Syntax Literate: Jurnal Ilmiah Indonesia p�ISSN: 2541-0849

e-ISSN: 2548-1398

Vol. 7, No. 3, Maret 2022

THE ANTECEDENT OF CUSTOMER DELIGHT AND CUSTOMER LOYALTY

AND THEIR IMPACT ON REVISIT INTENTION

Yuliawati Kusumaningrum, Tanggor Sihombing, Ferdi Antonio, Rosdiana Sijabat

Master's Degree in Hospital Administration, Pelita Harapan University, Jakarta

Email: [email protected], [email protected], [email protected], [email protected]

Abstract

The purpose of this study was to examine the model of the antecedent of customer delight and customer loyalty and their impact on revisit intention at a Japanese Acupuncture family medicine clinic XYZ, Jakarta. PLS-SEM was used to analyze empirical data obtained through simple random sampling. There were 162 respondents who met the requirements through questionnaire that had been distributed online on March 2021. The result showed� that seven of eight hypotheses are supported and one of hypotesis is unsupported. Customer loyalty proven has a postive impact on revisit intention while customer delight could positivly influence customer loyalty. Customer satisfaction, customer trust, persive quality as independent variables found significantly influenced. This research model has predictive accuracy and predictive relevance which are relatively weak against revisit intention. Therefore, it is necessary to develop further research in the future related to healthcare services in acupuncture family medicine clinicsx.

Keywords: customer delight; customer loyalty; revisit intention; Japanese acupuncture; family medicine

Introduction

Delight is described as an emotional reaction to a service or product that not only satisfies customer�s expectation but also provides an unexpected value. Customer satisfaction and loyalty is better understood by the mediating link of customer delight. Case management in primary health care with a Family Medicine approach pays attention to the potential of the family as a resource for supporting and or hindering the success of patient management. Japanese Acupuncture has spread to many countries since thousands of years ago. So far, previous research related to the factors that influence customer delight and customer loyalty. Technological advances have given rise to competitive competition in the healthcare industry, so healthcare services are expected to be more creative and innovative in providing their services to the community (McKinsey et al., 2020). The management of healthcare providers have paid attention on managing the quality and patient-centered healthcare services for a long time (Donabedian, 1988). Studies on patient satisfaction have shown how the influence of patient satisfaction and behavior can support the business of healthcare providers (Asnawi, Awang, Afthanorhan, Mohamad, & Karim, 2019; Wang, 2019). Traditional and complementary medicine (T&CM) is an important and often underestimated health resource with many applications, especially in the prevention and management of lifestyle-related chronic diseases, and in meeting the health needs of ageing populations. Many countries are seeking to expand coverage of essential health services at a time when consumer expectations for care are rising, costs are soaring, and most budgets are either stagnant or being reduced. Given the unique health challenges of the 21st century, interest in T&CM is undergoing a revival. Monitoring health trends is a core function of WHO and it is key to supporting countries in generating evidence-based policies and strategic plans.

This report reviews global progress in T&CM over the past two decades and is based on contributions from 179 WHO Member States. It clearly shows that more and more countries are recognizing the role of T&CM in their national health systems. For instance, by 2018, 98 Member States had developed national policies on T&CM, 109 had launched national laws or regulations on T&CM, and 124 had implemented regulations on herbal medicines. In an ideal world, traditional medicine would be an option offered by a well-functioning, people-centered health system that balances curative services with preventive care. WHO is halfway through implementing the WHO Traditional Medicine Strategy 2014�2023, (Organization, 2019).

Since the early 2000s, the implementation of integrative and complementary practices (ICPs) has been increasing. WHO estimates that currently� ICPs have been applied by more than 100 million people in 32 countries, including Indonesia. One of the most widely used and developed ICPs today is acupuncture (Boing et al., 2019). Acupuncture is considered very useful for people to maintain their health as well as to prevent and treat several diseases. Acupuncture has had a good impact on healthcare services, so it has attracted the attention of the international healthcare community which can be indicated from the increasing number of studies in the field of acupuncture (Zhi, 2019).

