Patients ’ perception of reputation and image-Private and public hospitals

The aim of this study is to compare patients’ corporate reputation and image perceptions towards private and public hospitals. In order to understand patients corporate reputation and image perceptions towards private and public hospitals, questionnaire is applied to 400 patients taking health services from 20 different hospitals located in the metropolitan area of the city of Ankara between January to July, 2011. As a result of the study it was found that respondent patients’ corporate reputation and image perceptions towards private and public hospitals were different (p˂0.001).


INTRODUCTION
In competitive markets, to differentiate corporations in terms of price, personel and service caharacteristics is very difficult.Corporate reputation and image which are both a corporate communication elements can help differentiate corporations through creating good pictures in customers minds.Creating good pictures in patients minds and having a good relationship with them which is based on trust is an important task for any health institution.Therefore, in this study it was aimed to comperatively assess corporate reputations and images of private and public hospitals located in Ankara by way of examining perceptions of the patients.

LITERATURE
The word reputation is derived from the Latin word 'reputance', which means to place one's trust in (Balmer, 1998).Reputation does not mean 'being famous'.Reputation is not a product, or service, which may be bought in return to money.We may have lots of money, but our reputation may be inversely proportional with such an amount of money (Kadıbeşegil 2006).According to Fombrun (1996), corporate reputation reflects the emotional reactions -good or bad, strong or weak-which the customers, investors, employees, and the society as a whole possess with regard to the name of the respective enterprise.An enterprise may possess a good overall reputation, which depicts each or all of its respective aspects, including price, product quality, innovativeness, management quality (Nguyen and Leblanc 2001).Rate of motion has a vital role for reputation.Reputation management is a task for 7/24 (Alsop 2004).
Another concept, which involves meanings familiar with reputation, is image.According to Kotler and Clarke (1987), image is the totality of the beliefs, opinions and E-mail: cinaroglus@hacettepe.edu.trAuthor(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License impressions about a person, or an object.Image means not only the belief, but more than that.Corporate image is the portrait, which emerges in the minds of the target population of an enterprise, when they hear the name of the same enterprise, or see the logo (Gray and Balmer 1998).Many marketing researchers are interested in corporate reputation and image.When we look at studies mentioning corporate reputation and image for healthcare organizations and how they are estimated, consumer preferances comes to the fore.For understanding preferances of consumers we must know that healthcare consumers have unlimited access to number of hospitals, doctors and medical technologies.Healthcare providers, on the other hand, 'create their own markets', where they try to improve their technology, doctors' specialities, services and activities.Javalgi et al. (1992) have pointed to the fact that, overall images of the hospitals in competition depend on numerous factors and consumers assess images by taking various elements into consideration and for a successful image management consumers understand the most important factors for successfully manage image.'America's Best Hospitals' is one of the most popular corporate reputation and image determining research which was organized by U.S. News and World Report published in the year 1990 this has been for many years a leading news weekly, focusing more than its counterparts on political, economic, health and education stories in the literature.Rothberg et al. (2008), as a result of their comparison study between Health Grades, Leapfrog, Hospital Compare, Mass QC, US News have indicated that comparisons between the hospitals were made upon considering different structures, processes and outcomes of these approaches and no consistency was found between these studies in terms of the definition of patient, business processes and outcomes of the study.So further research is needed to determine what the patients would need in the future.
While there are studies in the literature about determining the corporate reputations and images of the hospitals, no studies have been found comparing private and public hospitals in terms of corporate reputation and image, depending on assessments of the patients.Therefore, in this study it was aimed to comperatively assess the corporate reputations and images of the private and public hospitals by way of examining perceptions of patients towards the reputations and images of the private and public hospitals in Ankara.

METHODOLOGY
The research type of this study is quantitative.While there are several studies in the literature about determining the corporate reputations and images of the hospitals but no studies have been found comparing private and public hospitals in terms of corporate reputation and image, depending on assessments of the patients.Therefore, in this study it was aimed to comperatively assess the corporate reputations and images of the private and public hospitals Cinaroglu 13 by examining perceptions of patients in the private and public hospitals located in Ankara.In this study it was aimed to access all 50 hospitals located in metropolitan area of Ankara but permissions taken from only 20 of them, 11 of them are public, 9 of them are private.We use convenience sampling method which is a kind of non-probability sampling technique.Data gathered from voluntary patients with face to face interviews in the policlinics.Questionnaire is applied to 400 patients taking health services from 20 different hospitals.
Two different questionnaires were applied to measure the patients' corporate reputation and image perceptions.Three questions, having been included in Karaosmanoğlu's (2006) study, named 'Determinants of Corporate Image Formation: A Consumer-Level Model Incorporating Corporate Identity Mix Elements and Unplanned Communication Factors', were asked in both two questionnaires so as to measure the corporate image perception.These three questions, having been asked in the questionnaires, were based on Likert scale, in which 1 represents 'Very Good', and 5 represents 'Very Bad'.
Corporate reputation perception, on the other hand was assessed by means of the 15 dimensions, and 25 questions, having been used by Abraham (2007) in the study named 'Identifying the Parameters of Corporate Reputation for The Hospital Industry in Singapore'.Hospital facilities, doctors, modern technology/ equipments, medical care quality, customer services, nursery services, hospital processes, foods, outlook and internal decoration of the building, settlement, financial performance, social projects, treatment costs, advertisement and publicity, and management were included among the sub-dimensions of the corporate reputation.This questionnaire was based on Likert scale, in which 1 represents 'I do not agree at all', and 6 represents 'I mostly agree'.Reliability of the questions on the corporate reputation and image were assessed by means of the internal reliability coefficient.Accordingly, internal coefficient of the questions about hospital image was found as 0.81, and internal coefficient of the questions about hospital reputation was found as 0.92.

