Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
DOI: 10.31876/er.v4i34.749
35
Endomarketing as a service quality strategy of Public
Health Institutions: A study of user behavior
Endomarketing como estrategia de calidad del servicio de instituciones
públicas de salud: un estudio del comportamiento del usuario
Walter Jiménez Silva, Fernando Silva Ordoñez, Kléver Moreno, David Caisa
Recibido: 08 de noviembre de 2019.
Aprobado: 02 de agosto de 2020.
Cite this:
Jiménez, W. et al. (2020). Endomarketing as a service
quality strategy of Public Health Institutions: A study
of user behavior. Espirales. Revista Multidisciplinaria
de investigación cientíca, 4(34), 35-48
*
Master in Business Administration. Universidad
Técnica de Ambato, Ambato, Ecuador.
E-mail: walterrjimenez@uta.edu.ec.
ORCID: 0000-0001-8373-3549.
Google Scholar
**
Master in Business Administration. Universidad
Técnica de Ambato, Ambato, Ecuador.
E-mail: ivanfsilva@uta.edu.ec.
ORCID: 0000-0002-2649-8578.
Google Scholar
***
PhD in Business Science. Universidad Técnica de
Ambato, Ambato, Ecuador.
E-mail: kleveramoreno@uta.edu.ec.
ORCID: 0000-0002-3404-9457.
Google Scholar
****
Master in Public Administration. Universidad
Técnica de Ambato, Ambato, Ecuador.
E-mail: eliasdcaisa@uta.edu.ec.
ORCID: 0000-0003-4168-4800.
Google Scholar
Abstract
Procurement for the provision of health services in
Ecuador is growing and of vital importance for society.
The research objective is to investigate how inadequate
endomarkeitng strategies affect the provision of health
services in users of public hospitals. The study had
theoretical and empirical methods, the approach was
quantitative. The research design was correlational. The
study population was 96 internal clients. The technique
for data collection was the survey whose instrument
(questionnaire) is made up of 18 items. The results when
performing the seven editions in the mutltivariable linear
regression model, with adjusted R squared of each model,
were: commitment (50.1 %); remuneration (87 %); work
environment (68.8 %); compliance (58.7 %); initiatives
(63.9 %); resources (71 %) and service (77.2 %); which
indicate the inuence on the service provision variable
(dependent variable). In other words, by inuencing the
variation factors, the quality of the service will be superior.
Key words: Endomarketing, quality of service, public health
institution.
36
Endomarketing as a service quality strategy of Public Health Institutions: A study of user behavior
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
Resumen
La procuración por la prestación de servicios de salud en el Ecuador
es creciente y de vital importancia para la sociedad. El objetivo
de investigación es indagar como las inadecuadas estrategias de
endomarkeitng afectan la prestación de servicios de salud en los
usuarios de los hospitales públicos. El estudio tuvo métodos teóricos
y empíricos, el enfoque fue cuantitativo. El diseño investigativo fue
correlacional. La población de estudio fueron 96 clientes internos. La
técnica para la recolección de datos fue la encuesta cuyo instrumento
(cuestionario) está constituido por 18 ítems. Los resultados al realizar
los siete tirajes en el modelo de regresión lineal multivariable, con el
R cuadrado ajustado de cada modelo, fueron: compromiso (50,1 %);
remuneración (87 %); ambiente laboral (68,8 %); cumplimiento (58,7
%); iniciativas (63,9 %); recursos (71 %) y servicio (77,2 %); los cuales
indican la inuencia sobre la variable prestación de servicio (variable
dependiente). Es decir que al inuir los factores de variación, la calidad
del servicio será superior.
Palabras clave: endomarketing, calidad de servicio, institución de
salud pública.
Introduction
In the international context, endomarketing is considered as a way of managing marketing,
programs in the aspect of talent management, production, sales, nance, among others
(Regalado, Allpacca, Baca & Gerónimo, 2011). In relation to this, different studies have been
carried out aimed at many areas, a clear example is the study carried out in Venezuela to
different pharmaceutical companies where they point out that they did not know previously
and worse still apply endomarketing, but by applying they have been able to acquire multiple
benets mainly in the work environment, since interpersonal relationships between different
coworkers were more dynamic. Likewise, in Bogotá it has been possible to perceive the great
changes when applying the endomarketing model in 5 hospitals, of which 3 have an international
accreditation for the provision of health services.
