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An Empirical Investigation of The Impact of Commitment and Trust On Internal Marketing

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Journal of Relationship Marketing

ISSN: 1533-2667 (Print) 1533-2675 (Online) Journal homepage: http://www.tandfonline.com/loi/wjrm20

An Empirical Investigation of the Impact of


Commitment and Trust on Internal Marketing

Eric Ng, Wei-Ta Fang & Ching-Yu Lien

To cite this article: Eric Ng, Wei-Ta Fang & Ching-Yu Lien (2016) An Empirical Investigation of
the Impact of Commitment and Trust on Internal Marketing, Journal of Relationship Marketing,
15:1-2, 35-53, DOI: 10.1080/15332667.2016.1158046

To link to this article: http://dx.doi.org/10.1080/15332667.2016.1158046

Published online: 22 Apr 2016.

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Download by: [Library Services City University London] Date: 26 April 2016, At: 08:12
JOURNAL OF RELATIONSHIP MARKETING
, VOL. , NOS. –, –
http://dx.doi.org/./..

An Empirical Investigation of the Impact of Commitment


and Trust on Internal Marketing
Eric Nga , Wei-Ta Fangb , and Ching-Yu Lienc
a
Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba,
Queensland, Australia; b Graduate Institute of Environmental Education, National Taiwan Normal
University, Taipei, Taiwan; c School of Tourism, Sanming University, Sanming, Fujian, China
Downloaded by [Library Services City University London] at 08:12 26 April 2016

ABSTRACT KEYWORDS
This article seeks to explore the impact of commitment and trust commitment; internal
on internal marketing effectiveness within the hospital industry. marketing; relationship
The study was exploratory in nature and was conducted using the marketing; service quality;
services marketing; trust
case study methodology. It involved 10 cases in the hospital indus-
try, and a total of 20 interviews were conducted. Results revealed
that both commitment and trust played a moderating role in five
of the key tasks (i.e., training, motivation, company vision/goals,
co-optation, and communication) of effective internal marketing.

Introduction
Services play a major role in the world’s established economies and are increas-
ingly important in developing economies. In today’s increasingly dynamic, deregu-
lated, technologically enhanced, and unpredictable business environments, services
organizations seek to develop competitive advantage through the delivery of con-
sistently high service quality to improve customer satisfaction. Berry, Hensel, and
Burke (1976) some 30 years ago proposed and highlighted the importance and sig-
nificant contribution of internal marketing to achieving a high level of service qual-
ity. For this reason, many hospitals and health care service providers nowadays seek
to explore ways in which they can better engage and capitalize on internal market-
ing to enhance the service quality provided to their customers/patients (Berkowitz,
2011; Cooper & Cronin, 2000; Peltier, Pointer, & Schibrowsky, 2008).
Despite the extensive literature on internal marketing (e.g., Ahmed & Rafiq, 2003;
Ballantyne, 2003; Greene, Walls, & Schrest, 1994; Grönroos, 1994; Rafiq & Ahmed,
2000), there is an apparent lack of research into the importance of commitment and
trust in internal marketing and specifically within the hospital industry. Therefore,
this article aims to investigate the impact of commitment and trust on internal mar-
keting. This study draws from both theory and preliminary empirical knowledge

CONTACT Eric Ng eric.ng@usq.edu.au Faculty of Business, Education, Law and Arts, School of Management and
Enterprise, University of Southern Queensland, West Street, Toowoomba, Queensland , Australia.
©  Taylor & Francis Group, LLC
36 E. NG ET AL.

acquired from interviewing stakeholders who are directly involved in internal mar-
keting at hospitals in Taiwan and Singapore. Hence, this exploratory research seeks
to address the following questions: What is the impact of commitment and trust
on internal marketing effectiveness? Why? The research findings seek to contribute
to internal marketing theory, specifically in the hospital context, by exploring new
insights and also by confirming or disconfirming the impact of commitment and
trust as identified in the literature. In addition, the findings can also provide practi-
cal contributions that are beneficial to hospital managers in that their competitive-
ness in the industry can be further enhanced through the development of effective
internal marketing that helps to deliver consistently high service quality in improv-
ing customer satisfaction.
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This article begins by reviewing the literature relevant to the research issue
and then discusses the methodology used in investigating this issue. Next the
research findings are presented. These are followed by the conclusions drawn
from the research, the implications of these, and finally suggestions for future
research.

