Modern Marketing Management and Customer Experience Through Relationship Marketing: An Empirical Evidence towards Speech Therapy in Health Science Industry Malaysia

Introduction: This study explores the influence of marketing approach on customer experience in speech therapy industry. The respondents were the parents or caregivers of children with communication difficulties, who are receiving speech therapy in therapy centres. The modern marketing management consists of four elements which are People, Process, Program and Performance. The mediating effect of these four elements towards relationship marketing will be also investigated in this study. Methodology: Quantitative method was used to analyze the data collected via questionnaire regarding customer experience. The analysis tool involved are SPSS and Smart PLS. 335 participants are recruited in full study; 46 participants had been recruited in pilot study. Findings: For both pilot study and full study, the Cronbach’s alpha for item in questionnaire are more than 0.7. As a result, this study explores that the Process, Performance and People are, surprisingly, not always influence the Customer Experience. However, finding suggests that both Program and Performance can affect the Relationship Marketing, while Relationship Marketing has significant relationship with Customer Experience. Program has a stronger effect compared to Performance, as Program has direct significance towards Relationship Marketing and also direct significance towards Customer Experience; but Performance itself only have indirect significance towards Customer Experience via Relationship Marketing as mediating factor. Conclusions and Recommendation: In conclusion, this study investigates the efficiency of modern marketing skill towards customer experience through relationship marketing. It is worth for marketers to be fully aware that, by focusing on Program and Performance, it can further speed up the process of building good customer experience in this unique healthcare industry. Future researchers can even replicate this study to study what base the customer experience in different types of speech therapy delivery modes (home visit or online speech therapy) and to adult population who needs speech therapy.


Introduction
In speech therapy profession industry, the supply is getting more and the market is getting mature, resulting high switching behavior among customers. Quite recently, there is increasingly emergence of speech therapist entrepreneurs. To drive growth, speech therapist entrepreneurs have to learn to apply the marketing strategies to achieve the firm performance. Therefore, speech therapy centre is prompted to enhance marketing effort to optimize customer experience and strengthen customer retention.
Modern marketing management includes the element of People, Process, Program and Performance (Booms, 1981) while relationship marketing is the activity of marketing in order to form, generate and sustain successful relationship with customers. With an effective use of relationship marketing, it can assist to widen the customer base, directly increase market profit and then market share.
When a therapist/business owner forms a good relationship with customer/customer's parents, it helps create customer satisfaction (good customer experience) and loyalty. Literature about the impact of relationship marketing is available in general, but studies about relationship marketing in healthcare industry especially fit to this specific work nature of speech therapy are rather limited. Hence, this paper will be focusing on investigate the impact of modern marketing management, quantitatively, with relationship marketing as the mediating factor, towards speech therapy in health science industry Malaysia.

Literature Review
To take a fresh look at the relationship marketing, it is vital to manage multiple contact channels in an integrated fashion so to establish more communications and sales channels, in the market-based relationship marketing; and also, to develop interfunctional organizational solutions to coordinate the relationship exchange, in the network-based relationship marketing (Möller & Aino, 2022). To put these two perspectives into speech therapy industry, relationship marketing appears to be vital to create customer advocacy and brand advocacy, via developing high quality customer-care systems (with special needs population) and also to initiate and develop the strategic partnerships (with other speech therapist, paediatrician and other professionals).

People in Marketing Perspective and its Impact towards Customer Experience
There is a value of people interaction in relationship marketing, impacting the customer relationship positively, to meet both parties' objectives and fulfil both parties promise (Edeling et al., 2021). Compared with traditional marketing mix, modern marketing management prioritized customers. It is customer-oriented marketing strategy instead of push marketing. It strives to maintain long-term relationship with customer, working in customer retention and attracting new customer.
When there is more weight placed on People, it leads to a situation when the transactional point of view is based on the dyadic relationship between customers and the sellers. The way to develop and maintain this relationship is getting more important. Marketers came out many methods to improve customer subsequent satisfaction and buying experience in purchasing the speech therapy service. One-to-one therapy is a must for speech therapy; hence, one-to-one marketing can be done as well after studying individual needs. Another episode is, when parents get to know other parents through an activity hosted by the speech therapy centre, they are designed to meet and share experiences. This environmental influence empowered them and helps with customer retention. Parents are much willing to invest in the relationship with centre providers, happy with the networking platform created and resulting in positive customer experience.

