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J Educ Health Promot
J Educ Health Promot
JEHP
J Edu Health Promot
Journal of Education and Health Promotion
2277-9531
2319-6440
Wolters Kluwer - Medknow India

JEHP-13-229
10.4103/jehp.jehp_817_23
Original Article
Tehran private hospitals—identifying and prioritizing factors affecting employer branding
Saghari Sam 1
Safavi Mahboobeh 12
Khalesi Nader 12
Mirzaei Abasat 12
Begloo Amin G. 23
1 Department of Health Care Management, Faculty of Health, Tehran Medical Science, Islamic Azad University, Tehran, Iran
2 Health Economic Policy Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
3 Department of Health Services Management, Faculty of Health, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
Address for correspondence: Dr. Mahboobeh Safavi, Department of Health Care Management, Faculty of Health, Tehran Medical Science, Islamic Azad University, Tehran, Iran. E-mail: msafavi@iautmu.ac.ir
2024
11 7 2024
13 22911 6 2023
27 7 2023
Copyright: © 2024 Journal of Education and Health Promotion
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
BACKGROUND:

Employer branding (EB) is a collection of ideas and beliefs that influence the perspectives of current and prospective employees regarding an organization and their employment experiences, serving as a strategic tool in the competition to attract talent. Positive EB can help retain current employees and attract new talents, making it an important issue in human resource management. This study aimed to identify and prioritize the factors affecting the EB of private hospitals in Tehran.

MATERIALS AND METHODS:

The study is applied in purpose and descriptive and analytical in terms of data analysis. Eleven hospitals were selected from 55 private hospitals in Tehran using non-probability and theoretical sampling methods. An expert from each hospital was purposively selected and interviewed. The experts held doctoral degrees in medical specialties and hospital administration experience. In-depth, unstructured interviews with experts constituted the primary method of data collection. Theoretical saturation was reached following the interview with the 11th expert. The entire research process lasted one year, from 2021 to 2022. The method of pairwise comparison matrix with triangular fuzzy numbers was utilized to rank factors contributing to hospital EB.

RESULTS:

By using a fuzzy method of identification and prioritization, it was found that the most significant factors influencing the EB of private hospitals in Tehran were the level of industry competitiveness, an empowering work environment based on a coaching approach, cooperation with strong suppliers of drugs and hospital and surgery consumables, a generation-based focus on value, and a competitive advantage in EB.

CONCLUSIONS:

This study provides valuable insights into the factors that contribute to EB in private hospitals in Tehran, which can be used to inform health policy making. The identified factors, such as industry competitiveness, an empowering work environment, and cooperation with strong suppliers, can help private hospitals attract and retain talented employees, ultimately improving the quality of healthcare services provided in the region.

Health personnel
hospital
personnel management
personnel selection
personnel turnover
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pmcIntroduction

In the modern era, companies place a high value on intangible assets such as their brand, innovation and creativity, job creation, entrepreneurship, and accumulated knowledge. These assets can help a company stand out from its competitors and attract customers and employees. People-centric organizations prioritize hiring skilled and competent individuals before striving to outperform their rivals.[1] It is crucial for companies to create a positive image of themselves in the minds of the community, customers, and employees to retain talented and committed staff.[2] This remains true regardless of the human resources type, organizational strategies and policies, human resources architecture, work and personnel strategies, organization method, or management and communication style.[3] To attract top talent, companies must establish themselves as a reputable brand that resonates with their target audience. By being aware of their professional image, companies can more effectively attract their desired audience. Companies can proactively identify opportunities with superior human capital by adopting employer branding (EB) practices to recruit the best talent available.[4]

