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EBHPME 2022; 6(2): 126-36
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ORIGINAL ARTICLE
Evidence Based Health Policy, Management & Economics
Copyright: ©2022 The Author(s); Published by ShahidSadoughi University of Medical Sciences. This is an
open-access article distributed under the terms of the Creative Commons Attribution License
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Investigating the Relationship Between Management Style and Market Orientation
in Qazvin University of Medical Sciences
Bahman Ahadinezhad 1, Omid Khosravizadeh 1*, Fatemeh Vahdati 2, Mohammadreza Mohammadkhani 2,
Rana Soheylirad 2, Sogol Sarikhani 2
1 Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases,
Qazvin University of Medical Sciences, Qazvin, Iran
2 Student Research Committee, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
A R T I C L E I N F O
A B S T R A C T
Article History:
Received: 24 May 2021
Revised: 29 Dec 2021
Accepted: 12 Jun 2021
Background: Hospital management style can affect various aspects of hospital
performance. One of these aspects is the level of market orientation of the
hospital. Therefore, the present study attempts to answer whether management
style makes a difference in the degree market orientation of hospitals or not.
Methods: This research is a descriptive-analytical and cross-sectional study
conducted in 2020. About 420 people were selected by stratified sampling out of
the six medical centers' staff in Qazvin, Iran. A total of 411 people (97.86 %)
completed the questionnaires. The collected data were analyzed using STATA15
and SPSS16 software. Robust regression analysis was used to estimate the role of
management style in the level of market orientation of hospitals. Mean variables
were analyzed using one-way analysis of variance and post hoc test.
Results: The score range of the variables was from 1 to 5. Autocratic and
delegating styles obtained the highest average (3.22 ± 0.54) and the lowest
average (2.87 ± 0.70), respectively. Among the dimensions of market
orientation, customer orientation had the highest average (3.32 ± 0.84), while
competitor orientation obtained the lowest average (2.80 ± 0.86). The average
score of market orientation was 2.88 ± 0.65. A statistically significant
difference between hospitals was observed in terms of participative and
delegating styles (P-value < 0.05). In addition to market orientation, there was
a statistically significant difference between hospitals (P-value < 0.05). The
regression coefficient between the level of the hospital market orientation and
the participative and delegating styles was 0.10 and 0.09
, respectively (P-value < 0.05). In contrast, the regression coefficient between
autocratic style and level of market orientation was estimated to be -0.76.
Conclusion: It can be concluded that managers should use more participatory
and delegating styles to increase the market orientation of the studied hospitals.
Key words: Management style, Market orientation, Hospital, Qazvin
*Corresponding Author:
Omid Khosravizadeh
Social Determinants of Health
Research Center, Research
Institute for Prevention of Non-
Communicable Diseases, Qazvin
University of Medical Sciences,
Qazvin, Iran.
Email:
omid.khosravizadeh@gmail.com
Tel:
+98-9123826540
Citation
This paper should be cited as: Ahadinezhad B, Khosravizadeh O, Vahdati F, Mohammadkhani M, Soheylirad R,
Sarikhani S. Investigating the Relationship Between Management Style and Market Orientation in Qazvin
University of Medical Sciences. Evidence Based Health Policy, Management & Economics. 2022; 6(2): 126-36.
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Introduction
overnment budget constraints have led public
hospitals to constantly strive to raise more
revenue to have more resources to offset their
rising costs and avoid financial instability in the
long run. The entry of private hospitals and social
security hospitals into the market of high-income
services such as profitable surgeries has put
pressure on the revenues of public hospitals. In this
situation, public hospitals should meet the
preferences and needs of high-income groups in
the best possible way and provide effective access
to hospital services for the middle and lower-
income groups of society by capturing the lucrative
service market. The realization of this importance
depends on the teaching and medical centers
moving towards market orientation. Market
orientation is defined as the values and beliefs in a
hospital that place the patient at the center of
hospital thinking, strategy, and operations and
create the behaviors necessary to produce superior
value for patients and meet society's current and
future medical needs (1).