Analysis
Statistical Package for the Social Science (SPSS) 15.0 statistics program is used for analysis of the data, characteristics of the patients examined by using descriptive statistics, corporate image and reputation perceptions towards private and public hospitals were shown using independent t test comperatively.Hypothesis of this study is "Patients corporate reputation and image perceptions towards private and public hospitals were different"

FINDINGS
Personal and occupational characteristics of the patients were examined in Table 1.57.5% of the patients were women and 66% of them were married persons.In terms of the educational backgrounds of the patients, 61% of the patients educational level is primary education and below, a vast majority of respondents 81.5% were residing in Ankara.Taking the age distribution of the patients into consideration, 47% of them were found to be in ages of 34 and below.
Table 2 shows patients' corporate reputation and image perceptions about public and private hospitals.When we look at patients' assessments about images and reputations of public and private hospitals there was a meaningful difference (t=8.121,p0.001) between them, and we accept the research hypothesis.According to these results, it can be said that, images of the private hospitals has higher averages (4.4) than those of the public hospitals (3.8).Similarly, a meaningful difference has been found also between the overall reputation levels (t=9.386,p0.001).Accordingly, it has been found out that, there are meaningful differences in almost all of the dimensions regarding corporate reputation, and that the average of the scores of private hospitals (5.5) is higher than that of the public hospitals (4.9).In this questionnaire corporate reputation and image has 15 dimensions as a results of this study we can say that there were 14 meaningful differences out of 15.Dimensions which are meaningful are hospital facilities (t=4.446,p0.001), doctors (t=4.453,p0.001), modern technology/ equipment (t=5.750,p0.001), medical care quality (t=5,506, p0.001), customer services (t=6.012,p0.001), nursing services (t=6,165, p0.001), hospital processes (t=8,398, p0,001), foods (t=9.129,p0.001), appearance and internal decoration of the building (t=8,398, p0.001), financial performance (t=4.980,p0.001), social projects (t=4,507, p0.001), treatment costs (t=4,257, p0,001), advertisement and publicity (t=5,627, p0.001), and management (t=9,386, p0.001).In spite of these, the only sub-dimension, which is not meaningful is the settlement (t=0.958,p0.05).

DISCUSSION
Corporate reputation and image is a portrait of any corporation in the minds of different stakeholders.This portrait shaped stakeholders expectations and views (Bromley 2002, Fombrun et al. 2000).In recent years there has been an increasing attention for improving stakeholders' corporate reputation and image perceptions about any institution.This increase can be seen both in academic and managerial field.Despite reputation and image management is a key element for improving corporate communication it is noteworthy that, there are several studies in the literature making comparisons between them (Helm 2007).In this study, it has been found that according to the patients assessments private hospitals corporate reputation and image perceptions are much better than public hospitals.Types of ownership differentiate hospitals in numerous aspects.These aspects can be in financing (Sloan et al., 2001), human resources, physical appearance (Baker et al. 2000) and management in general.When we look at patients general assessments about corporate reputation and image of any hospital, patients may assess healthcare services only through their feelings because of asymmetric information in the healthcare market.The leading one of these feelings is trust.According to Drevs et al. ( 2012) other feelings except from trust are competence in patient care and patient's feelings of intimacy and warmth towards the health services providers especially doctors (Aaker et al. 2010).This means that in this study private hospital patients have more trust than public hospital patients.
On the other hand, according to previous researches, which indicates that patients have more trust to public hospitals than their trust to the private hospitals; patients in this research have assessed private hospitals as better in terms of corporate image and reputation, and the underlying reason of this result is that, image and reputation are shaped mainly around the physical elements of the corporation, including the name, building, advertisement, product and services (Nguyen and Leblanc, 2001), and patients from Turkey view the private hospitals as better than public hospitals in terms of the these elements (Akıncı et al. 2012).
It is well known that, there are studies in the literature explaining corporate reputation and image.
Mentioning these two corporate communication elements is quite different from each other (Nguyen and Leblanc, 2001).In Abraham's (2007) study corporate reputations of the hospitals were assessed, according to the patients perceptions living in Singapore, at the end of this study it was found that corporate reputations of private hospitals were better than the public hospitals.Another study which have been conducted by Andaleeb (2000) for accessing service quality of the private and public hospitals in Bangladesh, and to determine the factors affecting hospital choice, it has been found out that, private hospitals in Bangladesh, depending on the market incentives, offers higher quality services for patients and private hospitals provide more physical facilities and opportunities for the patients, the image and reputation perceptions towards private hospitals were higher.
Turkey experiencing numerous transformations in health since 2003, this date marks the beginning of Transformation Program in Health (Akıncı et al. 2012).After implementation of Transformation Program in Health there is an apparent increase in the number of private hospitals.There were 274 private hospitals in the year 2003, this number increased to 503 in the year 2011 (Ministry of Health Turkey, 2012).According to a supportive study which belongs to Taner and Antony (2006), public and private hospitals in Turkey with health transformation process improve their service quality and patients' perceptions towards private hospitals were higher than those towards public hospitals.

CONCLUSION
As a result of this study, it has been found out that, private hospitals has better corporate reputation and image in the eyes of patients.Results of this study supports that private hospitals are much better than public ones in terms of service quality, giving importance to customer satisfaction and physical appearance of the hospital buildings.So these factors can affect and change the pictures on patients' minds about any hospitals corporate reputation and image because of that, public hospital managers should spend more time improving their corporate reputation and image.

Table 1 .
Personal and occupational characteristics of the patients

Table 2 .
Comparison of patients' perceptions about public and private hospitals corporate ımage and reputation