Introduction: Understanding the branding aspects of health care and its application and development strategies is undoubtedly necessary for hospitals to achieve optimal marketing. The purpose of the present paper was to systematically review healthcare branding factors, the results of which can be useful in the understanding of these factors and improving the healthcare services. Materials and Methods: The present systematic review was conducted in 2017. Research related to branding in the field of healthcare services was searched using valid keywords, including hospital, medical service, and healthcare combined with keywords such as brand and brand building and through various databases (e. g., Google Scholar, Scopus, PubMed, and Web of Sciences). Using a check list, analytical studies (SCORB) were evaluated qualitatively. Endnote X6 was applied to arrange and evaluate abstract titles and to remove duplicate abstracts. Results: A total of 54 papers were selected for the systematic review. The results were classified and reported based on three categories, including dimension, process/strategies, and results/benefits. The most important brand building dimension was brand equity, the most important process was stabilization of brand positioning, and the most important result was development of optimal marketing. Moreover, some of the results suggested the effect of branding on financial and clinical performance of hospitals. Conclusion: The concept of brand building in healthcare services is an emerging phenomenon, and most of the healthcare organizations have limited experience in building brand strategies and developing their services. In this regard, it is necessary for hospitals to identify comprehensively the dimensions, processes, and results of optimal branding in healthcare services and use them for planning, implementation, and management.
Keywords: Branding, medical service, hospital
|How to cite this article:
Khosravizadeh O, Vatankhah S, Maleki M. A systematic review of medical service branding: Essential approach to hospital sector. Ann Trop Med Public Health 2017;10:1137-46
|How to cite this URL:
Khosravizadeh O, Vatankhah S, Maleki M. A systematic review of medical service branding: Essential approach to hospital sector. Ann Trop Med Public Health [serial online] 2017 [cited 2018 Oct 3];10:1137-46. Available from: https://www.atmph.org/text.asp?2017/10/5/1137/217522
At present, in healthcare system, factors such as increasing market transparency, increasing competition among healthcare providers, increasing demands for investment, and increasing the number of private hospitals and public hospitals limited budgets are some of the most important changes in healthcare market. Under these circumstances, healthcare providers should immediately consider marketing principles to satisfy their clients. In the field of healthcare, the main role of marketing is to determine the needs and wishes of patients and meet their marketing vision through design, pricing, and communication and providing appropriate products and services. In this regard, the most distinctive organizational marketing capability is its ability to create, maintain, improve, and protect its brand equity. In addition, in recent years, due to increased awareness and patients’ participation in decision-making, marketing has become an essential element in the management of healthcare organizations, and creating a favorable brand image is very important in these organizations. Therefore, hospitals should strive to increase their market share and ensure their profitability by creating a personal identity of their brand image. On the other hand, as far as healthcare supplement goes, creating a famous hospital brand is considered a valuable tool for managers toward recruitment and retention of doctors and nurses. Successively, the better and more experienced medical staff is employed; the more favorable healthcare quality is provided. This, in turn, attracts the interest of patient satisfaction and leads to achieve the main purpose of health services marketing. According to the survey, branding in healthcare is a new phenomenon, and the most healthcare organizations have limited experience in developed branding strategies. However, they are increasingly becoming aware of its competitive advantages. Limited economic resources in health care are the main reasons to pay attention to the appropriate use of available resources with optimal efficiency in all areas of healthcare management. In this regard, branding can greatly help hospitals. As a result, understanding the branding aspects of healthcare and its application and development strategies for hospitals is undoubtedly necessary. The purpose of the present paper was to systematically review the studies in the field of healthcare branding, the results of which can be useful in the development of medical center branding and achievement of the desired marketing goals, by creating a comprehensive understanding.
|Materials and Methods|
The present systematic review was carried out between 2006 and 2017, attempting to identify the aspects, processes, as well as the results of healthcare branding. Keywords such as hospital, medical service, and health care combined with keywords such as brand, branding, branded, and brand building were searched using PubMed, Scopus, Web of Science, and Google Scholar.