Process in Marketing Perspective and its Impact towards Customer Experience
Traditionally, speech therapist may market his service via physical pamphlets or through name card sharing to increase brand awareness. However, this type of marketing activity is no longer effective considering its high cost and low return. In this era, speech therapist may need to rethink the marketing process, such as engaging in public talk over radio station, or organizing free educational talk in Facebook live, to spread knowledge and reach a wider circle of audience.
Additionally, the mechanism of social exchange employed is quite unique for speech therapy industry. From booking appointment to discharge the cases, the marketing perspective are fundamentally different from the mechanism employed in other industry such as information technology, hotel management, food and beverage industry. It seems like a dividing line is critical to differentiate the therapy itself and the marketing itself, but the contents in both areas can be overlapping. Hence, the integration of marketing element into the therapy process seemed to be adding value to the customer experience.

Program in Marketing Perspective and its Impact towards Customer Experience
Some speech therapy centre will adopt Corporate Social Responsibility (CSR), to stimulate favourable response from the customer. When marketer involves in CSR, the marketing capability will be enhanced, mediating towards the customer responses (Kankam-kwarteng et al., 2022). In marketing literature review, behavioural responses have strong linkage with the consumer buying behaviour (Akhtar, Sun, Akhtar & Chen, 2019).
Even though there is conservative attitude toward marketing in professional service, digital marketing is considered in speech therapy industry, where client can understand about the speech therapy program via online communication. Through a good marketing on knowledgeintensive program, it provides a pathway for customer to approach the service provider. Once it is compatible, the customer will get to know the professional service by the employee and improve his customer experience.

Performance in marketing perspective and its impact towards customer experience
Relationship marketing program is likely to evolve when it matures, especially it involves the performance of the marketing. Multiple decisions get involved, originated from both parties who engaging actively and passively at different stages of relationship marketing. These decisions may refer to termination, modification, enhancement or continuation of the relationship engagement. When the relationship performance is highly satisfying, the relationship marketing will evolve into a better direction. The customer is more motivated to continue engaging in the relationship marketing program. However, if the relationship performance is way below what customer expected, customer may choose to stop or alter the relationship.
Traditionally, the customers will get to know speech therapist's background and therapy approach, but nowadays, customers tend to rely on social recommendations from parent's support group or social media review rating to look for professionals, especially there are growing speech therapists fight for attention. The field became much competitive. The number of clicks of advert in website considered as one of the performance indicators of marketing. With those new indicators, it can enhance the customer experience.

How relationship marketing influencing customer experience
Relationship marketing can happen at any point in the marketing process; it is not just at the point of first line customer service front desk. For instance, modern marketing management works on People element, heightened effort in satisfying customers' needs, clients feel appreciated and happy to receive customized offerings; while relationship marketing lowers the marketing costs and smoothens the process. When relationship marketing is built up via the 4Ps of modern marketing management, the firm-client relationship is strengthened.
Customers nowadays are much more aware of their rights and more opinionated. The suggested blueprint to promote optimized customer experience is via three steps: learn, create and do (Marutschke, Gournelos, & Ray, 2019). Customer emotion can determine the value of service by either driving it or destroying it (Hsieh & Yuan, 2021). This will affect relationship between customer and the organization.

Mediating effect of modern marketing management towards relationship marketing
When marketer focus on improving the People, Process, Program and Performance elements, this indirectly facilitate the relationship marketing. Other than commitment on clinician/therapist-customer relationship, a proper relationship marketing can be formed via pouring commitment into firm-customer relationship. The bonding is strengthened at three levels, which are first, financial; second, social; third, structural bonds (Siebert et al., 2020).
As speech therapy centre can also be founded by speech therapist himself, the marketing orientation can led to entrepreneurial success (Dzogbenuku & Keelson, 2019). Therapist aspires to do better than the competitors, contact clients regularly to understand their needs and always stay at the top for changing market needs. When therapist takes on the marketing role, he has much chances to collect the market data and share with his stakeholders, increasing the information dissemination, in order to achieve the entrepreneurial success.

Research Methodology
Data collection will be conducted via distributing and collecting questionnaires to 335 respondents, who are the receivers of speech therapy service. Customer experience is measured using the adapted scale (Garg et al., 2014). With a 5-point Likert scales, ranging from 1 (strongly disagree) to 5 (strongly agree), the data will be recorded. Data will be analysed using Statistically Package for Social Science (SPSS) Version 18.0 and Smart PLS. Correlation analysis will be used to identify the correlation between the independent variables (i.e., modern marketing management), mediating variable and dependent variables (i.e., customer experience).
This study presents a framework which involves the relationship among independent variable, mediating variable and dependent variable. There are four independent variables, which are the People, Process, Program and Performance (elements of Modern Marketing management). The mediating variable is Relationship Marketing, while there is only one dependent variable, which is the Customer Experience, specifically in speech therapy industry. The research framework is illustrated in Figure 1.

