The Effect of Marketing Culture Aspects of Healthcare Care on Marketing Creativity

The main purpose of this study is to analysis the impact of marketing culture aspects of healthcare on marketing creativity. The research was conducted at healthcare sectors in Kurdistan region of Iraq. The researchers employed quantitative research method via using a survey to measure the current study. However, the researchers were able to gather 161 completed questionnaires. The researchers applied hierarchal multiple regression analysis and Sobel test to measure the current study; the findings revealed. The findings proved that there is a positive and significant direct and indirect relationship between cultural value and cultural satisfaction as marketing culture aspects and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural value as marketing culture aspect and marketing experience. However, a key element in improving patient-endorsed healthcare systems is an emphasis on cost savings and increased quality, as well as differentiated industry. This are achievable with the acquisition of new technology and well-trained and driven workers who can use their expertise for the good of society in a way that carves out a distinct market that rivals can seldom replicate or copy at a high cost.


INTRODUCTION
Regardless of the nature of organization, current organizations face various environmental conditions, which are characterized by those ones such as their rapid change that posed many challenges on these organizations. In order to adapt to these challenges in a scientific and organized way, the organization has to cope with a new philosophy. Cultural philosophy of marketing is an example that can be adapted to the philosophy mapping of management of these organizations (Mkhize & Ellis, 2020). It will provide the most important tools to face new environmental conditions. This philosophy has an impact on the profitability of organizations; it is also regarded as one of the leading economic and management philosophies. It calls organizations to adopt an organizational culture. It also encourages ethical practices and activities designed to enhance their competitiveness (Joshi & Dhar, 2020). At the same time, practicing activities across different levels of the organization aim to provide an exchange marketing knowledge, and then it will get a collective response from it. As a result, there will be a unified goal for all sections and individuals in the organization providing its customers a continuous and superior value. Moreover, it offers a high capacity to adapt and deal with achieving change and transformation through the fulfillment of effective marketing of organizations. In this sense, due to the complicated and rapid changes in marketing, market management puts a greater emphasis on exploring and finding customers' needs and desires (Carah & Brodmerkel, 2021). It also offers products that are different from what competitors show about their competitive features. For example, if an organization could accomplish this marketing process satisfactorily, as well as focusing on a customer, it leads to an increase in marketing innovation ISSN: 2456-7620 https://dx.doi.org/10.22161/ijels.62. 25 172 through planned and achieved goals. Based on the aforementioned importance, this research has been conducted to encompass these subjects and show their key roles in performing studies organizations that run at hospitals in the Kurdistan region of Iraq (Anwar & Balcioglu, 2016).
The current study sheds light on both marketing cultural dimensions and their effectiveness that have been employed depending on elements of marketing, inventory through building conceptual and field to know the link between marketing culture and elements of innovative marketing, in addition to analyzing the relationship and abstract effects on these dimensions (Möller et al. 2020). As we can see, contemporary experiences need to accept organizational culture at the same time. These simultaneous experiences make good use of marketing service firms and support them. Proponents of this approach agree that organizational culture plays an important role in commercializing services. The provision and simultaneous use of services, including in-person meetings, will increase the physical and mental integrity of employees and customers (Ali, 2020). In addition to that, Chatterjee & Kar, (2020) said that the culture of marketing refers to fashions and political behaviors and a timely recipe. The same culture guides employees to challenging behaviors, and the importance of the organization is to glance at marketing and conduct marketing activities. On the other hand, lately, Anwar, (2017) and other researchers and professionals have paid more attention to the fact that they can make cultural services organizational and highly regulated marketing patterns.
Based on "organizational culture", the "marketing culture" can be defined as "a more efficient and effective organizational culture in creating employee behavior, giving exceptional value to buyers of corporate assets and enabling exceptional business results" (Al-Dmour et al. 2020 suggestions. Thus, it is very important to create superior communication in organizations. According to Ali, (2021), self-knowledge is a source of awesome management, which with knowledge and awareness enables the people present in the company to extract the maximum of all available resources for it. Managing knowledge and awareness by presenting a pre-identifier and coordinated work, to enhance and transform resources into capabilities, plays an excellent role. In the world, when a global competition is increasingly occurring it brings about loyal customers. In order to create these customers through the excellent quality of service and customer satisfaction, it is important to take advantage of the advancement and prosperity of service companies.
Having an organization that has satisfied employees will also increase revenue, reduce costs, and provide customer satisfaction (Fields et al. 2021). Anwar, (2017) state that the general idea of marketing, in turn, is believed to be as the key to achieving organizational consistency, such as the ratio of market and profitability, through communication with the determination of needs and desires. Furthermore, it will give you a satisfactory deal, which will have the most impact on the competitor.
According to Van Huy et al. (2020), innovation is a key element for the success of industrial companies. Innovation is about the ability to participate in innovation. This means introducing new processes, products, services, new marketing methods or ideas to improve commercial practices in internal or external business organizations. , the link between market orientation and innovation business culture, as well as the function of the name of the trade is evident. They provide the necessary backgrounds to enhance our understanding of market-based performance orientations and cultural searches. These factors contribute to the development and management of special models. García-Granero et al. (2020) defined marketing innovation as "the introduction of a new marketing method that involves significant changes in product design or packaging, product placement, product promotion or determination of the price ".