There is a need for human resource management to consider EB due to the current and projected labor market shortage of qualified employees. EB is a fundamental strategic concept[5] and a collection of functional, economic, and psychological benefits. It is assumed as an interdisciplinary field that determines the structure of long-term relationships between employers and employees.[6] According to researchers, half of EB is art, and the other half is science. This includes recruiting and maintaining efforts to enhance the company’s image. Branding fosters a sense of ownership and satisfaction among employees and explains to the target audience the advantages of joining an organization.[7] Indeed, EB is a collection of ideas and beliefs that influence the perspectives of current and prospective employees regarding an organization and their employment experiences. It demonstrates the organization’s culture and values and reassures employees that everyone is enthusiastic about their work and in sync with the organization. Moreover, it gives identity to the company’s current and future employees, as well as other stakeholders who are somehow connected to people inside the company. Therefore, EB is related to the majority of the organization’s attracting and hiring efforts, which consume a significant portion of its human resources budget.[8]

With the goal of differentiating and creating a distinctive employment experience, EB continually builds solid foundations as a strategic approach to recruiting and retaining employees. By emphasizing the advantages of working for a particular company, EB can present its organization as a top employer to potential (future) employees.[9] EB’s primary purpose is to be a strategic tool that aids organizations in the fierce competition to attract talent.[10] Strong employer brands establish a unique and distinct identity that defines and attracts existing and prospective human resources.[11] EB can serve as a tool for managing scarce resources, or what is known as talent management. It comprises management processes designed to create, implement, and communicate the image and identity of a desirable employer.[12] Positive EB can help retain current employees and attract new talents.[13] The concept of EB has emerged as an important issue in human resource management today. The position of the best employer is something for which nearly all organizations strive and compete. There are few articles on EB, and the lack of academic content on the topic is palpable,[14] despite the concept’s increasing popularity among HR professionals. The novelty of this study lies in its focus on identifying and prioritizing the factors that contribute to EB in private hospitals in Tehran. The use of a fuzzy method of identification and prioritization adds a unique approach to the study. Additionally, the study’s findings provide valuable insights into how private hospitals can attract and retain talented employees, ultimately improving the quality of healthcare services provided in the region. This information can be used to inform health policy making, making it a significant contribution to the field of human resource management in healthcare. Accordingly, this study aimed to identify and prioritize factors affecting the employer brand of private hospitals.

Materials and Methods

Study design and setting

This study aimed to identify and prioritize the factors contributing to EB in private hospitals in Tehran. The study utilized a fuzzy method of identification and prioritization, which added a unique approach to the research.

In the quantitative phase of the research, a pairwise comparison table with fuzzy triangular numbers was utilized to prioritize the identified hospital EB factors. No exclusion criterion was applied in the present study [Figure 1].

Figure 1 Classification of criteria and determination of fuzzy values related to linguistic variables (membership functions of triangular and trapezoidal numbers)

Study participants and sampling

The statistical population consisted of experts from 11 private hospitals in Tehran who had a doctorate in a medical specialty and at least one year of hospital management experience. A purposive sampling approach was adopted, and recruitment continued until theoretical saturation was reached after 11 interviews.

Data collection tool and technique

In-depth, unstructured interviews with subject matter experts constituted the primary method for collecting qualitative data. The researcher spent six months collecting literature, identifying research gaps, and interviewing experts, and her personal interest in resolving this issue led to a six-month commitment to data analysis.

The interviewees verified the findings to ensure the validity of the analyses, and corrections were made based on the feedback of the supervising professors. MAXQDA was used to verify the researcher’s findings from the interviews, and the results matched up perfectly. To evaluate the reliability of the meta-synthesis phase, one of the experts was given a selected document. Following evaluation, the Kappa coefficient (0.901) was found to be above the acceptable threshold, indicating the research’s reliability.

Ethical consideration

This study was approved by the ethics committee at Tehran Islamic Azad University of Medical Sciences (IR.IAU.TMU.REC.1400.183). Informed consent was obtained from the participants to allow them to decide voluntarily whether to participate in the study. The research objectives were explained to participants, and written informed consent was obtained from all the participants. The participants had the right to withdraw from the study. Also, we explained to the participants that codes instead of names would appear on the interview documents to ensure anonymity.

