessity for patients to seek external testing services. Similarly, the
participants asserted that Ma Har Myaing Hospital possesses an ambulance vehicle and
maintains an additional backup ambulance vehicle to address unforeseen emergencies. In
addition, the hospital provides a drug sales counter that operates 24 hours a day, 7 days a
week. The collective average score (3.64) indicates that a significant majority of the
participants hold a favorable view of the physical evidence of Ma Har Myaing Hospital.
(g) Patient Perception on Process

Process is one of the crucial elements of the expanded marketing mix components
in services. Simple process and procedure are vital for patients as they want quick service.
Patient perception on process of Ma Har Myaing Hospital is presented in Table (4.10).
37
Table (4.10) Process of Ma Har Myaing Hospital
Sr. Mean Std.
Process
No. Score Dev
1. Having standby Medical Officers (MOs) 3.74 0.81
2. Having simple Bill settlement process 3.70 0.87
3. Having simple and easy booking process 3.67 0.80
4. Setting sufficient service counters 3.55 0.86
5. Offering reasonable waiting time 3.47 0.85
6. Being able to make the appointment in advance before 3.66 0.89

coming
7. Having well organized medical teams for operations 3.70 0.80
8. Keeping members of service team in touch (such as 3.54 0.93
professors, MOs, Nurses etc.)
9. Having integrated service teams at the Ma Har Myaing 3.56 0.83
Hospital.
10. Offering supports from Staffs at the entrance. 3.45 0.90
Overall Mean 3.60

participants indicated that medical officers are consistently available at Ma Har Myaing
Hospital. This is attributed to the presence of a doctor in the emergency unit who is directed
by specialists through telephonic communication. In a similar vein, the participants express
the belief that Ma Har Myaing Hospital possesses efficiently structured medical teams for
surgical procedures, facilitating pre-treatment consultations between patients and the
medical staff. In addition, the hospital is equipped with a computerized billing system,
which facilitates efficient and expeditious billing settlement. The collective average score
of 3.60 indicates that a significant proportion of the participants hold a favorable view of
the operational procedures of Ma Har Myaing Hospital.
Table (4.11) presents the summary of overall mean values of independent variables,
service marketing mix 7Ps.
38
Table (4.11) Summary of Overall Mean Value
Sr. No. Marketing Mix Mean Score
1. Product 3.65
2. Price 3.54
3. Place 3.64
4. Promotions 3.46
5. People 3.63
6. Physical Evidence 3.64
7. Process 3.60
According to Table (4.11), all mean scores of marketing mix are above 4.00. Hence,
customers are satisfied with the medical services of Ma Har Myaing Hospital. All those
factors contributes in achieving customer satisfaction.
4.4.2 Patient Satisfaction

