IJEBA: International Journal of Economic, Business and Applications

p-ISSN: 2477-1244, e-ISSN: 2477-1236

DOI: https://dx.doi.org/10.31258/ijeba.5.2.25-44
Received: Sebtember 2020; Accepted: November 2020

The Effect of Brand Image and Service Quality on Purchase Decision With Word
of Mouth as Mediation Variable at Prof. Dr. Tabrani Hospital Pekanbaru

Ririn Agustin
Susi Hendriani And Syapsan
Faculty of Economics and Business Riau University, Pekanbaru, Indonesia
[email protected]

Abstract: This study aims to examine the effect of brand image and service quality
on purchase decision with word of mouth as mediation variable. The study was
conducted in Prof. Dr. Tabrani Hospital in Pekanbaru. The data used consist of
primary and secondary data. Data were collected by using questionnaires that given
to 120 patients of Prof. Dr. Tabrani Hospital in Pekanbaru that used purposive
sampling. Descriptive analysis method is used to describe the characteristics of
respondents and the research hypotheses by using relevant statistical tests. The
focus study are brand image and service quality as independent variable, patient
decision as dependent variable and word of mouth as mediation variable. Analyser
used is path analysis by using program of SPSS 21 for windows. These results find
that brand image and service quality have a direct influence significantly and positive
on word of mouth, brand image and service quality have a direct influence significantly
and positive on patient decision. In additon, word of mouth has a positive mediation
role on the influence of brand image on purchase decision and word of mouth has a
positive mediation role on the influence of service quality on patient decision. The
improvement of brand image and service quality are recommended in order to
optimize patient decision.

Keywords : Brand Image, Service Quality, Purchase Decision and Word of Mouth

INTRODUCTION

Health industry is one of the businesses that provides profitable opportunities given
the high competition and fast growth in line with the rapidly developing times. Moreover,
Indonesia is a country with the fourth largest population in the world after China, India and
the United States, which also make the need for health services more than other countries.
However, the potential for the health industry in Indonesia is still not running optimally
because the number of quality health facilities still has disparities between
regions(Trisnantoro & Prabowo, 2019).
The existence of hospitals in Indonesia is grouped into public hospitals and private
hospitals where the growth of public hospitals is not as good as the growth of private
hospitals. The average growth of public hospitals during 2012 to 2018 was only around
0.4%, while private hospitals grew by 15.3%. The number of hospitals throughout
Indonesia until 2018 was 2,813 units (Trisnantoro & Listyani, 2018).
Hospitals in Riau province are among the ones that have experienced significant
developments. In Riau Province, there are 73 hospitals in each area, of which 31 units are

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in the city of Pekanbaru. A total of 26 hospitals in Pekanbaru city are private
hospitals(Trisnantoro & Listyani, 2018). However, no private hospital in the city of
Pekanbaru has won the predicate class A, even though 4 hospitals already have a B
predicate, and 1 hospital has a class D predicate and about 22 hospitals or r 85% of
hospitals in Pekanbaru are still in the predicate class. C. There are 11 class C hospitals in
Pekanbaru city, of which are general hospitals and the rest are specialist hospitals.
One of the hospitals in Pekanbaru that can be an option for the community is Prof.
Dr. Tabrani Hospital that has been engaged in the health industry for a long time. But
unfortunately this hospital has not received much attention from the community where the
title of this hospital is still class C. However, some hospitals with the same class predicate
are more chosen by the community when they need their health services.
This is in line with the data regarding the number of general patients who directly
choose this hospital as their choice for treatment even though without receiving fees from
companies or insurance, which is decreasing every year, while referral patients are
increasing every year, as can be seen in the following graph.1 :

Graph 1. Development of General Patients and Referrals at Prof. Dr Tabrani

Hospital Pekanbaru for 2017 – 2019 period

6000
4.886
4000 3.968 4.352

2000
501 419 340
0
2017 2018 2019

General Patient Referral Patient

Source: Prof. Dr. Tabrani Hospital, 2020.

