Ahmad, Ala'eddin Mohamad Khalaf. (2007) The impact of competitive environment on the service marketing mix strategy of health organisations in developing countries : Jordanian private sector hospital senior managers perspective. Doctoral thesis, University of Huddersfield.

The environment of Jordanian private hospitals has never been so complex and challenging as
at present. There are huge influences on these hospitals in the current climate. Managers in
these hospitals are finding themselves, more than ever before, confronted by increasing
pressures and demands which they must seek to understand and respond to in their service
marketing mix strategy in order to achieve effective strategic marketing in terms of their
choice of service marketing mix strategy components (namely health service, pricing,
distribution, promotion, physical evidence, process, and personal strategies). This research,
therefore, investigates the influence competitive environment factors have on the service
marketing mix strategy components made by Jordanian private hospital managers, and on the
reality of the Jordanian private hospital marketing. The literature review reveals that there is
an extensive body of research that addresses service marketing mix strategy in general but
there is less emphasis on the health sector. Moreover, evidence of the impact of a competitive
environment on service marketing mix strategy and hospital performance measurements'
criteria in the hospital industry is limited. In order to explore this issue, a triangulation method
was used to collect primary data through a questionnaire, which was administered in the
private sector hospitals in the six Jordanian governorates and, via in-depth semi structured
interviews with hospital managers and experts in the health services in Jordan. All Jordanian
general private sector hospitals were targeted in this research rather than a representative
sample of these hospitals. A purposive sampling strategy was used to choose the participants
in this research. In total, -
143 senior managers (general manager, administrative manager,
medical manager, public relation manager, marketing manager, and out patients clinic
manager) participated in this study.

The results confirm significant differences in the influence of competitive environment
factors on service marketing mix strategy components. They also reveal that the components
of the marketing mix strategy have varied significant and insignificant influence on the
hospital performance, which demonstrates that the hospital performance phenomenon is
complicated and multi-dimensional in nature. Furthermore, the results exhibit that hospital
managers might benefit more by placing more emphasis on an integrated service marketing
mix strategy and recognising the competitive environment influences on their hospitals. The
results also highlight several implications for future research in health services marketing and
fills in several gaps in the existing literature on health services marketing.

This research contributes to the academic and practical knowledge as being one of the first
attempts to investigate empirically the impact of the competitive environment on service
marketing mix strategy. As such, the influences of service marketing mix strategy on
hospitals' performance criteria, identifying the main concerns and problems which face the
management and marketing in Jordanian private sector hospitals, are explored in addition to
recognising the vital roles of marketing in improving the hospital performance. This research
integrates, refines and extends the empirical work conducted in the field of health services
marketing in developing countries. It raises many implications for managers in these
hospitals, such as considering the importance of influences by competitive environment on
marketing mix strategy and the vital role this strategy plays in the performance of Jordanian
private sector hospitals. This research provides useful guidelines for further and future
research possibilities such as exploring the influence of the competitive environment
factors influence on hospital performance criteria.

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