II. LITERATURE REVIEW
Ali, (2021) conducted empirical investigation of the connection between the marketing culture of British tourism companies and customer loyalty. The sample selected by the UK-based Association of Hotels and Tourism included in the FAME CD-ROM database. To create the example sketch, two sample criteria were used: companies must be hotel or travel manager and have at least 500 employees. Using this sampling scheme, 250 companies were selected through a stratified random sampling process. This study uses multiple confirmatory regressions. The results showed a moderately strong relationship between marketing culture and customer loyalty. Finally, the implications of the results for tourism managers and the modalities for future research are discussed. Anwar, (2017) reviewed the relationship between two focal constructs in the debate: market orientation and product innovation. 194 small businesses in their sample had been in business for 28 years, employed 267 people and had annual sales of $ 51 million. About 35% of small businesses used mass production. The remaining 65% used tailor-made production technologies for key informants who participated in the survey. 32% had a marketing title and 68% had a non-marketing shotgun. This study used multiple regression models. The authors examined the relationship between two key constructs in the debate: market orientation and product innovation.
Bejtkovský & Copca, (2020) studied the relationship between Market-Oriented and Organizational Culture, sample was1100 supervisors in 1100 hierarchical cultures at the strategic commerce unit from five distinct industries in Germany, they guaranteed the respondents' skill before the mailing of directing a phone, distinguishing proof of key witnesses on the premise of addresses got from a business supplier. They focused on the key sources included general directors, marketing administrators, and supervisors from other utilitarian zones additionally used the chi-square test.
The results show that a market-oriented culture indirectly influences financial performance through market performance and that this relationship is stronger in a very dynamic market.  2020) focused on what Singapore organizations neglected when they were addressing knowledge management. Furthermore, the work involves collecting, organizing and subdividing information, using both univariate and multivariate measurable tests of the information collected. The result showed that knowledge management should consider not only the technological aspects of the implementation, but also the cultural, leadership and contextual aspects of an organization. Markova et al. (2020) investigated the relationships between organizational cultures. Business environment, business strategy and functional strategies are rarely explored from a holistic perspective. The food industry contributes around 25% of GDP and is important in terms of its importance to the economy. Therefore, it recognizes the multilevel effect of cultural orientation -taking into account the functioning of a rational model that combines cultural orientation, business conditions, organizational strategy, functional strategies and performance -which has been proven experimentally. Abdullah et al. (2017) measured the relationship between market orientation and performance using data from 201 international hotels and used multiple regressions. The results show that market orientation is critically correlated with performance metrics -quality of service, consumer loyalty, and employee satisfaction and execution metrics -population, gross operating margin and market share. In particular, the investigation revealed that the immediate effect of market orientation is to stimulate innovation, thus improving the application of judgment, thereby improving the achievement of objectives. Mesfin et al. (2017) attempted to seek and determine the market orientation and marketing culture of all employees in organizations, to determine the extent to which other members of an organization support or hinder the proper implementation of the marketing concept. A meeting of central assemblies including all staff was conducted in a public library service. A total of eleven meetings of the center took place in nine weeks with 165 stakeholders. A semi-structured approach focused on key issues, such as the role of marketing, the different elements of the marketing mix and the impact of the marketing strategy used. The results showed that while all regions inside this association are focused on marketing, there are different elucidations of marketing and how it ought to be executed. In addition, exploration identified several components that could be relevant to the effective implementation of the marketing concept in public libraries   . The essential point is to investigate the direct, indirect and aggregated effects of LO and MO on the results of the implementation of human resources and innovation (administrative, process innovation and planned product) as an intermediary. The study deliberately follows the effects of each factor to identify the effects and deviant effects that have occurred. Results HRPs are one of the main mechanisms for transferring the benefits of LO and MO. In some models, this is even more important than innovation.
The results also suggest that LO should be considered as an investigation, while MO is the interface between investigation and abuse and, ultimately, human resources and innovation must be seen as exploitation or implementation problems.