Graph. 1 above shows that the number of general patients at Prof. Dr. Tabrani has
decreased every year, which indicates that the community's decision to choose this
hospital for treatment is getting lower. This is inversely proportional to the number of
referral patients which is increasing every year.
The factor that influences a patient's decision in choosing a hospital for treatment
is word of mouth (WOM) which can be interpreted as communication made by consumers
who have made purchases and then tell their experiences related to these products /
services to others, so that indirectly the consumers have do promotions that can make
other consumers interested in listening to these conversations (Rosen, 2012).
If the WOM method is implemented properly, the public will find out more
information about Prof. Dr. Tabrani Hospital. This information can be in the form of
recommendations, praise and public views of Prof. Dr. Tabrani Hospital. The information
obtained by the community will become a reference for the community itself in choosing
Prof. Dr. Tabrani Hospital as an option for treatment. Thus, WOM can improve patient
decisions in choosing these hospitals.
The factors that can influence the patient's decision in choosing a hospital and
implementing the WOM method are brand image. The image of the hospital influences the
patient's decision whether they will enjoy the health services that the hospital provides.
The image of the hospital has a function as a liaison and guardian of harmony in their
relationship with their customers(Wu, 2011).Therefore, a good hospital brand image is
expected to influence consumer attitudes and behavior, especially in terms of the patient's
decision process in choosing a hospital. The existence of a good and positive brand image

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will make it easier for consumers to take promotional actions by word of mouth / WOM to
others, so that the patient's decision to choose this hospital will increase.
The quality of service and the implementation of the WOM method are other factors
that can influence a patient's decision to choose a hospital. Service quality is simply about
a measure of how well the level of service provided is able to meet customer expectation
(Fandy & Chandra, 2011). The better the quality of service provided, the higher the
customer satisfaction with the company, which causes the higher the decision to choose
from customers.
The high level of customer satisfaction as a result of better service quality will make
it easier for consumers to promote these products / services to others through the WOM
method. Providing and improving the quality of services for patients will provide special
benefits for the hospital, because with this, the patient will feel confident and confident in
the hospital's ability which in turn will make the patient recommend the related hospital to
other people and still choose the hospital as their health facility (Nugraha et al., 2017).
Based on the background described above, the formulation of the research
problem is as follows: 1) is there any effect of brand image on word of mouth? 2) is there
any effect of service quality on word of mouth? 3) is there any effect of brand image on
patients' decision to choose the hospital? 4) is there any effect of service quality on the
patients' decision to choose the hospital? 5) is there any effect of word of mouth on the
patients' decision to choose the hospital? 6) is there any effect of brand image on the
patients' decision to choose the hospital through word of mouth? and 7) is there any effect
of service quality on the patients' decision to choose the hospital through word of mouth?
Based on the problem formulation described previously, the objectives to be
achieved from this study are as follows: 1) empirically analise the effect of brand image on
word of mouth, 2) empirically analise the effect of service quality on word of mouth, 3)
empirically analise the effect brand image on the patients' decision to choose the hospital,
4) empirically analise the effect of service quality on tthe patients' decision to choose the
hospital, 5) empirically analise the effect of word of mouth on the patients' decision to
choose the hospital, 6) empirically analise the effect of brand image on the patients'
decision to choose the hospital through word of mouth and 7) analise empiricall, the effect
of service quality on the patients' decision to choose the hospital through word of mouth.

THEORETICAL FRAMEWORK

Purchase Decision
A purchase decision is a person's attitude to buy or use a product in the form of
goods or services that are believed to satisfy him and his willingness to bear the risks that
may result. Purchasing decisions taken by buyers are actually a collection of a number of
organized decisions (Kodu, 2013).
The processes before and after purchasing a product, namely (Kotler & Keller,
2012):
1. Problem Recognition
2. Information Source
3. Alternative Evaluation
4. Purchase Decision
5. Post-Purchase Evaluation
There are four internal factors that are relevant to the consumer decision-making
process, namely(Kotler & Keller, 2012):
1. Motivation
2. Perception
3. Attitude Formation
4. Integration

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Word of Mouth

Word of mouth is the whole communication from person to person about a

particular product, service or company at a time.(Rosen, 2012).
Most of the communication between humans is word of mouth. Every day everyone
talks with each other, exchanges ideas, exchanges information, makes comments and
other communication processes. Maybe in fact consumer knowledge of various kinds of
product brands is more due to word of mouth communication which is actually very
beneficial for producers, especially producers who rarely do promotions and lack in
communicating their products to consumers due to limited costs making it difficult to reach
more consumers area(Sutisna, 2010). The indicators of Word Of Mouth are as follows
(Neni Rambe dkk, 2017) :
1. Personal Experience
2. Provide Information
3. Promote Excellence
4. Give a Recommendation

