Critical Success Factors and Performance of Business Operations in Malaysian Healthcare Industry

This research study explores the relationship between critical success factors and business performance of US based service providers in the Malaysian healthcare industry. It also examines the moderating role of intercultural competence in this relationship. The study aims to identify the most pertinent critical success factors for the healthcare industry, dimensions of intercultural competence of US multinational healthcare firms, and dimensions of business performance. The research questions and hypotheses are presented, along with the research model and operational definitions of variables. The study uses a quantitative moderation model and questionnaires for data collection.

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CRITICAL SUCCESS FACTORS AND PERFORMANCE OF BUSINESS OPERATIONS OF
A US BASED SERVICE PROVIDER IN THE MALAYSIAN HEALTHCARE INDUSTRY:
THE MODERATING ROLE OF INTERCULTURAL COMPETENCE
Research Methodology
Research Framework and Variables
Background
This section arrives at and presents a research framework to relate and test the relationship
between the Critical success factors (CSFs) and Business Performance of US based service
providers in the Malaysian healthcare Industry according to the review of literature. As per the
literature reviewed, the Intercultural Competence (ICC) has been found to have a possible
moderating effect on the critical success factors and business performance, which needs to be
tested. Johnson et al. (2006) observed that many international or multinational business failures
had been ascribed to a lack of cross-cultural competence. As per Lertxundi & Rodriguez
(2011), there is a significant effect of intercultural competence factors or context as a moderating
variable between the critical success factors like high performance work systems and business
performance within the context of Multinational enterprises. Intercultural competence as inverse
concept of cultural distance has also been found to be moderating the relationship between
critical success factor namely knowledge transfer and performance of the multinational company
in overseas location (Qin et al., 2017). ICC or intercultural competence is vector of constructs
which has a bundled relationship with business performance and has been measured through
different scales spanning over various research works (Messner, 2015; Washington et al., 2012).
This is indicative of the fact that intercultural competence can play a significant role in
critical success factors specific to the healthcare industry as well (Duavrin & Lorant, 2015);

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(Anand & Lahiri, 2009). Thus, the proposed research framework studies the relationship as
moderated by the Intercultural competence (ICC), within the context of the performance of US
based multinational healthcare firms in Malaysia. Boynton and Zmud (1984), in their seminal
work, defined critical success factors (CSFs) as – “those few things that must go well to ensure
success for a manager or an organization, and therefore they represent those managerial or
enterprise areas, which must be given special and continual attention to bring about high
performance. CSFs include issues vital to an organization’s current operating activities and to its
future success.” This definition is indicative of the fact that critical success factors are a set of
factors, which can be very specific to an organization or types of organizations, or in other words
to an industry. This implies that CSFs vary with the organizational context and industry and thus,
can be seen as a bundle of factors, as related to the organizational performance, rather than
individually.
Variables
As also indicated by the research framework background discussed above, the variables of
this study include Business performance (BP), which is the dependent variable in the study and
the CSF vector or set/bundle of critical success factors pertinent to Health Insurance Industry
(CSFHI), which is the independent variable affecting the business performance of multinational
firms critically. Finally, there is Inter cultural competence (ICC), which is the intercultural
competence of the individual employees in the multinational firms and is being studied as a
moderating variable affecting the relationship between MBP and CSFHI.
Research Model
Based on the review of literature and the appraisal of the relationships being studied
between the variables, the following conceptual model of the moderation effect of the

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Intercultural Competence (ICC) on the relationship between critical success factors pertinent to
healthcare industry firms (CSFsHI) and the Business Performance (BP) is presented in Figure 1
below (Fairchild & MacKinnon, 2009).
Figure 1: Conceptual model of US healthcare firms’ Business performance in Malaysia
Research Questions
Based on the research background and the conceptual model, the following research
questions for the present study are proposed herewith:
1. What are the most pertinent critical success factors for the healthcare industry as
applicable to multinational US firms operating in Malaysia?
Critical
Success
Factors –
Healthcare
Industry
Business
Performance
of Healthcare
Firms
Intercultural
competence of
the firms
US Healthcare Firms in Malaysia

