| 1. Research PurposesThe research objects of this study are city integrated hospitals. Starting with discussion on general theory problems in customer loyalty of medical institutions, such as the basic characteristics of hospitals customer loyalty, basic features, the value of customer loyalty, this research aims at that what hospital's customer loyalty include, the relationship between customer loyalty and customer satisfaction, the distinguish between customer loyalty and medical dependence, and what the key influential determines of the hospital's customer loyalty are, through customer loyalty and its influential factors measurement at some typical city integrated hospitals. Based on those, this article is to ensure the elements of customer loyalty, reasons lead to the customer's loss and link between hospital management and customer loyalty. Ultimately, research will provide suggestion to improve hospital quality of service and enhance the hospital management system.2. Research MethodsBy reviewing literatures through the campus library network and using Customer Loyalty as the search term in "Topic /Keywords / Abstract", the domestic and international journals, academic papers and other documents from 2001 to 2007 are obtained. Through analysis of those literatures, previous research results of customer loyalty have been accumulated from relevant industries, associated with the theories of operation and management.Then, hospital administrators and customers from four city integrated hospitals, Shenzhen City People Hospital, Futian District Hospital of Shenzhen, Wuhan Union Hospital and Hubei Xinhua Hospital, provide the information for field investigation on. Spot research has obtained valid 932 sheets from 1000 customers, which are inputted and stored by database software Microsoft office Excel 2003, and analyzed by SPSS12.0. Statistical analysis includes both descriptive statistics, such as frequency, average, to depict the structure and distribution of sample, for example, customers'gender, age, education and medical insurance, and multiple statistics, for instance, correlation analysis, multiple regression, to demonstrate the factors impacting customer loyalty of city integrated hospitals, and based on which, the impact models can be established.3. Findings and Conclusions3.1 making sure of the customer loyalty dimensionsCustomer loyalty includes behavior loyalty and attitude loyalty. Behavior loyalty is the actual purchase of sustainability resulted from all the possible reasons. Attitude loyalty represents the positive degree of customer's attitude to service, and reflects the willing that customer will recommend to other customers. Attitude loyalty can promote behavior loyalty, indirectly affect the value of loyalty, and can also have a strong effect of spread, which thus will result in higher value.3.2 defining the customer loyalty of city integrated hospitalThe hospital customer loyalty, in this study, can be defined that a customer has continued to visit the same hospital at least three times, and would visit hospital again once being ill, with the prerequisite that customer could choose hospital freely and hospital visiting is due to different diseases each time. So, the definition includes two premise and two basic dimensions, the former are that customers can choose treatment agencies and not visit the same hospital in the same disease course, and the latter are that customers prefer some hospital or some staff of that hospital and convey such preference with instant purchase till at least 3 times, which can be called behavior loyalty.3.3 characteristics of customer loyalty of city integrated hospitalThe characteristics of loyal customer of city integrated hospital include that the tendency that customers of hospitals are more loyal to technology is higher than those of general services. Because conversion costs of hospital are higher, customers will not easily give up loyalty to the hospital just for the price temptation from competitors. Besides loyal to a whole hospital, customers may become loyalty probably because of a section of the hospital, a medical staff with high technical level.3.4 value of customer loyalty of city integrated hospitalTo hospitals, the value of customer loyalty can be reflected in bringing more economic and social benefits, reducing the cost of developing and maintaining those customers, and continuing such effect of benefits growth and cost control. To customers, besides the provider can offer quality products and services what customers are required, it is more important that loyalty can bring more added values to customers, including establishment of customer information files and reducing health risks of medical treatment, if customers are loyal to a provider.3.5 customer loyalty measurement of city integrated hospitalMeasurement of customer loyalty is divided into individual customer loyalty measurement and overall customer loyalty measurement. Individual customer loyalty is the degree of a single customer's loyalty to provider's services, based on the assessment of interaction of behavior and attitude two-dimensional vector. However, this study can only distinguish whether a customer is loyal or not, yet not estimate the level of customer loyalty. The so-called overall customer loyalty is