حضور ذهن، قابلیت اطمینان، دست زدن به تعارض پیشگیرانه، مشتری مداری و نتایج در بخش بهداشت و درمان در مالزی

This paper draws from the mindfulness theory in examining the effects of service reliability (including reliable health information and care), pre-emptive conflict handling, and customer orientation on customer satisfaction and loyalty in healthcare service delivery in Malaysia. A survey of 423 consumers of healthcare services in Malaysia provides support for the theory. The findings of the study indicate that care reliability, information reliability, and pre-emptive conflict handling directly affect customer orientation; all four directly affect customer satisfaction, and indirectly affect customer loyalty via customer satisfaction. Thus, customer satisfaction fully mediates in the relationship of care reliability, information reliability, pre-emptive conflict handling, and customer orientation with customer loyalty. These findings lead to research and managerial implications that conclude the paper.

Healthcare organizations (HCO) operate in an extremely difficult environment with little or no room for errors or service failures, as errors may result in disastrous consequences, including death (in extreme circumstances), customer dissatisfaction, and defection. None of these outcomes is good for the HCO. While customer defection may not be as catastrophic as death, it is an unwelcome result for the organization since attracting new customers tends to be more expensive than keeping existing customers (Reichheld and Sasser, 1990). Consequently, an increasing number of service organizations (in particular HCO) are recognizing the importance of stable customer relationships and focusing on the enhancement of the overall customer experience (Johnston, 1999). Some try to create healthcare initiatives and programs in ways that prevent disastrous outcomes by applying the mindfulness strategies. According to Zeithaml and Bitner (2003), the first rule of service quality is to implement a procedure right the first time, which would make service recovery largely unnecessary. To get it right first time, is to create reliable service. When individuals and institutions increase mindfulness or decrease mindlessness (Langer and Moldoveanu, 2000) they can enhance service reliability. Changing existing procedures (or services) to eliminate those aspects that unwittingly promote mindlessness or by implementing procedures that strategists develop mindfully (Langer and Moldoveanu, 2000) can enhance service reliability. Systems and processes need to promote individual and collective mindfulness — a way of working marked by a focus on the present, attention to operational detail, willingness to consider alternative perspectives, and an interest in investigating and understanding failures (Langer, 1989 and Weick and Sutcliffe, 2001). Mindfulness theory provides a succinct and compelling lens for viewing key aspects of reliability (Butler and Gray, 2006). Mindfulness theory is useful for confronting errors and failures in healthcare services. Tucker and Edmondson (2003), in a study of hospitals distinguish between errors which are the execution of a task that is either or incorrectly carried out, and errors that hospitals could avoid making with information. This study examines healthcare service reliability in terms of care reliability and information reliability (Issel and Narasimha, 2007 and Tucker and Edmondson, 2003). While extant literature shows that service recoveries positively affect customer satisfaction and loyalty (e.g., Mattila and Patterson, 2004 and Maxham and Netemeyer, 2002), researchers neglect other important areas. Little understanding of the ways service firms can avoid service failures exists (e.g., Vázquez-Casielles et al., 2007). Another area is in the context of healthcare delivery where service recovery may leave the customer incompletely restored with some costly avoidable losses. While effective service recovery may help regain customer satisfaction in some sectors, it may not be equally effective in the area of healthcare. In the long-term, the ability of a firm to avoid service failure and conflict is likely to have a greater bearing on overall customer satisfaction and loyalty (La and Kandampully, 2004). Because of the low error tolerance of healthcare service delivery, mindfully pre-empting errors, failures and other sources of conflicts and adequate understanding of target customers can help HCOs improve customer satisfaction and loyalty. Research on the implementation and outcomes of these pre-emptive mechanisms in the healthcare sector remains scarce. This scarcity is paradoxical in view of the probable positive effect of a firm's effectiveness in anticipating and eliminating future sources of customer complaints (Lapidus and Pinkerton, 1995) on customer satisfaction and customer loyalty, in line with the reciprocity theory. The reciprocity theory advocates that an individual (a firm) can create increased utility (value) by distributing it fairly with relevant stakeholders who behave in a fair and equitable manner (Bosse et al., 2008). The study aims to understand: (1) the direct effects of care reliability, information reliability and pre-emptive conflict handling on perceived customer orientation; (2) the direct effect of care and information reliability, pre-emptive conflict handling and customer orientation on customer satisfaction; and (3) the indirect effect of care and information reliability, pre-emptive conflict handling and customer orientation on customer loyalty (via customer satisfaction). The setting of the study is Malaysia (dubbed as “Malaysia Truly Asia”), a representative Asian country with a unique potpourri of Asian cultures. There are several calls for more service research in non-western countries (Zhang et al., 2008). The Malaysian healthcare sector is increasingly gaining global importance, attention, and patronage as seen in the rapid growth of its healthcare tourism sub-sector. Kuala Lumpur (the setting of the study) is experiencing an increase of visitors seeking medical treatments due to its high standards and medical cost that is one of the most competitive in the world (http://www.myhealthcare.gov.my/en/index.asp#). Quality and affordability are the key benefits proposal that the sector uses to woo customers.

HCOs should meticulously provide reliable health information and care to customers. They should proactively identify potential sources of service failures (instead of trying to fix manifest errors), provide reliable and personalized services, sniff around for information, and disseminate information timely and accurately. The provision of good healthcare service occurs when the provider has knowledge of the buyer's health history, which points to the salience of a long-term relationship between the service provider and consumer. This requirement puts the need for customer retention and loyalty to the fore. Since loyalty increases with increases in consumer satisfaction, HCOs must pursue the rewarding path of providing reliable services, pre-emptive conflict handling, and customer orientation to ensure a good understanding of customers needs, provision of quality service, and forestalling any possibility of failure. Such proactive and mindful measures will contribute to improvements in customer satisfaction and loyalty. In view of the many rewards of customer loyalty (see Rapp and Collins, 1990, Reichheld, 1993 and Reichheld and Sasser, 1990), HCOs that seek real loyalty benefits will be better served adopting mindfulness-based strategies. This is in line with the paradigm shift in service research (e.g. Song et al., 2006) which is now focusing on managing service failures more effectively.