Results

The research findings included the 22 categories listed below, which were obtained following analysis and placement of identified categories on the paradigm model: Causal factors, including 1- Effective and appealing mission statement, 2- Periodic review and enhancement of the hospital’s macro-level human resource management strategies, 3- Internal marketing, 4- Periodic evaluation of the hospital’s EB strength, 5- Hospital’s economic viability, and 6- The level of industry competitiveness [Table 1].

Table 1 Guide to abbreviations associated with the model variables

Variable		Manner of labeling categories in the software	Labeling in the software	
Causal factors	Factor 1	Effective and appealing mission statement	Var. 1	
Factor 2	Periodic review and enhancement of the hospital’s macro-level human resource management strategies	
Factor 3	internal marketing	
Factor 4	Periodic evaluation of the hospital’s employer brand strength	
Factor 5	Hospital’s economic viability	
Factor 6	The level of industry competitiveness	
Background factors	Factor 7	Supporting the hospital’s specialized team through liability insurance	Var. 2	
Factor 8	Social responsibility	
Factor 9	Empowering work environment based on a coaching approach	
Category	Factor 10	Practical efforts of the hospital for a successful employer brand	Var. 3	
Environmental factors	Factor 11	Modeling successful hospitals	Var. 4	
Factor 12	Cooperation with strong suppliers of drugs and hospital and surgery consumables	
Strategic factors	Factor 13	Designing employee value proposition (EVP)	Var. 5	
Factor 14	Establishing and strengthening the International Patients’ Department (IPD)	
Factor 15	Flexible organization of work time	
Factor 16	Using digital marketing tools	
Factor 17	Creating an exclusive table (ED)	
Factor 18	Generation-based value orientation	
Factor 19	Smartening of hospitals	
Consequences	Factor 20	The highly motivated and constant presence of the hospital’s specialized team	Var. 6	
Factor 21	Transforming the specialized team into the hospital’s employer brand ambassadors	
Factor 22	The hospital’s practical efforts to strengthen the hospital’s employer brand relative to competitors	

Background factors, including 7- Supporting the executive staff of the hospital through liability insurance, 8- Social responsibility, and 9- Empowering work environment based on a coaching approach.

Environmental factors, including 10- Modeling successful hospitals, and 11- Cooperation with strong suppliers of drugs and hospital and surgery consumables.

Strategic factors, including 12- Designing employee value propositions (EVPs), 13- Creating and strengthening the International Patients’ Department (IPD), 14- Flexible organization of working time, 15- Using digital marketing tools, 16- Creating an exclusive desk, 17- Generation-based value orientation, and 18- Smartening of hospitals.

Consequences, including 19- The highly motivated and constant presence of the hospital’s specialized team, 20- Transforming the specialized team into the hospital’s EB ambassadors, and 21- The hospital’s practical efforts to strengthen the hospital’s employer brand relative to competitors.

Axial category: 22- The hospital’s practical efforts to build a successful EB.

Ranking

In this analysis, the factors influencing EB are expressed as variables (Var.), whereas the categories are referred to as factors. The following table illustrates the model’s structure:

Ranking of var. 1 criteria

After the table of pairwise comparisons with fuzzy triangular numbers was constructed, the extent analysis (EA) method was used to calculate the ratio of the indices to one another, and each index’s abnormal weight (w’) was subsequently determined. Abnormal weights were normalized, and normal weights (W) were achieved [Figure 2] [Table 2].