Brand Image

Images of a company will be formed within a certain period of time because this is
the accumulation of perceptions of an object, what is thought, known, experienced which
enters one's memory based on inputs from various sources over time (Kotler & Keller,
2009).
According to Sutisna in Kurniawan et al., (2018), there are several benefits of brand
image, namely:
1. Consumers who have a positive brand image towards the products are more likely to
make purchases
2. Companies can develop product lines by utilizing the positive image that has been
formed towards old product brands.
3. Family branding and leverage branding policies can be implemented if the existing
product brand image is positive.
The indicators of Brand Image are as follows(Putro et al., 2016):
1. Strategic Location
2. General Services
3. Reputation
4. Health Services
5. Good impression

Service Quality

Service quality is simple, which is a measure of how good the level of service
provided is in accordance with customer expectations, meaning that the quality of service
is determined by the ability of a particular company or institution to meet needs in
accordance with what is expected and what is desired based on customer / visitor
needs(Fandy & Chandra, 2011).
The benefits of service quality include (Fandy & Chandra, 2011):
1. Great customer loyalty
2. Bigger market share
3. Higher stock prices
4. The selling price of the product / service is higher
5. Products of greater vitality

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 The indicators of service quality are as follows (Putro et al., 2016):
1. Good service
2. Appearance of administrative officers
3. Administrative procedures
4. Clear information
5. Complete facilities

Conceptual Framework

Brand image variables shape consumer perceptions in choosing to use certain

products / services. A positive brand image will give a good impression to consumers and
form consumer confidence to continue using the products / services of the brand.
Consumers who have trusted in a brand will form a sense of love for the brand itself. The
love that consumers have will influence consumers to recommend the brand to others, so
that the brand image can positively influence WOM. The value of a good brand image can
also increase the decision to choose consumers to use these products / services.
Information that is done by word of mouth is felt to be more real and honest than
information from an advertisement. Therefore, consumer purchasing decisions will be
better for the brand image when the WOM action occurs.
The service quality variable shows how good the service capability provided by the
company to consumers is, the better the service provided will provide a higher sense of
satisfaction to consumers. The high level of customer satisfaction caused by excellent
service quality will provide benefits for the company. Consumers will easily promote word
of mouth because they are satisfied with the services provided by the company.
Consumers will provide recommendations to others regarding the company's products so
that it will influence the level of consumer decisions to buy / use products / services offered
by the company
Based on the explanation above, a research model can be made as follows:

Purchase
Decision

Service
Quality

Figure 1.Research Model

METHODOLOGY

Population and Sample

The population in this study were patients who had been treated at Prof. Dr.
Tabrani hospital Pekanbaru. The sampling technique used was purposive sampling
technique, which is a sample selection technique with certain criteria.
The determination of the number of samples in this study was carried out using the
Hair formula approach. Based on the formula above, the number of samples that can be

29
taken from the population was 120 respondents or patients at Prof. Dr. Tabrani hospital
Pekanbaru.

Types and Sources of Data

In this study, two types of data were used, namely 1) qualitative data, which was
obtained through interviews and literature on theories related to writing research, 2)
quantitative data, namely numerical data or qualitative data which was then made in the
form of scoring.
There are two types of data sources used to support this research, namely 1)
primary data, obtained by distributing questionnaires which are directly given to patients
at Prof. Dr. Tabrani Pekanbaru and 2) secondary data, namely data related to patient age,
patient education level, occupation, type of financing, gender, length of treatment and
other required data.

Method of data collection

The data collection method used in this study was a questionnaire method. The
questionnaire is a number of formal questions written in writing aimed at obtaining
information from respondents (Simamora, 2004). The questionnaire used in this study is
an open question and uses a Likert scale which gives respondents the opportunity to
express their feelings in the form of an agreement or agreement on a question.