Patient satisfaction reflects the effectiveness of the hospital in delivering value to
its patients and other customers. The survey results of patient satisfaction are mentioned
below in Table (4.12).
Based on the data shown in Table 4.12, it can be observed that a significant
proportion of the participants express contentment with the professionalism and expertise
exhibited by the staff and nurses at the hospital. This positive perception is attributed to the
presence of highly skilled practitioners, such as paediatric specialists, general physicians,
OG experts, and various other specialists, who are available to deliver their services.
39
Table (4.12) Patient Satisfaction
Sr. Mean Std.
Patient Satisfaction
No. Score Dev
1. Satisfying staff’s response and prompt services. 3.52 0.96
2. Satisfying with the questions answered by staffs. 3.47 1.00
3. Satisfying with the readiness of staff at Ma Har Myaing 3.57 0.88
Hospital.
4. Satisfying with the politeness and skilful of service 3.57 0.90
providers (staff, nurses and doctors).
5. Satisfying with the service price of Ma Har Myaing 3.55 0.95
Hospital
6. Satisfying with the neat and cleanliness of hospital. 3.42 1.03
7. Satisfying with the promotions of Ma Har Myaing 3.46 0.95
Hospital.
8. Satisfying with the waiting time at the reception area. 3.39 0.97
9. Satisfying with the ease of appointment by phone. 3.51 0.87
10. Satisfying with products and services offered by Ma Har 3.55 0.94
Myaing Hospital.
Overall Mean 3.50
Specialists and medical officers are readily accessible around the clock to aid
patients. Moreover, the participants express contentment with the pricing of services at Ma
Har Myaing Hospital due to its comparably fair rates in relation to other competing
establishments, the transparency in pricing displayed for each service, and the provision of
premium pricing for newly introduced services. Based on the obtained mean score of 3.50,
it can be inferred that a significant proportion of the participants express satisfaction with
Ma Har Myaing Hospital. This positive sentiment may be attributed to the hospital's
provision of high-quality care, round-the-clock service availability, a diverse range of
specialized medical practitioners, a hygienic atmosphere, and state-of-the-art medical
equipment.
40
4.4.3 Patient loyalty
Patient loyalty is an ongoing positive relationship between a patient and Ma Har
Myaing Hospital. The survey is using structured questionnaires with 5-point Likert scale
and the results are presented in Table (4.13).
Table (4.13) Patient Loyalty
Sr. Patient Loyalty Mean Std.
No. Score Dev
1. Ma Har Myaing Hospital being first choice 3.42 0.98
2. Continuing going to Ma Har Myaing Hospital. 3.43 0.98
3. Saying positive things about this clinic to other 3.49 0.99
colleagues.
4. Recommending Ma Har Myaing Hospital to colleagues 3.45 1.01
5. Encouraging others to patronize Ma Har Myaing Hospital. 3.41 1.00

6. Continuing use of Ma Har Myaing Hospital services even 3.45 0.98
if prices go up
7. Recommending Ma Har Myaing Hospital to others even if 3.21 1.03
the arrangements of facilities and service quality are not
well standardized
8. Talking about positive things of Ma Har Myaing Hospital 3.41 0.99
to colleagues, friends and relatives.
Overall Mean 3.41
Based on the findings presented in Table 4.13, it can be observed that the
respondents express favorable opinions about Ma Har Myaing Hospital when discussing it
with their colleagues. These positive perceptions are primarily based on the respondents'
personal encounters, which include timely appointment scheduling, availability of qualified
specialists, convenient access to information, and satisfactory interactions with the medical
staff. Moreover, the participants in the study highly suggest Ma Har Myaing Hospital to
their peers due to the clinic's provision of excellent services by medical practitioners,
nurses, and staff members. Additionally, the availability of a 24-hour drug sales counter, a
comfortable waiting area, and a user-friendly appointment booking system further
contribute to the clinic's positive reputation. The collective average score of 3.41 indicates
41
that a significant proportion of the participants exhibit loyalty towards Ma Har Myaing
Hospital.
4.5 Analysis on the Effect of Marketing Mix on Patient Satisfaction

In order to investigate the impact of influencing factors on patient satisfaction, a
standardized questionnaire was administered to a sample of 341 employees. In order to
examine the data, a multiple regression analysis was conducted and the findings are
displayed in Table 4.14.
According to the data presented in Table 4.14, the R square value of 0.862 indicates
that the model under consideration is capable of accounting for 86.2% of the observed
variability in patient satisfaction, as influenced by the components being examined. The
model can be considered valid due to the substantial relevance of the F value at the 1 percent
level. Out of the seven components that have an influence, it has been determined that five
of these factors hold significant importance in relation to patient satisfaction. The impact
of location and procedure on patient satisfaction is not statistically significant.
Table (4.14) Effect of Marketing Mix on Patient Satisfaction

