Satisfaction Is Transactional, Commitment Is Relational

Caring man cupping a red heart in his hands with one hand held protectively over the top in a love, romance and nurturing concept.

What Is Commitment?

It is critical to understand that loyalty and commitment are two different constructs:

  • Loyalty is behavioral (i.e., What you buy)
  • Commitment is emotional (i.e., How you feel about what you buy)

From a marketing perspective, loyalty can be bought while commitment cannot.

A person can be behaviorally loyal to your brand, using it over and over but not be committed emotionally to the brand. These customers are vulnerable to switching because:

  1. The brand experience may falter.
  2. They just don’t care that much about brand choice.
  3. Another brand may come along with a better offer.
  4. No single brand totally satisfies their need-state.

Gaining emotional commitment from, in our case, a patient can lock in behavioral loyalty unless market factors (such as location, insurance, physician referrals, access, etc.) come heavily into play or patients remain committed to multiple brands (i.e., when no one hospital can fulfill all their health needs).

Commitment’s Role

Three key elements of a healthy brand are behavioral loyalty to a brand, emotional commitment to a brand, and environmental factors that impact both loyalty and commitment.

  1. Some people buy a brand out of habit or convenience, for example. While they are behaviorally loyal (buying it again and again), they may not be emotionally committed. This type of brand is vulnerable to environmental forces and competition and even to the customer deciding to try another brand. And, these customers aren’t that concerned if one brand becomes unavailable; they’ll just switch to another. For example, I fill up at the local Marathon gas station because it is most convenient. But if it closed I’d just go to the Mobil station, which is next most convenient.
  2. When people are emotionally committed to a brand they tend to be behaviorally loyal. That is, committed customers tend to purchase more of that product, are more receptive to an offer from the brand, and are advocates of the brand to others. However, people can also be emotionally committed to a brand but not purchase it very much or at all. Price, availability, and need-states are factors that can limit behavioral loyalty even with commitment. For example, I fly both United and Southwest and am perfectly satisfied with the service from both airlines. However, I feel an emotional bond with United that I don’t feel with Southwest. As a result, I give more business to United.
  3. Some brands are successful simply because they are available when others aren’t. Environmental factors (i.e., Market Barriers) tend to have more of an impact on behavior when the brand choice is not that important to people (e.g., low brand commitment). Involvement theory suggests that the more important the choice is, the more time people spend learning about and comparing brands before making a decision. Plus the more important brand choice is the more likely people will be to switch from or try a new brand (even though there may be switching barriers/costs).


Satisfaction Is Transactional

Research has long shown that the traditional ‘overall satisfaction’ measure alone is only a modest predictor of future behavior (e.g., loyalty) because it doesn’t take into account the overall relationship patients have with the brand or environmental factors that can inhibit or promote switching. Essentially, satisfaction is ‘transactional’ while commitment is ‘relational.’

Understanding how emotionally ‘committed’ patients are to a brand and what environmental factors may inhibit or promote change enhances (and better explains) satisfaction’s impact on future behavior. Because satisfied patients sometimes switch and dissatisfied patients sometimes stay, you need to enhance your understanding of what influences your brand’s relationship with its patients.

The chart below illustrates how adding in the element of commitment provides a much clearer picture of the relationship between satisfaction and future loyalty (i.e., likelihood to use again) to a hospital. Satisfaction is most strongly ‘correlated’ with future loyalty when a patient has no emotional connection, good or bad, with that hospital… essentially that last experience or ‘transaction’ is all they can base their intended future loyalty off of. In contrast, when a patient is emotionally connected to that hospital, good or bad, satisfaction’s role in future loyalty is negligible… because the patient has a more vested interested in their relationship with that hospital, a single good or bad experience has little impact on their loyalty.
Klein chart A
Commitment: Two sides of one coin

Attachment (Among Patients)

There are four segments of Attachment among patients. And patients in each segment feel and act very differently. Interestingly, other than age (older tend to be more Attached), these segments look very similar demographically.