Literature review
Although there are several different definitions for internal marketing (e.g., Berry
& Parasuraman, 2004; Grönroos, 1985; Han, Hsu, & Sheu, 2010; Piercy & Mor-
gan, 1989), there is no one single agreed-on concept of what it means. However,
five key components should be considered when setting the boundaries of the inter-
nal marketing concept, namely, (a) customer orientation and customer satisfaction
(Arnett, Laverie, & McLane, 2002; Grönroos, 1981, 1985; Lee, Song, Lee, Lee, &
Bernhard, 2013; Robledo & Arán, 2014), (b) employee motivation and satisfaction
(Esfahani, Amirosadat, Rahimi, & Marandi, 2013; Yao, Chen, & Cai, 2013), (c) a
marketing-like approach to employee and customer satisfaction (Cervone & Per-
vin, 2009; Grönroos, 1994; Han et al., 2010; Keelson, 2014; Wu, Tsai, & Fu, 2013), (d)
interfunctional coordination and integration (Al-Hawary, Al-Qudah, Mash’al Abu-
tayeh, Mash’al Abutayeh, & Al-Zyadat, 2013; Farzad, Nahavandi, & Caruana, 2008;
Ferdous, Herington, & Merrilees, 2013; Han et al., 2010), and (e) implementation
of specific corporate or functional strategies (Karlíček, Chytková, Tyll, & Mohelská,
2014; Keelson, 2014; Papasolomou & Vrontis, 2006). With this in mind, internal
marketing can be broadly referred to as
a planned effort using a marketing-like approach to overcome organizational resistance
to change and to align, motivate and inter-functionally co-ordinate and integrate employ-
ees towards the effective implementation of corporate and functional strategies in order to
deliver customer satisfaction through a process of creating motivated and customer orien-
tated employees. (Rafiq & Ahmed, 2000, p. 454)

It has been evident that there exists continual internal resistance to marketing
in many organizations, but unless employees’ needs are satisfied, the delivery of a
high level of service quality to external customers is not possible (Ballantyne, 2003;
JOURNAL OF RELATIONSHIP MARKETING 37

Han et al., 2010; Malhotra, Mavondo, Mukherjee, & Hooley, 2013; Wu et al., 2013).
Thus, internal marketing plays an important role in achieving and improving cus-
tomer satisfaction through a process of motivating and satisfying employees who
will be committed and supportive towards the implementation of customer-oriented
strategies (Arnett et al., 2002; Fang, Chang, Ou, & Chou, 2014; Fu, 2013).
The literature indicates that there are several activities and/or tasks that a com-
pany undertakes in its internal marketing, and the extent to which these activi-
ties and/or tasks are being conducted can potentially influence the effectiveness of
internal marketing. Therefore, a detailed understanding of these activities and/or
tasks can further enhance the success of internal marketing, leading to improved
service quality and a greater level of customer satisfaction. The literature has
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revealed empirical investigation into the different categories of activities and/or


tasks, which can be broadly classified as follows: (a) recruitment (Akroush, Abu-
ElSamen, Samawi, & Odetallah, 2013; Feist & Feist, 2009; Han et al., 2010; Rafiq
& Ahmed, 2000), (b) training (Ahmed, Rafiq, & Saad, 2003; Conduit & Mavondo,
2001; Piercy & Morgan, 1989; Wu et al., 2013), (c) motivation (Chow, Lai, & Loi,
2015; Han et al., 2010; Rafiq & Ahmed, 2000), (d) communication (Ahmed & Rafiq,
2003; Ballantyne, 2003; To, Martin, & Billy, 2015), (e) company vision/goals (Hart-
ley & Trout, 2015; Kale, 2012; Tsai & Tang, 2008), and (f) co-optation (Martinez,
Stinson, & Jubenville, 2011; Nyongesa, 2014; Peltier et al., 2008). However, there
is limited evidence of studies being conducted to provide greater insights into the
impact of commitment and trust on internal marketing, which is the key focus of
this study.
Although the commitment-trust theory of relationship marketing proposed by
Morgan and Hunt (1994) has been widely documented, the focus has been mainly on
external suppliers and customers (Brito, Brito, & Hashiba, 2014; Eddleston & Mor-
gan, 2014; Friman, Gärling, Millett, Mattsson, & Johnston, 2002; Gao, Sirgy, & Bird,
2005; Mukherjee & Nath, 2007), and very few studies have been conducted inter-
nally within organizations, specifically on employees and functional departments
(Georgiades, 2015; Podsakoff, MacKenzie, & Bommer, 1996; Ruekert & Walker,
1987). Thus, this research study attempts to bring the two themes together by apply-
ing the commitment-trust theory in the context of internal marketing within the
hospital industry.
A preliminary framework (see Figure 1) was developed and derived from Morgan
and Hunt (1994) for this study to investigate the potential impact of commitment
and trust on the effectiveness of internal marketing. Each of these drivers of com-
mitment and trust is addressed in turn.
Commitment is regarded as one of the most important variables in relationship
marketing, in which exchange partners believe that an ongoing sustainable rela-
tionship with one another is critical, has significant mutual benefits, and requires
maximum efforts to maintain (Cullen, Johnson, & Sakano, 2000; Jap & Ganesan,
2000; Morgan & Hunt, 1994; O’Donnell, Brown, & Marsh, 2014). Commitment
also plays a critical role in determining between stayers and leavers, in which such
commitments to learning processes and investments are evident to the continuity
38 E. NG ET AL.