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2. What are the most important dimensions of Intercultural competence (ICC) of the US
multinational healthcare firms operating in Malaysia?
3. What are the most important dimensions of business performance of US multinational
firms operating in Malaysia?
4. What is the relationship between the Critical success Factors (CSFs) and Business
Performance (BP) of multinational US firms operating in Malaysia?
5. How is the relationship between CSFs and BP of the US multinational firms operating in
Malaysia, affected by the Intercultural competence of the firms?
Hypotheses for quantitative study
Based on the research background, research questions and the conceptual model, the
following hypotheses are proposed for the quantitative study under this research:
H01: There is no statistically significant positive relationship between the Critical Success
Factors (CSFs) and Business Performance (BP) of Multinational US firms operating in Malaysia.
Ha1: There is a statistically significant positive relationship between the Critical Success Factors
(CSFs) and Business Performance (BP) of Multinational US firms operating in Malaysia.
H02: There is no statistically significant positive relationship between the Intercultural
Competence (ICC) and Business Performance (BP) of Multinational US firms operating in
Malaysia.
Ha2: There is a statistically significant positive relationship between the Intercultural
Competence (ICC) and Business Performance (BP) of Multinational US firms operating in
Malaysia.

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H03: The Intercultural Competence (ICC) of US Multinational firms operating in Malaysia does
not moderate the relationship of between their Critical Success Factors (CSFs) and Business
Performance (BP) in a statistically significant way.
Ha3: The Intercultural Competence (ICC) of US Multinational firms operating in Malaysia
moderates the relationship of between their Critical Success Factors (CSFs) and Business
Performance (BP) in a statistically significant way.
Operational Definitions of Variables
Business Performance (BP): Business Performance is the performance of a firm in business
terms. In this study, the Business Performance is being measured in a multinational or global
business context. The construct is measured on an ordinal scale of 1 to 6 through a Business
Performance questionnaire scale adapted from that developed by (Joubert et al., 2004). The
construct is measured on the four performance dimensions namely business growth, profitability,
image and customer loyalty, and product service innovativeness. The scale consists of 12 items,
wherein items BP1 through BP9 are assertive statements seeking endorsement of participants
over performance of the respective multinational firm with respect to competitors. The items
BP10 through BP12 are questions seeking the frequency of occurrence of certain events
reflective of internal processes determining the performance of the business (Harwell, 2011).
Intercultural Competence (ICC): Intercultural competence is the composite set of three
abilities of individuals to accomplish their goals or in this case the business or organizational
objectives in terms of facilitating intercultural effectiveness, namely the ability to deal with
psychological stress, the ability to effectively communicate and to establish interpersonal
relationships. Further, the ICC construct is measured through the scale adapted from the
measuring existent intercultural effectiveness (MICE) scale developed by Messner (2015). The

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scale items were measured on a Likert Scale ranging from (1) Strongly Disagree to (6) Strongly
Agree.
Critical Success Factors pertinent to Healthcare Industry (CSFHI): Critical success factors
pertinent to healthcare industry are the bundle of critical success factors, as defined above, which
are applicable to the healthcare industry. This is a vector of unique factors, which will be studied
as a single variable. A semi-structured questionnaire will be prepared to measure the variable.
The same will measured on the following ten dimensions or critical success factors pertinent to
the healthcare industry mentioned as follows (Becker's Hospital Review, 2014):
1. Indispensability: The healthcare firm has made itself indispensable in the perception of
its patients as well as other stakeholders with respect to its services and facilities as
packaged together, which is not possible to get around.
2. Reinvent patient experience: The healthcare firm is perceived to have achieved a positive
transformation in the way the patients experience the healthcare service.
3. New revenue cycle: The healthcare firm is capable and has developed a new revenue
cycle based on diversification and differentiation of its services.
4. Diversified and Integrated Specialization: The firm has a proven specialization, which is
optimized and aligned to the physicians’ capabilities as well as patient needs.
5. Mindset of well-being: The firm has demonstrated a mindset and policy of perceived
well-being of patients.
6. New horizons: The healthcare firm is expanding the patient care beyond the immediate
physician centered and acute-hospital related care and delivery of services and moving
towards advanced technology based care such as smart healthcare.