Unstandardized
Standardized
Coefficients
Variable Coefficients t Sig
Std
B (Beta)
Error
(Constant) .422 .099 4.276 .000
Product .105* .057 .087 1.835 .067
Price .227*** .043 .212 5.309 .000
Place .027 .073 .022 .375 .708
Promotions .167*** .043 .165 3.902 .000
People .480*** .069 .420 6.982 .000
Physical Evidence .189** .073 .157 2.601 .010
Process .110 .081 .094 1.358 .175
R2 .862
Adjusted R2 .859
F Value 297.381***
*** Significant at 1% level, ** Significant at 5% level, * Significant at 10% level
42
The relationship between the product and patient satisfaction is statistically
significant at a 10 percent level. The round-the-clock availability of services and diverse
range of medical packages offered by Ma Har Myaing Hospital have resulted in high levels
of patient satisfaction. Higher product quality leads to increased consumer satisfaction.
The relationship between price and patient satisfaction is statistically significant at
a confidence level of 1 percent. The satisfaction of patients with the service price of Ma
Har Myaing Hospital can be attributed to the hospital's use of competitive pricing strategies
for ordinary medical services, resulting in reasonable costs. The greater the extent to which
a more favorable price is provided, the higher the level of customer satisfaction that will be
attained.
The relationship between promotion and patient satisfaction is statistically
significant at a 1 percent level. Ma Har Myaing Hospital produces outpatient department
(OPD) booklets and distributes them to enhance the dissemination of information on
various specialists and clinic-related details through the use of leaflets or brochures. Patients
express satisfaction with the hospital's promotional efforts due to their ability to readily
choose experts and therapies. The provision of superior promotional incentives is directly
correlated with increased levels of customer satisfaction.
The relationship between individuals and patient satisfaction is statistically
significant at a significance level of 1 percent. The doctors of Ma Har Myaing Hospital
possess exceptional knowledge and skills. Furthermore, all of them provide equal treatment
to their patients. Therefore, the patients express satisfaction with the staff members of the
facility. Higher levels of qualification and the provision of courteous service to individuals
within a hospital setting are directly correlated with increased levels of customer
satisfaction.
The presence of physical evidence exhibits a statistically significant relationship
with patient satisfaction at a significance level of 5 percent. Ma Har Myaing Hospital
possesses its own laboratory facility and a medical sales counter that operates round the
clock. Therefore, patients find convenience in the physical proof provided by hospitals,
leading to their satisfaction. The correlation between improved physical arrangements in
hospitals and increased client satisfaction is evident.
Based on the standardized coefficient (Beta) score, it can be observed that the
variable "People" exhibits the highest value among the five important explanatory factors.
This finding suggests that individuals have the greatest impact on patient satisfaction, with
pricing, promotion, physical evidence, method, and product also playing significant roles.
43
4.6 Analysis on the Effect of Patient Satisfaction on Patient Loyalty
In this section, to find out the effect of patient satisfaction on patient Loyalty, linera
regression analysis is applied. The regression result is shown in Table (4.15).
Table (4.15) Effect of Patient Satisfaction on Patient Loyalty
Unstandardized
Coefficients
Variable β t Sig
Std
B
Error
(Constant) .191 .097 1.960 .051
Patient Satisfaction .919*** .027 .879 33.919 .000
R2 .772
Adjusted R2 .772
F Value 1150.468***
Source: Survey Data (2022)
*** Significant at 1% level
Based on the data presented in Table (4.15), it can be inferred that the model in
question, as indicated by an R2 value of 0.772, has the ability to account for approximately
77.2% of the variability observed in patient loyalty, as predicted by patient satisfaction. The
model can be considered valid due to the substantial relevance of the F value at the 1 percent
level.
The pleasure of patients has a notable and favorable impact on their loyalty, which
is highly statistically significant at the 1 percent level. The majority of respondents
expressed satisfaction with the marketing mix of Ma Har Myaing Hospital, often providing
favorable feedback and recommending the hospital to others. Increased patient satisfaction
with hospital services is positively correlated with higher levels of patient loyalty.
44
CHAPTER (5)
CONCLUSION
This chapter presents the findings and discussions. Then, it describes the
suggestions and recommendations. Finally, it presents the need for further study based on
the scope and limitations of the study.
5.1 Findings and Discussions
satisfaction on patient loyalty towards Ma Har Myaing Hospital. This study utilizes both
primary and secondary data sources. In order to obtain primary data, a structured
questionnaire on a 5-point Likert scale is utilized. A sample size of 341 outpatients is
determined randomly.
The present study examines the prevailing perception of the respondents towards
the round-the-clock medical services provided by Ma Har Myaing Hospital. The hospital's
24-hour medical system and in-house laboratory are key factors contributing to the
favorable outlook expressed by the majority of participants. Furthermore, it has been
observed that Ma Har Myaing Hospital offers a diverse choice of packages that cater to a