Results
From the demographic characteristic shown in this research, 65.1% of respondents were female. 68.4% of respondents are at age of 31 to 40 years old. 66.3% of respondents are Degree holders. 27.5% of respondents are professionals, 59.1% of respondents have average monthly income of RM4,850 to RM10,959. 82.1% of respondents attended speech therapy centre in Kuala Lumpur; 49.6% of respondents attended speech therapy between 1 to 2 years.  Out of the initial 5 items for process and 5 items were used for final analysis. Out of the initial 12 items for program and 12 items were used for final analysis. As for the performance, all of the 7 items were used for final analysis. Out of the 5 items in relationship marketing and all 5 items were used for final analysis. Out of the initial 8 items in customer experience and 8 items were used for final analysis.

Reliability
The analysis of this questionnaire in this study has Cronbach's alpha value of more than 0.7 for all 46 items in the scale. In fact, the scale had value of 0.877. The composite reliability value is ranging from 0.796 to 0.907. Besides, as figured by PLS algorithms, the factor loading is ranging from 0.726 to 0.846; all above 0.5. Hence, the research instrument was deemed to be reliable based on the alpha statistic.

Validity Convergent Validity
The factor loadings of items surpassed the 0.5 thresholds as the least factor loading is 0.726. Data can be said to be good as the variable with the least composite reliability value is 0.818 which is more than the recommended cut-off value of 0.5. Average Variance Extracted (AVE) for the seven scales ranged from 0.37 being the least to 0.509 being the highest. Therefore, it is clear that all the constructs met the three criteria of determining convergent validity.

Discriminant Validity
For each construct, all indicator values exceeded the cross loading values of all other constructs and their indicators. 0.509 All the AVE of the construct loads higher than 0.5. Based on these findings, this indicates that there was no discriminant validity issue and each construct is unique. Equally, all the diagonal components are fundamentally higher than the off-diagonal values in relating rows and columns. The inclining components are the square root of the AVE score for each construct. Hence, it can be submitted that each construct is unique when it is compared with the other constructs in the study, thereby indicating that all the constructs do not have problems as far as discriminant validity is concerned. It is obvious that there is no discriminant validity problem because the outer loading on the associated construct is greater than all of its loadings on the other constructs. Equally, the Heterotrait-Monotrait (HTMT) criterion also shows that there is no discriminant validity problem.

Structural Model
Partial Least Squares-Structural Equation Modeling (PLS-SEM) was utilised for the second phase of the analysis and Smart PLS 3.2.4 is the chosen software. No collinearity issue There is no issue of collinearity in the structural model of this study as each of the construct has a VIF value less than 5.00 which is the threshold value for determining the existence or non-existence of collinearity issues.  127 People with an f² value of 0.002, process has an f² value of 0.014, program has an f² value of 0.050, performance has an f² value of 0.577, relationship marketing has f² value of 0.127 and customer experience has an f² value of 0.127. These results indicate that if no construct was omitted it would have no effect on the endogenous latent variable.

Assessing the predictive Relevance of Q 2 Effect
To determine the Q² effect, the researcher conducted the blindfolding procedure by utilising the default exclusion separation of 7 in SmartPLS. Blindfolding as explained by Hair et al. (2014a:201) refers to "a sample reuse technique that omits part of the data matrix and uses the model estimates to predict the omitted part". As a rule of thumb, values that are bigger than zero for any particular endogenous latent variable demonstrate the path model's prescient significance. The coefficient of determination, R 2 , is 0.583 for the Customer experience endogenous latent variable. This means that the five latent variables (People, Process, Program, performance and relationship marketing moderately explain 58.3%% of the variance in Customer Experience. We can also see in the figure that People, Process, Program and Performance together explain 63.1 % of the variance of relationship marketing. The inner model suggests that relationship marketing has the strongest effect on customer experience (0.378).

First Direct Relationship Hypotheses Testing
The path coefficients from people to customer experience is 0.034 with t-value of 0.431 which is significant at p > 0.000. This means that that there is a negative relationship between people and customer experience. The path coefficients from process to customer experience is 0.143 with t-value of 1.96 which is significant at p>0.000. This indicates that there is negative relationship between process and customer experience. On the other hand, the path coefficients from program to customer experience is 0.342 with t-value of 4.413 which is significant at p>0.000. This indicates that there is positive relationship between program and customer experience. The path coefficients from performance to customer experience is 0.323 with t-value of 5.9 which is significant at p>0.000. This indicates that there is positive relationship between performance and customer experience.

