بازارگرایی و عملکرد سازمانی در بیمارستانهای غیرانتفاعی

This study explores market orientation in the not-for-profit hospital setting. The authors hypothesize a positive relationship between market orientation and four organizational factors, including professional commitment, professional education, and professional ethics of the senior management team, and organizational entrepreneurship, and three environmental factors, including perceptions of two states of competition and the state of demand. The study also examines the relationship between market orientation and hospital performance. Data from 237 top hospital administrators are used to empirically test the hypothesized relationships. Results provide evidence of a positive association between market orientation and both the professional commitment of the senior management team and organizational entrepreneurship. Furthermore, the study provides strong support for the relationship between market orientation and hospital performance. Market orientation is the organization-wide generation of market intelligence, dissemination of market intelligence across departments, and the organization-wide responsiveness to market intelligence (Kohli and Jaworski, 1990). The benefits of having a market orientation are pronounced in numerous scholarly papers, textbooks, and speeches Kotler 1988 and Webster 1988. High market orientation has been linked to higher business performance Jaworski and Kohli 1993 and Narver and Slater 1990. Simply stated, market orientation is theorized to be the central construct behind successful modern marketing management and strategy. A body of empirical work on the topic of market orientation also is emerging. Researchers have focused on modeling the antecedents and consequences of market orientation, and developing a valid measure of the construct to test its effect on organizational performance Jaworski and Kohli 1993, Kohli, Jaworski, and Kumar 1993, Narver and Slater 1990, Siguaw, Brown, and Widing 1994 and Slater and Narver 1994. Previous research, however, has several limitations. First, most studies used strategic business units (SBUs) of a few select corporations, particularly for-profit business corporations, as the unit of analysis. Although such settings provide valuable insights, the robustness of any model of market orientation should be studied using other organization types, specifically not-for-profit organizations (see calls for research by Kohli, Jaworski, and Kumar 1993 and Narver and Slater 1990). Second, only one study (Jaworski and Kohli, 1993) tested the influence of antecedents on market orientation. The role of additional influences on market orientation within organizations needs to be investigated Hambrick 1987, Jaworski and Kohli 1993 and Siguaw, Brown, and Widing 1994. Third, only two studies Kohli, Jaworski, and Kumar 1993 and Narver and Slater 1990 attempted to develop valid measures of market orientation systematically, with limited results. Narver and Slater's (1990) measure of market orientation was criticized for its narrow focus and inclusion of items that did not reflect specific activities and behaviors representing market orientation (Kohli, Jaworski, and Kumar, 1993). Similarly, realizing the psychometric shortcomings and the pragmatic limitations of their own scale of market orientation, Kohli, Jaworski, and Kumar (1993) strongly recommend additional and substantive attention be paid to market orientation. They suggest that the most promising applications of the measure may lie with not-for-profit organizations (p. 475). As many practitioners will testify, the current environment confronting not-for-profit organizations is challenging. There is increasing demand for services (Kotler and Andreasen, 1991), pressure from the for-profit sector to curtail tax exempt status and other privileges Unterman and Davis 1984, Mason 1984 and Hodgkinson 1989, enhanced competition among not-for-profits for privately contributed revenues (Schwartz, 1989), and significant shortages of professionally trained and experienced personnel Wolf 1984 and Cruickshank 1989. Faced with these conditions, not-for-profit hospitals are seeking ways to survive, to remain viable, and to grow in today's business environment. Although many specific suggestions have been offered to address these challenges, a number of authors have called for a broader approach, including a model of market orientation in not-for-profit organizations. Indeed, a number of calls have been made for this type of research specifically focusing on not-for-profit hospitals Hansler 1988 and Wood and Bhuian 1993. This study is guided by these and other calls and critiques. Its results contribute to our over-all knowledge of market orientation by extending a host of earlier studies (e.g., Carbone 1990, Hambrick 1987, Hambrick, Fredrickson, Korn, and Ferry 1989, Hansler 1988, Kohli and Jaworski 1990, Kotler and Andreasen 1991, Morris and Paul 1987, Narver and Slater 1990 and Wood and Bhuian 1993). Specifically, the research reported here: (1) develops a model describing the relationships between market orientation, its antecedents, and resulting organizational performance (consequences); (2) tests the model by empirically examining eight specific hypotheses concerning the antecedents and consequences of market orientation; and (3) presents the results and implications for managers and researchers seeking prescriptive advice for improving organizational performance. The focus is on not-for-profit hospitals, addressing the call for more research focused in this area.