On the other hand, in the eld of health, endomarketing management is dened, based on the
World Health Organization, which points out that health is not only the absence of diseases,
but on the contrary, it is a state well-being in the mental and social sense. It is a state of balance
37
Walter Jiménez Silva, Fernando Silva Ordoñez, Kléver Moreno, David Caisa
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
between human and his environment (Costales & García, 2017). This was evident in Spain
with the promotion of health and compliance with services to the entire society to achieve
the institutional objectives of the Madrid Health Centers (Bustamante, 2013). In Brazil, the
Federal University Hospital of Santa Catarina has based its actions on endomarketing to
achieve quality accreditation by implementing the ONA Manual to manage external customer
service (Bonetti, 2015).
In Ecuador, administrative management in the health eld in the last 10 years has had a
signicant increase, according to statistical data from the National Institute of Statistics and
Censuses since 2007, Health Institutions as well as Hospitals and Health Centers are on the rise.
In Cantón Ambato there are two public hospitals: the Regional Teaching Hospital Ambato and
the Hospital la Merced. The Ambato Regional Teaching Hospital works as a zonal unit that has
400 beds and provides medical care in different specialties to the population of Tungurahua,
Chimborazo, Cotopaxi and Pastaza. The most relevant specialties are: Hospitalization, Imaging,
Emergency, Intensive Care, Pharmacy, Surgery, Gynecology, Cardiology, Psychiatry, among
others. The problem that has been identied is the inadequate endomarkeitng strategies
that affect the provision of Health services in users. In addition, it is evident that the internal
communication media are obsolete, the protocols for user care are generalized for all hospitals.
The poor socialization of institutional policies leads to non-compliance with institutional goals
and objectives, discrediting the Ambato Teaching Hospital. For the development of the research,
the formulation of the question was considered: How do the inappropriate endomarkeitng
strategies affect the provision of Health services in the users of the Public Hospitals of the
canton Ambato?
The research was characterized by the study of two variables, (i) Endomarketing. It is made
up of sub variables: job satisfaction, motivation, suggestions, interaction, training, prestige and
evaluation; and (ii) provision of the service. With their respective sub variables: commitment,
remuneration, work environment, compliance, initiatives, resources and service (Mira, 2013).
Endomarketing emerges as a strategic tool to increase the commitment of workers and align
them to the objectives of the organization (Da Silva, 2013). As it dates back to the 60s and
70s in the United States and Europe, companies were no longer engaged in production but
also in maintaining good relationships among their internal customers (Petracci, 2011). On the
other hand, the processes are aimed at increasing the benets of internal customers with the
intention of achieving motivation and an optimal environment. Because a motivated human
talent and that they feel part of the company generates greater productivity and positioning
in the market (Camacho & De León, 2016).
38
Endomarketing as a service quality strategy of Public Health Institutions: A study of user behavior
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
The importance of endomarketing rests on the process of exchanging internal communication,
which makes the management of human talent operationally ecient. In addition, it allows
to take maximum care of its collaborators through effective internal communication policies
that seek a positive climate, trust, market mentality and customer service (Mira, 2013; Jiménez
& Gamboa, 2016).
In the early 1990s, the appearance of endomarketing models began, which sought external
and external customer satisfaction. The rst models were: The Berry which recognizes the
internal client as a fundamental part of endomarketing, which must be developed to acquire a
competitive advantage (Bohnenberger, 2015). The importance of the model lies in recognizing
employees and focusing activities seeking involvement. On the other hand, the Gronroos
model is a more specic way that promotes employee motivation. The Raq and Ahmed Model
was based on the Berry and Gronroos models considering that to achieve the motivation of
internal clients the only way is through the management of activities by the organization, in
order to achieve in client’s internal job satisfaction and directly create consumer satisfaction.
Motivation: Organizations have a challenge in terms of employee motivation, as what is
intended is that they make decisions, are committed and motivated. Motivation affects two
factors: rst in productivity and the second in line with the objectives of the organization
(Azêdo & Alves, 2013).
Institutional image: The image that is projected abroad by an independent company or institution
if it is public or private. It is considered as a process in which collaborators try to give a subtle
appearance and control the impressions that external clients have of the company in which
they work (Robbins, 1999).