the proportion of loyal customers in customer groups. From field investigation, there are 203 loyal customers, a ratio of 30.12%, in a total of remained 674 customers in four city integrated hospitals, which has removed 258 Customers from 932 because of their constant visiting due to their same disease periods, which disobey the prerequisite for customer loyalty definition.3.6 determining the authenticity of customer loyalty of city integrated hospitalThere are 233 customers in this survey, who are continuing visit in less than three times and show negative will on choosing this hospital again. So regardless the behavior dimensions or attitude dimensions, those customer are disloyal customers.281 customers, who are constantly visiting less than three times, but expressed the wishes of choosing again, are potential loyal in term with A.S. Dick and K. Basu definition, which infers that potential loyal customers are those although whose behaviors did not meet the criteria of loyal customers, their attitudes are satisfied with those of the loyal customers'.Other 87 customers have persisted visiting some hospitals at least three times, but do not want to choose those hospitals again. They are false loyalty customers, because according to the concept of from A.S. Dick and K. Basu, they are behavior loyalty but not attitude loyalty.3.7 loyal customers description of city integrated hospital In this study, loyal customer ratio in male customers is 32.94%, and that in women customers is 28.44%, which is no significant difference between them according to theχ~2 test.The loyal customer ratio in under 18-year-old customers is 32.00%, that in 18 to 44-year-old customers is 31.63%, in 45 to 59-year-old customers is 19.79 % and in above 60-year-old customers is 34.09%. There is no significant difference among them according to theχ~2 test.The loyal customer ratio in post-graduated education customers is 43.24%, that in college-level education customers is 38.76%, in high-school-level education customers is 27.62 %, in junior-middle-school-level education customers is 20.59%, in primary-school-level education customers is 27.08% and in other customers is 20.59%. According to theχ~2 test, there is a significant difference among them and the loyal customer ratio in post-graduated education customers is highest.The loyal customer ratio in workers is 32.11%, that in farmers is 3.66%, in intellectuals is 35.71 %, in civil servants 37.50%, in liberal professions is 32.79% and in no work is 38.89%. According to theχ~2 test, there is a significant difference among them and the loyal customer ratio in farmers is lowest.The loyal customer ratio in monthly income less than 1,000 yuan customers is 16.74%, that in monthly income between 1,000 and 1,999 yuan customers is 33.06%, in monthly income between 2,000 and 2,999 yuan customers is 44.32 %, in monthly income above 3,000 customers 52.99% and in no income customers is 14.84%. According to theχ~2 test, there is a significant difference among them and the loyal customer ratio in monthly income above 3,000 customers is highest and in no income customers is lowest.The loyal customer ratio in local customers is 41.28% and that in non-local customers is 21.28%. According to theχ2 test, there is a significant difference between them and the loyal customer ratio in local customers is higher.The loyal customer ratio in the customers, who have medical insurance and the hospitals they are loyal to are the designated hospital by insurance system, is 51.41%, that in those who have medical insurance but choose non-designated hospitals is 21.29% and that in customers without insurance is 40.63%. According to theχ~2 test, there is a significant difference among them and the loyal customer ratio at first status is highest.3.8 frequency analysis of customer loyalty influential factorsBy working on 84 articles about customer loyalty influential factors from relevant scopes, many determinants of customer loyalty are found, which comprising service quality, customer satisfaction, conversion costs, situations, customer perceived value, trust, restrictions, price awareness, customer value characteristics, stakeholders , brand image, emotion, social culture, perception of purchase risk, customer experience, customer relations and service remedy, etc.. According to the cumulative ratio, the most core factors are service quality, customer satisfaction, conversion costs, situations, customer perceived value, trust, restrictions, price awareness, customer value characteristics and stakeholders, for their accumulated ratio is over 80%.3.9 core customer loyalty factors from practical studyThe result can be supported by Logistic regression analysis that the most significant factors to customer loyalty (including behavior loyalty and attitude loyalty)of city integrated hospital are customer's profession, medical equipment, hospital reputation, customer recommendation, service remedy, customer income, distance from the dwelling, designated hospital, accessibility, conversion costs, and trust. Among them, customer's profession, medical equipment, hospital reputation, customer recommendation, service remedy can make function on customer loyalty, behavior loyalty and attitude loyalty respectively. While customer income, distance from the dwelling and