Figure 2 Prioritization of var. 1 criteria

Table 2 Abnormal weights (w’) of each index

	L	M	U	
S1	38,000	57,000	71,000	0.003	0.003	0.005	0.100	0.189	0.353	
S2	25,000	41,000	56,000	0.003	0.003	0.005	0.066	0.136	0.279	
S3	27,000	41,000	57,000	0.003	0.003	0.005	0.071	0.136	0.284	
S4	43,000	61,000	72,000	0.003	0.003	0.005	0.113	0.203	0.358	
S5	29,000	43,000	55,000	0.003	0.003	0.005	0.076	0.143	0.274	
S6	39,000	58,000	70,000	0.003	0.003	0.005	0.102	0.193	0.348	

Ranking var. 2 criteria

After the table of pairwise comparisons with fuzzy triangular numbers was constructed, the EA method was used to calculate the ratio of the indices to one another, and each index’s abnormal weight (w’) was subsequently determined. Abnormal weights were normalized, and normal weights (W) were achieved [Figure 3] [Table 3].

Figure 3 Prioritization of var. 2 criteria

Table 3 Abnormal weights (w’) of each index

	L	M	U	
S1	35,000	53,000	67,000	0.005	0.006	0.010	0.177	0.340	0.644	
S2	32,000	49,000	62,000	0.005	0.006	0.010	0.162	0.314	0.596	
S3	37,000	54,000	69,000	0.005	0.006	0.010	0.187	0.346	0.663	

Ranking of var. 3 criteria

This dimension of the model did not need to go through prioritization as it only contained only one factor.

Ranking of var. 4 criteria

After the table of pairwise comparisons with fuzzy triangular numbers was constructed, the EA method was used to calculate the ratio of the indices to one another, and each index’s abnormal weight (w’) was subsequently determined. Abnormal weights were normalized, and normal weights (W) were achieved [Figure 4] [Table 4].

Figure 4 Prioritization of var. 4 criteria

Table 4 Abnormal weights (w’) of each index

	L	M	U	
S1	35,000	53,000	66,000	0.007	0.009	0.013	0.254	0.465	0.846	
S2	43,000	61,000	72,000	0.007	0.009	0.013	0.312	0.535	0.923	

Ranking of var. 5 criteria

After the table of pairwise comparisons with fuzzy triangular numbers was constructed, the EA method was used to calculate the ratio of the indices to one another, and each index’s abnormal weight (w’) was subsequently determined. Abnormal weights were normalized, and normal weights (W) were achieved [Figure 5].

Figure 5 Prioritization of var. 5 criteria

Ranking var. 6 criteria

After the table of pairwise comparisons with fuzzy triangular numbers was constructed, the EA method was used to calculate the ratio of the indices to one another, and each index’s abnormal weight (w’) was subsequently determined. Abnormal weights were normalized, and normal weights (W) were achieved [Figure 6].

Figure 6 Prioritization of var. 6 criteria

Discussion

This study aims to identify and rank the factors influencing the EB of private hospitals in Tehran. According to the ranking of causal factors, industry competitiveness has the highest priority, with a weight of 0.1892. Competitiveness in the industry means focusing on one’s competitive dynamics by recognizing the industry’s general characteristics. Additionally, the level of market competitiveness can impact the market’s attractiveness. The healthcare industry has evolved into a highly competitive industry, and the emergence of new competitors has become commonplace. An effective human resource is essential for gaining an edge in the healthcare industry, where creating a competitive advantage is highly difficult. Specialized teams are, without a doubt, a competitive advantage for a hospital. A team that can continuously accompany patients throughout the treatment process is an advantage that will endure. Rahimian maintains that the lack of a truly free market and the absence of business competition in public and quasi-public corporations in Iran pose a significant obstacle to EB. His findings validate the significance of the industry’s competitiveness level,[15] which complies with the present study. Corbett and Luk Van noted that the globalization of the economy and markets, as well as the intensification of international competition in the world economic arena as a result of the emergence of a potentially unique global market for a broadening array of products and services, has recently garnered considerable attention in business policies and strategies. Also, according to the ranking of causal factors, the periodic evaluation of the hospital’s EB has the lowest priority, with a weight of 0.1397.