wide spectrum of medical requirements, encompassing both urgent and essential healthcare
services. Based on the data collected, it can be inferred that a significant proportion of the
participants hold a favorable view of the product provided by Ma Har Myaing Hospital.
The findings pertaining to pricing suggest that the costs at Ma Har Myaing Hospital
are deemed reasonable due to the hospital's focus on middle-class clientele and its
implementation of an economical pricing strategy. Ma Har Myaing Hospital adopts a
competitive pricing strategy for its standard medical services by providing a variety of
specialized packages and discounts that are priced lower than the prevailing market rates.
Hence, a significant proportion of the participants hold a favorable opinion of the pricing
structure provided by Ma Har Myaing Hospital.
In terms of location, Ma Har Myaing Hospital is conveniently positioned and
accessible by many modes of transportation such as buses and taxis. Furthermore, the
45
hospital offers a variety of doctor schedules, allowing respondents to conveniently visit the
facility at a time that suits them. Hence, a significant proportion of the participants hold a
favorable view of the place or service distribution channels provided by Ma Har Myaing
Hospital.
The presence of OPD booklets at Ma Har Myaing Hospital serves as a means to
facilitate patient selection of various specialists, hence promoting their services.
Additionally, the research revealed that Ma Har Myaing Hospital provides informational
booklets or brochures regarding its medical services. Furthermore, individuals have the
option to avail themselves of the personalized package. Hence, a significant proportion of
the participants exhibit a favorable attitude of the promotional initiatives provided by Ma
Har Myaing Hospital.
In relation to individuals, it has been observed that doctors had exceptional
knowledge and expertise due to the appointment of renowned medical professors in relevant
fields by Ma Har Myaing Hospital. Furthermore, the hospital has a history of assessing
doctors' patient treatment practices. Furthermore, the data demonstrates that physicians
provide equal treatment to all patients. Hence, a significant proportion of the participants
hold a favorable view of healthcare professionals at Ma Har Myaing Hospital.
The findings indicate that Ma Har Myaing Hospital possesses its own laboratory
facility, hence obviating the necessity for patients to seek other testing services.
Additionally, it has been observed that Ma Har Myaing Hospital possesses a dedicated
ambulance vehicle to cater to the urgent transportation needs of patients requiring
immediate medical attention. Additionally, the hospital provides a drug sales counter that
operates 24 hours a day, 7 days a week. As a result, a significant proportion of the
participants hold a favorable opinion regarding the tangible evidence of Ma Har Myaing
Hospital.
The results of the study suggest that there is a consistent presence of medical officers
at Ma Har Myaing Hospital. A recent study has demonstrated that Ma Har Myaing Hospital
exhibits a high degree of organization in its medical teams, particularly in the context of
operations. Furthermore, it has been observed that conversations are routinely conducted
prior to patients undergoing treatment, facilitating effective communication and
coordination among the medical personnel. Additionally, the hospital is equipped with a
computerized billing system, which facilitates a streamlined and efficient process for billing
settlement. Hence, a significant proportion of the participants hold a favorable view of the
operational procedures of Ma Har Myaing Hospital.
46
Regarding the first aim, the regression analysis reveals that out of the seven
characteristics examined, five of them exhibit a statistically significant association with
patient satisfaction. The impact of location and procedure on patient satisfaction is not
statistically significant. The findings also suggest that the people element is the most
influential aspect in determining patient happiness.
With respect to the second objective, the regression analysis reveals that patient
satisfaction exerts a statistically significant impact on patient loyalty. Patients express high
levels of satisfaction with the services and goods provided by Ma Har Myaing Hospital,
leading them to actively promote the hospital to others and express their intention to
maintain their patronage in the future.
5.2 Suggestions and Recommendations
First and foremost, it is recommended that Ma Har Myaing Hospital enhance the
human resource aspect by providing comprehensive patient service training to all healthcare
staff. This measure aims to enhance patient satisfaction with the hospital's healthcare
personnel. Furthermore, it is imperative for the hospital to offer educational programs and
training opportunities that focus on enhancing knowledge and skills pertaining to the
current epidemic and emerging diseases. It is imperative for hospitals to ensure that all
healthcare professionals, including doctors, adhere to the practice of wearing clean and
well-maintained duty jackets during the provision of medical treatment. Furthermore, it is
imperative for healthcare professionals to demonstrate a sense of caring and provide
personalized attention to their patients. Subsequently, individuals undergoing medical
treatment will experience a sense of being attended to and contented.
In order to enhance patient happiness and foster loyalty, it is recommended that Ma

