International Journal of Business,

Marketing and Communication Vol.1(2), No. 13, Oct 2021, 1-15

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Effect of the service marketing mix (7Ps) on
patient satisfaction for clinic services in Thailand

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Pattanapong Chana1
Supaprawat Siripipatthanakul2

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Wasutida Nurittamont3
Bordin Phayaphrom4
UNITAR International University, Malaysia1
Asia eLearning Management Center, Singapore2,4

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Rajamangala University of Technology Suvarnabhumi, Thailand3

armybuu55@gmail.com1 (Corresponding Author)

ake@aemcenter.com.sg2
wasutida.n@rmutsb.ac.th3
alex@aemcenter.com.sg4
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ABSTRACT
This study investigates the service marketing mix (7Ps) affecting patient satisfaction in clinics,
Thailand. The link between variables to see the increasing healthcare quality management to
respond to patients' needs and expectations were tested. The clinics in Thailand were studied to
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get more clarification of the relationship in this sector. The online questionnaires were used from
the previous studies that have validity. The service marketing mix includes people, price, place
(location), promotion, product (services), process, and physical evidence whereas the outcome
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variable is patient satisfaction. The results reveal that process is the most significant predictor,
followed by people, price, product (services), physical evidence, and place (location), respectively.
Only promotion is not significantly influenced patient satisfaction.

Keywords: healthcare service, marketing mix (7Ps), patient satisfaction, clinics, quality
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1. INTRODUCTION
1.1 Background of the Research
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The healthcare industry is a dynamic and changing environment. The dual challenge of being
strong in both healthcare management and expertise cannot be ignored when it comes to healthcare
services. Patient satisfaction is at the forefront of healthcare and will continue to be so in the
foreseeable future (Wooldridge & Camp, 2019). Customers are looking for high-quality products.
In other words, customer satisfaction is the yardstick by which quality is measured. It is a factor
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that has a high impact on the success of the business (Nurittamont, 2021). Because customers are

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 International Journal of Business,
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the ultimate judges of service quality, customer-focused quality management is one of the essential

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components of any successful organization (D’Cunha & Suresh, 2015).
Patients have a right to receive high-quality medical care. The efforts to improve the quality
of healthcare should be directed toward the needs and experiences of patients (Pruitt et al., 2020).
When it comes to persuading customers to purchase a product or service offered by a company,

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the marketing mix is critical. A company's marketing mix elements are made up of all the variables
it can control to satisfy customers. The marketing mix strategy combines marketing activities to
find the most effective combination to result in the most outstanding amount of satisfaction. The
marketing mix comprises the organizational elements of a company that the company can control
to communicate with customers and provide them with a satisfactory experience (Kotler &
Armstrong, 2012, Alma, 2011, Zeithaml & Bitner, 2013 and Yoyada & Kodrat, 2017).

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1.2 Problem Statement
Patient satisfaction in the healthcare industry is positively influenced by the patient's perception of
the quality of the services provided (Malik, 2012). Whenever there is a misalignment between
customer expectations and perceptions of quality attributes, dissatisfaction is the result. Patients

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are satisfied when the services provided by the organization meet their expectations. When
performance meets or exceeds expectations, there is a sense of satisfaction with the overall service
quality (D’Cunha & Suresh, 2015).
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Patients' perceptions of the quality of healthcare must be taken into consideration by
healthcare providers. Patient satisfaction is the most important indicator to consider when
identifying patient perceptions and evaluating the quality of care (D’Cunha & Suresh, 2015).
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Patient satisfaction is a critical outcome of medical care, and it is associated with patient safety
and clinical effectiveness, among other things (Ahmed et al., 2014, Doyle et al., 2013). Patient
satisfaction is frequently used interchangeably. Patient experience, as opposed to patient
satisfaction, refers to individual interactions, what happened, and how often they occurred. Patients
with a known terminal illness may be hospitalized in a supportive, patient-centric environment
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with an overall positive impression, despite a poor clinical outcome. Those two terms are
distinguished from the patient outcome. Subjective patient satisfaction surveys are used to assess
the patient experience instead of clinical outcomes accurately, generally defined by objective
measures such as lab results. According to the type of clinical service, patients have different
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expectations (Jensen et al., 2016). Patient satisfaction is influenced by the patients' and their
families' perceptions of the situation. These dimensions include everything from service-related
aspects to medical aspects and nursing services, amongst other things (Al-Qarni et al., 2013).
The marketing mix (7Ps) strategies add value to the patient experience and patient
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satisfaction by focusing on the customer (Wooldridge & Camp, 2019). Patient satisfaction is the
standard for measuring the quality of healthcare services. The value of a health facility's service
quality is determined by the administrator and the people who use the healthcare services
(D’Cunha & Suresh, 2015).
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It is on this foundation that the relationship between healthcare service marketing and
patient satisfaction is based on Sreenivas et al. (2013); Ofili (2014); Thawalyawichachit, (2014),
Al-Qurni et al. (2014). Thus, the relationship between the healthcare service marketing mix (7Ps)
and patient satisfaction is investigated in this study. The implications of this study could lead to an
improvement in the quality of healthcare services in Thailand's private healthcare sector
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particularly for the clinics.