Based on the prioritization of contextual factors, the coaching-based empowering work environment, with a weight of 0.3432, has the higher priority. In an article titled “Linking EB and internal branding: Establishing perceived employer brand image as an antecedent of favorable employee brand attitudes and behaviors,” Hoppe M[16] stated that employee empowerment is the primary contributor to a company’s success. According to them, research has demonstrated that employee empowerment is positively associated with performance, efficiency, innovation, and employee loyalty. Empowerment is regarded as an effective management tool that fosters a shared understanding of vision and goals.[9] Trank, Rynes, and Bretz argue that people with greater success or abilities tend to prefer attractive and challenging jobs and behave differently during the job selection stage. They seek out organizations and positions that will expand their knowledge and skills.[17] In another study, Mousavifard et al.[18] noted that offering employees the opportunity to learn and gain experience is one of the most alluring aspects of organizations in the technological age. Talent development is a long-term process that requires regular review and evaluation. Effective talent management strategies include performance management; attraction, selection, training, and development of talents; career development management; strategic human resource planning; succession planning; and benefits and service compensation.

Vaezi et al.[19] analyzed and ranked the dimensions of EB attractiveness and promotion in Kashan’s hotel industry. They propose that one’s education and scientific ability, material and non-material facilities of the organization, employee’s perception of the organization’s credibility, external factors, environment, working conditions, advancement opportunities, and career growth have a positive and statistically significant effect on the EB with a confidence level of 95%. The findings of these studies confirm the significance of an empowering work environment based on a coaching approach, consistent with the current study.

In addition, with a weight of 0.3183, social responsibility has the lowest priority among background factors. In similar lines, Tanor and Prasad identified the ethics and social responsibility of the company as the fourth-most influential factor affecting EB.[20]

Environmental factors include modeling successful hospitals with a weight of 0.4692 and cooperation with strong suppliers of drugs and hospital and surgery consumables with a weight of 0.5308. According to the ranking of these two factors, cooperation with strong suppliers of drugs and hospital and surgery consumables was given a higher priority. In collaboration with medication suppliers, the hospital prepares consumables as quickly as possible so that the patient and physician do not have to wait for a lengthy time for drugs and supplies. Given the current sanctions climate in Iran and the need to import medications and surgical consumables, this consideration is crucial and warrants top priority. Tikhonov explains that the values of the target group of applicants impact the brand’s value and technological core. He argues that besides salary, employers must pay special attention to work quality, equipment and comfort of the work environment, attractive conditions, and flexible organization, particularly when seeking the most valuable and scarce human talents.[21] This finding is consistent with and strengthens the findings of the present study.

According to the prioritization of strategies, the generation-based valuation with a weight of 0.1768 has the highest priority. Employee brand is the sum of the values of all employees during their working life.[22] Private hospitals can maximize the motivation of the specialized team by designing and using a special and local system. Today, prominent hospitals in the world have their own EVP.

According to Yadegari et al.,[22] numerous organizations today employ a variety of factors that are effective in the commitment and retention of employees. They believe that work environment, supervisor support, organization’s image, EVP, pay rate, reward, recognition, and career development influence the retention of these forces. Bayat et al.[23] have observed that the impact of EB on the organizational identity might vary based on the working generations and years of service, which may alter employees’ recruitment and retention priorities.

Alnıacık and Alnıacık published an article titled “Identifying dimensions of attractiveness in EB: effects of age, gender, and current employment status.” They argue that some have defined the EB in terms of values, taking into account the employees’ values and dimensions such as social value, market value, economic value, practical values, corporate values, and work environment.[24]

According to Mousavi et al.’s[25] study, employees compare the employer brand image to their own demands, personalities, and values. Employees are much far likely to be attracted to an organization whose values align with their own. The evidence suggests that employees are not only hired based on their technical and professional knowledge but are also attracted to and hired by an organization based on the degree to which their values align with the target brand. If an organization adopts the opposite approach and favors the values of its employees, it will be able to attract and retain more talented individuals. Branding is influenced by the four employee-oriented values of social value, desire, growth, and economic value. The least significant factor in this area is creating an exclusive table with a 0.1194 weight.