Second Direct Relationship Hypotheses Testing
The path coefficients from relationship marketing to customer experience ; and process and relationship marketing , is -0.022 and 0.080 with t-value of 0.320 and 0.963 which are not significant. There is negative relationship between people and relationship marketing; between process and relationship marketing. The path coefficients from program to relationship marketing; and performance and relationship marketing , is 0.193 and 0.617 with t-value of 2.264 and 10.785 which are significant. There is positive relationship between program and relationship marketing; performance and relationship marketing.

Indirect Relationship Hypotheses Testing (Mediating)
The path coefficients from relationship marketing to customer experience is 0.701 with tvalue of 15.541 which is significant at p > 0.000. This means that that there is a negative relationship between relationship marketing and customer experience. 378 GFI ought to be somewhere around 0 and 1 where 1 demonstrates an impeccable fit. The prescribed model fit cutoff quality is 0.9 (Gefen, et al., 2000). For this study the GOF is 0.607. Consequently, it is obvious that the model for this study is fit.

There is no Significance between People and Customer Experience
The literature review from Medberg & Grönroos (2020) have a difference from current study especially in terms of service type. That study narrows to specifically retail banking industry, where customers are emphasizing value-in-use. However, in rehabilitation world, which speed of recovery takes time, and customer may perceive the people elements in a different way compared to the customer in retail banking. The service loop will repeatedly happen and can only generated the good customer experience with many episodes of good program rather than people element.

There is no Significance between Process and Customer Experience
Taking the service path in speech therapy service (Varonen, 2020) for example, when the client do not engages in the pre-core service encounter but engage well in the core service, he still can generate pleasant customer experience even though the process is not complete. That can be explained by core service is the most important area in whole service encounter, that it can offset the limitation occurred in pre-core service and post-core service categories.

There is Significance between Program and Customer Experience
According to previous literature review done by Kankam-kwarteng et al (2022), speech therapy centre that adopt corporate social responsibility (CSR) enhances its marketing capability and thus mediating the customer responses. A program that is well-designed to a special needs child takes a long time and energy, not just in terms of designing but also in terms of implementing and adjusting. This creates pleasant customer experience (Andreason, 2002).

There is no Significance between Performance and Customer Experience
In customer perspective in speech therapy, they may focus much on the clinical outcome rather than the marketing performance outcome. The study done by Mulyana, Hendar, Moch, & Alifah (2020) indicates that there is impact of performance on customer service, however there is cultural difference compared to the current study. Other than that, that study is working on religo-centric relational marketing strategy which is different from the relationship marketing adopted in the current study.
There is negative relationship between people and relationship marketing; between process and relationship marketing. There is positive relationship between program and relationship marketing; performance and relationship marketing.
The way researcher explains about this study findings of lack of mediating significance between people towards relationship marketing is, the clinician/therapist-customer relationship bonding may not facilitate the effectiveness of relationship marketing. The program is the core service and with parental training, parents can get what is the most important and is primary at the first place. Amount of manpower and people element in marketing perspective such as the number of actor present in the socially-drive ecosystem (Lipkin & Heinonen, 2021) deemed like the secondary to the parents. Eagerness of parents sending child for early language intervention may also encourage them to turn oblivious to the location of the centre, despite how far is it. Program itself can mediate the Relationship Marketing. The quality of the program is the most essential element that parents go for and fight for in the speech therapy service pathway. The selection of good program is extremely vital for building the Relationship Marketing, considering the marketing is built on the success of the program that fits to the child and satisfies the needs of the cases. The presence of customer does not contribute to customer experience, as shown in this study; however, the presence of customer in the centre can mediate the relationship marketing. the customer experience does not depend on the outcome of discussion; despite the findings of discussion, customer experience is not altered; but the process of discussion can definitely assist in promoting building of relationship marketing. This explains why the Performance has mediating effect towards the Relationship Marketing.

Conclusion
In conclusion, this study investigates the modern marketing skill and relationship marketing strategy to improve customer experience, using the quantitative method. Even though this research contributes new finding to the speech therapy field, there is limitation of study found as shown below, that should bear in mind by readers when interpreting this study findings: In this research, it uses a small sample size. Sample is only restricted to Kuala Lumpur and Selangor, Malaysia. The item for construct included in the questionnaire was adapted from previous articles. Type of speech therapy delivery is only restricted to centre visit speech therapy. It is using quantitative methodology.
Other than that, it warrants future researchers' attention to consider alternate study methodology, be it quantitative or qualitative, to enhance relationship marketing and to improve the customer experience.mThe questionnaire adopted in this study is using the items used in previous study. In future study, there is possibility to come out with new questionnaire in the similar area, or using the current questionnaire to investigate different areas in speech therapy marketing field.