Operational Definition of Variables

The operational definition of a variable is a definition of a variable that is formulated

based on the observable characteristics of these variables (Azwar, 2007). The variables
used by the author in this study are:
1. Exogenous variables or independent variables are variables that cause the occurrence
or influence of endogenous variables. The exogenous variables used in this study were
brand image (X1) and service quality (X2).
2. Endogenous variable (endogenous variable) or dependent variable is a variable whose
value is influenced by exogenous variables. Endogenous variables used in this study
are word of mouth (Y1) and purchase decisions (Y2).

Data Analysis Method

Test of Research Instruments

Validity Test

The validity test is used to measure whether a questionnaire is valid or not. The
questionnaire is said to be valid if the questions on the questionnaire are able to reveal
something that will be measured by the questionnaire.

Reliability Test

The reliability test is intended to test the extent to which the measurement results
remain consistent if two or more measurements are made of the same symptoms with the
same measuring instrument later.

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Path Analysis

Path analysis is the use of regression analysis to estimate the causal relationship
between variables that have been determined based on theory (Ghozali, 2013).Path
analysis aims to explain the direct and indirect effects of a set of measured (parametric)
variables with one intervening variable. The regression equation can be formulated as
follows:
WOM = ρy1x1BI + ρy1x2KL + ρy1ε1 ….. (Structural 1)
KP = ρy2x1BI + ρy2x2KL + ρy2y1WOM + ρy2ε2 …. (Structural 2)

where:
KM = Purchase Decision
WOM = Word of Mouth
BI = Brand Image
KL = Service Quality
ρ = Unstandardized Coefficients and Coefficients
ε = Error

Classic Assumption Test

Normality test

The normality test aims to determine whether the distribution of a data follows or
approaches the normal distribution. The test criteria in the normality test is if the
significance value (Sig.)> 0.05, then it shows that the data is normally distributed (Santoso,
2017).

Heteroscedasticity Test

The heteroscedasticity test aims to test whether in a regression model, there is an

inequality of the residual variance from one observation to another (Ghozali, 2006).
Heteroscedasticity test can be done using the Glejser test, if the significance value of each
variable is greater than the 5% confidence level. (0.05), then it means that there is an
indication that heteroscedasticity does not occur, and vice versa.

Autocorrelation Test

The autocorrelation test aims to test whether in the linear regression model there
is a correlation between confounding error in the period and confounding error in the
previous period (Santoso, 2017).

Multicollinearity Test

The multicollinearity test serves to test the correlation between independent

variables (Santoso, 2017). A good regression model should not have a correlation
between the independent variables.

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F Stastistical Test

The F statistical test is used to determine whether the independent variables

simultaneously or together have a significant effect on the dependent variable. If the value
is sig. <0.05 and F count> F table, it shows that simultaneously the independent variables
have a significant effect on the dependent variable.

T Statistical Test

The t statistical test basically shows how far the influence of one independent
variable individually in explaining the variation of the dependent variable partially or
respectively. If sig. > 0.05, it means that the model is rejected or it can be interpreted that
the independent variable individually does not affect the dependent variable.

Sobel Test

This is used to test the partial significance of the indirect effect (testing the
mediation hypothesis) partiallu. The sobel test is done by testing the strength of the indirect
effect of the independent variable (X) on the dependent variable (Y 2) through the
intervening variable (Y1).

Determination Coefficient Test (R2)

This test is used to measure how far the model's ability to explain the variation in
the dependent variable. The coefficient of determination is between zero and one. The
value (R2) is small or close to zero, meaning that the ability of the independent variables
to explain the variation in the dependent variable is very limited.

RESEARCH RESULTS

Descriptive Analysis
Tests on the research results obtained from the spread were carried out to obtain
the structural path analysis equation. The following is a complete description of the results
of the questionnaire distribution of the variable indicators used.

Table 1. Descriptive Analysis Results

Variable Average Category

Brand Image 3,37 Poor
Service Quality 3,36 Poor
Word of Mouth 3,30 Poor
Purchase 3,37 Poor
Decision
Source:Processed Data, 2020.