Har Myaing Hospital develop medical products and services tailored to the specific
demographic characteristics of its respondents. Ma Har Myaing Hospital provides a
comprehensive range of patient care services, tailored to meet the specific needs of each
individual. These services encompass a wide spectrum, ranging from essential nursing care
to highly specialized medical interventions, including laboratory workups. Furthermore, it
is imperative for Ma Har Myaing Hospital to prioritize the maintenance and modernization
of its medical equipment, ensuring that it is both current and seamlessly integrated. This
47
approach is crucial in order to maximize the quality of patient care, enhance the efficiency
of healthcare delivery, and optimize the overall performance of the facility.
In order to enhance customer acquisition, it is imperative for the hospital to establish

a competitive pricing strategy by conducting a comprehensive analysis of service prices
offered by rival healthcare facilities. Patients desire to assess the quality of care provided
by a hospital prior to undergoing treatment. Therefore, it is recommended that the hospital
includes information regarding the cost of medical packages on brochures and its online
platform, as this would enhance patient satisfaction about pricing.
In order to enhance its promotional efforts, Ma Har Myaing Hospital may consider
implementing a more robust digital marketing strategy, particularly through the utilization
of social media platforms such as Facebook. Furthermore, it is imperative for the
organization to provide sponsorship for health talks conducted by renowned experts in order
to enhance patient awareness. There is a suggestion to consider updating the products and
services offered by Ma Har Myaing Hospital on its web platform. Subsequently, patients
will receive updated information and health understanding, so enhancing their inclination
towards Ma Har Myaing Hospital.
In relation to the matter of physical evidence, it is recommended that Ma Har

Myaing Hospital take measures to address the issue of stench by implementing more
ventilation systems. The hospital should consider implementing a larger emergency room
and expanding its service capacity in order to enhance patient convenience and satisfaction
during their visits.
5.3 Need for Further Research
This study exclusively examines the service marketing 7Ps of Ma Har Myaing
Hospital, without encompassing those of other hospitals. It is recommended that future
research be conducted to examine patient happiness and loyalty in relation to the service
marketing mix within the healthcare industry. Furthermore, the attitudes exhibited by ients
can have an impact on their views and levels of satisfaction with regard to healthcare
facilities. Therefore, it is imperative to undertake further research on the attitudes of patients
towards the healthcare industry in Myanmar.
48
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Woodruff, R. B., Ernest, R. C., & Jenkins, R. L. (1983). Modeling Consumer