III. METHODOLOGY
This research aimed to analysis the impact of marketing culture aspects of healthcare on marketing creativity. The research was conducted at healthcare sectors in Kurdistan region of Iraq. To enable the study to measure marketing creativity at healthcare sectors, the researchers used two marketing culture aspects, first was cultural value as marketing culture aspect and second cultural satisfaction as marketing culture aspect. Moreover, the researcher intended to measure cultural experience as a mediator to measure both marketing culture aspects and find the direct and indirect influence on health care marketing creativity. The researchers employed quantitative research method via using a survey to measure the current study. The questionnaire was distributed randomly among 180 administrative employees of different healthcare sectors in Kurdistan region. However, the researchers were able to gather 161 completed questionnaires. All items in the questionnaire were evaluated by using five point Likert scale ranging from 1=Strongly Disagree, 2= Disagree, 3= Neutral, 4= Agree to 5= Strongly Agree. After the completion of data gathering, all data were examined by SPSS to find out the influence of marketing culture aspects of healthcare on marketing creativity.

Research Hypotheses
H1: Cultural experience mediates Cultural value as marketing culture aspect with marketing creativity.
H2: Cultural experience mediates Cultural satisfaction as marketing culture aspect with marketing creativity. Marketing creativity 14 161 Cultural experience 13 161 As we can see in table (1), the result of KMO for all independent variables (cultural value as marketing culture, cultural satisfaction as a marketing culture), cultural experience as mediator and marketing creativity as dependent variable r; is .667 which is higher than .001 this indicates that the sample size used for the current study was more than adequate. Furthermore, the result of Chi-Square is 2155.2 with the significant level .000. As seen in table (2), the reliability analysis for 55 items used to measure the influence of independent variables (cultural value as marketing culture, cultural satisfaction as a marketing culture), and marketing creativity as dependent variable also cultural experience as mediator factor. The above 55 questions were distributed as follow; 13 items for Cultural value as marketing culture, 14 items for Cultural satisfaction as marketing culture, 14 items for Marketing creativity, and 14 items for Cultural experience. The researchers applied reliability analysis to find out the reliability for each factor, the findings revealed as follow: as for Cultural value as marketing culture was found the Alpha to be .751 with the sample size of 161 for 13 questions which indicated that all 13 questions used to measure Cultural value as marketing culture were reliable for the current study, as for Cultural satisfaction as marketing culture was found the Alpha to be .762 with the sample size of 161 for 14 questions which indicated that all 14 questions used to measure Cultural satisfaction as marketing culture were reliable for the current study, as for Marketing creativity was found the Alpha to be .781 with the sample size of 161 for 14 questions which indicated that all 14 questions used to measure Marketing creativity were reliable for the current study, and as for Cultural experience was found the Alpha to be .731 with the sample size of 161 for 14 questions which indicated that all 14 questions used to measure Cultural experience were reliable for the current study. As it can be seen in table (3), the correlation analysis between Cultural value as marketing culture, Cultural satisfaction as marketing culture), and Marketing creativity as dependent variable also Cultural experience as mediator factor. The finding revealed that the value of Pearson correlation (r= .578 **, p<0.01), between Cultural value as marketing culture and Marketing creativity this indicated that there is positive and strong correlation between Cultural value as marketing culture and Marketing creativity, the value of Pearson correlation (r= .602 **, p<0.01), between Cultural satisfaction as marketing culture and Marketing creativity this indicated that there is positive and strong correlation between Cultural satisfaction as marketing culture and Marketing creativity, and the value of Pearson correlation (r= .639 **, p<0.01), between Cultural experience and Marketing creativity this indicated that there is positive and strong correlation between Cultural experience and Marketing creativity, H1: Cultural experience mediates Cultural value as marketing culture aspect with marketing creativity. Cultural value as marketing culture aspect and marketing creativity, the value of B = .632, the value of Beta = .637 with P-value =.000 this indicated that there is a significant and positive relationship between Cultural value as marketing culture aspect and marketing creativity. As for model (2) which applied multiple regression analysis to find both Cultural value as marketing culture aspect as independent factor and Cultural experience as a mediator factor with marketing creativity as dependent factor, the findings showed that the value of B =.644, the value of Beta = .647 with P-value .001 as indirect relationship between Cultural value as marketing culture aspect and marketing creativity, on the other hand, the value of B =.669, the value of Beta = .672 with P-value .000 as mediation between Cultural experience and marketing creativity. The findings proved that there is a positive and significant direct and indirect relationship between Cultural value as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural value as marketing culture aspect and marketing experience.   (5), illustrates the findings of Sobel test to find the mediation analysis, the result demonstrates the direct relationship between Cultural value as marketing culture aspect and marketing creativity, P-value =.0002 this indicated that there is a significant and positive direct relationship between Cultural value as marketing culture aspect and marketing creativity. Furthermore, P-value is .000 as indirect relationship between Cultural value as marketing culture aspect and marketing creativity.
Moreover, the results proved that there is a positive and significant direct and indirect relationship between Cultural value as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural value as marketing culture aspect and marketing creativity.
H2: Cultural experience mediates Cultural satisfaction as marketing culture aspect with marketing creativity.  (6), demonstrates a hierarchal multiple regression analysis to investigate second research hypothesis which stated that Cultural experience mediates Cultural satisfaction as marketing culture aspect with marketing creativity. Concerning model (1) the direct relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, the value of B = .522, the value of Beta = .526 with P-value =.000 this indicated that there is a significant and positive relationship between Cultural satisfaction as marketing culture aspect and marketing creativity. As for model (2) which applied multiple regression analysis to find both Cultural satisfaction as marketing culture aspect as independent factor and Cultural experience as a mediator factor with marketing creativity as dependent factor, the findings showed that the value of B =.578, the value of Beta = .581 with P-value .001 as indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, on the other hand, the value of B =.539, the value of Beta = .542 with P-value .000 as mediation between Cultural experience and marketing creativity. The findings proved that there is a positive and significant direct and indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural satisfaction as marketing culture aspect and marketing experience.  (7), illustrates the findings of Sobel test to find the mediation analysis, the result demonstrates the direct relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, P-value =.000 this indicated that there is a significant and positive direct relationship between Cultural satisfaction as marketing culture aspect and marketing creativity. Furthermore, Pvalue is .000 as indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity. Moreover, the results proved that there is a positive and significant direct and indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural satisfaction as marketing culture aspect and marketing creativity.