Relationship
termination costs

Relationship Commitment
benefits

Shared values Internal


marketing
effectiveness
Communication Trust

Opportunistic
behavior
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Figure . Preliminary Framework for the Impact of Commitment and Trust on Effective Internal Mar-
keting. Adapted from Morgan and Hunt ().

of the valued relationship (Dwyer, Schurr, & Oh, 1987; Handfield & Bechtel, 2002;
Jain, Khalil, Johnston, & Cheng, 2014). Furthermore, commitment can ensure future
value and benefits to businesses that are involved in the relationship (Caceres &
Paparoidamis, 2007; Macht, 2014; Ng, 2012).
In contrast, trust is seen as a fundamental element in developing successful rela-
tionships and signifies a willingness to rely on and confidence that exchange part-
ners have with each other (Grudinschi, Sintonen, & Hallikas, 2014; MacMillan,
Money, Money, & Downing, 2005; Morgan & Hunt, 1994; Wong & Sohal, 2002).
Trust encourages open communication, exchange of ideas, knowledge, and shar-
ing of resources between exchange partners that improve the relationship (Cowles,
1997; Ratnasingam, 2005; Schnackenberg & Tomlinson, 2014). The level of trust
between exchange partners serves as a key indicator of the continuity of the rela-
tionship as well as their success (Dahwa, Al-Hakim, & Ng, 2013; Doney & Cannon,
1997; Sharma & Patterson, 1999). It is also important to highlight that trust influ-
ences commitment, as relationships characterized by a high level of trust are highly
valued by exchange partners, which will have a stronger desire to commit them-
selves to such a relationship (Goodman & Togna, 2014; Kwon & Suh, 2005; Morgan
& Hunt, 1994; Rodríguez & Wilson, 2002).
Relationship termination costs refers to all anticipated losses from the termination
of the relationship that result from the perceived lack of similar potential alterna-
tive partners (Morgan & Hunt, 1994). These costs can be financial (e.g., switching
and opportunity costs, dissolution expenses) or nonfinancial (e.g., loss of reputation,
unnecessary stress) in nature and have a significant impact on the level of commit-
ment to an ongoing relationship (Liao, Wang, & Yeh, 2014; Sharma & Patterson,
2000; Tähtinen & Vaaland, 2006). Therefore, it is the expectation of total costs that
influences commitment, such that higher costs are likely to generate a higher level
of commitment. This study posits that relationship termination costs will impact
on the level of commitment from employees and the management, which in turn
influences the effectiveness of internal marketing.
JOURNAL OF RELATIONSHIP MARKETING 39

