Comparative Study of Branding in Iranian Public Hospitals and Some other Public Hospitals in Selected Countries

1Department of Health Care Administration, College of Medical Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran. 2Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran. 3School of Management and Medical Information Services, Iran University of Medical Sciences, Tehran, Iran. 4Department of Health Care Administration, College of Medical Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran.

In today's competitive world all organizations such as health care organizations are paying greater attention to providing products and services with unique quality and in compliance with customers' needs.In fact, in order to survive, organizations must inevitably adapt themselves with global situations and market utility 1 .
Growing health care expenses, less control over selection, lower service quality and patient satisfaction and big changes in health culture and healthcare system are among the challenges hospitals face in Iran.Therefore, it is necessary for them to revise the ways services are provided and modify their business structure in order to adapt with changes.To achieve long term success it is definitely essential to recognize present situation and unique stable condition of hospitals.More than anything, creating and transferring positive changes, having stable emotional relationships with patients and their families is important.Meanwhile, these challenges are suitable opportunities for hospitals to create a powerful brand for themselves and attract more customers 2 .
Most of the non trading organizations and centers like hospitals and health care centers are not positive about marketing and branding and some even say it's opposed to professional ethics.This is rooted in lack of knowledge about marketing concepts and branding.Hospitals and other health care centers are strongly in need of an effective marketing plan.In contrary, they just analyze target market in final stages of services production.In other words, marketing and brand improvement is not merely advertisement but is meeting customer needs and requirements in an organized way 3 .
Brand bridges the gap between organization output and fame and customers needs and investors hopes 4 .Powerful brands help organizations to have independent valuable identity in related market and to be less vulnerable tocompetitive activities, earn more profit and have more chance of improving their brand 5 .A powerful brand is a way for reducing customer challenges in choosing service provider 6 .
Successful hospital brands increases confidence in intangible services and customers can clearly imagine and recognize their services.Also a high level of special brand value increases the level of customer satisfaction, repeated visits and level of loyalty 7 .
In recent years distinguishing service philosophy in health care services is rapidly turning into the last wave of change.In this regard, service systems like hospitals especially private hospitals around the world; have taken effective steps in implementing this kind of thinking.The goal of using and implementing this philosophy is patient attraction, satisfaction and confidence.In Iran public hospitals pay less attention to branding.
Recognizing successful experiences of public hospital around the world can open the door to laying the ground for branding in public hospitals.Thus the present study aims at conducting an adaptive study of branding variables in public hospitals in selective countries.

Research Method
This study is a practical research which is conducted in adaptive-descriptive way.Data was gathered through library research about how hospital branding has been done in different public hospitals around the world.Therefore, the study population includes public hospitals which have been branding.Researchers picked 8 public hospitals from 8 countries using experts and specialists advice.

Findings
Subject public hospitalshave done branding and were successful in this field.According to the studies, mainly in these hospitals objective efforts have been done for improving strong points, outcomes and titles earned by hospital.For example York hospital in England introduced itself as the first rank for the highest reception rate in the region, the best service provider in the region and candidate of many prizes, and also focuses on having skilled doctors and qualified personnel.Another example is Alberta children's hospital in Canada.This hospital is a brand in city planning and a leading center for providing services in the geographic region 8 this hospital publishes accurate financial audits and annual reports 9 .This hospital also has the highest rate of activity in emergency department in the region 10 .Thus the above mentioned hospitals − Implementing new health care model for higher demanding groups in a geographic region − Establish a weblog for executive team − Supporting personnel against violence − Providing consultancy services to alcoholics according to regional demand − Providing consultancy to alcohol users according to regional demand − Doing basic key researches − Improving and developing educational activities  Regarding competitive positioningSeoul National University Hospital from South Korea did a series of actions including doing research with other industries, setting up different health campaigns with other organizations, international partnerships with hospitals around the globe, using modern equipments and moving towards being a smart hospital [11][12][13][14] .Chris Hani Baragwanath Hospital in South Africa developed AIDS treatment services regarding the need of the region 15 .The hospital cooperates with public sector in the form of public-private partnership 16 and has used charity helps from other organizations for improving different sectors as a way of improving hospital services 17 .Baragwanath has also designed and implemented strategic plans 18 .
Each of the subject hospitals use a strategy for hospital branding like Cork University Hospital in Ireland.Cork University hospital implementsthese strategies: comprehensive medical and surgery evaluations 19 , providing services with different insurance schemes 20 , reducing risk plan 21 ,and advanced infectious control plan as the first active hospital in this field in Ireland 22 .Xuzhou Central Hospital in China has also implemented similar strategies like: providing services with 3 visits policy after clearance in order to develop follow up activities among patients, providing extra services like transfer to hospital, daily care at home and so forth, preparing VIP for special patients like organization managers and famous people, physicians must necessarily provide specialized consultation to active specialized groups in villages through educational programs [23][24] .
Preserving brand positioning among customers and in the market as the effective factor in hospital branding, relates to improving the relationship between brand and customers and market.This has been in focus in conducting research on subject hospitals.Among them Fiona Stanley Hospital in Australia provides patient oriented services 25 .In Fiona Stanleypatient feedback paths have been introduced and patient are more satisfied with unique services and environment of the hospital (this hospital is designed in nature) 26 .In Middlemore Hospital in New Zealand some healthcare action processes have been designed 27 and free transportation services are available for patients 28 .
Shahid Hashemi Nezhad public hospital as a brand hospital in the specific field of kidney and urinary tracts and ShahidrRajaei hospital in Tehran as the brand hospital in cardiovascular disease have conducted interventions for being distinguished or that is to say branding.For example, ShahidHashemiNezhad hospital has introduced gained glories and credits, attracted experienced personnel and famous physicians, officials have visited leading hospitals over the boarders, they have had successful experiences, the hospital has also completed the service providing chain with partnerships of private sector, and prepared a treatment program before admission which continous after the clearance and such acts.So the brand is more valid [29] [30] [31].ShahidRajaei hospital in Tehran has been recognized as one of ten cardiology centers Inthe world and provides integrative services to patients, develops subspecialty servicesfor children, has created health tourism department and diplomat department for foreigner patients and government officials, doing more than 10 heart implant annually and sending physicians and personnel to national and international scientific events, having modern medical equipments and continuously improve brand services [32][33] .
Summary of subject hospital actions regarding subject variables are presented in table 1 (adaptive table of subject variables in selective hospitals).