For the selection of articles related to research area, the inclusion criteria were (1) studies done in the field of healthcare branding during the last 10 years, (2) all sectional descriptive and analytical studies with different methodologies, and (3) only Persian and English studies. The exclusion criteria were (1) studies in branding related to other service areas, (2) studies in branding related to pharmaceutical products and public health, and (3) articles whose fulltext was not easily accessible.
Searching any of the databases was done using the database-specific search strategy. The articles with the words “branding,” “healthcare service,” and “hospital” in their titles and abstracts were selected. Then, duplicate publications were identified and removed from the review process. Then, inclusion and exclusion criteria were applied. Finally, a list of titles of all searched articles in the databases was prepared. List of selected studies was screened to determine the most relevant ones, and the irrelevant articles were rejected. Evaluating and organizing the abstract titles as well as finding and removing the duplicate records were all done using resource management software (EndNote X6).
After articles were downloaded and extracted in specified databases, they were evaluated using descriptive, analytical study checklist and articles without required quality for reporting were excluded.
After evaluating the quality of the extracted articles, 54 of them were selected. The required data including author/publication year, setting, topic area, research design, and important results were extracted in the form of a table.
Summary of reviewed articles
After evaluating the extracted articles and screening in terms of relevance and quality, 54 articles were selected to be studied. These studies were carried out between 2006 and 2016 in different parts of the world. The process of review is shown in [Figure 1].
|Figure 1: Searches and inclusion process
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Regarding target population, 36 of the studies were done in hospitals and 18 of them in other healthcare centers. In terms of the understudied countries, most of the studies (57.4%) are related to Asia. Moreover, the most frequent research method in the reviewed articles was quantitative study. Most studies (88.9%) have been done after 2010. [Table 1] provides the data.
|Table 1: Descriptive characteristics of the selected articles classified by type of determinants
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Due to the structure of the studied articles [Table 2], healthcare branding in different countries can be divided into three categories: branding dimensions, branding process and strategies, and results and benefits of branding.
|Table 2: Characteristics of the studies
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Key dimensions of healthcare branding
Dimensions are a set of variables considered in branding patterns of healthcare in hospitals and medical centers, each of which has a series of subfactors that are described in details.
Most reviewed articles pointed to brand equity and its analysis. In fact, as the studies mentioned, brand equity is an important dimension and the final result of a successful branding. The followings are some effective factors for brand equity: brand awareness, transactional/transformational leadership, ethical dimension, patient’s service quality, brand association, brand trust, brand loyalty, authenticity, innovation (product, service, and process), marketing innovation, and brand image. Moreover, creating healthcare brand equity can affect these factors: hospital image, intention to pursue job opportunity, improving hospital efficiency and productivity, and patient’s willingness to revisit the hospital.
In the reviewed articles, brand loyalty is one of the main strategies to create patient’s willingness to revisit the hospital. On the other hand, it has a strong positive effect on creating brand equity. The followings are some effective factors for patient loyalty to healthcare brand: brand image, patient’s satisfaction, brand attitude, brand trust, advertising, perceived quality, brand association, and relationship commitment.
This dimension creates a positive view in patients to choose the right healthcare center for receiving service. In fact, positive image of a hospital affects brand awareness toward revisiting the hospital. It also promotes efficiency and financial performance of a hospital. Some reviewed articles indicated that brand image has an influence on brand loyalty and brand equity. The followings are some effective factors for creating a pleasant brand image: hospital-created social media, word-of-mouth, quality medical personnel, tangible and critical service lines, and perceived quality.
One of the dimensions that affect the success of branding is creating brand awareness. In fact, patients who visit hospitals should know and understand what healthcare branding is and what its features are so that they can get the best services fit their characteristics. Studies indicated the positive impact of brand awareness on brand equity. Perceived service quality, social responsibility, and commercial service are also effective on brand awareness.