Another key driver of commitment is relationship benefits. In order to attain a


long-term sustainable relationship, there needs to be perceived values derived from
a relationship that are mutually beneficial to the exchange partners (Hohenthal,
Johanson, & Johanson, 2014; MacMillan et al., 2005; Palmatier, Dant, Grewal, &
Evans, 2006). Furthermore, businesses that deliver superior benefits are highly val-
ued, and in return exchange partners will be more willing to commit themselves to
developing and maintaining such relationships (Edvardsson, Klaus, Payne, & Frow,
2014; Friman et al., 2002; Wetzels, De Ruyter, & Van Birgelen, 1998). Thus, this
study suggests that higher relationship benefits for employees and the management
will lead to greater commitment from both parties to the development and mainte-
nance of the relationship, which can have an impact on the effectiveness of internal
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marketing.
Shared values are the extent to which exchange partners agree and/or disagree
with the understanding and beliefs about the behaviors, goals, and policies that
they have in common (Danchev, 2005; Morgan & Hunt, 1994; Zineldin et al.,
2015). Shared values also play a critical role in facilitating business relationships
by contributing to the development of commitment and trust between exchange
partners (Battisti & Perry, 2015; Dwyer et al., 1987; Friman et al., 2002; Mukher-
jee & Nath, 2007). This study proposes that a higher degree of mutual accep-
tance of shared values will contribute to increased commitment and trust between
employees and the management, which can affect the effectiveness of internal
marketing.
One of the key drivers of trust is communication, which broadly refers to the for-
mal and informal sharing of valuable information between businesses (Lages, Lages,
& Lages, 2005; Shipilov, Gulati, Kilduff, Li, & Tsai, 2014). Regular communications
in a relationship can help minimize and resolve disputes and ambiguities, increase
the frequency of the exchange of accurate and critical information, and align per-
ceptions and expectations (Cason & Mui, 2014; Koza & Dant, 2007; Ryssel, Ritter, &
Gemünden, 2004). Through communication, trust and openness between exchange
partners can be enhanced, leading to mutual benefits. This study posits that com-
munications between employees and the management will have adverse effects on
the level of trust they have in one another, which can influence the effectiveness of
internal marketing.
Opportunistic behavior refers to self-interest seeking with guile and can result in
extensive violation of rules and information distortion that affects the trust between
exchange partners (Mastilak, Matuszewski, Miller, & Woods, 2014; Mukherjee &
Nath, 2007). In addition, when exchange partners lack the means to deal with
opportunism, relationship risk will be perceived as high, resulting in the relation-
ship being terminated (Brown, Dev, & Lee, 2000; Kwon & Suh, 2005; Nooteboom,
Berger, & Noorderhaven, 1997; Wiengarten, Humphreys, Gimenez, & McIvor,
2015). This study proposes that when employees and/or the management believe
that the other party engages in opportunistic behavior, such perceptions will
lead to decreased trust and subsequently impact on the effectiveness of internal
marketing.
40 E. NG ET AL.

Research methodology
This research was exploratory in nature and was conducted using the case study
methodology, which aimed to confirm or disconfirm the impact of commitment
and trust in the preliminary framework, as identified in the literature reviewed
(Parkhe, 1993; Yin, 2014). The adoption of the case study approach was justi-
fied on three grounds. First, the approach for this research focused on exploring
the complexity and dynamism of the context within organizational settings and
events such as the impact of commitment and trust on internal marketing in the
Taiwanese and Singaporean hospital industry (Carson, Gilmore, Perry, & Gron-
haug, 2002; Perry, 1998; Yin, 2014). Second, case study research focuses on an
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organization or industry with the aim of rigorously exploring and analyzing thor-
oughly contemporary real-life experiences and events while retaining the holis-
tic and meaningful characteristics of these experiences and events. This helps to
capture the richness and depth of contextual meaning (such as the reasoning on
how the key drivers of commitment and trust can potentially influence the effec-
tiveness of internal marketing) that can give rise to possible new insight (Yin,
2014). Third, case study research provides a more informed basis for theory build-
ing than surveys and is considered appropriate for new research areas or research
areas in which existing theory is inadequate (Eisenhardt, 1989; Patton, 2002; Yin,
2014). As is evident in this research, there are limited research studies in this
area, particularly in the context of the Taiwanese and Singaporean hospital indus-
try. Through case studies, this research attempted to investigate the complex busi-
ness environment in the hospital industry to provide a real-life account of the
research issue raised in this research and build on theory for further conclusive
research.
Ten cases within the hospital industry were selected judgmentally based on
the criteria that they had operated in the industry for a minimum of 10 years
and had practiced internal marketing for at least 3 years. For each case, two
interviews were conducted with the relevant director or equivalent (who was
involved in managerial activities) and a lower middle-level manager or oper-
ational staff (who was involved in the daily operational activities) to deter-
mine whether significant differences existed between management and operations
perspectives.
In this research, replication logic in multiple case studies was used to achieve
external validity, whereas the construct validity of this study was achieved with the
use of multiple sources of evidence through secondary sources (such as the hospi-
tal’s development plans, service charters, and other relevant documentations) that
were used to further triangulate the results. These interviews were semistructured in
nature and conducted in a flexible and informal manner that provided a greater sen-
sitivity to misunderstanding by interviewees and also to reveal in-depth understand-
ing and information about feelings and emotions toward commitment and trust that
were considered influential to the effectiveness of internal marketing. Furthermore,
a case study protocol was developed and used throughout the interviewing process
JOURNAL OF RELATIONSHIP MARKETING 41