DISCUSSION
Findings of the present research shows that the subject hospitals know the benefits of branding for attracting more patients and increasing credit and fame and consider planned actions for hospital branding.Therefore, they believe in brand positioning and try to increase their market share through brand image positioning.Subject hospitals lay the ground for customer confidence through introducing their skills, strong points and outcomes so that customers choose them relying on concrete measures.Helen et al., reached similar results and emphasized that "strong hospital brands severely increase the need for intangible products and it's more likely that customers buy their product, visit again or be loyal to them.Thus, recently hospital brand image has turned into an important factor for comparing hospitals by customers 7 .
Success of branding projects among public hospitals relies on competitive ability.Hospitals tendency towards offering distinguished quality and according to customers' needs helps them be superior and valuable among customers.This also increases personality and serf confidence 34 .In subject hospitals in the present study competitive policies have been observed, which are a way of improving the level of performance and service acceptance 35 .Seoul National University also uses international partnership with other countries hospitals as a competitive policy because "change and adaption of services with new circumstances and needs is one of the reasons a brand lives a long life compared with competitors 36 .Yassin, Nour and Mohammad concluded that competitive activities leads the organization to more profit and chances for developing brand and this confirms the importance of competitive positioning of the brand 5 .
Brand strategy improves the organization brand with recognizing customer favorableness and unique identity for the services and products and this Way brings value for the customer and identity for the organization 37 .Nafisi (1388) stated that most of health care organizations have limited experiences in developed branding strategy.The reason is less knowledge regarding the brand and its role in general organizational strategy 36 .In subject hospitals branding strategies are used for developing services magnitude and improving quality and using innovation.According to Sorayaei and Mehraei, following correct branding strategies, leads to organization positioning in the market 38 .Thus, subject hospitals tried to improve their brand using branding strategies.
Desired relationship of the organization with customer is a solution for long term customer satisfaction it even starts before direct contact with the customer and continues after the contact 35 .In subject hospitals the relationship of the brand with customers is made with electronic media networks and advertisement also having effective behavioral relationship and customer desired services.In their study Kim Kim and Kong suggested that customer relationship is one of the suitable ways for growth and improvement and increasing the value of the brand.To do so Service departments try to make a relationship with customers and make a positive image for them through the effects of services on customers' perception.Also for increasing loyalty to brand and brand value and in order to meet customers' needs in hospital service sector, relationship marketing activities can be used to increase customers' benefits 39 .Sirishia, Babo and Kishor believe that branding in health care system and hospitals relies on patients' experiences of the hospital and word of mouth marketing.They believe that customers are hospitals ambassadors.Thus, accelerating hospital buildings in India resulted in branding for hospitals and health care system by health care providers 40 .
Having the native situation of our country in mind and considering the actions of selective hospitals in developing hospital branding, using their experiences in Iran and regulating and resolution of policies and principle, it is suggested to look for branding strategy.