Japanese acupuncture, one of the existing acupuncture development techniques, is often used by the elderly population because it is considered more comfortable. Another reason is the fact that elderly people experience physical changes that affect their bodies' responses and the history of diseases that are difficult to be cured in old age, and accupuncture has been applied and become a culture as well as an important component in health sciences and technology (Yano, 2018). Japanese acupuncture services are administered by hospitals and health clinics, including the family medicine clinics.

Case management in primary health care with a Family Medicine approach pays attention to the potential of the family as a resource for supporting and or hindering the success of patient management, (Djuhaeni et al., 2017).� The management of the clinics need to conduct a relevant evaluation to their services that face the problem of lower level of patient loyalty. Having seen this new development, the clinic management have to compete intelligently and knowledgeably in getting the attention and loyalty of their customers as well as in catering the new needs by paying attention to how to create a pleasant and comfortable experience (experiential) rather than just satisfying the customers. This is what it means by customer delight (Barnes & Krallman, 2019). Therefore, the management should prioritize the research on the effects of customer loyalty and customer delight on revisit intention, and they also need to study which variables can function in these roles at the XYZ Acupuncture Japanese Family Medicine Clinic, Jakarta, so that they can contribute new knowledge to the development of other similar clinics.

Some previous studies have shown positive relationships between customer satisfaction and the desired business outcomes such as the increase in customer loyalty, company earnings, stock performance (Anantharanthan Parasuraman, 1998)� However, the positive relationship between customer satisfaction and loyalty tends to be weak (Keiningham, Aksoy, Buoye, & Cooil, 2011). Customer perceptions are based on not only their satisfaction but also their memorable experiences, so the management need to pay attention to their service designs (Andreassen et al., 2016). When compared with customer satisfaction, it is found that a comfortable and pleasant experience indicates a higher level of loyalty,commitment, and repurchase intention (Barnes & Krallman, 2019). And this becomes the consideration that the research findings show that customer satisfaction does not always encourage customer loyalty (Jones & Sasser, 1995).

From this description, it can be understood that customer satisfaction and customer delight have differences, in which customer satisfaction alone is not enough for certain types of industries, and their customers need to be given certain emotional memorable experiences (Barnes & Krallman, 2019). Amid fierce competition, a company's efforts to create customer delight can be seen as an effective new way to retain customers as is suggested by the new theory of customer delight by (Ananthanarayanan Parasuraman & Grewal, 2000).

Revisit intention can be defined as the status of the consumer's desire to continually return to the same healthcare service in the future. This becomes the expectation of every medical service, and it indicates the consumers� trust in the services they have received (Cakici, Akgunduz, & Yildirim, 2019). Revisit intention can be influenced by environmental factors, social, physical environment, customer satisfaction, and various other factors (Chan, 2018).

Currently, practitioners have incorporated the customer delight concept into the company's mission stating the commitment to put the customer delight as the first step in their efforts to pursue customer strategy (Barnes & Krallman, 2019). The relationship between customer satisfaction and loyalty can be mediated by customer delight which serves as the conceptualization of the highest level of satisfaction for the customers (KIM & PARK, 2019).

Customer loyalty in a healthcare service is a big concern and has long-term implications; therefore, it has become a mandatory choice for every medical service provider (Abu-Alhaija, Hussein, & Allan, 2019). This concept indicates a positive attitude of healthcare customers who have received services, and this can increase their purchasing power (Vilkaite-Vaitone & Skackauskiene, 2020).

Customer loyalty is the loyalty of customers to be firmly committed to creating and supporting their preferred medical services in the future (Khadka & Maharjan, 2017).

The research model in this study involves the relation between customer satisfaction variable and other variables as suggested by (KIM & PARK, 2019) in their new concept of consumer behavior. In this concept, there is a triple variable continuum or a linear continuity relationship from the customer satisfaction variable that affects the customer delight which, in turn, will encourage the creation of customer loyalty. In this research model, customer satisfaction becomes the independent variable, while customer delight serves as the mediating variable that has been proven to have a significant role (KIM & PARK, 2019).