Satisfaction Processes Using Experience-Based Norms. Journal of Marketing
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Woodside, A. G., Frey, L. L., & Daly, R. T. (1989). Linking Service Quality, Customer
Satisfaction, and Behavio. Mark. Health Serv, 9(5), 44-49.
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Loyalty, and Brand Loyalty. Journal of the Academy of Marketing Science, 229-
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Customer Focus Across The Firm (4th ed.). Singapore: McGraw-Hill.
APPENDIX A
QUESTIONNAIRE
Section A: Demographic Data
1. Gender
Male Female
2. Marital Status
Single Married
3. Age (Years)
Under 18 18-20 21-25 26-30 31-35
36-40 41-45 46-50 Above 50
4. Education Background
High School Undergraduate Graduate Post
Graduate Others…….
5. Occupation
Compay Employee Government Staff Student
Business Owner Retired
Other……………………………………….
6. Salary (MMK)
Below 300,000 300,000-500,000 500,001-700,000
700,001-900,000 900,001-100,000 Above 1,000,000

Section B:
Please state level of your agreement on each statement by providing the most
relevant number.
1= Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree
Product
No. Items Scale

1 2 3 4 5
1. The services provide at Ma Har Myaing Hospital are
attractive.
2. Ma Har Myaing Hospital has up-to-date medical equipment.
3. Ma Har Myaing Hospital 24/7 medical services.
4. This hospital is capable of developing new services.
5. Ma Har Myaing Hospital has own laboratory service.
6. Ma Har Myaing Hospital offers many kinds of core services
for health care.
7. Ma Har Myaing Hospital has variety of packages (OG, Uro,
Surgery)
8. Ma Har Myaing Hospital has various Checkup Programs
(couple, pre-employment etc.)
9. Ma Har Myaing Hospital provides telemedical service.
10. Ma Har Myaing Hospital offers home medical service for
elders.
Price
No. Items Scale

1 2 3 4 5
1. Ma Har Myaing Hospital offers services in fair prices.
2. The charges in Ma Har Myaing Hospital are reasonable.
3. The products value for money in terms of quality.
4. The charges of Ma Har Myaing Hospital are cheaper than
those of other private hospitals.
5. Ma Har Myaing Hospital has price transparency by
listing prices of each service.
6. Ma Har Myaing Hospital sets the premium price for new
services.
7. Ma Har Myaing Hospital sets competitive price for ordinary
medical services.
Place
No. Items Scale
1 2 3 4 5
1. It is easy and convenient to go to Ma Har Myaing Hospital.
2. Ma Har Myaing Hospital has large parking lot.
3. The length of waiting time at the waiting area is not long.
4. Ma Har Myaing Hospital can be arrived by many ways (bus,
taxi etc.)
5. Ma Har Myaing Hospital has many schedules of doctors.
6. Ma Har Myaing Hospital has emergency service for providing

immediate treatment.
7. Ma Har Myaing Hospital offers home medical service.
8. Ma Har Myaing Hospital 24 hours ambulance service to

provide emergency assistance.
9. Ma Har Myaing Hospital offers telehealth services.
10. Ma Har Myaing Hospital has well-organized teams for home