The final prioritization of the factors affecting the EB of private hospitals concerns the consequences, with the factor of strengthening the hospital’s EB relative to competitors having the highest weight (0.3707).

Additionally, Javadi et al.[26] noted that adopting smart and appropriate strategies can lead to the enhancement of the EB. A strong EB is one of the best weapons in today’s competitive labor market, according to Leadership Consulting Company. The findings of Javadi et al.’s[26] research confirm those of the current study. Lastly, the lowest priority is the motivated and constant presence of the hospital’s specialized team, with a weight of 0.2958.

Limitation and recommendation

The study’s limitations include its narrow focus on private hospitals located in Tehran, which may hinder the generalizability of the findings to other regions or public hospitals. Non-probability and theoretical sampling methods may also introduce selection bias and limit the generalizability of the results. Another potential weakness of the study is the exclusive reliance on expert interviews as the primary method of data collection, which may not fully reflect the perspectives of current or prospective employees. Future studies could incorporate the viewpoints of a broader range of stakeholders, such as patients and employees, to provide a more comprehensive understanding of the factors that influence hospital EB. Despite these limitations, the study provides valuable insights into the factors that contribute to hospital EB in private hospitals in Tehran. The identified factors can help inform health policy making and assist hospitals in attracting and retaining talented healthcare professionals, ultimately contributing to the improvement of healthcare service quality in the region.

Conclusion

The findings of this study have significant implications for health policy making in the healthcare industry. By identifying and prioritizing the factors that contribute to EB in private hospitals in Tehran, this study provides a framework for policymakers to develop targeted policies and strategies that can improve the quality of healthcare services provided in the region. One of the most significant factors identified in this study was the level of industry competitiveness. Private hospitals in Tehran can improve their EB by investing in measures that enhance their competitive advantage, such as increasing the quality of their healthcare services and adopting innovative technologies. An empowering work environment based on a coaching approach was also found to be a significant factor contributing to EB. Private hospitals can foster such an environment by providing their employees with opportunities for professional development, creating a supportive workplace culture, and promoting a work–life balance. Cooperation with strong suppliers of drugs and hospital and surgery consumables was another factor identified in this study. By collaborating with reputable suppliers, private hospitals can ensure the quality and reliability of the products and services they provide, which can enhance their reputation and EB. A generation-based focus on value was also identified as a significant factor contributing to EB in private hospitals. By prioritizing the needs and expectations of different generations of employees, private hospitals can create an inclusive workplace culture that values diversity and fosters a sense of belonging. Indeed, a competitive advantage in EB was found to be a crucial factor in attracting and retaining talented employees in private hospitals. By investing in EB initiatives such as employee engagement programs, social media campaigns, and positive brand messaging, private hospitals can differentiate themselves from their competitors and attract the best talent in the industry. Finally, the findings of this study highlight the importance of EB in the healthcare industry and provide policymakers with practical recommendations to improve the quality of healthcare services provided in the region. By prioritizing factors such as industry competitiveness, an empowering work environment, cooperation with strong suppliers, a generation-based focus on value, and a competitive advantage in EB, private hospitals in Tehran can attract and retain talented employees, ultimately contributing to the overall health and well-being of the population.

Abbreviations

EB: employer branding, MAXQDA: mixed methods data analysis, EVP: employee value propositions, IPD: International Patients’ Department, Var: variables, EA: extent analysis, w’: abnormal weight, W: normal weights,

Consent for publication

Not applicable.

Availability of data and materials

Data are available from the corresponding author on reasonable request.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

This paper (approved by ethics committee code: IR.IAU.TMU.REC.1400.183) is based on a healthcare management PhD thesis at the Islamic Azad University of Medical Sciences in Tehran.
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