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Classical Assumption Test Results

Normality test

The results of the normality test in this study can be seen in Figure 2 below:

Table 2. Normality Test Results

The First Stroke The Second Stroke
Unstand.Residual Unstand.
Residual
N 120 120
Normal Parametersa,b Mean .0000000 .0000000
Std. 1.88134914 1.93483748
Deviation
Most Extreme Absolute .062 .062
Differences Positive .062 .060
Negative -.042 -.062
Test Statistic .062 .062
Asymp. Sig. (2-tailed) .200c,d .200c,d
Source: Processed Data, 2020.

From Table 2 it can be seen that from the results of the Kolmogorov Smirnov test,
the significance value obtained in each model is 0.200> 0.05, so it means that the path
model in this study fulfills the assumption of normality.

Heteroscedasticity Test

The results of the heteroscedasticity test in this study can be seen in Figure 3
below:

Figure 3. Heteroscedasticity Test Results

Purchase Decision

Source: Processed Data, 2020.

From the picture above, it can be seen that the points spread above and below the
number 0 on the Y axis. Thus, it can be decided that the path model in this study is free
from heterocedasticity symptoms.

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Autocorrelation Test

The results of the autocorrelation test in this study can be seen in table 3 below:
Table 3. Autocorrelation Test Results

First Structural

Second Structural

Source:Processed Data, 2020.

Based on table 3, the DW value obtained in the first structural is 1.987. The dU and
4-dU values obtained were 1.736 and 2.264, respectively. While in the second structural,
the DW value is 2.017 with dU value of 1.754 and 4-dU value of 2.246. Therefore, it can
be concluded that the path model in this study is free from autocorrelation symptoms.

Multicollinearity Test

The multicollinearity test results in this study can be seen in table 4 below:
Table 4. Multicollinearity Test Results.

First Structural First Structural

Service Service
Quality Quality

Purchase Decision

Source: Processed Data, 2020.

From table 4, it can be seen that the tolerance value for all variables in the two
models obtained is greater than 0.1 and VIF less than 10. It means thatthat there is no
multicollinearity in this research path model.

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Overall Results of Path Analysis

To see the path analysis for the entire model, each sub-structural test is described
as follows:
Table 5. First Sub Structural Regression Test Results

Service
Quality

Source: Data Processed, 2020.

Table 6. Second Sub-Structural Regression Test Results

Service
Quality

Source:Data processed, 2020.

Based on the test results in tables 5 and 6, an overall path diagram image can be made
as follows:

Purchase
Decision

Service
Quality

Figure 2.
Overall Results of Path Analysis
Source: Processed Results, 2020.

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Mediation Effect Detection Test

It is used to find out whether the relationship through a mediating variable is

significantly capable of acting as a mediator for the independent variable and the
dependent variable. The implementation of this test is as follow:

The Effect of Brand Image on Purchase Decision Through Word of Mouth

Purchase Decision

Figure 3. The First Mediator Model

Source:Processed data, 2020.

The model above is a model that is formed from the results of the first regression
to form a path analysis model with the word of mouth variable as the mediator. The z value
of the sobel test cannot be generated directly from the fixed regression results with manual
calculations using the sobel test formula. The results of the calculation of the z value from
the sobel test obtained the z value on the sobel test of 4.787, thus it is known that the z
value (4.787)> t table (1.965) which means that brand image has a significant effect on
the decision to choose through word of mouth.

The Effect of Service Quality on Purchase Decision Through the Word of Mouth

Service Quality Purchase Decision

Figure 4. Second Mediator Model

Source: Processed Results, 2020.

The model above is a model that is formed from the results of the first regression
which then forms a path analysis model with the word of mouth variable as the mediator.
The z value of the sobel test cannot be generated directly from the fixed regression results
with manual calculations using the sobel test formula. The z value obtained from the
calculation of the z value on the sobel test is 5.061. Thus it can be said that the value of z

36
(5.061)> t table (1.965) which means that service quality has a significant effect on the
decision to choose through word of mouth.

The coefficient of determination (R2)

Analysis of the coefficient of determination is used to determine the percentage

contribution of the influence of exogenous variables on endogenous variables as in the
following table:

Table 9. The Effect of Brand Image and Service Quality on Word Of Mouth

Sumber: Processed Results, 2020.

Tabel 10. The Effect of Brand Image and Service Quality On Purchase Decision

Source: Processed Results, 2020.