Service: In the world context it has several scopes, but the one with the greatest relevance
and applicability is in health. The use of new technologies to exercise the health service and
contribute to the satisfaction of the population has incurred, in the need to review deciencies
that exist such as the quality and safety of care that harm the image of the institution in this
case in hospitals.
Quality of service: The need to improve health has given rise to the constant evolution of
strategies in this century, particularly health focuses on the knowledge of three aspects:
mastering new technologies, improvements in vaccines and medications in general (Álvarez,
2013). Additionally, the aspect of service quality regardless of the group that performs it,
there is a quality decit in the care provided by health institutions in Ecuador. However, it has a
minimal relationship between quality of care and patient satisfaction, perhaps due to the fact
that people never stop incorporating more satisfaction characteristics into our lives (Santana
et al., 2014; Pedraza et al., 2015).
39
Walter Jiménez Silva, Fernando Silva Ordoñez, Kléver Moreno, David Caisa
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
Services are very important for the development and development of people and the health
sector. But there is evidence of the constant scarcity of resources that are destined for the
systems of health institutions, which puts administrators to work tirelessly to nd alternatives
to improve the provision of services for users (Gutiérrez et al., 2014). The provision of services
is a greatly expanded concept which must guarantee the life of the human being, the World
Health Organization considers that the state has shared responsibility.
Timely attention: Our country has been oblivious in the matter of the provision of health
services, this is evident by the various problems that the hospitals have had, specically the
IESS hospitals, which have always had diculties with their members and not have been
treated (Puig, 2013). By evaluating patient satisfaction, it can be seen that there is no timely
care, which requires an institutional growth strategy to achieve the perspectives that can be
visualized when users receive care.
Good deal: Many perspectives have arisen from how clients or users are served, both in public
and private companies. Hence the importance of knowing about which indicators, which
allows identifying if people had a good deal when looking for a service. Well, if a person has
problems and arrives with them at work, they usually affect their work performance and it is
demonstrated with unpleasant and bad faith behaviors (Saldarriaga, 2013).
Cordiality: It is synonymous with education, since it is considered as a set of available means
used by people or society to improve their development and practices. Well, cordiality is also
considered with the attitude that a certain person has in his job when acting with another person
or group with different needs in search of being satised, which is presented as a civilized
mechanism with the ability to improve well-being of people (Patrici, 2013).
Materials and Methods
The study was carried out with the support of theoretical historical, inductive-deductive, and
synthetic analytical theoretical methods with which the theoretical subjects were constructed
(del Cid, Méndez & Sandoval, 2011). Furthermore, the empirical method was expert assessment
which allowed validating the research and dening the line of research (Hernández, Fernández
& Baptista, 2010). The data collection was to form primary and secondary. The approach that
was given to the research was quantitative because it has a logical, rigorous and veriable
structure. Well, we started from the problem statement until the hypothesis testing and writing
of results (Hernández, Fernández & Baptista, 2010; del Cid, Méndez & Sandoval, 2011).
The adopted design had an exploratory posture since it did not have a pre-established structure
to understand the reality of the problem. Subsequently, it was directed to a correlational level
because it was necessary to check the assumptions made and it was used to demonstrate the
40
Endomarketing as a service quality strategy of Public Health Institutions: A study of user behavior
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
relationship between variables. For the verication, the statistical model (multivariate linear
regression) was applied, which can admit a relationship (positive or negative) (Triola, 2009;
Hernández, Fernández & Baptista, 2010).
The study population was 96 people made up of: Administrative staff 23, doctors 60,
psychologists 2, nurses 6, nursing assistants 5 who are health professionals at the Teaching
Hospital Ambato. The survey technique was used, the instrument of which was the questionnaire,
which consisted of 18 items, which were phrased by the literature review, the Likert scale which
is considered to be more practical and of optimal management, its extremes were “Always”
and “Never” with the option of abstaining if the case required it.
The instrument had two applications: the rst was that it was a pilot and it was applied to 10
% of the total population in order to validate the instrument and discard duplicate or poorly
focused items and the second was the denitive one and the one that contributed with the
information for the verication of the hypotheses and the writing of results (Hernández,
Fernández & Baptista, 2010).