Brand trust is known as a guarantee for the performance of a brand. In fact, this dimension is the matter of how successful a brand is in achieving its goals, as well as how honest the brand is in its performance. Reviewed articles showed the effect of brand trust on brand equity, brand loyalty, and brand advocacy. It also brings about a willingness to use a particular service. On the other hand, perceived interactivity, brand satisfaction, and regulatory fit have impact on brand trust.
Other branding dimensions
The followings are other branding dimensions that were evaluated in the reviewed studies: brand mark, brand promise, brand positioning, brand advocacy, brand attitude, brand personality, brand satisfaction, brand resonance, brand choice, and brand performance.
Branding strategy, branding process
Reviewed studies show that healthcare branding process in hospitals and other medical centers has the following dimensions:
- Develop a new brand name: Convey the benefit
- Change the message: It is about living well
- Enhance the experience: Deliver a service the public demands
- Determine what distinguishes the practice from others
- Understand what branding will do for the practice
- Support branding with effective systems.
On the other hand, results of the review indicated that branding strategies which have a role in creating successful and distinctive healthcare brand as well as creating brand equity include as follows.
- Recognizing hospital services and benefits
- Clear expression of the conditions and benefits of each service (advertising: print media, billboards, and pamphlets)
- Establishing 3C strategy (company mental identification, company behavior identification, and company visual identification
- Extending the brand carefully
- Protecting the brand
- Responsibility and brand auditing
- Communication and competitive awareness
- Interactive and direct marketing.
Branding outcome and benefits
- Increasing patients’ awareness about the type and characteristics of health care provided
- Patients’ appropriate decisions about ideal choice of hospital and health care
- Medical team’s correct decision for referral and transfer of patients to receive optimal health care
- Improving the performance of hospitals
- Increased patients’ satisfaction for choosing the correct choice needed
- Suggesting other family members and relatives to get health care from the same hospital
- Improving clinical outcomes in hospital
- Creating a pleasant image of hospital
- Doctors and other medical staff’s great interest for being employed in the hospital for its favorable background and name
- Developing favorable competition among hospitals
- Having the tendency toward the same hospital readmission for getting the same healthcare service.
In this study, 52 articles were evaluated in the field of healthcare branding in hospitals and other medical centers. A systematic review showed that branding has a number of unique dimensions. The most frequently mentioned dimension in these studies was brand equity. In fact, brand equity can be known as the final results of any branding process. Brand equity creates a pleasant image in the minds of patients and get them go back to the same hospital to get the service. Concerning the results of this study, brand equity had been considered equally important and highly beneficial in pharmaceutical industry as well as in areas of primary healthcare. In regard to pharmaceutical industry, Panchal et al.‘s study in India showed that brand loyalty, brand awareness, and perceived quality affect positively brand equity. Moreover, Battistoni et al.‘s study in Italy indicated that advertisement is effective on pharmaceutical brand development and creation of brand equity. On the other hand, with regard to primary health services in Thailand, Vantamay’s study showed that advertising messages and marketing communication tools have an influence on the development of health campaigns’ brand equity and bring about a better understanding of the health messages. In addition, Shiferaw’s study in private sector showed that brand equity affects brand preference. In other service industries, the development of brand equity and its effective factors is emphasized which shows the importance of its role in branding a unique service.,, Another important dimension of branding is brand loyalty, which is effective on patients’ further reference for receiving unique healthcare services as well as on brand equity development. Brand loyalty is actually influenced by patients’ satisfaction, service quality, and responsibility of healthcare providers. When the patient is faithful to a hospital brand, he/she is not going to be confused in choosing the best and most appropriate option for getting health care. Parallel to the results of the present study, in the pharmaceutical industry, Liu and Liu demonstrated that unlike store image, brand trust and satisfaction are directly effective on brand loyalty. However, Vijayalakshmi and Manimozhy’s study on health drink product showed a significant relationship between the three items of price, advertising, and sales development strategies and the dimension of customer loyalty. Brand image is another important dimension of healthcare branding that focuses on hospital efficiency, as well as financial and clinical performance; in fact, creating a positive viewpoint of the hospital history increases brand loyalty and develops brand image. However, in some studies, brand image is known to be effective on perceived service quality  and Huei et al. approve it. In some other studies, on the other hand, perceived service quality is considered effective on brand image. The findings of Wu et al. on private label brands approve it.