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7. Embedded innovation: Innovation and change embedded in policy making and day to day
functioning.
8. Leveraging new technology: The healthcare firm has a demonstrated ability to leverage
new technology to improve patient experience.
9. Transformational leadership: The firm has a leadership, which is able to foresee the
changes in the business and organizational environment and accordingly steer and adapt
the organization to better performance through course correction.
10. Responsible and Accountable: Overall the firm exhibits a culture of responsibility and
accountability for their actions directed to the patients and the interests of the
stakeholders.
Quantitative Moderation Model
This research will test the moderation effect of Intercultural Competence (ICC) on the
relationship between the predictor variable that is the critical success factors (CSFs) and the
outcome variable that is the Business Performance (BP) of the US healthcare firms operating in
Malaysia as per the conceptual model, research hypotheses and operational definitions of the
variables. In order to achieve the same, a quantitative regression moderation model has been
employed (Fairchild & MacKinnon, 2009; Jackson, 2012). The moderation model tests whether
the prediction of a dependent variable Y, from an independent variable X, differs across the
levels of a third variable Z. The moderator variables impact the strength and/or the orientation or
direction of the relation between the predictor and outcome variables. The moderation effect is
tested with multiple regression analysis and is represented through a general multiple regression
of the form:
Y = a + β1X + β2Z + β3XZ + e

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Where, β1 is the coefficient which relates the independent variable X to the outcome Y, when Z
= 0, β2 is the coefficient relating the moderator variable Z with the outcome when X=0, a is the
intercept in the equation and e is the residual error in the equation (Fairchild & MacKinnon,
2009).
In this case,
Y= BP
X=CSFHI
Z = ICC,
Therefore, the general equation model for this study is as follows:
BP = a + β1 x CSFHI + β2 x ICC + β3 x CSFHI x ICC + e
Research Tools/Questionnaire Design
The research has been conducted through suitably designed questionnaires. The
questionnaires were designed to measure the variables of the study on the semantic/ordinal scales
as mentioned in the operational definitions of the variables. The questionnaire set (see appendix)
consists of variable scales, of which the scale for ICC has been adapted from the pre-existing
MICE scale by Messner (2015); the ICC scale has been adapted from that by Joubert et al.
(2004), whereas, the scale for CSFHI has been developed as part of the study. The questionnaires
were administered via email. The respondents were asked fill the questionnaire and return them
on the specified email ID.

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Sampling Method
The sample size was arrived at through power analysis in G*power software, which is
shown in figure 2. As per the analysis, the optimal sample size arrived at was 73, which was
approximated to 70 (Piasta & Justice, 2017).

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Figure 2: A priori power analysis for calculation of sample size
The sampling method followed in this study was mixed methods sampling. Firstly, a
convenient sample of ten US based multinational healthcare firms was selected. From these ten
firms, samples of seven managerial/supervisory employees each were randomly selected, making
an effective sample size of 70, however, we sent questionnaires to 75 respondents to take care of
possible attrition. A prior written permission from the management was received. The
respondents were given one week to fill and submit the questionnaire. 72 responses were
received out of which, two rejected due to incomplete information. Thus, finally, 70 responses
were considered for analysis (Broeck et al., 2005; McReady, 2017).
Results, Analysis & Interpretation
Results & Analysis
Descriptive Statistics
The exhibit 1 shows the descriptive statistics for the data collected for the variables of the
study. As can be seen from the exhibit, the mean, median and mode scores of business
performance (mean=3.65, median=4, mode=4) of the US healthcare firms operating in Malaysia
have reported an above average performance, especially with respect to their closest competitors.
Interestingly, these companies or firms are operating in slightly different segments of the
healthcare industry and thus, can be deemed to be performing reasonably well in their respective
segments in general, especially in Malaysia. In terms of the intercultural competence (ICC) the
respondents are by and large slightly agreeable to its presence (mean=3.73, median=4, mode=4).
In terms of the presence of the critical factors also, the sample respondents are slightly agreeable
to the same. However, the mean of the product of ICC and CSF (14.17) as compared to the