in order to enhance the reliability of the study and also to ensure that all relevant
issues were consistently addressed and conveyed to the interviewees. Each of the
in-depth interviews lasted approximately 60 min.

Data analysis

This study adopted content analysis procedures that began with the coding of
themes in the interview questions, which assisted in organizing the data for easier
retrieval (Berg, 2012; Miles, Huberman, & Saldana, 2014; Neuman, 2011). In this
analysis, data in each interview were coded in terms of the actual questions on the
interview protocol, which could assist in revealing relationships and new ideas or
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areas for coding (Berg, 2012; Neuman, 2011). The coded interview questions within
each interview were then compared and contrasted to identify the major issues and
derive some form of generalization (Berg, 2012; Neuman, 2011). In addition, nar-
rative text and quotations from case studies were used to enhance the credibility of
the data analysis and also to add qualitative insights into the research issues (Patton,
2002). The findings of this research are discussed in the next section.

Results
A total of 20 in-depth interviews were conducted with 10 hospital cases (i.e., eight
from Taiwan and two from Singapore). The majority of the interviewees (12 out
of 20) were female, and the remaining eight were male. Seventeen of the 20 inter-
viewees had 10 or more years of experience in the hospital industry, and the other
interviewees had at least 5 years of relevant experience. All interviewees had direct
involvement in activities related to internal marketing. A summary of the intervie-
wees’ profiles is presented in Table 1.
The findings were generally consistent across the interviewees, who agreed that
commitment and trust as identified in the literature were influential to the effec-
tiveness of internal marketing. Results revealed that both commitment and trust
played a moderating role in five of the key tasks (i.e., training, motivation, company
vision/goals, co-optation, and communication) of effective internal marketing. In
addition, the study found no major differing opinions between interviewees from
the management and operational perspectives with regard to the impact of com-
mitment and trust on internal marketing effectiveness.

Relationship termination costs

All interviewees agreed that relationship termination costs could impact on the
effectiveness of internal marketing, particularly through tasks related to training,
motivation, and co-optation that the company undertakes. Interviewees revealed
that high termination costs would lead to an ongoing employer–employee relation-
ship being regarded as important because there were much higher stakes involved,
42 E. NG ET AL.

Table . Profiles of the interviewees.


Case/Interviewee Position (Gender) Years of Hospital Experience

A Quality director (Male) 


A Quality service team leader (Female) 
B Public affairs director (Female) 
B Client service team leader (Female) 
C Development and planning director (Male) 
C Planning officer (Female) 
D HR manager (Female) 
D HR officer (Female) 
E General affairs vice-director (Female) 
E Quality service officer (Male) 
F Senior planning and development manager (Male) 
F Strategic planning officer (Female) 
G HR director (Male) 
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G HR team leader (Female) 


H Quality management office director (Male) 
H Quality service manager (Male) 
Ja Strategic planning and governance manager (Male) 
Ja Senior planning officer (Female) 
Ka Senior corporate service manager (Female) 
Ka Client service officer (Female) 

Notes: HR = human resources.


a Case hospital from Singapore.

and as a result both the employer and employee would give greater commitment to
the relationship, and this would enhance internal marketing effectiveness.
From the management perspective, interviewees were more likely to commit to
and engage in activities and tasks that would motivate (e.g., performance incentive
programs) and co-opt (e.g., career advancement opportunities) their employees so
that they would be satisfied and remain loyal to the hospital, which could contribute
positively to the effectiveness of internal marketing. This was supported by an inter-
viewee who stated,
We cannot afford the significant costs (related activities and training with new recruitment)
involved if we were to lose them. We would rather invest to retain them, making them feel
motivated and valued as part of the team so that they are happy in their jobs and willing to
deliver high-quality service to the patients. Happy staff means happy patients. (C1)