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Designing healthcare action processes for patients − Setting up the first care unit for heart attack patients in New Zealand − Providing free transportation services − Having a complaint assessment office − Providing religious volunteer services − Presence of the hospital in social networks University tal Ireland Introducing the hospital as the biggest educational hospital in Ireland − Locating in center of the city as a strategic location − Introducing hospital as a narcotic free hospital − Among the leading hospitals of continental plan for clinical audit of deaths cases − Updating heart related services − Attending alcohol use researches according to regional demand − Improving breast cancer screening plan according to regional demand in Ireland − Increasing radiation oncology services according to regional demand − The only first rate trauma service provider in Ireland − Partnership with private sector in providing services − Providing services to patients with different insurance programs − Regular plan for improving service quality through patient satisfaction evaluation studies − The leading hospital in providing nursing education − Advanced plan for controlling infectious disease as the first active hospital in this field in Ireland − Setting up and developing national mother infant health management − Integrative medical and surgery plan − Providing wireless services related to telecommunication − Stating the glories and certificates acquired by the hospital − Welcoming and inviting different medias for sending reports from hospitals − Publishing most important events, reporting hospital activities and expenses data in hospital magazine − Try to be the role model hospital for local and regional hospitals − Leading in implementing submitted plans by organizations and superior organizations − Introducing hospital as the leading hospital in providing charity services specially paying attention to WHO plans − Providing services with 3 visits after clearance for follow up − Providing extra services like transportation to the hospital, daily care and so forth.− Setting up non communicable disease campaigns to attract more patients − Asking physicians to provide specific consultancy services to active specialist groups in villages trough educational plan − Creating VIP departments for specific patients like organizational managers and famous people Developing communication with patients and other stakeholders with the hospital − Healthcare planning for patients before admission to after clearance − Enriching the culture of respecting patients and inducing healthcare personalization according to patients features − Planning continuous studies for patient satisfaction evaluation − Reducing the waiting time for patients expecting services Alberta ildren's ospital anada Introducing the hospital as the leading center of providing services in the geographic region − Introducing past, present and future plans using the time capsule idea − Reporting and accurate financial audit and publishing annual reports − Partnership and developing volunteer plans by the hospital − Improving brain and nerve services for children − Setting up scientific conference − Installation of advanced medical equipment − Welcoming innovative ideas and plans through using suitable communication ways − Attracting financial resources through setting up sport plans and so forth.− Using colors and internal designs along with playground for children − Planning for family oriented services − Forming a unit for supporting patients and charity plans − Implementing cultural plans in hospital including shows, music and forth.− Selling products with hospital brand like Tshirt − Considering accommodation for patient relatives − Providing wireless internet, computer, video games and renting lap top to patients − Dedicating parking to patient families − Preserving privacy and safety for patients and families Fiona tanley ospital ustralia One of the biggest hospitals in the geographic region in Australia − Asset strategic management in the hospital − Providing third level services the best way possible − Designing the hospital in a natural landscape as a bonus for the hospital − Outsourcing support services and sometimes clinical by the hospital − Setting up conferences and meetings with medical organizations and universities in the field of research − Designing hospital based on energy efficiency standard as the 4 star hospital − Practical synergy with private sector with proximity − Forming service providing network with other hospitals in the geographic region − Providing clinical support to other hospitals and service providers − Providing patient oriented services − Separate emergency department for children and adults − Personnel's' respective behavior with patients as a principle − Introducing patient feedback ways − Considering entrance lobby for patients dHashem Nezhad ospital Stating glories and certificates of the hospital − Considering slogan for advertisement − Publishing articles and attending different congresses in order to improve scientific aspect of the hospital − Welcoming and inviting different medias for introducing to hospital − Establishing clinical development research center − Planning to be a role model hospital among other hospitals − Visiting the leading hospitals around the globe and gain valuable experiences − Forming partnerships with private sector in private and public framework − Completing the providing services chain in partnership with private sector − Implementing specific plans to attract human resources and preserving them − Taking part in sport and cultural programs to introduce the hospital better − Using color and designs for different departments − Creating specific departments for special patients − Providing services after clearance in order to develop follow up for patients − Creating a communication network with customers through Email, SMS and telephone.− Creating and implementing patient glorification in different stages of providing services − Creating a your voice department for more contact with patients − Providing free welfare services for dialysis patients according to the demand in the country − Creating a communication line for hospitalized patients to answer religious needs.dRajaeiCa gy tal One of ten biggest cardiology hospitals in the world − Scientific hub of cardiovascular disease in the country − Doing more than 10 heart implantation annually.− Gaining certificates and high rankings − Providing specific services to government officials Creating health tourism department − Creating 4 research centers in one center and creating a knowledge based company − Hospital independency in attracting resources (independent budget row) − Having modern diagnosis medical equipments − Publishing 3 specific heart journals − Cooperating with Iran heart charity foundation − Setting up a genetic laboratory − Supporting practical research − Evaluating providing services and continuously improve the quality of the services − Developing sub specialty services for children according to the demand − Publishing magazine to inform patients and provide them with more information − Forming a customer communication unit − Visual and audio educations through media of heart hub of Iran in hospital site − Psychology clinic for educating and consulting patients before hospitalization, also for educating their supporter, hospitalized patients, free visitors and personnel.

Table 1 .
Summary of adaptive research results of effective components on branding in selective hospitals made a move for branding.