service and telehealth service.
Promotions
No. Items Scale
1 2 3 4 5
1. Ma Har Myaing Hospital has leaflets or brochures on the
clinic information.
2. Facebook marketing of Ma Har Myaing Hospital is attractive.
3. Ma Har Myaing Hospital has various promotional packages.
4. Ma Har Myaing Hospital OPD booklets to promote various
specialist
5. Ma Har Myaing Hospital’s promotion packages are attractive.
6. Digital marketing of Ma Har Myaing Hospital is attractive.
7. Ma Har Myaing Hospital offers customized package.
People
No. Items Scale
1 2 3 4 5
1. Doctors have excellent knowledge and expertise.
2. Doctors treat all the patients alike.
3. The supporting staff and nurses are qualified.
4. Practitioners always show commitments and are always
available.
5. Doctors are reliable and polite.
6. Doctors and nurses demonstrate concern and competence.
7. There are adequate number of people for service delivery.
8. All the staffs are courteous and kind to patients.
9. All the staffs wear a clean, tidy and neatly pressed uniform.
10. All the staffs wear ID badge.
Physical Evidence
No. Items Scale
1 2 3 4 5
1. The treatment room, waiting area and toilet are comfortable,
clean and free of bad smells.
2. Ma Har Myaing Hospital has good layout.
3. Ma Har Myaing Hospital has good ventilation and lighting.
4. Signs and logos of the Hospital are clear and easy to seek.
5. Ma Har Myaing Hospital has ambulance car.
6. Ma Har Myaing Hospital has own laboratory room.
7. Ma Har Myaing Hospital has enough examination rooms.
8. There is a large emergency room.
9. Ma Har Myaing Hospital has enough rooms for patients.
10. Ma Har Myaing Hospital has 24/7 medicine sales counter.
Process
No. Items Scale
1 2 3 4 5
1. MOs are always standby at Ma Har Myaing Hospital.
2. Bill settlement process is simple.
3. Booking process is simple and easy.
4. Service counters are sufficient.
5. Waiting time is reasonable.
6. The appointment could be made in advance before coming.
7. Ma Har Myaing Hospital has well organized medical teams
for
8. Members of service team keep in touch (such as professors,
Medical Officers, Nurses etc.)
9. There are integrated service teams at the Ma Har Myaing
Hospital.
10. Staffs follow and support the patients since the entrance.
Customer Satisfaction
No. Items Scale
1 2 3 4 5
1. I am satisfied with staff’s response and prompt services.
2. I am satisfied with the questions answered by staffs.
3. I am satisfied with the readiness of staff at Ma Har Myaing
Hospital.
4. I am satisfied with the politeness and skillful of service providers
(staff, nurses and doctors).
5. I am satisfied with the service price of Ma Har Myaing Hospital
6. I am satisfied with the neat and cleanliness of hospital.
7. I am satisfied with the promotions of Ma Har Myaing Hospital.
8. I am satisfied with the waiting time at the reception area.
9. I am satisfied with the ease of appointment by phone.
10. I am satisfied with products and services offered by Ma Har
Myaing Hospital.
Customer Loyalty
No. Items Scale
1 2 3 4 5
1. I consider Ma Har Myaing Hospital as my first choice
whenever I need medical service.
2. I will continue going to Ma Har Myaing Hospital.
3. I have said positive things about this clinic to other colleagues.
4. I have recommended Ma Har Myaing Hospital to colleagues
who seek my advice.
5. I have encouraged others to patronize Ma Har Myaing Hospital.
6. Even if the charges of Ma Har Myaing Hospital go up, I will
continue using services of Ma Har Myaing Hospital.
7. Even if the arrangements of facilities and service quality are not
well standardized, I will always recommend it to others.
8. I used to talk about positive things of Ma Har Myaing Hospital
to my colleagues, friends and relatives.
APPENDIX B
Effect of Influencing Factor on Customer Satisfaction
Model Summary
Adjusted R Std. Error of
Model R R Square Square the Estimate
a
1 .928 .862 .859 .31085
a. Predictors: (Constant), Process Mean, Product Mean,
Price Mean, Promotions Mean, Place Mean, People Mean,
Physical Evidence Mean
ANOVAa
Sum of
Model Squares df Mean Square F Sig.
1 Regression 201.143 7 28.735 297.381 .000b
Residual 32.176 333 .097
Total 233.320 340
a. Dependent Variable: Customer Satisfaction Mean
b. Predictors: (Constant), Process Mean, Product Mean, Price Mean, Promotions
Mean, Place Mean, People Mean, Physical Evidence Mean
Coefficientsa
Unstandardized Standardized
Coefficients Coefficients
Model B Std. Error Beta t Sig.
1 (Constant) -.422 .099 -4.276 .000
Product Mean -.105 .057 -.087 -1.835 .067
Price Mean .227 .043 .212 5.309 .000
Place Mean .027 .073 .022 .375 .708
Promotions Mean .167 .043 .165 3.902 .000
People Mean .480 .069 .420 6.982 .000
Physical Evidence .189 .073 .157 2.601 .010
Mean
Process Mean .110 .081 .094 1.358 .175
a. Dependent Variable: Customer Satisfaction Mean
Effect of Customer Satisfaction and Customer Loyalty
Model Summary
Adjusted R Std. Error of
Model R R Square Square the Estimate
1 .879a .772 .772 .41392
a. Predictors: (Constant), Customer Satisfaction Mean
ANOVAa
Sum of
Model Squares df Mean Square F Sig.
1 Regression 197.105 1 197.105 1150.468 .000b
Residual 58.080 339 .171
Total 255.185 340
a. Dependent Variable: Customer Loyalty Mean
b. Predictors: (Constant), Customer Satisfaction Mean
Coefficientsa
Unstandardized Standardized
Coefficients Coefficients
Model B Std. Error Beta t Sig.
1 (Constant) .191 .097 1.960 .051
Customer Satisfaction .919 .027 .879 33.919 .000
Mean
a. Dependent Variable: Customer Loyalty Mean