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1.3 Research Objective
This study aims to identify the impact of the healthcare marketing mix (7Ps) on patient satisfaction
towards clinic services in Thailand. The findings may help to improve the quality of clinics
management in Thailand by enhancing the service marketing mix (7Ps) and increasing patient

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satisfaction.

1.4 Research Question

How the service marketing mix (7Ps) impact patient satisfaction in Thailand's clinics?

2. LITERATURE REVIEW

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2.1 Service Marketing Mix Factors (7Ps)
Healthcare Service Marketing Mix (7Ps) in this study includes people, price, place (location),
promotion, product (services), process and physical evidence. The definition of terms of
independent variables (7Ps) are based on the study of Yoyada & Kodrat (2017), Wooldridge &
Camp (2019) and Lestari et al. (2020). People refer to the doctor when conveying information

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about a disease or complaint to a patient, information about the officer's medicine, the staff's
attitude, and skill in serving patients, the doctor's friendliness when serving patients, and the

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courtesy and friendliness of the team when assisting patients (Lestari et al., 2020). Price refers to
the appropriateness of the service rates established for the services provided, the fees charged, and
the affordability of drug prices (Lestari et al., 2020). Place (Location) refers to the physical
location, business hours, type, or presentation in new channels. (Wooldridge & Camp, 2019)
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Promotion refers to a combination of sales, advertising, and personal selling tactics. It includes
sales channels as well as other means of marketing and selling (Yoyada & Kodrat, 2017). Physical
evidence refers to equipment and pharmaceuticals, as well as the atmosphere and physical
environment. Physical symbols such as logos, uniforms, and equipment will be displayed in
various ways depending on the organization (Wooldridge & Camp, 2019). Product (Services)
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refers to the process of generating value for patients or service recipients through the organization
of an adequate evaluation (Wooldridge & Camp, 2019). Process refers to the accuracy and speed
of the services provided (Lestari et al., 2020).
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2.2 Patient Satisfaction (PS)

Patient satisfaction refers to a difference between expectations and perceptions of quality attributes
and outcomes, dissatisfaction results from this difference. Patients are satisfied when the services
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provided by the organization meet their expectations. (D'Cunha Suresh, 2015). Therefore, feeling
of patient satisfaction will be related to expectations and lead to success or outcome of individual
(Nurittamont, 2020).
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2.3 Research Hypotheses

H: There is a significance influence of service marketing mix (7Ps) on

patient satisfaction in clinics, Thailand.
H1: There is a significance influence of product factor on
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patient satisfaction in clinics, Thailand.

H2: There is a significance influence of price factor on
patient satisfaction in clinics, Thailand.

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 International Journal of Business,
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H3: There is a significance influence of place (location) factor

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on patient satisfaction in clinics, Thailand.
H4: There is a significance influence of promotion factor on
patient satisfaction in clinics, Thailand.
H5: There is a significance influence of people factor

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on patient satisfaction in clinics, Thailand.
H6: There is a significance influence of physical evidence factor on
patient satisfaction in clinics, Thailand.
H7: There is a significance influence of process factor
on patient satisfaction in clinics, Thailand.