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maximum score on the dimension (36), can be deemed to be on a slightly lower side. In other
words, the combined effect of the ICC and CSF leaves much to be desired in terms of the
strength of presence in the sample firms. In order to compare the variability in each of the
variables: the coefficient of variation (CV=standard deviation/mean) is calculated. For BP, the
CVBP=.80/3.65 = 0.22, that for ICC, CVICC = 0.66/3.73 = 0.18, that for CSF is CVCSF = 0.79/3.67
=0.21 and that for ICC*CSF is CV ICC*CSF = 5/14.17 = 0.35. This shows that the ICC has the
lowest variability or highest consensus among the sample respondents in terms of its presence in
the respective firms, whereas in terms of Business performance (BP), the respondents are much
less agreeable with each other. As far as the combined presence of ICC and CSF, the variability
is much higher and shows that the firms are much variable in terms of the combined presence of
ICC and CSF. The variables are negatively skewed, which shows that the data are slightly more
concentrated on the left of the mean (Beckstead, 2013; Creswell, 2013).
Exhibit 1: Descriptive Statistics
Statistic BP ICC CSF ICC*CSF
Mean 3.657143 3.735714 3.671429 14.17143
Standard Error 0.095197 0.079934 0.094839 0.601833
Median 4 4 4 16
Mode 4 4 4 16
Standard Deviation0.796473 0.668773 0.793478 5.0353
Sample Variance 0.634369 0.447257 0.629607 25.35424
Kurtosis 1.864571 0.645525 1.183263 0.456689
Skewness -0.53612 -0.40474 -0.76733 0.134089
Range 5 3 4 23
Minimum 1 2 1 2
Maximum 6 5 5 25
Sum 256 261.5 257 992
Count 70 70 70 70

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Inferential Statistics
The exhibit 2 shows the output for the multiple regression analysis of the moderation
model equation as described in the methodology section (Bryman & Cramer, 2002; Fairchild &
MacKinnon, 2009). As the multiple R = 0.51 shows, there is an overall high linear relationship
between the dependent and independent variables in the model. This shows that the business
performance is highly correlated with the critical success factors and the intercultural
competence of the US healthcare firms operating in Malaysia. As far as the model fit or the
soundness of the model is concerned, the R squared = 0.26 value shows that the model as a
reasonably overall good fit and is a decent model in terms of predicting the effect of critical
success factors, the intercultural competence and the combined effect of the same. We can say
that the model fit is close to 30%, which can be considered a good fit, given the fact that this is a
moderation model. The F value is 2.32 which are greater than 0.05 and this shows that the
multiple variable model is not significant.
The coefficients of regression for the constant, CSF, ICC and CSF*ICC are 456.12, -
3.20, -4.51 and 0.03 respectively. This shows that a unit of change in ICC and CSF respectively
produces a negative 320% (β1=-320 %) and 451% (β2 = -451%) change in the business
performance (BP) of the US multinational healthcare firms in Malaysia respectively in individual
terms. The combined effect produced by the intercultural competence and the critical success
factors, however produces 3% (β3 = 3%) change in the business performance. A positive value of
the constant shows that large levels of changes in the variables produce positive effects in the
business performance. Statistically, the individual effects of the ICC (p >.05) and CSF (p>.05)
factors on the business performance are insignificant. In addition, there is no statistically
significant moderating effect of ICC on the relationship between CSFs of the US multinational