On the other hand, market orientation is one of
the competencies that allow the hospital to have an
advantage over competing hospitals (2). Contrary
to some health policymakers' beliefs, university
hospitals must meet the demand of high-income
groups of society to strengthen revenue generation
and long-term financial sustainability. Market
orientation can affect the various performance
indicators of an organization (3-5). Mohammadi
(6), in his study in private hospitals in Isfahan,
concludes that market orientation through brand
identity affects hospital performance. Amangala
and Wali's (7) study shows a positive relationship
between market orientation and service quality.
Market orientation in an organization can be both a
cultural issue and a managerial issue (8).
Therefore, the dominant management style can be
one of the critical determinants of the hospital's
market orientation. According to management
theories, the hospital manager can promote a
market-oriented culture by creating insight,
guidance, and coordination. To promote market
orientation, the manager must strengthen the
customer-centric culture, attention to the
competitor, and coordination between the functions
of different departments (1). Hospital management
can lead the hospital to be market-oriented by
implementing patient-centered mechanisms,
creating strategic thinking, and arranging different
units in the same line. To strengthen market
orientation, management must establish
prerequisites such as creating market intelligence
and spreading this intelligence throughout the
hospital, and responding to the market based on
this intelligence (9). The management style used
by the manager can strengthen or weaken the
hospital's market-oriented culture and behavior.
Abolfazli et al. (10) concluded that companies with
a high degree of market orientation use an
entrepreneurial management style, while
companies with a low degree of entrepreneurship
and market orientation use an administrative and
conservative management style. Harris & Ogbonna
(11) also found a significant positive relationship
between participatory style and market orientation.
Other studies indicate that the positive attitude of
senior managers and their emphasis on the
importance of market orientation, their experience
in marketing, their perception of environmental
changes, their level of education, employee
orientation, and risk-taking have a positive
effect on the level of market orientation of
the organization (12-17). Neglecting market
orientation may have negative consequences such
as reduced demand for services and reduced
hospital revenue (3). Therefore, determining the
type of management style that strengthens market
orientation in the hospital is a prerequisite for
increasing revenue. This study aimed to determine
the role of management style in the level of
market orientation of Qazvin University of
Medical Sciences hospitals. The findings of this
study can add valid empirical evidence to the
hospital management literature.
Materials and Methods
This study is descriptive-analytical research
based on the survey of employees' opinions
G
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working in the Qazvin University of Medical
Sciences hospitals in 2020.
Participation
In multivariate regression analysis, the sample
number (observations) ratio to independent
variables should not be less than 5. Otherwise, the
results of the regression equation will not be very
generalizable. A more conservative ratio of 10
observations per independent variable is also
suggested. Considering 15 observations for each
predictor variable in the multiple regression
analysis with the standard method of least squares
is an accurate guide. So, in general, the sample size
can be determined between 5 to 15 observations
per measured variable in the structural equation
modeling methodology:
5Q < n < 15Q
Where Q is the number of variables observed or
the number of items (questions) of the
questionnaire, and n is the sample size (18).
Considering that in this study, the sum of the
questionnaire items is equal to 42, and considering
10 samples per item, the final sample size was
obtained 420. 420 people were selected from the 6
Educational and Medical Centers of Qazvin
University of Medical Sciences as the optimal
sample size by stratified random sampling. In this
way, the share of clusters (hospitals) in the total
sample size was determined. In the next step, the
subjects were randomly selected in each hospital.
The inclusion criteria included willingness,
satisfaction, and ability to participate. In the case
of exclusion of samples, an alternative individual
would be selected.
Measurement tools
Market orientation questionnaire
The market orientation of hospitals was
measured using the Ahmad and Iqbal (2013)
questionnaire (19). In this questionnaire, the
hospital staff judges the frequency of each of the
market orientation items in the hospital based on
individual observation or perception and answer
each of the questions on a Likert scale. This
questionnaire has three dimensions: Customer
orientation (6 items), competitor orientation (5
items), and inter-functional coordination (5 items).