The validation of the instrument maintained two criteria: (i) expert criteria, when reviewing the
literature; (ii) reliability criterion, considered by the number of items with which the instrument was
built. The process for reliability was performed by applying the SPSS Statistics software version
23.0. Consequently, a reliability coecient of 0.952 was obtained, which is a signicant value.
The research had two hypotheses (Ho) Null: “The endomarketing model will not improve the
provision of the health service;” and (Ha) Alternative: “The application of the endomarketing
model will improve the provision of the health service.” In turn, they were veried by the
mutltivariable logistic regression statistical model, which fullled all the assumptions necessary
for its application: linearity, normality, collinearity, the observations must not be less than 20,
for each dependent variable there must be at least 2 independent inuencing variables can be
scalar or ordinal and must be quantitative variables. Well, the model looked for the relationship
that exists between the dependent variable and each of the independent variables.
Results
The procedure was performed looking for the relationship of each sub variable of service
provision by the set of sub-variables of endomarketing. It is for this reason that 7 editions
(models) were carried out, the same ones that can be seen in Table 2. It shows the variables
that were tested in the different multivariate linear regression models, thus showing that the
sub variables were entered correctly.
41
Walter Jiménez Silva, Fernando Silva Ordoñez, Kléver Moreno, David Caisa
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
Table 1. Variables Input/removed
Model Input variables Deleted variables Method
a. Dependent Variable
1. Commitment
2. Remuneration
3. Work environment
4. Compliance
5. Initiatives
6. Resources
7. Service
Job satisfaction,
Motivation, Suggestions,
Interaction, Training,
Prestige, Evaluation
b
———- Input
a: Dependent variable: service provision.
b: All requested variables entered.
Source: author’s own elaboration.
In Table 1, which is the summary of the seven models, it can be seen that each sub-variable
of the variable (service provision) has been related to all the sub-variables of endomarketing.
Giving the Durbin-Watson test score indicating that there is independence of errors.
The models that indicate that there is independence of errors were: the model (1) commitment
(1.623), (3) work environment (1.319) and (6) resources (1.697) which were accepted, on the
other hand, those not accepted (2) remuneration (0.516), (4) compliance (0.752), (5) initiatives
(0.435) and (7) service (0.480); as for the criteria, if the value is between 1 and 3, we accept
the assumptions and if it is not rejected.
The seven regression models tested with the seven independent sub-variables showed that the
adjusted R squared of each model was: (1) commitment (50.1 %), (2) remuneration (87 %), (3)
work environment (68.8 %), (4) compliance (58.7 %), (5) initiatives (63.9 %), (6) resources (71 %)
and (7) service (77.2 %); which indicate the variance that inuence the service provision variable
(dependent variable), that is to say that when increasing independent variables the variation
of the dependent will be higher. Because the R squared allows to identify the percentage of
changes in the dependent variable and the corrected square integrates the number of variables
and data in order to try to take care of the income effect of new variables that may or may not
have a signicant contribution, so what is the most recommended value to take to interpret.
Table 2. Model summary
Model R R
2
Adjusted R
2
Standard error Durbin-Watson
1. Commitment 0.734
a
0.538 0.501 0.25601 1.623
42
Endomarketing as a service quality strategy of Public Health Institutions: A study of user behavior
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
Model R R
2
Adjusted R
2
Standard error Durbin-Watson
2. Remuneration 0.938
a
0.879 0.870 0.36394 0.516
3. Work environment 0.843
a
0.711 0.688 0.39246 1.319
4. Compliance 0.786
a
0.617 0.587 0.18461 0.752
5. Initiatives 0.816
a
0.665 0.639 0.24973 0.435
6. Resources 0.855
a
0.732 0.710 0.47818 1.697
7. Service 0.888
a
0.789 0.772 0.25434 0.480
a. Predictors: (Constant), Job satisfaction, Motivation, Suggestions, Interaction, Training, Prestige, Evaluation.
Source: author’s own elaboration.
The ANOVA of the regression model with seven sub-variables indicates a signicant
improvement in the prediction of the dependent variable (service provision). As can be seen
in Table 2. When having the ANOVA with seven sub-variables in the model (1) commitment (F:
14.652; P <.000), (2) remuneration (91.644; P <.000), (3) work environment (30.982; P <.000),
(4) compliance (20.263; P <.000), (5) initiatives (25.263; P <.000), (6) resources (34.259; P
<.000) and (7) service (47.033; P <.000); with these values it can be considered that there is
a signicant improvement and it is inuential in the dependent variable (service provision),
since the level of signicance is below the p <0.01 that the evaluation parameter.