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healthcare firms operating in Malaysia (β3 = 3%, p>0.05). While the sample shows a positive
moderating effect of ICC of the sample firms on the relationship between their CSFs and
business performance, this cannot be generalized to the population of all such firms operating in
Malaysia as β3 is not significantly different from zero and thus, there is no significant moderating
effect of ICC under the model.
Exhibit 2: Inferential Statistics
Run MATRIX procedure:
*************** PROCESS Procedure for SPSS Version 3.3 *******************
Written by Andrew F. Hayes, Ph.D. www.afhayes.com
Documentation available in Hayes (2018). www.guilford.com/p/hayes3
**************************************************************************
Model : 1
Y : BP
X : CSFs
W : ICC
Sample
Size: 24
**************************************************************************
OUTCOME VARIABLE:
BP
Model Summary
R R-sq MSE F df1 df2 p
.5080 .2581 956.9703 2.3191 3.0000 20.0000 .1062
Model
coeff se t p LLCI ULCI
constant 456.1050 481.1930 .9479 .3545 -547.7038 1459.9139
CSFs -3.1971 5.8618 -.5454 .5915 -15.4254 9.0311
ICC -4.5101 6.2239 -.7246 .4771 -17.4936 8.4735
Int_1 .0347 .0743 .4671 .6455 -.1203 .1898
Product terms key:
Int_1 : CSFs x ICC
Covariance matrix of regression parameter estimates:
constant CSFs ICC Int_1
constant 231546.738 -2775.7991 -2969.9393 35.4115
CSFs -2775.7991 34.3608 35.1155 -.4315
ICC -2969.9393 35.1155 38.7367 -.4562
Int_1 35.4115 -.4315 -.4562 .0055
Test(s) of highest order unconditional interaction(s):
R2-chng F df1 df2 p
X*W .0081 .2182 1.0000 20.0000 .6455
----------
Focal predict: CSFs (X)
Mod var: ICC (W)
Data for visualizing the conditional effect of the focal predictor:
Paste text below into a SPSS syntax window and execute to produce plot.

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DATA LIST FREE/
CSFs ICC BP .
BEGIN DATA.
68.0000 75.0000 77.4881
81.0000 75.0000 69.7716
92.0000 75.0000 63.2423
68.0000 81.0000 64.5911
81.0000 81.0000 59.5824
92.0000 81.0000 55.3442
68.0000 90.0000 45.2457
81.0000 90.0000 44.2985
92.0000 90.0000 43.4970
END DATA.
GRAPH/SCATTERPLOT=
CSFs WITH BP BY ICC .
*********************** ANALYSIS NOTES AND ERRORS ************************
Level of confidence for all confidence intervals in output:
95.0000
------ END MATRIX -----
Interpretation
The above findings have shown that there is a significantly considerable effect of
intercultural competence (ICC) on the business performance of the multinational US firms
operating in Malaysia, and there is a significantly high effect of critical success factors (CSFs) of
the respective firms on their business performance as a separate performance enhancing factor.
However, the interaction of the ICC and CSFs does not produce a significant effect on the
Business Performance of these firms. This could be attributed to the fact that while the
Intercultural Competence efforts though are potent and effective and produce a desirable effect
per se; the respondents don’t perceive them to be very well aligned with the critical systems and
best practices of the respective firms in general. In fact, specifically, for the given set of firms,
there is a possibility that a combined reinforcement of the ICC and the CSFs is likely producing
a negative effect on business performance. This is possible in situations, where, the management
of these firms is implementing various ICC measures as a matter of policy, without addressing