IV. CONCLUSIONS
Healthcare providers are enslaved by the immense pressures of lowering treatment prices and rising service quality because most of them are reluctant to invest in the everchanging innovations that aim to do so. Healthcare providers' ability to work successfully in Kurdistan region of Iraq is limited by their limited scale, patients' low knowledge and refusal to try new things, inadequate skills and resource base, rapid technical advances, and failure to transfer strategic grounds to their areas of power. Focusing on a certain geographic area of healthcare increases providers' experience and specialization, resulting in a sustained competitive advantage or a long-term advantage that competitors will find impossible to duplicate. According to the Economics rule of supply and demand, such knowledge and specialization should focus on the expense of treatments and the level of service provided. The researchers applied hierarchal multiple regression analysis and Sobel test to measure the current study; the findings revealed that a hierarchal multiple regression analysis to investigate first research hypothesis which stated that Cultural experience mediates Cultural value as marketing culture aspect with marketing creativity. Concerning model (1) the direct relationship between Cultural value as marketing culture aspect and marketing creativity, the value of B = .632, the value of Beta = .637 with P-value =.000 this indicated that there is a significant and positive relationship between Cultural value as marketing culture aspect and marketing creativity. As for model (2) which applied multiple regression analysis to find both Cultural value as marketing culture aspect as independent factor and Cultural experience as a mediator factor with marketing creativity as dependent factor, the findings showed that the value of B =.644, the value of Beta = .647 with P-value .001 as indirect relationship between Cultural value as marketing culture aspect and marketing creativity, on the other hand, the value of B =.669, the value of Beta = .672 with P-value .000 as mediation between Cultural experience and marketing creativity. The findings proved that there is a positive and significant direct and indirect relationship between Cultural value as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural value as marketing culture aspect and marketing experience. Moreover, it was found that the direct relationship between Cultural value as marketing culture aspect and marketing creativity, P-value =.0002 this indicated that there is a significant and positive direct relationship between Cultural value as marketing culture aspect and marketing creativity. Furthermore, Pvalue is .000 as indirect relationship between Cultural value as marketing culture aspect and marketing creativity. Moreover, the results proved that there is a positive and significant direct and indirect relationship between Cultural value as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural value as marketing culture aspect and marketing creativity. On the other hand, the hierarchal multiple regression analysis to investigate second research hypothesis which stated that Cultural experience mediates Cultural satisfaction as marketing culture aspect with marketing creativity. Concerning model (1) the direct relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, the value of B = .522, the value of Beta = .526 with P-value =.000 this indicated that there is a significant and positive relationship between Cultural satisfaction as marketing culture aspect and marketing creativity. As for model (2) which applied multiple regression analysis to find both Cultural satisfaction as marketing culture aspect as independent factor and Cultural experience as a mediator factor with marketing creativity as dependent factor, the findings showed that the value of B =.578, the value of Beta = .581 with P-value .001 as indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, on the other hand, the value of B =.539, the value of Beta = .542 with P-value .000 as mediation between Cultural experience and marketing creativity. The findings proved that there is a positive and significant direct and indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural satisfaction as marketing culture aspect and marketing experience. As for Sobel test was found that the direct relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, P-value =.000 this indicated that there is a significant and positive direct relationship between Cultural satisfaction as marketing culture aspect and marketing creativity. Furthermore, P-value is .000 as indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity. Moreover, the results proved that there is a positive and significant direct and indirect relationship between Cultural satisfaction as marketing culture aspect and marketing creativity, moreover cultural experience has a positive and significant mediating role between Cultural satisfaction as marketing culture aspect and marketing creativity. However, a key element in improving patient-endorsed healthcare systems is an emphasis on cost savings and increased quality, as well as differentiated industry. This are achievable with the acquisition of new technology and well-trained and driven workers who can use their expertise for the good of society in a way that carves out a distinct market that rivals can seldom replicate or copy at a high cost.
The findings suggest that healthcare standardizes service offerings, educates workers, and places a premium on teamwork. They adjust their prices, recruit local workers, and help with local research and development. The standardizing elements of the initiative are based on the healthcare delivery definition, while the adaptation problems are focused on marketing strategy. This mix of adaptation and standardization is influenced by local culture and leads to the creation of trust and networks, making the offering tangible and straightforward. Formal networks with government, regulators, foreign organisations, physicians, and students concentrate on international problems, while informal networks are embedded in the local context and help to establish the credibility of service providers. As a result, this network expansion has an effect on the firm's trustworthiness and tends to resolve the intangibility and heterogeneity of the service offering. Culture is important for services marketing because it contributes to a deeper understanding of which facets of the offering can be standardized/adapted, as well as the growth of trust and networks that sustain the international process by increasing homogeneity and tangibility.