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2.4 Conceptual Framework

Service Marketing Mix (7Ps)

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Product

People
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Price

H1 – H7
Place (Location) Patient Satisfaction
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Promotion
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Physical Evidence

Process
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Figure 1. Conceptual Framework of the Study

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The link between service marketing (7Ps) and patient satisfaction in clinics is based on Yoo et al.
(2013), Santoso (2013), Thawalyawichachit (2014), Khumnualthong (2015), Yahyazadeh (2015),
Do & Vu (2020), Hasan & Islam (2020), Pardede & Saragih (2020), Phalitnonkiat &
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Ngamtrakulchon (2020) and Bekele (2020). Thus, this study explains the relationship between
healthcare service marketing mix (7Ps) and patient satisfaction. The implications could improve
healthcare service quality in the private healthcare sector (clinics).

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3. RESEARCH METHODOLOGY
3.1 Population & Sample
The study's target population is an unknown number of clinic patients in Thailand. A standard
survey usually has a confidence level of 95%. (Zikmund, 2003) The required sample error 5%

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precision level is 95% is a minimum of 385 cases at P=0.5 by probability sampling (Stratified
Random Sampling) to collect data in four regions of Northern, Eastern-Central, South-Western,
and Northeastern in Thailand. The sample in this study was 501 respondents.

3.2 Research Method

In this study, closed-end questionnaires (Likert's rating scale) were used to collect data. The

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questionnaire items were developed by the researchers based on previous research. Measuring
instruments were evaluated in terms of reliability and validity. It is important to note that validity
refers to how well an instrument measures the concept that the researcher is attempting to measure.
(Zikmund, 2003) All of the main variables in this study were measured using a five-point Likert
Scale, which was classified as follows: strongly agree with a value of 5, agree with a value of 4,

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neutral with a value of 3, disagree with a value of 2, and strongly disagree with a value of 1. The
questionnaire items in the product (service), price, place (location), promotion, people constructs

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were based on Sreenivas et al. (2013) and Siripipatthanakul & Puttharak (2021). The questionnaire
items in the process construct were based on Sreenivas et al., 2013, Siripipatthanakul & Puttharak
(2021) and Saub et al. (2019). The questionnaire items in the patient satisfaction construct were
based on Al-Qarni et al. (2013). The demographics of the respondents were derived from the study
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conducted by Thawalyawichachit (2014).

3.3 Data Collection

Self-administered questionnaires were used for data collection in four regions covering the clinic
in Thailand. The researchers adopted Stratified Random Sampling. It is necessary to explain the
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study's objectives to the respondents and solicit their participation before online questionnaire
distribution.

3.4 Data Analysis

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The SPSS-Version 27 Program was used to analyze the collected data. The demographic
characteristics of the respondents were analyzed using descriptive statistics (frequency and
percentage). For each variable and its questionnaire items, mean analysis and standard deviation
were used to calculate the results. The Cronbach's Alpha reliability test was used to determine the
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Reliability of the data. The validity test was carried out using factor analysis. It was decided to test
the hypotheses using an inferential statistic (Multiple Regression Analysis: MRA).

4. Results
Table 1. shows the summarized Loading Factors, Construct Reliability. According to Ercan et al.
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(2007) the factor loadings and reliability should be over 0.7 following the recommendation.
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Table 1. Factor loadings, Cronbach’s Alpha (reliability)
Items Factor Cronbach
Loading Reliability
Product (service) (X1) 0.885
1. The clinic services provided are attractive 0.839

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2. The clinic has good patient care 0.872
3. Reception services are good 0.843
4. The clinic is capable in developing new services 0.808
5. Procedures and prices are informed before the treatment begins 0.802

Price (X2) 0.896

1. Prices are affordable 0.840

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2. Treatment quality depends on price 0.876
3. The charges in clinic are reasonable 0.872
4. The treatment fees are informed at any channels or willing to 0.833
answer if required
5. The payment is equal to the informed prices 0.801

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Place (location) (X3) 0.766
1. Patients are from all places 0.700
2. The clinic is located at a right place 0.732
3. The clinic is near the markets, schools, or places
4. The clinic is near the patient’s workplace

Promotion (X4)
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1. Clinic’s promotional campaigns are gaining the attention of the
0.745
0.751

0.843
0.909
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needy
2. Special campaigns at concession rates are getting good 0.886
response from patients
3. Discounts and promotion packages are informed via Line app 0.895
or fan pages
4. Discounts and promotion packages are informed in front of the 0.885
clinic
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5. Brochure, leaflets, or business cards that include phone 0.774

numbers can be easily picked up

People (X5) 0.927

1. Doctors with excellent knowledge 0.857
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2. Doctors treat all the patients alike 0.841