H1: Customer satisfaction has a positive influence on word of mouth

Customer satisfaction is one of the most important things to increase revenues in the healthcare service processes, and it has become one of the main indicators of success for healthcare services in the future. Revisit intention is strongly influenced by customer satisfaction (Taghizadeh, Taghipourian, & Khazaei, 2013). It is believed that the word-of-mouth technique can directly affect patient satisfaction; thus, when patients are satisfied with the healthcare services, they will pass this information on to other potential customers voluntarily (Ruswanti, Eff, & Kusumawati, 2020).

H2: Customer satisfaction has a positive influence on customer delight

Customer delight describes the customers� emotional reactions to the given medical services which do not only satisfy their expectations but also provide them with the unexpected values. In the field of consumer psychology, (KIM & PARK, 2019).

H3: Customer trust has a positive influence on customer delight.

Trust is acknowledged in the development and maintenance of relationships between customers and healthcare service providers (Lepage et al., 2013). Customer trust must be earned by healthcare services in order to yield best results because customer trust can create customer satisfaction and customer delight (Birkh�uer et al., 2017).

H4: Perceived quality has a positive influence on customer delight

Perceived quality as a positive perception of service providers is an intangible asset that guarantees the competitive advantage of the service providers (Asnawi et al., 2019).

H5: Customer delight has a positive influence on word-of-mouth

The experience of creating customer delight will make customer loyalty as one of the main competitive strategies in the healthcare business (Torabi, Hamidi, & Safaie, 2021).

H6: Customer delight has a positive influence on customer loyalty.

Customer delight is a comprehensive evaluation of the customers' perception of the values which they have received during their healthcare services, and it is considered as the output of the services provided to the customers (Chiguvi & Guruwo, 2017)

H7: Word-of-mouth has a positive influence on customer loyalty.

WOM can affect patient satisfaction, and the dissemination of this information to others will affect the revisit intention and customer loyalty (Ruswanti et al., 2020). Customer loyalty is formed from positive experiences which are mediated by the word-of-mouth to build sustainable relationships with these healthcare services (Leninkumar, 2017).

H8:� Customer loyalty has a positive influence on revisit intention

Customer loyalty can increase revisit intention in the future (Cakici et al., 2019). Customer loyalty is considered an important factor which serves as the commitment to fulfil the revisit intentions (Leninkumar, 2017).

In this research model, there are seven variables that were used to test and analyze the positive influences of customer satisfaction, customer trust, perceived quality, word-of-mouth, customer loyalty, and revisit intention. The data analysis technique in this study uses the partial least square structural equation model (PLS-SEM) because there are several independent variables in this study.

Method

This study applies the quantitative research method with cross-sectional studies with PLS-SEM method to analyze the data which were obtained through the use of purposive sampling from 162 respondents who met the requirements. The questionnaires were distributed online

Results and Discussion

The results of the study were obtained from the online questionnaires data distributed to 162 respondents. The questionnaires were distributed in March 2021 using google forms, and questionnaire items had fulfiled the research requirements at the XYX Japanese Acupuncture Family Medicine Clinic, Jakarta. The respondent profile can be seen in Table 1.

Table 1

Respondent Profile

Age �	18-29	4	2%
	30-39	19	12%
	40-49	44	27%
	50-59	62	38%
	>60	33	20%
Total		162	100%
Gender	Woman	71	44%
	Man	91	56%
Total		162	100%

Table 2 illustrates the indicator realibility which shows that the 21 indicators have an outer loading value > 0.708. This means all indicators are reliable in the construct measurement.