Another interviewee also supported this by commenting,


We have monthly service excellence award for employees who demonstrate exceptional
level of service delivery. This gives them a sense of achievement and recognition by others
of what they have done well. This award also aims to motivate others to excel. Through
this, we hope that good staff will continue to stay on with the hospital. (E1)

However, interviewees in operational roles also indicated that they would engage
more seriously to understand, adhere to, and align their performance with the hospi-
tal’s service delivery standards and culture to avoid hefty termination costs. In order
to enhance their performance, they would seek to improve their knowledge, skills,
and abilities through attending relevant training programs provided by the hospital,
which could have a positive impact on internal marketing. This was supported by
comments from Interviewee D2, who stated, “I will do whatever it takes to secure
JOURNAL OF RELATIONSHIP MARKETING 43

my job, this includes attending additional training courses and seminars. I suppose
this will only benefit me if I intend to stay on at this hospital.” Another interviewee
said,
It will be silly of me not to take advantage of the training courses to improve on my knowl-
edge and skills, this at least shows that I am keen to meet the hospital’s performance require-
ments and will not lose my job. (K2)

Relationship benefits
Interviewees indicated their support for relationship benefits being influential to the
effectiveness of internal marketing. They suggested that employees and employers
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who were capable of delivering superior benefits would be highly valued and there-
fore more committed to the ongoing development of such relationships. As a result,
internal marketing effectiveness could be improved.
From the management perspective, interviewees were inclined to commit them-
selves to developing and maintaining relationships with employees, specifically
through tasks such as training, motivation, and co-optation. This could motivate
employees to attain greater job satisfaction, improving their performance and also
retaining them as valuable assets to the hospitals, which could contribute positively
to the effectiveness of internal marketing. In supporting this, an interviewee com-
mented,
We provide advance training programs to our employees whom we see great potential in
them. Not only that their skills and knowledge can be further developed but also giving
them career advancement opportunities. By doing this, we can retain and capitalize our
employees’ know-how, valuable experience, and newly acquired skills and knowledge to
the benefit of our hospital. (H1)

Another interviewee also stated,


We have reward programs (e.g., recognition of performance, long service awards, and cus-
tomer service excellence) that seek to recognize the employees’ contributions made towards
the hospital. We believe that without these valuable employees, our hospital will not be as
successful. (D1)

Interviewees from operational roles also suggested that their commitment to


the hospitals would greatly increase as a result of substantial benefits arising
from the relationship. They regarded the benefits (e.g., performance incentive) as
key motivating factors for them to remain loyal working at the hospital and as
playing an important role in stimulating job satisfaction, which in turn impacts
on the effectiveness of internal marketing. An interviewee who supported this
stated,
Given that the hospital provides some great benefits (e.g., pension, health-related entitle-
ments) to me, I will be very reluctant to quit my job. I will do my best to help in any way
that I can for the hospital to avoid losing these benefits. (A2)

Interviewee E2 said, “I am committed to working at this hospital because I


feel that my efforts are being recognized and well compensated. The rewards and
44 E. NG ET AL.

performance incentives given are good and I am encouraged to perform better the
next time round.”

Shared values
Interviewees revealed that shared values could impact on internal marketing effec-
tiveness. They believed that commitment and trust between employees and the man-
agement would be enhanced through a better alignment of their beliefs and under-
standing of the appropriateness of behaviors, goals, and policies that existed in the
hospital. Consequently, this would contribute to the effectiveness of internal mar-
keting.
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Interviewees in management roles suggested that a higher level of commitment


and trust between employees and the management could occur when there was
evidence of agreement by both parties on the goals and vision (e.g., service phi-
losophy) of the hospital. They believed that employees played a critical role in the
success of the hospital and needed to be a part of the hospital’s mission and vision
statements. This would enable employees to appreciate how their work would fit
in to the hospital and its goals as well as understand the rationale behind them.
Furthermore, it offered employees the feeling of being an integral part of the hos-
pital, thus leading to greater job satisfaction. Through this, internal marketing
would be more effective. In supporting this, Interviewee B1commented, “When
the two (hospital and the employee) see eye to eye, they agree with each other
and will be committed to working together in order to achieve their common
goals.”
Moreover, another interviewee said,
Our mission statement reads “Employees will be given similar respect and caring attitude
within the hospital that they are expected to demonstrate externally with every patient.”
Our employees are important to us and we have to ensure that they feel being part of the
big family where they will commit to doing their best and trusting us to do the same in
return. (G1)