Table 3. ANOVA
Model Sum of squares df Square root F Sig.
1 Regression 6.722 7 0.96 14.652 .000
b
2 Regression 84.969 7 12.138 91.644 .000
b
3 Regression 33.404 7 4.772 30.982 .000
b
4 Regression 4.834 7 0.691 20.263 .000
b
5 Regression 10.918 7 1.56 25.011 .000
b
6 Regression 54.836 7 7.834 34.259 .000
b
7 Regression 21.297 7 3.042 47.033 .000
b
a. Dependent variable: service provision
b. Predictors: (Constant), Job satisfaction, Motivation, Suggestions, Interaction, Training,
Prestige, Evaluation.
Source: author’s own elaboration.
43
Walter Jiménez Silva, Fernando Silva Ordoñez, Kléver Moreno, David Caisa
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
In the Table 4 shows the component values of the regression model, which are given by the
least squares equation, which is the (mathematical model). The regression model coecients,
that is, the scores indicate the sub variables that contribute signicantly to the dependent
variable (service provision). The value t and sig. Of the seven models, they were as follows:
Model 1 (Commitment) the sub-variable that contributes the most is prestige (3.889), Model
2 (Remuneration) is training (6.425), Model 3 (Work environment) is job satisfaction (4.032),
Model 4 (Compliance) are training and suggestions (5.433, 4.561), Model 5 (Initiatives) are
interaction and evaluation (2.383, 3.842), Model 6 (Resources) is training (6.408) and Model 7
(Service) is training (6.518). Therefore, it is considered that the sub-variables of endomarketing
(VI) contribute signicantly and there is a close relationship with the provision of the service
(DV), the only one that does not contribute is motivation and this because if the rest of the
sub-variables will not be able to count on motivation. All of the above manifested is ratied
because the signicance level is p <0.01 (Table 3). In addition, the criterion of assumption 3 is
met that there is no multicollinearity of the values, since no value is for above 10 and together
all the values are close to 1.
Table 4. Coecients
Model Non-standardized coecients Standardized
coecients
T Sig.
B Standard error Beta
1 Commitment -.038 .173 -.218 .828
Service -.011 .038 -.048 -.297 .767
(Constant) -.012 .028 -.063 -.427 .671
Interaction 1.083 .278 .780 3.889 .000
Motivation -.038 .064 -.118 -.595 .553
Prestige .116 .062 .394 1.884 .063
Training -.069 .056 -.192 -1.230 .222
Evaluation -.008 .136 -.012 -.058 .954
2 Remuneration -.126 .247 -.511 .610
Interaction -.060 .054 -.092 -1.113 .269
Motivation .078 .040 .148 1.951 .054
Prestige .510 .396 .132 1.289 .201
Training .581 .090 .650 6.425 .000
Evaluation .078 .088 .096 .893 .374
Suggestions -.003 .080 -.003 -.038 .970
Work satisfaction .320 .194 .176 1.648 .103
44
Endomarketing as a service quality strategy of Public Health Institutions: A study of user behavior
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
Model Non-standardized coecients Standardized
coecients
T Sig.
B Standard error Beta
3 Work
environment
Interaction
Motivation
Prestige
Training
Evaluation
Suggestions
Work satisfaction
1.122
.067
.030
-1.347
-.131
.294
.162
.843
.266
.058
.043
.427
.097
.095
.086
.209
.148
.083
-.501
-.210
.514
.232
.667
4.221
1.155
.709
-3.157
-1.339
3.108
1.880
4.032
.000
.251
.480
.002
.184
.003
.063
.000
4 Compliance
Interaction
Motivation
Prestige
Training
Evaluation
Suggestions
Work satisfaction
.513
.004
.010
.250
.249
-.375
.185
.038
.125
.027
.020
.201
.046
.045
.041
.098
0
.020
.067
.228
.979
-1.608
.648
.074
4.104
.133
.493
1.246
5.433
-8.435
4.561
.387
.000
.895
.623
.216
.000
.000
.000
.700
5 Initiatives
Interaction
Motivation
Prestige
Training
Evaluation
Suggestions
Work satisfaction
.458
.088
-.130
.086
.109
.231
-.061
.133
.169
.037
.027
.272
.062
.060
.055
.133
.329
-.602
.054
.296
.685
-.146
.178
2.708
2.383
-4.770
.315
1.754
3.842
-1.100
1.002
.008
.019
.000
.753
.083
.000
.274
.319
6 Means
Interaction
Motivation
Prestige
Training
Evaluation
Suggestions
Work satisfaction
.559
-.003
-.110
-.556
.761
-.151
.168
.540
.324
.071
.052
.520
.119
.115
.105
.255
-.005
-.238
-.163
.967
-.210
.190
.338
1.726
-.042
-2.105
-1.068
6.408
-1.313
1.595
2.119
.088
.967
.038
.288
.000
.193
.114
.037
45
Walter Jiménez Silva, Fernando Silva Ordoñez, Kléver Moreno, David Caisa
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
Model Non-standardized coecients Standardized
coecients
T Sig.