From table 9 above, it is known that the R2 value obtained is 0.652 or 65.2%. These
results indicate that 65.2% of word of mouth variables are influenced by brand image and
service quality, while the remaining 34.8% is influenced by other variables not included in
this study. Furthermore, table 10 above shows that the R 2 value is 0.831 or 83.1%, which
means that 83.1% of the variable choosing decision is influenced by brand image, service
quality and word of mouth and the remaining 16.9% is influenced by other variables which
were not included in this study.
Meanwhile, the results of the path analysis shows that the total coefficient of
determination R2 is 0.941, which means that 94.1% of the research model was influenced
by the variables used in this study, while the remaining 5.9% (100% - 94.1%) is influenced
by other variables.

Hypotheses Testing

The Effect of Brand Image on the Word of Mouth

The test results in table 5 show that the path coefficient for the brand image variable
on word of mouth is 0.397 and the significance level obtained is 0.000 or smaller than the
alpha level of 0.05. Therefore, it can be concluded that brand image has a significant effect
on word of mouth so that H1 is accepted.

The Effect of Service Quality on the Word of Mouth

The test results in table 5 show that the path coefficient for the variable service
quality to word of mouth is 0.497 with the significance level obtained is 0.000 or smaller
than the alpha level of 0.05. Therefore it can be concluded that service quality has a
significant effect on word of mouth so that H2 is accepted.

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The Effect of Brand Image on Purchase Decision

The test results in table 6 show that the path coefficient for the brand image variable
on the decision to choose is 0.213 with a significance level of 0.000 or less than the alpha
level of 0.05. Therefore, it can be concluded that brand image has a significant effect on
the decision to choose so that H3is accepted.

The Effect of Service Quality on Purchase Decision

The test results in table 6 show that the path coefficient for the service quality
variable on the decision to choose is 0.220 and the significance is 0.000 or less than the
alpha level of 0.05, so it can be concluded that service quality has a significant effect on
the decision to choose or H4 is accepted.

The Effect of Word of Mouth on Purchase Decision

The test results in table 6 show that the path coefficient for the word of mouth
variable on the decision to choose is 0.567 with a significance level of 0.000 or less than
the alpha level of 0.05, so it can be concluded that word of mouth has a significant effect
on the decision to choose or H5 is accepted.

The Effect of Brand Image on Puchase Decision Through Word of Mouth

The results of the previous sobel test calculation obtained a z value of 4.787 or
greater than the t table value (1.965) with a significance level of 5%, which means that
word of mouth is able to mediate the relationship between the influence of brand image on
the decision to choose or H6 is accepted.

The Effect of Service Quality on Purchase Decision Through the Word of Mouth

The results of the previous sobel test calculation obtained a z value of 5.061 or
greater than the t table value (1.965) with a significance level of 5%, which means that
word of mouth is able to mediate the effect of service quality on the decision to choose so
that H7 is accepted.

DISCUSSION

The Effect of Brand Image on the Word of Mouth

Based on the test results, it shows that brand image has an effect on word of
mouth. This shows that the brand image of Prof. hospital. Dr. Tabrani Pekanbaru will shape
the patient's perception of the hospital where the patient will consider a good health service
if many people who visit using this hospital services have the same opinion as him.
A positive and good brand image that is embedded in the patient's mind will make
the patient voluntarily promote the hospital by word of mouth. Patients will tell various
pleasant experiences, the superiority of the hospital and other positive things they got
during their treatment at Prof. Dr. Tabrani hospital Pekanbaru. Therefore, it can be said
that the better the brand image, the higher the possibility of the patient or someone to take
word of mouth action.

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 The results of this study are supported by research conducted by Ahdah (2015)
and Steven(2020) which proved that brand image has a significant effect on word of mouth.

The Effect of Service Quality on the Word of Mouth

Based on the test results, it shows that service quality has an effect on word of
mouth. This shows that the better the level of service provided by Prof. Dr. Tabrani hospital
Pekanbaru will influence patients to take word of mouth action.
Prof. Dr. Tabrani hospital Pekanbaru in this case needs to pay attention to the
quality of services they provided to patients and the community where they must improve
their services both in terms of physical appearance and the content of the information they
convey. The better the quality of service provided by the hospital, the more happy patients
will be when they need treatment at the hospital. Patients who feel comfortable and safe
to seek treatment in the hospital which will make patients voluntarily carry out word of
mouth promotion actions.
The results of this study are supported by research conducted by Wahyudi & Artanti
(2014) andDharmawan & Hidayat (2018) which showed that service quality has a
significant effect on word of mouth..