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the possible intercultural biases or underlying issues or popular yet negative perceptions about
other cultures. However, it is significant at p=0.1 or 10% level, which implies that there is lesser
chance of a significant negative moderation on of ICC than would be desirable. This also means
that the moderation effect is less likely to be applicable to the larger population than would be
desirable or as that hypothesized. Based on the above results, the null hypotheses H01, and H02,
were rejected, while the study failed to reject the null hypothesis H03.
Discussion & Conclusion
Overall, the results of the study can be discussed in terms of the hypotheses of the study
and the results of the study showed that the Hypotheses H01 and H02 were rejected and it is
concluded that:
1) There is a statistically significant positive relationship between the Critical Success
Factors (CSFs) and Business Performance (BP) of Multinational US firms operating in
Malaysia.
2) There is a statistically significant positive relationship between the Intercultural
Competence (ICC) and Business Performance (BP) of Multinational US firms operating
in Malaysia.
However, as we failed to reject H03 as per the findings, it is further concluded that:
3) The Intercultural Competence (ICC) of US Multinational firms operating in Malaysia
have does not moderate the relationship of between their Critical Success Factors (CSFs)
and Business Performance (BP) in a statistically significant way.
In terms of the research questions, one through three, the most pertinent CSFs, the most
important dimensions of ICC and BP have been identified and administered as part of the

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questionnaire (see appendix). The research questions four and five have been addressed by the
conclusions one through three above.
As the interpretation of the results has shown, the moderating effect of the Intercultural
competence on the relationship between the critical success factors and business performance is
not statistically significant at p=0.05, though it is significant at the p=0.1 level. This implies that
while individual implementations of ICC and CSFs are producing some effect on the business
performance, there could be a possible resentment among the staff in terms of the applicability of
the ICC systems being applied to the practices of CSFs in those multinational firms. As
mentioned in the previous section this is possibly decreasing the chances of any moderation
effect of ICC on in the general firm population of US multinational healthcare firms operating in
the Malaysian market.
There is a need for the multinational firms to properly gauge and more than that address
the concerns of the employees and stakeholders from different cultural backgrounds, in terms of
translating them to productive work relationships. It is likely that the individual or even
organizational intercultural competence, though is creating a general conducive and productive
work environment for the employees, however, when it comes to making it work for the specific
systems or competencies that constitute the critical success of the firm, they are not well aligned
to the productivity systems of these firms and does not translate into a desirable business
performance. Therefore, there is a need for these multinational firms to a) clearly address any
intercultural issues on collective level especially those pertaining to critical performance of the
respective firms; and b) identify, monitor, enrich and align the existing performance management
systems, cultural competence measures and the critical success factors and communicate the
same with clarity to the employees so that there is no anomaly between what is achieved in

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business performance at primarily individual, due to the direct effect of ICC, and what is
expected at a collective level via tweaking of the critical success factors of the firm. This will
help attain much better performance of these firms than they are currently exhibiting.

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Appendix
Survey Questionnaire
Part I- Personal Profile
Name……………………………………
Age……………………………………..
Gender…………………………………
Nationality………………………………..
Email ID…………………………………..
Company Name…………………………..
Designation……………………………….
Work Experience…………………………
Part II- Questionnaire
i. Business Performance (BP) Scale
Sl.
No.
Code
Used
Please indicate your
best estimate of your
firm's position on
average related to your
close competitors over
the past two years Much worse than competitors Much better than
competitors
1 BP1 Our sales growth 1 2 3 4 5 6
2 BP2
The market share gains
by us
3 BP3 Our sales growth rate
4 BP4
The after-tax returns on
assets
5 BP5
The net profits after
taxes
6 BP6 Our financial liquidity
7 BP7 Our public image
8 BP8 Our customer