3. The supporting staff and nurses are qualified 0.882
4. The staff is sympathetic towards patients 0.865
5. Doctors are reliable and polite 0.833
6. The staff and nurses are reliable and polite 0.865
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Physical Evidence (X6)_ 0.908

1. The interior decoration is very good 0.786
2. Lighting and ventilation is good 0.856
3. Drinking water facility is good 0.825
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4. Communication facilities are good 0.858

5. Signs and logos of the clinic is clear and easy to seek 0.803
6. The treatment room, waiting area and toilet are comfortable, 0.850
clean and free of bad smells

Process (X7) 0.908

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1. There is always doctor (s) work at the clinic for a convenience 0.792
time
2. Bill settlement process is simple and in any channels for 0.829
payment

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3. Service counters are sufficient 0.840

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4. Waiting time is reasonable 0.864
5. The safety and infection control of the clinic is appropriate 0.861
6. The appointment could be made in advance before coming 0.782

Patient Satisfaction (Y: PS) 0.916

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1. I am satisfied with the quality of services. 0.869
2. I am satisfied with the prices. 0.816
3. I am satisfied with the clinic’s promotion. 0.893
4. I am satisfied with the clinic’s environment. 0.878
5. I am satisfied with the process of services. 0.874

Model 1: Y = ß0 + ß1 X1 + ß2 X2 + ß3 X3 + ß4 X4 + ß5 X5 + ß6 X6 + ß7 X7

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PS = - 0.127 + 0.135X1 + 0.137 X2 + 0.105 X3 + 0.023 X4 + 0.195 X5 + 0.116 X6 + 0.318 X7

Table 2 shows the model summary (R-Square) explaining the prediction of patient satisfaction
from the service marketing mix (7Ps).

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Table 2 : Model Summary

Model

1
R

.903a
R Square

.816
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.813
Std. Error of the
Estimate
.30842
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Table 3 : ANOVAa

Model Sum of Squares df Mean Square F Sig.

1 Regression 207.716 7 29.674 311.955 .000b
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Residual 46.895 493 .095

Total 254.610 500
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Predictors (7Ps) and Independent Variables (7Ps)

Table 4 : Coefficients
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Unstandardized Standardized
Coefficients Coefficients
Model B Std. Error Beta t Sig.
(Constant) -.127 .104 -1.218 .224
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Product (X1) .135 .036 .144 3.750 .000

Price (X2) .137 .030 .157 4.614 .000
Place (X3) .105 .029 .099 3.615 .000
Promotion (X4) .023 .027 .028 .833 .405
People (X5) .195 .039 .181 4.965 .000
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Physical Evidence (X6) .116 .042 .113 2.775 .006

Process (X7) .318 .041 .309 7.736 .000

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Predictors: process, place, price, promotion, people, product, physical evidence dependent
variable: patient satisfaction (PS)
A significant regression equation was found F (7, 493) = 311.955, p = 0.000 (p < 0.05), with
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R =0.816. Service marketing mix predicts patient satisfaction was equal to - .127 + 0.135product +
0.137 price+ 0.105 place + 0.023 promotion + 0.195people + 0.116 physical evidence + 0.318 process.
Respondent’s patient satisfaction increased 0.135 units for each unit of change in product,
0.137 units for each unit of change in Price, 0.105 units for each unit of change in place, 0.023
units for each unit of change in promotion, 0.195 units for each unit of change in people, 0.116
units for each unit of change in physical evidence and 0.318 units for each unit of change in the

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process. All service marketing mix (7Ps) factors were significant predictors of patient satisfaction.
Eighty-one-point six percent of the variance of patient satisfaction was explained by combining of
the service marketing mix (7Ps) (R2 =0.816). If referring to the coefficient, process had the most
influence on patient satisfaction (B=0.318), followed by people (B=0.195), price (B=0.137),
product or service (B=0.135), physical evidence (B=0.116), place (B=0.105), and promotion

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(B=0.023), respectively. Individually, process, people, price, product (or service), place, physical
evidence significantly influenced patient satisfaction (PS) at p-value 0.000, 0.000, 0.000, 0.000.

satisfaction at a p-value of 0.405. er

0.000. 0.006 respectively. On the other hand, there was no influence of promotion on patient

Table 5 shows the summary of hypothesis testing results.