The Effect of Brand Image on Purchase Decision

Based on the test results, it shows that brand image affects the decision to choose.
This indicates that the brand image of Prof. Dr. Tabrani hospita; Pekanbaru that is positive
and kind will create a good perception in the patient's mind. Patients will assume a brand
image that gives them a positive and good impression will give them added value if they
choose the hospital for treatment, so that it will influence the patient's decision to choose
this hospital.
Hospital brand image that is still considered not giving a positive impression to
patients should be of particular concern to hospital management. Hospitals need to
improve their reputation by getting closer to the public and better understanding what
patients want. Such a good reputation will be embedded in the minds of patients so that
they will prefer to return to this hospital for treatment when needed.
The results of this study are supported by research conducted byNurochani &
Mulyana (2017) and Wulanda et al., (2019) which also proved that brand image has a
significant effect on the decision to choose.

The Effect of Service Quality on Purchase Decision

Based on the test results, it shows that service quality affects the decision to
choose. This shows that the better the level of service provided by Prof. Dr. Tabrani
hospital Pekanbaru, it will influence patients to re-choose this hospital as their main choice
in treatment when needed.
The quality of service reflects how big the gap is between expectations and reality
received by patients regarding services in the hospital. In other words, the bigger the gap,
the farther expectations are below reality, and vice versa. Prof. Dr. Tabrani hospital
Pekanbaru in this case needs to close this gap that is too big so that the quality of service
they can provide will be equal to what the patient wants. The better quality of service
provided by the hospital will increase the patient's desire to return to treatment at this
hospital which in turn makes the patient's decision to choose this hospital higher.
The results of this study are supported by research conducted byAdabi (2020) and
Amrullah et al., (2016) which both show that service quality has a significant effect on the
choosing decision.

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The Effect of Word of Mouth on Purchase Decision

Based on the test results, it is known that word of mouth has an effect on choice
decisions. This shows that the higher the word of mouth done by patients, it will indirectly
help hospitals in terms of promotion. The public will learn more about the advantages of
the hospital which led to their decision to choose Prof. Dr. Tabrani hospital Pekanbaru is
getting higher. Prof. Dr. Tabrani hospital Pekanbaru must be able to show its superiority
compared to other hospitals and be able to provide a pleasant experience for patients so
that patients will voluntarily share their experiences with treatment and the advantages of
the hospital to others. This will make many people know the positive side of Prof. Dr.
Tabrani hospital Pekanbaru, so that they will be more confident in choosing this hospital
for treatment. Therefore, a well-implemented WOM method can improve patient decisions
in choosing this hospital.

The results of this study are supported by research conducted by Putri & Hastini
(2019) and Alvionita (2017) which show that word of mouth has a significant effect on
Choosing decision.

The Effect of Brand Image on Purchase Decision Through Word of Mouth

Based on the test results, information was obtained that brand image affects
choosing decision through word of mouth. This shows that the word of mouth method used
by patients will affect the level of their perception of the hospital brand image on their
choice of decisions at this hospital. As the patient's decision to choose this hospital is
increasing, it is necessary to pay attention to the extent of the word of mouth method that
the patient will do, considering that more and more patients are promoting word of mouth
about the excellence of the hospital, it will make the hospital brand image positive which
ultimately makes the patient's decision to choose this hospital increases.
Prof. Dr. Tabrani hospital Pekanbaru must give a good impression to the patient
so that it creates a feeling of comfortable for the hospital. If the patient has that kind of
feeling for the hospital and also gets good service, then the consumer will has the desire
to continue to use the product / service. This feeling will influence consumers in
recommending the hospital to others.
The word of mouth information obtained from patients who have a love for the
hospital will be more real and honest than information from an advertisement. Word of
mouth occurs naturally from the experience a consumer gets for a product and comes from
one's own mind when someone has a love for the product. Therefore, the existence of this
word of mouth method will affect the relationship of brand image to the decision to choose
at this hospital.
The results of this study are supported by research conducted by Riyanto et al.,
(2019) andNaufal & Maftukhah (2017) where both show that brand image has a significant
effect on the choice decision through word of mouth.