Each question is scaled through a very low (1) to
very high (5). A score below 3 indicates that the
hospital's market orientation level is below average
and weak. A score of 3 to 4 means an above-
average market orientation level, and a score above
4 indicates that the hospital has a high level of
market orientation. The content validity of this
questionnaire was confirmed through a survey of
hospital management professors and hospital
managers. The Cronbach's alpha coefficient was
obtained 0.93.
Management style questionnaire
Data on management style was collected using
the Clark management style questionnaire (20). In
this questionnaire, hospital staff assess the
frequency of each item of management style based
on individual observation or perception in the
hospital and answer each of the questions on a very
low (1) to very high (5) level. The questionnaire
consists of three styles: Autocratic management
(10 items), participative management (10 items),
and delegating management (10 items). Any style
that achieves a higher mean (close to 5) reflects the
dominant management style in the hospital. The
content validity of this questionnaire was examined
through a survey of hospital management
professors and hospital managers, and its
Cronbach's alpha coefficient was calculated at
0.92.
Data collection and analysis
After getting permission from the research
deputy and receiving an ethics code, the researcher
went to the studied hospitals, explained the
research goals and the questionnaire structure for
the samples, and then, the staff filled the
questionnaires with informed consent. Robust
regression analysis was used to estimate the role of
management style in the level of market
orientation of hospitals. In order to consider the
unobservable heterogeneity between hospitals and
to neutralize the effect of confounding variables
specific to each hospital, the dummy variable was
used for each hospital. The collected data were
analyzed using STATA15 and SPSS 16 software.
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One-way analysis of variance was used to compare
the scores of market orientation and management
style among hospitals. Dummy regression was
used to estimate the effect of management styles
and unobservable heterogeneity of hospitals on
market orientation. The regression model of the
effect of management style on the level of market
orientation of hospitals is as follows:
In the above model, LMO shows the logarithm
of the market orientation score of the hospitals. Hi
is a dummy variable that captures the unobservable
effects of hospital i on the market orientation level.
LAU, LPA, and LDE also show autocratic,
participative, and delegating styles, respectively. It
is noteworthy that beta coefficients in the high
regression model show the percentage of reaction
of market orientation to the percentage of change
in explanatory variables.
The present study was approved by the ethical
committee of Qazvin University of Medical
Sciences (ethics code: IR.QUMS.REC.1399.062).
After selecting the eligible participants, the
researcher was introduced, and the study objectives
were elaborated for the participants. The informed
written consent was obtained from the subjects,
and they were assured that their information would
remain confidential.
Results
A total of 411 people (97.86 %) completed the
questionnaires. According to the results of Table 1,
most of the respondents (74.20 %) were women
belonging to the clinical group (73.70 %) and had a
bachelor's degree (66.70 %). Also, the average age
of study participants was 36 years, and their
average work experience was 11 years.
Based on Table 2 and Figure 1, the autocratic
style with the highest average (3.22 out of 5) has
been reported as the dominant management style.
In contrast, the delegating style obtained the lowest
average (2.87 out of 5). The average score of the
participative style was approximately 3. Among
the dimensions of market orientation, Customer
orientation had the highest average (3.32 out of 5),
while competitor orientation obtained the lowest
average (2.80 out of 5). The average score of
market orientation was 2.88 out of 5.
Figure 2 displays the radar diagram for the
market orientation dimensions. Three dimensions
of market orientation form the three vertices of
this triangle. If the radar diagram fits perfectly on
the triangle, it means that the hospital is at a high
level in terms of market orientation. As can be
seen, the diagram stretches to the dimension of
customer orientation, and the other vertex of the
radar triangle is stretched to inter-functional
coordination.
Table 3 shows the results of comparing the
mean of variables between the studied hospitals. A
statistically significant difference between
hospitals was observed in terms of participative
and delegating styles (P-value < 0.05). It is
noteworthy that hospitals did not show any
statistically significant differences from each other
in terms of autocratic style. In terms of market
orientation, there was a statistically significant
difference between hospitals (P-value < 0.05). In
terms of competitor orientation, no statistically
significant difference was observed between
hospitals.