V. CONTRIBUTION
To overcome issues of intangibility and heterogeneity of programs, our research contributes to the international services marketing literature by creating a model of internationalization of health services marketing focused on adaptation/standardization, confidence, and network. The research has management ramifications as well. Managers should know that selling people-processing facilities necessitates the creation of local networks in order to achieve confidence and credibility in the local market, as we understand it.

VI. MANAGERIAL IMPLICATIONS
The following recommendations are boldly made in the light of the preceding findings.
• Healthcare providers should focus on specific business segments because specialization decreases job complexities, prices, and time; carves out an enviable niche; and distinguishes a company's activities from others. • Since healthcare providers are unable to afford much of the innovations that boost procedures and minimize prices, the government will be able to assist them by bank facilities. • Healthcare providers in the Western world are urged to collaborate with their technologically superior peers so they can demonstrate openness in their overall dealings.

VII. LIMITATIONS
This analysis is constrained by the fact that it is based on only one scenario. Comparative experiments of healthcare cases in other distant countries to the Kurdistan region of Iraq may be performed to assess the conceptual model. The findings of the case studies should be compared to the findings of the current research to get a better understanding of how international health-care promotion works. A crosssectional analysis is useful for examining perceptions about, and perceived costs and benefits of, multinational companies' local adaptation while selling services internationally. In addition, a comparison of international marketing for complicated and moderately complex services will show how services can be planned and distributed to global markets.