In recent years, academicians and practitioners alike have increasingly focused on market orientation and the factors that engender this orientation in organizations. Narver and Slater (1990) and Jaworski and Kohli (1993) note that market orientation always has been of interest to individuals responsible for attaining higher organizational performance. Figure 1 displays the hypothesized model. It is outlined in the following pages.In an attempt to achieve both definitional precision and theoretical integration, Kohli and Jaworski (1990) described market orientation as the organization-wide generation and dissemination of, and responsiveness to, market intelligence. Market intelligence generation includes four distinct notions, including: (1) gathering, monitoring, and analyzing information pertaining to the current and future needs of customers; (2) monitoring and analyzing exogenous factors outside the industry that influence the current and future needs of customers (e.g., government regulations, technology, the general economy, and other environmental forces); (3) monitoring and analyzing competitive actions that influence the current and future needs of customers; and (4) gathering and monitoring market intelligence through both formal and informal means Day and Wensley 1983, Houston 1986 and Kohli and Jaworski 1990. Market intelligence dissemination has two distinct aspects, including: (1) sharing both existing and anticipated information throughout the organization (i.e., ensuring vertical and horizontal flows of information within and between departments) concerning: the current and future needs of customers, exogenous factors, and competition; and (2) ensuring effective use of disseminated information by encouraging all departments and personnel to share information concerning the current and future needs of customers, exogenous factors, and competitors Jaworski and Kohli 1993 and Slater and Narver 1994. Market intelligence responsiveness entails three distinct activities, including: (1) developing, designing, implementing, and altering goods and services (tangibles and intangibles) in response to the current and future needs of customers; (2) developing, designing, implementing, and altering systems to promote, distribute, and price goods and services that respond to the current and future needs of customers; and (3) utilizing market segmentation, product differentiation, and other marketing strategies in the development, design, implementation, and alteration of goods and services and their corresponding systems of promotion, distribution, and pricing Kohli, Jaworski, and Kumar 1993 and Narver and Slater 1990. The domain and key elements of market orientation are summarized in Figure 2.Several theoretical studies have explored possible antecedents to market orientation (e.g., Kohli and Jaworski 1990 and Wood and Bhuian 1993). As displayed in Figure 1, this study proposes that the degree of market orientation in an organization depends on seven major antecedents: (1) professional commitment of the senior management team; (2) professional education of the senior management team; (3) professional ethics of the senior management team; (4) organizational entrepreneurship; (5) perception of the presence and intensity of the competition; (6) perception of the competition as a threat; and (7) perception of demand as under and/or over the capacity of the organization to serve. In turn, the degree of market orientation directly influences organizational performance. A discussion of the seven major antecedents follows. The professional commitment of the senior management team is a primary dimension of professionalism Bartol 1979, Carbone 1990, Hall 1968, Moncrief and Bush 1988 and Wood and Bhuian 1993. It refers to the individual's dedication to a career and desire to remain with a particular profession, given opportunities to change professions. Several authors have suggested that professionalism of senior management teams is a key factor in developing a customer orientation and subsequently achieving greater organizational success Drucker 1989, Hambrick 1987, Kotler and Andreasen 1991 and Young 1987. Indeed, in attempts to ensure consistent quality service to customers, leaders of numerous organizations are enhancing their professionalism through participation in a wide range of management training activities (Byrne, 1990). A close examination of the construct suggests that professionalism of senior management teams may be related to market orientation (Unterman and Davis, 1984). Senior managers tend to have high levels of professional commitment and view their work as a career rather than merely a job. They typically are focused on practicing their career specialties and indicate that they would remain in their careers even if they had opportunities in an unrelated field of work with higher pay and/or other benefits (Unterman, and Davis, 1984). Such dedication to career and career aspirations reinforce long-term professional goals (e.g., consistent quality service to customers). In turn, this long-term orientation tends to influence the value senior managers place on information about customers—the essence of a market orientation. The professional education of the senior management team is another dimension of professionalism that seems to be relevant to market orientation. If refers to the belief that continual professional education is important for high quality management (Hambrick, Fredrickson, Korn, and Ferry, 1989). Senior managers of organizations who strongly identify with their profession tend to emphasize continual skills development for themselves as well as for other members of the management team. They often utilize development programs of their professional societies (Wood and Bhuian, 1993), which provide a variety of educational opportunities to their members, including information dissemination, research, conferences and seminars, and the open exchange of ideas among professionals. These activities are aimed at improving the knowledge and skills of members to ensure