From the operational perspective, interviewees also agreed that their commit-
ment and trust toward the management would increase when they shared the val-
ues and beliefs of the hospital. They indicated a higher level of performance and
enthusiasm in assisting the hospital to achieve its goals if they concurred with them.
However, any discrepancies would only result in a half-hearted effort that would be
detrimental and counterproductive. Therefore, the effectiveness of internal market-
ing could be affected by co-optation in which employees seek to foster and support
the philosophy and culture of the hospital that their values coincide with. An inter-
viewee supported this by commenting,
I go beyond my duties to provide good service to the patients as I like to see them being
happy. The hospital that I work for has placed great emphasis on service quality. I embrace
this type of service culture and it makes working here so enjoyable. (B2)

Another interviewee also commented,


JOURNAL OF RELATIONSHIP MARKETING 45

The hospital actually does what it says on its mission (providing health care services to
patients regardless of you being rich or poor) and provides patients with health care ser-
vices even though they cannot afford the expenses. I am very supportive of this important
societal value and am proud to be a part of it where I can contribute to this belief. (J2)

Communication

Interviewees suggested that the effectiveness of internal marketing could be affected


by the extent and nature of communications between employees and the manage-
ment. They also indicated that regular communications could enhance trust and
openness in their relationship, and more important align perceptions and expec-
tations, to avoid unnecessary disputes and misunderstandings. Therefore, the use
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of appropriate communication channels and techniques could impact on internal


marketing effectiveness.
From the management perspective, interviewees revealed that it was impor-
tant for them to maintain regular communication via different channels to effec-
tively convey the hospital’s visions and goals to the employees. Through this, the
hospital would generate a greater level of employee attention to its service qual-
ity standards and therefore to delivering quality service to the patients, subse-
quently improving the level of satisfaction. An interviewee who supported this
commented,
By having regular communications (e.g., daily section and fortnightly departmental meet-
ings) with my staff, there will be no ambiguity in terms of what our goals are and how we
are going to achieve them. Everyone knows their roles and focus on the tasks to be accom-
plished. (K1)

Furthermore, the hospital could also attract, develop, and retain employees who
shared its visions and goals, and the level of trust between them would increase as
they gained better mutual understandings. This was supported by Interviewee F1,
who stated, “If we have effectively communicated the hospital’s visions and missions
to the employees, those who share these similar values and beliefs are more likely to
take ownership of their work and stay on in the hospital.”
Interviewees from operational roles also agreed that communications played a
critical role in the effectiveness of internal marketing. In fact, they argued that
a lack of effective communication from the management, together with inap-
propriate channels and techniques used, was one of the key factors that led to
many internal marketing failures. This was supported by an interviewee who
stated,
I don’t feel like I am an employee working at this hospital. Often I only get to know about
important policy decisions from outside sources, and this is embarrassing for me. I like to
hear it from the management first instead. (C2)

Furthermore, interviewees also criticized the occasional provision of inac-


curate information to them that led to unnecessary confusion, anxieties, and
misunderstandings, which had adverse effects on their trust in the management.
An interviewee supported this by commenting,
46 E. NG ET AL.

I appreciate the management’s willingness to share information about the hospital’s plans
and decisions with us, but this information needs to be correct. Inaccurate information can
cause chaos and anxiety among us. This affects my level of trust on them. (F2)

Opportunistic behavior
Interviewees revealed their support for opportunistic behavior as being influential to
the effectiveness of internal marketing. They admitted that opportunism has damag-
ing effects on the relationship between employees and the management. As a result,
their trust in one another would decline, subsequently leading to a decreased rela-
tionship commitment. Interviewees believed that this self-interest-seeking attitude
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had no or little consideration and respect for the other party (employee or the man-
agement) and would hinder the effectiveness of internal marketing.
From the management perspective, interviewees suggested that employees who
demonstrated opportunistic behavior were less cooperative in working with the
management to achieve the hospital’s visions and goals. They also revealed that
employees driven by opportunism were more reluctant and less enthusiastic to par-
ticipate in and attend training programs and workshops. This could have a signifi-
cant impact on the effectiveness of internal marketing. This was attested to by two
interviewees:
There are a few of my staff that does not cooperate because they do not see the direct ben-
efits for them. And this makes my job a lot more difficult to bring the department together
in order to achieve the hospital’s goals. (A1)
I have a few staff in particular that often look restless and reluctant to attend those training
sessions. When I ask them why, they mention that there are no monetary benefits involve
and instead will delay their time from going home. (J1)