designated hospital only affect customer loyalty and behavior loyalty, accessibility only impacts customer loyalty and attitude loyalty, and conversion costs and trust will only work on the customer attitude loyalty .3.10 association and distinction between customer satisfaction and loyalty of city integrated hospitalCustomer satisfaction and customer loyalty are seemingly the psychological or acts of a same individual, but the beneficiaries of them are not accordant, the former is customer and the latter is provider. The customers pursue satisfaction and providers seek customer loyalty, so they have not the coherency and pertinence apparently. However, there is a certain link between them by view that both customers and providers can realize the maximize value in repeated purchases. That is, in general, customer satisfaction is a prerequisite of customer loyalty, other influential factors taking roles on customer loyalty are based on this premise.It is confirmed that the loyal customer ratio is a significant difference between not satisfied customers and satisfied customers and the latter is higher than the former. 97.04% loyal customers are satisfied with the health service, yet only 31.62% satisfied customers are loyal customers. However, subject to some relevant factors affection, such as degree of competition, customer perception of service quality, which will affect conversion from customer satisfaction to customer loyalty, the relationship between customer satisfaction and customer loyalty shows non-linear. Therefore, regardless of customer loyalty model, behavior model or attitude model, customer satisfaction doesn't enter the regression model.The key factors affecting customer satisfaction of city hospital are accessibility, hospital reputation, customer recommendation, conversion cost, respect, communication and personal preference, which are proved by practical research. The difference of influential factors between customer satisfaction and customer loyalty is respect, communication and personal preference, which are all intangible factors and connect with customer's psychology, mental state. Whereas, the compositions of customer loyalty are more than those, for one of two important dimension of customer loyalty is behavior, which means that it can be regarded as loyalty only until all the mental activities convert to actual behavior. Consequently, it could be inferred that, the reason why the relationship between customer satisfaction and customer loyalty isn't linear is that the limen of conversion from the psychology to behavior has not obtained, or though achieved, service provided couldn't match the requirement or preference of customers.3.11 management strategy of customer loyalty of city integrated hospitalCustomer loyalty management strategy can be manipulated from both active methods and passive way. The former includes improving customer satisfaction, enhancing service quality, customer complaints management, service remedy, customer relationship management and training staff loyalty. The latter involves establishing the technical barriers, but because of its high risk and high input costs, it isn't encouraged to perform solely. The most reasonable management strategy is a combination of more active measurements and less passive means.4.Points of innovation4.1 It is tested that the key factors customer loyalty (including customer behavior loyalty and customer attitude loyalty) in the city integrated hospitals include customer's profession, medical equipment, hospital reputation, customer recommendation, service remedy, customer income, distance from the dwelling, designated hospital, accessibility, conversion costs, and trust.4.2 According to preliminary literature research, 49 articles show that customer satisfaction is an important factor of customer loyalty, throught analyzing the total 84 articles in the literature. However, this study believes that customer satisfaction is not a major impact on customer loyalty, it is the main precondition of customer loyalty, and other factors should take impact on customer loyalty on the basis of it.5. Deficiency5.1 customer loyalty measuringFor customer loyalty measured in this study is qualitative, which means that customers can only be divided into loyalty and disloyalty. However, if the loyalty degree of each customer could be measured quantitatively, it will be helpful to make precision model of customer loyalty and discern loyal customer.5.2 research continuityBecause customer loyalty demands of the continuity, the time can be speculated as a factor of customer loyalty, and collecting data of a certain time is not enough to establish the model of customer loyalty. If there is sufficient time for follow-up survey and taking the time as a determinant in the study, customer loyalty model will be more scientific and comprehensive. Especially, monitoring and analyzing the loss of customers will be more beneficial to provide customer loyalty management strategy. As a rule, the customer loyalty in the short term will not be significant fluctuations, so changes in customer loyalty need a very long time monitor. While because of the limited research time, this study can only show current customer loyalty at a certain point of time.
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