According to Table 4, the regression estimations
show that β coefficient between the level of the
hospital market orientation and the participative
and delegating styles is 0.10 and 0.09, respectively
(P-value < 0.05). In contrast, the regression
coefficient between autocratic style and level of
market orientation was estimated to be - 0.76. In
addition, the unobserved hospital-specific effects
are also statistically significant (P-value < 0.05).
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Table 1. Demographic characteristics of sample
Variable
Frequency
Percentage
Mean ± SD
Gender
Female
305
74.200
-
Male
106
25.800
-
Total
411
100.000
Job group
Clinical
303
73.700
-
Administrative
108
26.300
-
Total
411
100.000
Literacy level
Diploma
16
3.900
-
Under graduate
21
5.100
-
Graduate
274
66.700
-
M.Sc
54
13.100
-
Doctor
46
11.200
-
Total
411
100.000
Age
-
-
36 ± 8.340
Work experience
-
-
11 ± 8.170
Table 2. Mean and standard deviation of the studied variables by hospitals
Variable
Mean ± SD
H1
H2
H3
H4
H5
H6
Total
Autocratic style
3.210 ±
0.490
3.260 ±
0.410
3.280 ±
0.600
3.120 ±
0.600
3.160 ±
0.660
3.440 ±
0.420
3.220 ±
0.540
Participative
style
2.960 ±
0.610
3.130 ±
0.600
3.100 ±
0.760
2.800 ±
0.820
3.140 ±
0.860
3.590 ±
0.520
3.030 ±
0.750
Delegating style
2.810 ±
0.580
2.960 ±
0.590
2.950 ±
0.720
2.670 ±
0.760
2.910 ±
0.810
3.340 ±
0.490
2.870 ±
0.700
Customer
orientation
3.020 ±
0.830
3.640 ±
0.800
3.260 ±
0.750
3.050 ±
0.890
3.200 ±
0.780
3.880 ±
0.430
3.320 ±
0.840
Competitor
orientation
2.750 ±
0.700
2.990 ±
0.890
2.090 ±
0.940
2.670 ±
0.920
2.700 ±
0.850
2.860 ±
0.880
2.800 ±
0.860
Inter-functional
coordination
2.950 ±
0.820
3.190 ±
0.710
3.000 ±
0.790
2.840 ±
0.910
2.900 ±
0.810
3.320 ±
0.760
2.860 ±
0.770
Market
orientation
3.320 ±
0.840
3.310 ±
0.660
3.070 ±
0.750
2.870 ±
0.800
2.950 ±
0.720
3.880 ±
0.560
2.880 ±
0.650
Table 3. Comparison of mean of variables among hospitals
Variable
d.f
F
Sig
Autocratic style
5
1.820
0.108
Participative style
5
5.190
0.001*
Delegating style
5
4.920
0.001*
Customer orientation
5
8.440
0.001*
Competitor orientation
5
1.460
0.201
Inter-functional coordination
5
2.650
0.023*
Market orientation
5
4.710
0.001*
*: Significance at the level 0.05
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Table 4. Regression model of impact of management styles on the level of market orientation of hospitals
LMO
β
Robust Std. Err
t
(95 % conf. interval)
H1
2.170
0.240
9.010
0.000
(1.695, 2.642)
H2
2.280
0.240
9.470
0.000
(1.806, 2.753)
H3
2.200
0.245
8.990
0.000
(1.721, 2.684)
H4
2.180
0.235
9.290
0.000
(1.724, 2.650)
H5
2.170
0.242
8.950
0.000
(1.693, 2.646)
H6
2.230
0.243
9.150
0.000
(1.750, 2.708)
LAU
- 0.060
0.082
- 0.760
0.450
(- 0.223, 0.099)
LPA
0.320
0.106
3.070
0.002
(0.116, 0.534)
LDE
0.220
0.099
2.290
0.023
(0.031, 0.423)
N = 411, F (9, 402) = 16138.500, Prob > F = 0.000, R-squared = 0.996, Root MSE = 0.219
Figure 1. Point- Range chart for management styles and level of market orientation in the studied hospitals
Figure 2. Radar diagram for hospital market orientation dimensions
Discussion
The impact of management styles on hospitals'
degree of market orientation can be a challenging
discussion for scientific literature. As far as we
know, our study is the first research in Iran that
examines the effect of management style on the
degree of market orientation of the hospital. Our
analysis showed that autocratic management is the
dominant style in the studied hospitals. The overall
level of market orientation in the studied hospitals
was below average. However, some of the studied
hospitals had above-average market orientation,
and the difference between the hospitals was
statistically significant. Yaghoubi et al. (21)
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conducted a study in private hospitals in Isfahan
and found that the private hospitals' market
orientation was lower than average. Our findings
also revealed that hospitals were above average
only in terms of customer orientation and the
difference in customer attention between these
centers was statistically significant. As in our
study, the research of Alhayari et al. (22) in one of
the public hospitals of Bushehr also showed that
the axial patient of nurses was above average.