consistent, high-quality service to their customers. As suggested above, better service to customers requires information about customers, which is the central tenet of a market orientation. The professional ethics of the senior management team is a third dimension of professionalism. It refers to a felt responsibility to avoid self-interest in the course of rendering services, as well as a dedication to providing high-quality service. It also includes a strong desire to “do the right thing” when dealing with publics Bartol 1979 and Carbone 1990. A strong service ethic of senior management teams is evidenced by a deep concern with using their profession to serve their customers when confronted with a conflict between self-interest and customer interests. Accordingly, a high sense of professional ethics would lead managers to yield their self-interest to customers' interests when conflicts exist. Therefore, managers with a strong professional ethic tend to be dedicated to high-quality customer service. Again, to better serve customers and to ensure high-quality service, they value information about customers and, thus, tend to be market-oriented Wood and Bhuian 1993 and Hambrick 1987. Each of the three dimensions of professionalism has a single, common theme: how the organization may better serve its customers. Clearly, to provide better service to customers requires gathering, disseminating, and using information about customers—the core of the market orientation. Traditionally, entrepreneurship has been identified with a dominant organizational personality Collins and Moore 1970 and Shapero 1975. However, entrepreneurship also has been conceptualized as distinct from activities of the individual. Organizational entrepreneurship, for example, examines entrepreneurship as an institutional phenomenon Burgleman 1984, Morris and Paul 1987 and Jennings and Lumpkin 1989. As described by Stevenson, Roberts, and Grousbeck (1985), organizational entrepreneurship is an organization's willingness to encourage and support creativity, flexibility, and calculated risk-taking. Similarly, authors such as Miller (1983) and Burgleman (1984) define organizational entrepreneurship as the willingness to strive for organizational renewal through the pursuit of new ventures and opportunities. More recently, organizational entrepreneurship has been described as taking constructive risk, emphasizing research and development, valuing rapid or steady growth over stability, introducing new products and services at a high rate, and actively seeking unusual or novel solutions to problems Ginsberg 1985, Khandwalla 1977, Mason and Friesen 1983 and Morris and Paul 1987. A common theme in these definitions is that organizational entrepreneurship has three conceptually related components, namely innovativeness, proactiveness, and constructive risk-taking Jarillo 1989 and Wood and Bhuian 1993. Although a variety of definitions exists for these three dimensions of organizational entrepreneurship, this study adopts the definitions previously used by Morris and Paul (1987), Winston (1984)(-85), and Wood and Bhuian (1993): innovativeness is introducing novel goods, services, or technology and opening new markets; proactiveness is actively seeking unusual or novel ways to achieve organizational objectives; and constructive risk-taking is making reasonable decisions when faced with environmental uncertainties. High levels of organizational entrepreneurship and high levels of market orientation represent responses to increasingly complex and turbulent environments Drucker 1980, Drucker 1985 and Wood and Bhuian 1993. Accordingly, this study posits a strong relationship between organizational entrepreneurship and market orientation. The perception of the presence and intensity of competition encourages organizations to seek out information about those entities that are affected by competition. It supports the view that organizational success and ultimate survival will come to those organizations that best understand the multiple publics that affect them Kotler and Andreasen 1991 and Steinberg 1987. The external environment in which organizations operate is complex and constantly changing; a significant characteristic of the external environment is competition. Every firm is competing for the attention, resources, and/or loyalty of customers. However, the degree to which organizations perceive the presence and intensity of competition varies. Organizations that recognize the presence and intensity of competition have a greater tendency to seek out information about customers for the purpose of evaluation and to use such information to their advantage Slater and Narver 1994 and Wood and Bhuian 1993. The organization's perception of competition as a threat also leads to a greater tendency to evaluate competition and attend to customers (Schwartz, 1989). Recognition of the threat from competition drives organizations to look to their customers for better ways to meet their needs and wants and thereby enhances organizational performance (Kohli and Clarke, 1986; Wood and Bhuian, 1993). Accordingly, when competition is perceived as a threat by the organization, there is a greater tendency to adopt a market orientation. The perception of demand faced by the organization as under or over the capacity to serve also influences organizations' search for information. Demand under the organization's capacity to serve is a situation where the current demand for the organization's goods/services is below the desired demand level; demand over the organization's capacity to serve is a situation where the current demand for the organization's goods/services is above the desired demand level or, more particularly, above the level that can be served. In theory, organizations faced with either under or over demand situations tend to seek out information about customers and modify their market offerings based on consumer data in order to improve or rectify the situation Bhuian 1992, Borkowski 1994, Kindra and Taylor 1995 and Wood and Bhuian 1993.