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compliments
9 BP9 Our customer loyalty
Please answer the
following additional
questions to best reflect
your organization
Neve
r Seldom Often
Very
ofte
n
Mostl
y
Alway
s
1 2 3 4 5 6
10 BP10
To what extent are
suggestions on doing
things differently made
in your organization
11 BP11
To what extent the way
work is done being
changed in your
organization
12 BP12
To what extent are new
ideas converted into
viable business
opportunities in your
organization
ii. Intercultural Competence (ICC) Scale
Please assess by rating each statement using the 6-point Likert scale as follows:
6=Strongly Agree
5= Moderately Agree
4= Slightly Agree
3= Slightly Disagree
2= Moderately Disagree
1= Strongly Disagree
Scale 1: How I think I am with them (fellow employees and clients from other culture)
(1) Ability to accept cultural differences:
i. I believe that cultural differences influence the way we think, communicate, and
work
ii. I keep discovering cultural differences and nuances
iii. I think that they have a right to hold different beliefs about right or wrong
iv. I believe that diversity is an asset

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v. I usually don’t have the time to think about cultural differences (rev scored)
vi. I feel my identity, style of working, and career is threatened (rev scored)
(2) Avoidance of psychological stress
i. I feel relaxed and at ease
ii. I have a feeling of enjoyment towards cultural differences
iii. I often act like a very different person (rev scored)
iv. I find it very hard to talk, express my opinion, and speak up for myself (rev
scored)
v. I get upset very easily (rev scored)
vi. I often feel useless (rev scored)
(3) Successfulness of communication
i. I am able to answer questions effectively
ii. I am a good listener
iii. I actively request the for feedback
iv. I don’t quite know how to initiate a conversation (rev scored)
v. I have problems with expressing my ideas clearly (rev scored)
vi. I often miss parts of what is going on (rev scored)
(4) Establishing of interpersonal relationships
i. I find it easy to identify with them
ii. I always show respect for their opinions
iii. I find it easy to recognize early signs of frustration with them
iv. I always try to understand their actions, thoughts, and feelings
v. I often feel a sense of distance (rev scored)
vi. I find it difficult to approach them
Scale 2: How I think they are with me (fellow employees and clients from other culture)
(5) Appropriateness of communication
i. They always show respect for my opinions
ii. They always try to understand my actions, thoughts and feelings
iii. They make a conscious effort to adapt their communication and working style to
me needs
iv. They hardly recognize if I find something frustrating (rev scored)
(6) Results of Collaboration
i. I am generally happy with our collaboration
ii. We are at least as effective as when I am interacting with colleagues from my
own culture
iii. I think that the results of our collaboration could be better (rev scored)
iv. I think that we could achieve more (rev scored)
iii. Critical Success Factors pertinent to Healthcare Industry (CSFHI)
Please assess by rating each statement using the 6-point Likert scale as follows:
6=Strongly Agree

Healthcare 24
5= Moderately Agree
4= Slightly Agree
3= Slightly Disagree
2= Moderately Disagree
1= Strongly Disagree
1. Indispensability (D1): The healthcare firm has made it indispensable and is hard to get
around.
2. Reinvent patient experience (D2): The firm has achieved a positive transformation in
patients’ experience of healthcare services.
3. New revenue cycle (D3): The healthcare firm is capable and has developed a new
revenue cycle based on new services.
4. Diversified and Integrated Specialization (D4): The firm has a proven specialization,
which is suited to both physicians’ capabilities and patient needs.
5. Mind-set of well-being (D5): The firm has a demonstrated a mind-set well-being of
patients.
6. New horizons (D6): The healthcare firm is expanding the patient care beyond the routine
care and delivery of services and moving towards smart healthcare.
7. Embedded innovation (D7): Innovation and change are embedded in policy and
functioning.
8. Leveraging new technology (D8): The healthcare firm has a demonstrated ability to
leverage new technology to improve patient experience.
9. Transformational leadership (D9): The firm leadership is able to foresee challenges
and adapt the organization to better performance through course correction.
10. Responsible and Accountable (D10): The firm exhibits a culture of responsibility and
accountability towards the patients and stakeholders.