  1. Strongly Attached: These are patients who are emotionally bonded (i.e., love your hospital) to only your hospital and your hospital is everything they look for in a hospital (i.e., needs-state fulfilled). This group of patients is most behaviorally loyal to you and they are your greatest advocates.
  2. Somewhat Attached: This segment is “multi-committed” to you. That is, they are emotionally bonded to you but also to another hospital(s). This group finds that that you typically are most of what they look for but they feel a draw to others as well. It’s not that they don’t like you it’s that you can’t fulfill all their needs.
  3. Somewhat Unattached: This segment has no vested emotional bond to any hospital (yours or the competition), making them vulnerable to switching. These patients rely mostly on Market Strengths/Barriers for its hospital choices (i.e., convenience, doctor recommendation, insurer network, etc.). Their doctor is the most important healthcare choice. Across the country, this segment typically takes up about half of a given hospital’s patients. Efforts to reduce the size of this segment should be paramount for any hospital. Furthermore, this is a major reason why hospitals are on the verge of becoming “commodities” or as I call it “death by vanilla.”
  4. Strongly Unattached: This group of patients is more emotionally attached to another hospital and you don’t do a very good job of fulfilling their needs. Essentially, they don’t like you. These folks often choose you because they don’t have adequate alternatives. This group can be called “captive customers.”

Klein chart B

Attraction (Among Non-Patients)

There are four segments of Attraction among non-patients. And non-patients in each segment feel and behave very differently toward your brand.

  1. Strongly Attracted: This segment of non-patients finds your hospital most appealing above all other hospitals. So why didn’t they use you most recently?
  2. Somewhat Attracted: You’re definitely in the consideration set. Your hospital is one of several hospitals that appeals to those who haven’t used them. Although they have positive feelings for your hospital, it is not necessarily their first choice.
  3. Somewhat Unattracted: These folks just didn’t mention you either positively or negatively. They don’t have strong enough feelings/opinions of you (good or bad) to include you in their thought processes. The challenge with this rather large segment is that “commodity” or “death by vanilla” syndrome… how do we get these folks to care?
  4. Strongly Unattracted: These folks find your hospital directly unappealing for whatever reason. They specifically expressed that they are not interested in using your hospital. It may end up being directly related to your brand (e.g., bad experience, heard bad things about you, etc.) or it could be a Market Barrier (e.g., inconveniently located or not in their network, etc.).

Klein chart C

Brand Strength vs. Market Strength

A strong brand creates interest in itself for initial and repeat use and it also has to make sure it is “available” for those who want to use it. That is why strong brands pay attention to the Push/Pull aspects of their brand strategy:

  • Push (aka, Market Strength): Consumer interest (i.e., Attraction) can be undermined if the service is not readily available (i.e., Market Barrier) or some other hurdle gets in the way of interest and actual behavior. For example, without a strong physician relationship, physicians can undermine a brand that consumers are interested in; not being in key insurer networks can cause people to go elsewhere; having locations inconvenient to people can cause them to go elsewhere; and making it hard for patients to get a timely appointment can make them give up.
  • Pull (aka, Brand Strength): A strong brand creates interest in itself through its marketing and communication and experience efforts that make people want to use it (again). Essentially, with this strategy, consumers “pull” the brand through the distribution channel with their interest. …or what Joel English, EVP at bvk, calls “brand craving.”

Why can a weaker brand still lead the market in utilization share…?

Klein chart D


…an example

Let’s look at a real-world example… As Chart E below illustrates, Hospital E is the utilization share leader by a wide margin. But it is a weak brand when it comes to how few non-patients are Attracted to it and in how few patients are Attached to it. In contrast, Hospital A, although not the utilization share leader, is the strongest brand in the market from a commitment standpoint. Something else must be going on.

Look at how high Hospital A’s Market Barriers score is and how low Hospital E’s Market Barriers score is (See Chart D). People are clearly choosing Hospital E because of its Market Strengths (e.g., convenience, physician admitting, insurance network, etc.) not its Brand Strengths. In contrast, people are choosing Hospital A despite its Market Barriers because it is a strong brand to which they are committed.

Commitment’s impact on acquisition and retention…

Klein chart E

Understanding emotional commitment creates a clearer picture of your brand’s (as well as your competitors’) acquisition and retention strengths and weaknesses along with what Market Barriers are getting in the way of growth.

Rob Klein is a recognized expert in healthcare marketing research and brand management.  His focus on staying abreast with developments in healthcare, brand management, commitment, and marketing research ensures information that keeps his customers one step ahead of the competition. 


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