The Effect of Service Quality on Purchase Decision Through the Word of Mouth

Based on the test results, it is known that service quality affects the decision to
choose through word of mouth. This shows that the more often patients use the word of
mouth method, the higher the level of service provided by Prof. Dr. Tabrani hospital
Pekanbaru which will ultimately influence the patient's decision to choose this hospital.
The better quality of service provided by the hospital will increase the patient's
desire to return to treatment at this hospital which will cause the patient's decision to
choose this hospital to be higher. The better the quality of service, the higher the customer
satisfaction with the company which causes the higher the customer's decision in choosing
this hospital.

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 The high level of customer satisfaction caused by the good quality of service will
make it easier for patients to promote the hospital to other people through word of mouth.
Therefore, by providing and improving the quality of services to patients, basically this will
provide its own benefits for the hospital because patients will feel confident and confident
in the hospital's ability which will eventually make patients recommend the hospital.The
results of this study are supported by research conducted by Nihlah et al., (2018) which
also shows that service quality has a significant effect on patient decisions in choosing a
hospital through word of mouth..

CONCLUSION AND SUGGESTION

Conclusion

1) Brand image has an effect on word of mouth which shows that the brand image of Prof.
Dr. Tabrani hospital Pekanbaru will shape the patient's perception of the hospital where
the patient will think that a health service is good if many people who also visit this
hospital have the same opinion.
2) The quality of service affects word of mouth, which shows that the better the level of
service provided by Prof. Dr. Tabrani hospital Pekanbaru, it will influence patients to take
word of mouth action.
3) Brand image affects the decision to choose. This indicates that a positive and good
brand image from Prof. Dr. Tabrani hospital Pekanbaru will also create a good
perception in patients. Patients will assume that if a brand image can give them a
positive and good impression, then they will have plus value when they choose the
hospital for treatment, so that the brand image can be said have an effect to influence
the patient's decision to choose a hospital.
4) Service quality affects the patients' decision to choose the hospital. This shows that the
better the level of service provided by Prof. Dr. Tabrani hospital Pekanbaru, it will
influence patients to comeback to thishospital as their main choice when they need
treatment.
5) Word of mouth affects the patient's decision in choosing a hospital, which indicates that
the higher the word of mouth is done by the patient, it will indirectly help the hospital in
terms of promotion. Thus the public will increasingly know more about the advantages
of this hospital so that their decision to choose Prof. Dr. Tabrani hospital Pekanbaru is
getting higher.
6) Brand image affects the decision to choose through word of mouth. This shows that the
word of mouth method used by patients will affect the level of patient perception related
to the hospital brand image on the patients' decision to choose this hospital.
7) The quality of service affects the patients' decision to choose this hospital through word
of mouth. This shows that the more often patients use the word of mouth method, the
higher the level of service provided by Prof. Dr. Tabrani hospital Pekanbaru which will
ultimately influence the patient's decision to choose this hospital

Limitations

1) This study only used brand image and service quality in determining the word of mouth
method and the decision to choose. Therefore, further researchers can try to use other
variables in determining word of mouth and purchase decision, for example the variable
promotion, uniqueness and ease felt by consumers. In addition, further researchers can
also use control variables so that more optimal results can be given.
2) The focus of thus study was only on one object, namely the hospital. For future
researchers, it is hoped that other research objects can be used such as state-owned /
government / private / other non-service companies so that they can provide different
and more interesting research results.

41
Suggestion

1) Prof. Dr. Tabrani Hospital Pekanbaru is expected to provide greater benefits to patients
and can form good and positive values so as to increase the patient's desire to do word
of mouth, which of course will have a positive impact on the patient's decision so that he
will seek treatment again at this hospital.
2) The results of this study are expected can be used to increase knowledge and enrich
information about the condition of Prof. Dr. Tabrani Hospital Pekanbaru which may be
taken into consideration when choosing health services.
3) The results obtained from this study are also expected can become a reading material
and guidelines for the academic world and further researchers to add insight and
knowledge about the variables studied.

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