Findings of Golparvar and Nadi's study (23) in
Isfahan medical hospitals also showed that nurses'
customer-oriented behavior was above average.
According to other results of our study, almost all
hospitals were in a weak position concerning
competitor attention, and there was no statistically
significant difference between them in terms of the
central competitor. In the study of Yaghoubi et al.
(21), the studied hospitals scored lower than
average in terms of competitor attention. One of
the reasons for the lack of attention to competitors
in the hospitals studied could be that these centers
have not yet felt the competitive pressure created
in the hospital services market due to their near-
monopoly position. In other words, in these
hospitals, competitors' activity is not regularly
monitored, so they do not react to the movements
of rival hospitals quickly. Neglecting the
movements of competitors can reduce the demand
for services of these hospitals. Rival hospitals try
to attract rich and complementary insured patients
through various strategies such as diversification of
services. It reduces the quality of revenues
generated in public hospitals. Also, the score of
inter-functional coordination in hospitals was
lower than average. However, some hospitals were
above average, and the observed difference
between hospitals was statistically significant. The
low coordination between tasks may be because
the information obtained from the hospital market
may not be shared within hospitals. Employees
of different departments are not involved in
developing strategies for the hospital market boom.
Furthermore, it can be said that maybe not all
activities are integrated to do things better. Weak
market orientation and its dimensions can reduce
their revenue generation by weakening the
performance of hospitals. Various studies have
shown the relationship between market orientation
and hospital performance (24, 25). Mohammadi
(26), in his study in private hospitals in Isfahan,
concludes that market orientation through brand
identity affects hospital performance. Our findings
showed that the management style in the studied
hospitals is more autocratic, and there is no
statistically significant difference between
hospitals in terms of using this style. While in
terms of using participatory and delegating styles,
there was a statistically significant difference
between the studied hospitals. Also, based on the
results, the managers of the studied hospitals use
delegating style less than other styles. Less use of
this style was seen in all studied hospitals. In a
study conducted by Arab et al. (6) in hospitals of
Qom province, authors concluded that the
leadership styles of heads and managers of
hospitals are advisory based on their answers, but
from the point of view of staff, managers and
heads have authoritarian-benevolent styles. In
other words, considering the perspective of
employees, bosses, and managers related to
hospital management, they have less partnership
with staff than they believe. In another study
conducted among nursing managers of teaching
hospitals in Hamadan, researchers concluded that
the leadership style of nursing managers of
hospitals was democratic (27). Amerion et al. (28),
in their study in Tehran hospitals, found that
managers of the studied hospitals have used more
authoritarian-benevolent style. In another study,
Mossadeghrad et al. (29) showed that hospital
managers of Tehran University of Medical
Sciences had used the cooperative style more in
conflict management. The results of Saeedi et al.'s
(30) study showed that most nurses in public and
private hospitals use a relationship-oriented style,
and there is no difference between hospitals in this
regard. Researchers further conclude that in private
and public hospitals in Ahvaz, there is no
autocratic management style. The style that a
manager adopts is based on a combination of
beliefs, ideas, norms, and values. It is impossible to
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offer the same management style for all hospitals
because using a specific management style is a
contingent decision and depends on various factors
such as organizational culture, hospital expertise,
hospital size, and others. In line with these results,
Lejpour et al. (32), in their study, conclude that the
internal characteristics of the organization such as
hierarchy level, managerial orientation towards
tasks and people, decision-making characteristics,
decision-making environment has a positive
relationship with choosing the type of leadership
style. The effectiveness of each style can be
specific to a defined organizational climate and
culture. Our findings also revealed that the
autocratic style has an insignificant reduction in
the level of market orientation of hospitals. While
participatory and delegating styles had a
significant increasing effect on the market
orientation of the studied medical centers.