Table 2

Indicator Realibility

Indicator	Customer Delight	Customer Loyalty	Customer Satisfaction	Customer Trust	Perceived Quality	Revisit Intention	Word-of-Mouth	Result
CD 1	0,877							Reliable
CD 2	0,883							Reliable
CD 3	0,912							Reliable
CL 1		0,823						Reliable
CL 2		0,847						Reliable
CL 3		0,892						Reliable
CS 1			0,875					Reliable
CS 2			0,917					Reliable
CS 3			0,911					Reliable
CT 1				0,905				Reliable
CT 2				0,926				Reliable
CT 3				0,942				Reliable
PQ 1					0,893			Reliable
PQ 2					0,893			Reliable
PQ 3					0,935			Reliable
RI 1						0,882		Reliable
RI 2						0,863		Reliable
RI 3						0,830		Reliable
WOM 1							0,833	Reliable
WOM 2							0,927	Reliable
WOM 3							0,92	Reliable

Inner Model

Based on the output of bootstrapping in Figure 1, the inner model below shows that the T-statistic value has 8 paths in this research model and describes significant relationships.

Fig 1

�Inner Model Analysis

Hypothesis Test Results

Table 3

Hypothesis Test Results

Hyphothesis	Path	Standardized Coefficient	T Statistics	Result
H1	Customer Satisfaction� Word-of-Mouth	0,132	1,377	Hypothesis unsupported
H2	Customer Satisfaction� Customer Delight	0,232	2,738	Hypothesis supported
H3	Customer Trust � Customer Delight	0,356	5,244	Hypothesis supported
H4	Perceived Quality� Customer Delight	0,334	4,981	Hypothesis supported
H5	Customer Delight� Word-of-Mouth	0,564	6,628	Hypothesis supported
H6	Customer Delight� Customer Loyalty	0,563	8,137	Hypothesis supported
H7	Word-of-Mouth� Customer Loyalty	0,216	2,973	Hypothesis supported
H8	Customer Loyalty� Revisit Intention	0,627	14,503	Hypothesis supported

Table 3 shows the results of of the hypothesis testing. Out of the eight hypotheses, seven significant hypotheses have positive coefficient values. In addition, there is one insignificant hypothesis with a T-statistic value of 1.377 and a standardized coefficient of 0.132.

Specific Indirect Effect

Table 4 shows the paths that have the strongest influence towards revisit intention are customer trust and customer delight with a standardized coefficient of 0.126.

Table 4

Specific Indirect Effect

Path	Standardized Coefficient	T Statistics	Result
Customer Satisfaction� Customer Delight � Customer Loyalty	0,131	2,599	significant
Customer Trust � Customer Delight � Customer Loyalty	0,201	4,271	significant
Perceived Quality�� Customer Delight � Customer Loyalty	0,188	4,179	significant
Customer Satisfaction� Customer Delight�� WOM � Customer Loyalty	0,028	1,970	significant
Customer Trust �� Customer Delight �� WOM � Customer Loyalty	0,043	2,402	significant
Perceived Quality�� Customer Delight � WOM� Customer Loyalty	0,041	2,328	significant
Customer Satisfaction� WOM � Customer Loyalty	0,029	1,131	Insignificant
Customer Satisfaction� Customer Delight � Customer Loyalty � Revisit Intention	0,082	2,574	significant
Customer Trust � Customer Delight �� Customer Loyalty � Revisit Intention	0,126	3,795	significant
Perceived Quality� Customer Delight �� Customer Loyalty � Revisit Intention	0,118	3,777	significant
Customer Satisfaction� Customer Delight� WOM � Customer Loyalty�� Revisit Intention	0,018	2,054	significant
Customer Trust � Customer Delight � WOM � Customer Loyalty �� Revisit Intention	0,027	2,412	significant
Perceived Quality � Customer Delight � WOM � Customer Loyalty �� Revisit Intention	0,026	2,357	significant
Customer Satisfaction� WOM � Customer Loyalty � Revisit Intention	0,018	1,119	Insignificant
Customer Satisfaction�� Customer Delight � WOM	0,131	2,448	significant
Customer Trust � Customer Delight �� WOM	0,201	3,989	significant
Perceived Quality �� Customer Delight�� WOM	0,188	3,950	significant

Importance-Performance Map Analysis (IPMA)

Based on Figure 3, the target construct of the research model is the revisit intention. The customer loyalty and customer delight variables are in the upper right quadrant. This quadrant shows important areas which have performed or which are performing well. Thus, the customer loyalty and customer delight variables are considered as the most important variables by respondents in terms of services at the clinic. Therefore, it is advisable to always pay attention to and maintain customer loyalty and customer delight that have been obtained properly, so that this can affect revisit intention.