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Table 5 : Results
Hypothesis Results of Action
Significant
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H1: Product -> PS 0.000 Accepted

H2: Price-> PS 0.000 Accepted
H3: Place-> PS 0.000 Accepted
H4: Promotion -> PS 0.405 Rejected
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H5: People-> PS 0.000 Accepted

H6: Physical Evidence-> PS 0.006 Accepted
H7: Process-> PS 0.000 Accepted
7Ps -> PS R-square=0.816 Marketing Mix (7Ps) can
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predict patient satisfaction by

about 81.6 %

5. DISCUSSION
5.1 Discussion of the Research Findings
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The hypothesis was tested and supported. The result showed that the service marketing mix (7Ps)
significantly influenced patient satisfaction. The service marketing mix can predict patient
satisfaction by 81.6%. In this study, the service marketing mix (7Ps) influenced patient satisfaction
and supported the hypothesis results. This finding supported the study of Yoo et al. (2013) that
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among 7Ps, product, price, promotion, people, and the physical evidence significantly influenced
customer satisfaction. Also, it supports Santoso (2013) that the overall marketing mix (7Ps)
significantly influenced customer satisfaction. A bit different from Thawalyawichachit (2014), the

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top three aspects of patient satisfaction in physiotherapy clinics in Bangkok are price, people, and

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services. According to Khumnualthong (2015), three factors, namely promotion, people, and
physical evidence, had a significant positive influence on customer satisfaction. But in this study,
the top three factors are process, people, and price. The finding confirmed Yahyazadeh (2015),
Phalitnonkiat & Ngamtrakulchon (2020), and Bekele (2020) that all the 7Ps marketing mix

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components positively affect customer satisfaction. According to Yahyazadeh (2015), among the
marketing mix components, the product has the most significant impact on customer satisfaction
that contrasts to this study which the process is the most influenced predictor. The results supported
Do & Vu (2020) and Hasan & Islam (2020) that promotion was not a significant predictor of
customer satisfaction. However, Hasan & Islam (2020) showed process had no significant
influence on customer satisfaction. But the study of Pardede & Saragih (2020) indicates that the

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process is the most powerful influence on customer (patient) satisfaction.

5.2 Research Contribution

The results confirmed the conceptual framework that the overall service marketing mix (7Ps)
significantly influences patient satisfaction. It may help the clinic managers to develop the strategic

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plan in the private healthcare sector (clinics). Moreover, the study results confirm managers to
improve their healthcare quality management that affects patient satisfaction and could apply to
any service company.

5.3 Conclusions
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The study was performed a service marketing mix on patient satisfaction in clinics, Thailand. The
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practical result uncovers the crucial service marketing mix factor the most is process. The
remaining essential elements are people, price, product (services), physical evidence, and place
(location). Only promotion is not significantly influenced patient satisfaction. Based on statistical
findings, the process has the predictive power effect on patient satisfaction over other factors. On
the other way, only Promotion has no significant impact on patient satisfaction. Thus, the managers
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should focus more on their process, people, price, product (services), place (location), physical
evidence. Moreover, the promotion by clinics may not respond to the patient’s needs and
expectations. Otherwise, the patients perceived that the promotion is not the essential factor.
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5.4 Limitations and Recommendations

Numerous studies support antecedents of patient satisfaction could be other factors. It may not be
included in this study so that further research is recommended. Wali, et al. (2015) recommend
studying the relationship between corporate social responsibility (CSR) and branding in clinics.
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Also, the link between service quality, patient satisfaction, and patient loyalty (Gasonbunnak &
Nurittamont, 2018) is the relationship between marketing mix, practices, and patient satisfaction
(Solimun & Fernandes, 2018) should be further consideration to study. The authors also
recommend further study in the influence of Customer Knowledge Management (CKM) practice
or Patient Knowledge Management (PKM) on patient satisfaction. The previous research indicates
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that the CKM is a significant factor influencing customer satisfaction, which leads to business
performance (Phayaphrom et al., 2021). Moreover, the effect of the COVID-19 Pandemic on
clinics is also recommended.
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