B Standard error Beta
7 Service
Interaction
Motivation
Prestige
Training
Evaluation
Suggestions
Work satisfaction
-.003
.037
-.177
.309
.412
.100
.032
.069
.172
.038
.028
.277
.063
.061
.056
.136
.109
-.638
.152
.872
.231
.061
.072
-.015
.995
-6.365
1.119
6.518
1.635
.579
.509
.988
.323
.000
.266
.000
.106
.564
.612
a. Dependent variable: Commitment
Source: author’s own elaboration.
Once the multivariate linear regression model has been carried out, it is concluded that the
values obtained are very high and the level of signicance is less than p <0.01, with which it
can be seen that the variable providing the health service largely depends on the application
of the endomarketing model. Therefore, the null hypothesis is rejected and the alternative
hypothesis is approved: “The application of the endomarketing model will improve the provision
of the health service.”
Discussion
Endomarketing is decisive in the provision of health services because it allows attracting,
convincing, satisfying and keeping customers, which was theoretically supported starting
from the origin and evolution of endomarketing using the historical method, which consisted
of historical review of theories (Da Silva, 2013). In this review it was also observed that the
philosophy was to serve internal and external clients, which can be done through a set of
strategies and activities whose purpose is to coordinate efforts to promote initiatives in
talent management, production and communication. On the other hand, the elements or
sub-variables that make up endomarketing are: interaction, motivation, prestige, training,
evaluation, suggestions and job satisfaction which inuence the provision of health services
according to studies carried out in different countries, which is found in the state of the art
and the theoretical framework (Jiménez & Gamboa, 2016).
When characterizing the factors of service provision, it was evident that there are several, which
are predictive of compliance or not of the activities to be performed in terms of user care at
the Ambato Teaching Hospital (Gutiérrez et al., 2014). Among the most important are: the
46
Endomarketing as a service quality strategy of Public Health Institutions: A study of user behavior
Espirales. Revista multidisciplinaria de investigación cientíca, vol 4, No. 34
Julio-septiembre 2020. e-ISSN 2550-6862. págs 35-48
commitment that refers to the degree of connection that an individual has with an institution,
the remuneration that is the link by which a person carries out an activity in exchange for a
monetary payment, the work environment that is a set of various factors and conditions that
affects the development of a persons activities. Compliance that is nothing more than the
involvement of collaborators to achieve the objectives and goals of the institution, the initiatives
that are given by the attitude that a person takes to generate something new or innovate it, the
resources that are all necessary inputs that is required to carry out an activity and the service
that is an action that translates into a set of activities whose purpose is to satisfy a need.
Conclusions
After analyzing endomarketing and the provision of health services, it can be seen that
endomarketing applied as a whole, that is, as a model, directly inuences the provision of
services. Because when applying the multivariable linear regression model, the relationship
between the variables whose values (percentages) were very high was evident, which indicate
the variance of inuence on the service provision variable (dependent variable), that is, when
increase independent variables the variation of the dependent will be higher. To this it should
be noted that the level of signicance of the seven runs was P <0.01. For this reason, the values
obtained are accepted and its credibility is increased. After having reviewed the different
contributions and results obtained, it is considered important to generate a possible model
that allows solving the detected problem, developing the factors with the greatest impact that
inuence the provision of health services, among which are: interaction, motivation, training,
prestige and evaluation.
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