Fig 3

IPMA Test Results with the Construct Target of Delivery of Quality Care (Indicators)

The purpose of this study was to test and analyses the research model based on empirical data of the services of a Japanese acupuncture family medicine clinic. The management of the clinic need to prioritize and focus on their patients so that the patients are satisfied with their services. In addition to patient satisfaction, there are other factors that make patients want to revisit the clinic for therapies. This study uses the customer delight theory by (Oliver, 1999), which was later developed by (Ananthanarayanan Parasuraman & Grewal, 2000). The customer delight construct is an affective sensation that is different and separate from customer satisfaction where the satisfaction construct is a cognitive evaluation (KIM & PARK, 2019). The constructs can be influenced by other variables outside the customer satisfaction, especially those shown by direct individuals (Routledge. & Collier, J.E., Barnes, D.C., Abney, A.K., & Pelletier, 2017). The customer delight construct has been tested empirically and is known to have an impact on customer loyalty and consumer intentions to behave in favour of premium service providers (Routledge. & Collier, J.E., Barnes, D.C., Abney, A.K., & Pelletier, 2017) and healthcare services in hospitals. So far, there have been only a few studies on the application of customer delight in the field of healthcare services, especially acupuncture clinics.

However, acupuncture has now been acknowledged as one of the medical sciences that can provide clinical benefits. The research model was adopted based on previous research (Elvira., 2020). Revisit intention is the dependent variable that is directly influenced by customer loyalty, while customer delight is a construct that mediates the effects of customer satisfaction, customer trust, and perceived quality on customer loyalty. The research model has been empirically tested on patients at a Japanese acupuncture family medicine clinic in order to answer the following question. �Do service activities in the clinic affect patient satisfaction, trust, and perception of service quality as the independent variables that are mediated by customer delight, so that it can have an impact on customer loyalty, which then encourage revisit intention to the clinic?� Based on the collected data which were analyzed by using PLS-SEM, the model of the research results is described as follows.

Fig 4

Result Model

Based on the hypothesis testing, out of eight hypotheses proposed in the research model, seven hypotheses were supported, while 1 hypothesis was not supported. This unsupported hypothesis is the effect of customer satisfaction on word-of-mouth.

Limitation and Future Recommendation

This research has some limitations that can be used as the basis for suggestions or recommendations for future research in the same field. The first limitation is that the research sample was taken during the Covid-19 pandemic by filling out online questionnaires independently. This creates potential risks of bias in filling out the questionnaire. The next limitation is the limited number of samples, which were taken only from the population of one acupuncture clinic. This can affect the generalization level of the research findings. The research findings also show that the predictive relevance of the model is still weak. Therefore, it can be suggested that the future research can obtain larger sample sizes within a wider geographic coverage and with strict criteria in order to obtain a more homogeneous and representative sample.

Conclusion

The conclusion of the research findings can provide managerial implications in the form of suggestions for managers or clinic administrators to carry out activities to encourage revisit intention which is driven by patient loyalty to the clinic. Therefore, the management need to pay attention and develop pro-active and personal customer loyalty programs for patients who have completed the therapy. This loyalty factor is important as competitions between clinics compel the management to come up with a unique, attractive loyalty program that can provide direct benefits for the patients. Patient loyalty to the clinic can be created through excellent services which are able to give a sensation of delight to patients who visit the Japanese Acupuncture Family Medicine clinic. Therefore, the clinic management needs to pay attention to the quality of services it provides and the outcomes of these services. The findings of this study indicate that it is important for patients to be able to interact well with clinic employees and express their feelings. Consequently, the clinic management also needs to pay attention and allocate its budget to implement the communication skill improvement program for the clinic employees and other healthcare professionals who work at the clinic.

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Yuliawati Kusumaningrum, Tanggor Sihombing, Ferdi Antonio, Rosdiana Sijabat (2022)

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