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YANGON UNIVERSITY OF ECONOMICS

MASTER OF MARKETING MANAGEMENT PROGRAMME

MARKETING MIX ON PATIENT SATISFACTION AND

KYAW ZIN HTOO

MMM (1st BATCH)

Supervised By: Submitted By:

Dr. Thynn Thynn Myint Kyaw Zin Htoo

Accepted by the Board of Examiners of the Department of Commerce, Yangon

My special thanks go to my MMM professors, colleagues, friends, and classmates

TABLE OF CONTENTS iii

1.1 Rationale of the Study 2

1.2 Objective of the Study 3

1.3 Scope and Method of the Study 3

1.4 Organization of the Study 4

CHAPTER 2 THEORETICAL BACKGROUND 5

2.1 Patient Satisfaction 5

2.2 Patient Loyalty 5

2.3 Service Marketing Mix 6

2.4 Related Theories 10

2.5 Previous Studies 14

2.6 Conceptual Framework of the Study 16

CHAPTER 3 PROFILE AND MARKETING MIX OF MA HAR MYAING

3.1 Profiles of Ma Har Myaing Hospital 19

3.2 Marketing Mix of Ma Har Myaing Hospital 20

4.1 Research Design 25

4.2 Reliability Test 26

4.3 Profile of the Respondents 27

4.4 Patient Perception on Marketing Mix 28

4.5 Analysis on the Effect of Marketing Mix on

4.6 Analysis on the Effect of Patient Satisfaction on

5.1 Findings and Discussions 42

5.2 Suggestions and Recommendations 44

5.3 Needs for Further Research 45

Table No. Description Page No.

3.1 Products and Services of Ma Har Myaing Hospital 21

4.1 Reliability Test 26

4.2 Demographic Data of the Respondents 27

4.3 Mean Rating Scale 28

4.4 Product of Ma Har Myaing Hospital 29

4.6 Place of Ma Har Myaing Hospital 31

4.7 Promotion of Ma Har Myaing Hospital 32

4.9 Physical Evidence 34

4.11 Summary of Overall Mean Value 36

4.12 Patient Satisfaction 37

4.13 Patient Loyalty 38

4.14 Effect of Marketing Mix on Patient Satisfaction 39

4.15 Effect of Patient Satisfaction on Patient Loyalty 41

Figure No. Description Page No.

2.1 Conceptual Framework of Influence of Services

2.2 Conceptual Framework of Healthcare Marketing Mix and

2.3 Conceptual Framework of Factors Impacting on

2.4 Conceptual Framework of the Study 17

3.1 Organizational Structure of Ma Har Myaing Hospital 20

The health care sector is characterized by a dynamic nature, wherein organizations

1.1 Rationale of the Study

There is a growing prevalence of health issues in contemporary times. This is the

The emergence of numerous private hospitals has led to a significant increase in

1.2 Objective of the Study

The main objectives of this study are

1.4 Organization of the Study