Interviewees from operational roles also agreed that they were unwilling to coop-
erate if the management (managers or supervisors) was only motivated to attain
their personal interest (e.g., career promotion) and was not genuine in leading the
employees toward achieving the hospital’s goals. In addition, they revealed that
in some instances the management would display opportunistic behavior at the
expense of the employees. This resulted in severe criticism by the employees and
also a loss in their trust and faith in the management. With this, the effectiveness of
internal marketing would be greatly affected. In supporting this, two interviewees
commented as follows:
Some managers will tell the staff that the directives are coming from higher up in the hos-
pital and they are required to adhere to the instructions so that the hospital’s missions can
be achieved. However, I noticed that this is not always true since the managers have their
own agenda and for obvious personal gains. How can I trust someone like this? To be coop-
erative and doing my best will be out of the question. (G2)
Quite often, some managers will tell their staff to improve on their performance and do
more, but this usually only benefit the hospital and the managers themselves. We are not
necessarily rewarded and there is nothing in it to motivate us to do so. But instead, many
of us have to sacrifice our other personal commitments and spend more of my own time,
for the benefits of others (management and the hospital). How is this fair? (H2)
JOURNAL OF RELATIONSHIP MARKETING 47

Recruitment

Training
Internal Service Customer
marketing quality satisfaction
effectiveness
Motivation

Company
vision/goals
Commitment
Co-opt
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Communication Trust

Figure . An Extended Framework for Effective Internal Marketing.


Note. Although commitment and trust have not played a moderating role on the recruitment task,
it may be explained by the fact that the effects of commitment and trust are only present when a
relationship has been established.

Conclusions, implications, and limitations


In conclusion, this study has investigated the impact of commitment and trust on
internal marketing effectiveness and provided insights into the current practices
of 10 hospitals in Taiwan and Singapore from 20 in-depth interviews. Using the
commitment-trust theory, the study has highlighted support for commitment and
trust as being influential to the effectiveness of internal marketing. Results have also
revealed that both commitment and trust have played a moderating role in five key
tasks (i.e., training, motivation, company vision/goals, co-optation, and communi-
cation) of effective internal marketing.

Theoretical and managerial implications

This research has several theoretical and managerial implications. First, this study
brought together two themes by applying the commitment-trust theory to internal
marketing, which had not been adequately researched collectively in the past. The
findings from this research add new knowledge to the existing literature on the
commitment-trust theory and internal marketing but more important the provi-
sion of new insights into the impact of commitment and trust on internal marketing
effectiveness. Second, the results led to the development of an extended theoretical
model (see Figure 2) for examining internal marketing effectiveness in a service-
oriented industry. This provides a more comprehensive framework to be considered
not only by services organizations (e.g., hospitals) but also by businesses that intend
to capitalize on internal marketing to enhance the service quality they provide to
48 E. NG ET AL.

their customers. Third, in addition to the six key tasks of effective internal market-
ing, managers also need to be aware of the role that commitment and trust play
in internal marketing effectiveness. Managers have to take into consideration the
impact of the various key drivers (i.e., relationship termination costs, relationship
benefits, shared values, communication, and opportunistic behavior) of commit-
ment and trust and in turn how they can affect tasks in developing effective internal
marketing plans and strategies. Their understanding and appreciation of the roles
that commitment and trust play in internal marketing will contribute to enhancing
service quality and customer satisfaction.
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Limitations

This study was exploratory in nature and only investigated the impact of commit-
ment and trust on internal marketing effectiveness in hospitals in Taiwan and Sin-
gapore, and therefore the findings cannot be generalized to other geographical areas
and/or the population at large. Further conclusive explanatory research is required
in order to allow for generalization of the findings. Future studies can also inves-
tigate other industries and countries to provide comparisons and determine their
similarities and differences.

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