Review of the literature shows that service brand awareness is very important for patients’ appropriate selection. In fact, brand awareness makes the patients know features, advantages, and disadvantages of their choice and get the most relevant services according to their need. In fact, brand awareness not only eliminates patients’ confusion but has also been effective on the development of brand equity. Parallel to the results of the review, study by Huang et al. on the technology commercialization showed that brand awareness is effective on brand equity. In some studies, brand trust is also presented as an important dimension of healthcare brand building. Trusting in the properties of a particular brand is very impressive regarding tendency toward receiving the same service next time. When patients comprehend the loyalty in the performance of a hospital, they will conduce to that hospital. In fact, we can say that brand trust influences loyalty and ultimately the brand equity. Laroche et al. examined the social media industry and revealed that trust on a particular brand will affect customer loyalty. In addition, Liao investigated Taiwan cosmetics industry and showed that brand trust is effective on the brand equity that is consistent with our findings. With respect to branding process, literature demonstrates the processes, including development of the name, creation of differentiation, stabilizing the brand positioning, creating a positive perception of the brand, and supporting healthcare services. In fact, choosing the right name for branding is a key point and its differentiation and uniqueness are very emphasized. Brand name can be developed and documented in the patient’s mind using advertising tools. In other words, branding process success is associated with patients’ understanding and trust. In line with our results, different branding processes are reported in other studies focused on manufacturing and service industries, including Kavaratzis on tourism  and Terglav et al. on internal branding. On the other hand, literature demonstrates that branding strategies for medical services in the field of brand names, accountability, and communication with the target community, correct locating, accurate timing for activities, and advertising can be impressive for creation of a valid brand, its introduction to the community, facilitating its understanding for the patient, and attracting patients’ attention, trust, and ultimately loyalty. Our findings are supported by other studies on service industries, including Neven in tourism  and Nor et al. in the export of furniture. Regarding results and benefits of branding in field of demand for health services, the increase of patients’ awareness and understanding can be addressed in a way that this awareness makes patients to choose the required healthcare services correctly and ultimately improve the community health status. Consequently, health status improves, patient’s satisfaction increases, and their loyalty to hospital enhances. Through development of loyalty, patients’ willingness for readmissions and receiving hospital services increase and they will recommend this hospital to others. On the other hand, the tendency of medical staff, especially doctors, toward hospitals used branding strategies are more regarding healthcare presentation. Moreover, hospital branding can improve clinical and financial performance and finally hospital branding can develop competition in the healthcare industry using band equity that is the ultimate goal of marketing.
The results of the review of the studies indicate the importance of healthcare branding and its special place in the development of healthcare marketing. In this regard, healthcare policy makers in macrolevel and hospital administrators in microlevel need to first know the dimensions that influence healthcare branding and distinguish their variables from each other. They, next, need to carry out the process of hospital branding based on the regular principles and strategies and report the results and benefits for performance evaluation and comparison with other sectors in the health system. To sum up, in spite of the fact that branding has been developed considerably in other areas of service and manufacturing industries, because of the inherent differences of the goods and services in healthcare, further researches should be carried out to expand and synchronize the concept of branding in healthcare marketing.
The main limitation of this review is the fact that only English language documents were included in the study. Another limitation was not access to the full text of some articles.
This article is a part of PhD thesis supported by Iran University of Medical Sciences with grant number of IUMS/SHMIS 2016-9221532207. Researchers are grateful to thank all the colleagues especially managers and personnel for their efforts.
Financial support and sponsorship
The study was supported by Iran University of Medical Sciences, Tehran, Iran.
Conflicts of interest
There are no conflicts of interest.
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Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]