This study is an important first step in validating the relationship between market orientation and hospital performance. Not-for-profit hospital administrators who seek to improve the quality of care the hospital delivers, increase the revenues and financial position of the organization, and enhance over-all patient satisfaction are advised to give considered attention to the findings of this study. These results indicate that upper management's ability to enhance operational efficiencies of their organization may lie in the focused efforts to develop and embrace an organization-wide commitment to a market orientation. To complement these efforts, special attention and resource allocation must be committed to the over-all professional education opportunities of organizational members, including memberships and participation in professional seminars, workshops, conferences, and other development programs. Organizational entrepreneurship also must be supported by actively encouraging new product idea generation, implementation of new methods and techniques in the delivery of health-care services. A focus on unique and novel approaches to achieving patient satisfaction and the proactive search for, and development of, new markets also are recommended. Once again, the key to success is achieving an organization-wide market orientation. This research advances a number of variables as significant determinants of market orientation and suggests ways by which managers may enhance the market orientation and performance of their organizations. Specifically, professional commitment of the senior management team seems to play an important role in determining the level of market orientation of an organization. This findings suggests that management should seek out factors that influence the level of professional commitment of the senior management team in pursuit of higher performance (here past research is particularly rich in prescriptive advice, and interested readers are referred to the work of Hunt, Wood, and Chonko 1989 and Morgan and Hunt 1994). In addition, organizational entrepreneurship seems to facilitate market orientation. This finding indicates that management can influence the level of market orientation by creating an organizational environment where innovativeness, proactiveness, and constructive risk-taking (the essence of organizational entrepreneurship) are encouraged and rewarded. Indeed, the belief that entrepreneurship can be learned has resulted in numerous organizations and universities offering programs in entrepreneurship. Results of this study suggest areas for further research. First is the examination of the organizational performance measure. To assess the robustness of the relationship between market orientation and organizational performance, future studies should incorporate other organizational performance measures, such as return on investment, sales growth, market share, and customer retention. Because performance measures and accounting treatments differ from organization to organization, care should be taken to control for organizational and accounting effects. Second, efforts to discover and assess the role of additional factors in determining the level of market orientation in organizations should continue. Although the antecedents in this study explain 38% of the variance in market orientation, previous research has identified several other antecedents of market orientation (e.g., ingratiation acceptance, attitude toward marketing, management training) that need to be tested Kohli and Jaworski 1990 and Wood and Bhuian 1993. Likewise, a number of the antecedents in this study deserve further investigation. In addition, some variables hypothesized as antecedents in this study (including organizational entrepreneurship and professional ethics of the senior management team) also could be considered consequences of a market orientation. For example, it would be very useful to undertake research examining the magnitude and direction of the relationship between organizational entrepreneurship and market orientation. Third, because environmental factors have not been found to have any moderating effect on the relationship between market orientation and organizational performance Jaworski and Kohli 1993 and Slater and Narver 1994 nor any direct effect on a market orientation (this study), it would be useful to conduct comparative studies to see the relative effects of various orientations (e.g., market, selling, product) on organizational performance. Finally, this study is limited by its sample and cross-sectional focus, which suggest additional factors to consider in future research efforts. Regarding the sample used in this research, it is limited by its homogeneity. Although it is desirable to use a homogeneous sample for early theory development and testing (Calder, Phillips, and Tybout, 1981), future studies should include samples of other health-care institutions and providers, including for-profit organizations. Regarding the study's cross-sectional focus, the influence of the antecedents on market orientation or the influence of market orientation on organizational performance in this study is primarily restricted to association (i.e., possible causal relationships are not tested). Future efforts should be geared toward the development of longitudinal databases to test the nature of change processes involved in the constructs of interest. The phenomenon of leading and lagging indicators, where operating results witnessed during one quarter may be attributable to actions implemented much earlier in time and even by different management, needs further study (i.e., Does market orientation drive performance or does robust performance induce management to affirm their market orientation? Is a cyclical pattern, where each plays the role of a causal factor driving the other over time, a truer pattern of the influence?) With deference to these suggestions, the present study concludes with one important statement: Market-oriented organizations tend to have higher performance than nonmarket-oriented organizations. Practitioners and academic researchers, alike, should not overlook this significant finding.Kotler Clarke 1986