Abolfazli et al. (10) concluded that companies
with a high degree of market orientation use an
entrepreneurial management style, while
companies with a low degree of entrepreneurship
and market orientation use an administrative and
conservative management style. In their study,
Harris & Ogbonna (11) also found a significant
positive relationship between participatory style
and market orientation. Kohli and Jawarski (9)
showed that the way of thinking of senior
managers and the behavior of managers affects
the spread of market orientation in the
organization. Other studies show that the positive
attitude of senior managers and their emphasis on
the importance of market orientation, their
experience in marketing, their perception of
environmental changes, their level of education,
employee orientation, and risk-taking have a
positive effect on the level of market orientation
of the organization (12-18). Winston and Dadzie
(33) concluded that top managers' emphasis on
market orientation has the greatest impact on
market orientation development. Mohammed et
al. (34) conducted a study on Ghanaian
pharmaceutical companies. Their study showed a
significant positive relationship between senior
managers' emphasis and market orientation, while
senior managers' risk aversion, formality, and
conflict had a significant negative relationship
with market orientation. One of the reasons for
the negative impact of autocratic style on the
market orientation of hospitals may be interpreted
in this way that this style makes change difficult
in the hospital. Since employees are not involved
in decision-making processes, they resist
managers' decisions and the organization's values.
Quality researchers state that service
organizations need to be flexible enough to
respond appropriately to customer needs. To do
this, managers must give employees the minimum
necessary authority. However, the autocratic
management style does not provide employees the
necessary freedom and authority (35). It should
be noted that empirical evidence regarding the
impact of management styles on the market
orientation of organizations such as public
hospitals is minimal, and definitive conclusions
on this subject need further study.
Conclusion
Our study revealed that autocratic management
had been the dominant style in the studied
hospitals, and there is no statistically significant
difference between hospitals in terms of using this
style. While in terms of using participatory and
delegating styles, there was a statistically
significant difference between the studied
hospitals. The overall level of market orientation in
the studied hospitals was below average. However,
some of the studied hospitals had above-average
market orientation, and the difference between the
hospitals was statistically significant. Also, all
hospitals obtained the lowest scores in terms of
competitor orientation. Our findings also revealed
that the autocratic style has an insignificant
reduction effect on the level of market orientation
of hospitals, while participatory and delegating
styles had a significant increasing effect on the
market orientation of the studied medical
centers. To capture the profitable service market,
hospitals must implement a strategic plan against
opponents and reorganize the roles and functions
of employees in order to strengthen market
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orientation. It is suggested that managers be taught
about the techniques and functional benefits of
participative and delegating styles.
Our study had one limitation. Since we could
not obtain data for all hospitals in Qazvin
Province, our findings cannot be generalized to all
hospitals in Qazvin. It is suggested that further
studies examine the impact of ownership and
specialization factors on the relationship between
management style and market orientation of
hospitals.
Acknowledgments
We would like to thank the managers and staff
of the studied hospitals for their participation and
cooperation in this study.
Conflict of interests
The authors declared that there was no conflict
of interests in this study.
Author's contributions
Khosravizadeh O designed research;
Mohammad khani M, Vahdati F, Soheylirad R and
Sarikhani S conducted research; Ahadinezhad B
analyzed data; and wrote the paper. All authors
read and approved the paper.
Funding
Qazvin University of Medical Sciences approved
and funded this study.
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