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Abstract

The paper examines different aspects of strategic marketing in the context of the healthcare organization. The review of studies on marketing in medicine proved that the sphere of medical business has a set of important features that directly influence marketing planning of the company. These features were revealed in 4 components of the marketing mix (promotion, price, place, product), however, there are no papers studying the extended version of this marketing model (7P) in medicine. In the case study the dental clinic “Dental Palace” in St. Petersburg is considered. Current market position of the clinic was considered both from the inside (internal environment), and from the outer side (analysis of external environment). SWOT analysis is conducted based on the results. The paper is written in a project-analytical format, which implies analyzing a problematic or challenging situation: implementation of a child's dentistry, which is planned by management of the clinic. So, in the project part, the new service is considered by interviewing an expert in child's dentistry, demand is analyzed using an online survey and recommendations on introduction are provided. Moreover, the core hypothesis is proved: innovative marketing tools used in dentistry for implementing a new service has a set of features in all 7 components of marketing mix: promotion, price, place, product, physical evidence, people, process.

Keywords: healthcare marketing, innovative marketing, dental clinic, “Dental Palace” Saint Petersburg, children's dentistry.

Introduction

Strategic planning of marketing is an important task of management of any company, which successful realization leads to an increase in a market share and profit of the organization, strengthening of competitive advantage and positive reputation about product among consumers. However, despite the importance of marketing planning, the strategies of many modern Russian companies do not fit to a context of this or that industry, disregarding specific features of their goods or services. One of such industries is the private medicine, where planning of marketing demands special consideration.

The choice of marketing tools in private medicine which help to implement marketing strategy poses big difficulties for company management. For optimization of this process there is a development of full marketing mix as a basic element of any business strategy as for many service companies there are general principles and signs of each element marketing of a mix. As theoretical background number of studies on healthcare industry as a specific type of business is considered and it is also proved that there is a set of features of marketing in healthcare which complicates development of marketing strategy and demands an individual approach. A set of researches cover this subject, however, all authors who modify marketing mix to general principles of medicine stop on outdated system 4P.

In a practical part of the work features of all "coordinates" of marketing planning (7P) will be considered in separate branch of medicine -dentistry, for a concrete service. Therefore, the core hypothesis is derived: because of a number of dental business features, development of marketing strategy of introduction a new service has a number of nuances in each element of the extended version of marketing mix. Also, it is considered how each of these characteristics influences the planning of successful start of a new service.

So, the research topic of the paper is developing marketing strategy of implementing a new service on the health care market. The research problem implies the question: what are the marketing tools that will lead private dental clinic in Saint-Petersburg to the organizational growth (effectively fighting the competition, gaining market share, catering to the customer needs, fixing the right price for its services and so on). Moreover, the main condition under which the company is analyzed and the recommendation has to be given, is characterized as innovation process, because the management of the clinic plans to introduce a new dental service for its customers - children's dentistry.

Therefore, the objectives of this exploratory research can be formulated as following: to reveal the most relevant and efficient marketing tools that can be used by a dental clinic to stimulate customer interest in children's dentistry, and according to these tools to identify the direction of organizational development that will help the management to strengthen the business at the innovation stage.

To achieve this objective, several tasks have to be performed in the context of assessing the phenomena of marketing strategy in a new light of dental clinic in Saint-Petersburg.

These tasks are:

a) to analyze the fundamentals of healthcare marketing and marketing tools

b) to carry out an overview of company which is chosen as a research object (the "Dental Palace" clinic)

c) to reveal features of the internal environment of the clinic and the existing external marketing and to illustrate the results in the SWOT analysis

d) to analyse a state and influence of the external environment on activity of the company

e) to consider features of children's stomatology as an innovative service for the clinic

f) to reveal features of demand for services of children's stomatology in St. Petersburg

g) to provide a set of recommendations for successful introduction of children's stomatology services in the "Dental Palace" clinic

For performance of the tasks "b" and "c" were chosen following methods of data collection: analysis of the web-site of the clinic (http://www.dentalpalace.ru/), face-to-face interviews with administration, analysis of company's documents, both openly accessible (current price list) and provided personally by the administration (guide for administrator of “Dental Palace”: “How to communicate with patients”). Moreover, review of social media is provided, using Instagram accounts of the most famous dentists of the company (e.g. Mazepov Dmitriy: https://www.instagram.com/mazepov_smiledesign/?hl=ru) and the VK account of the clinic itself (https://vk.com/club170623619).

The data to perform the task “d” (external analysis) is collected while analyzing the whole industry of children's dentistry in Saint-Petersburg and two articles about it: the research conducted by RBC and published on the website Business Planner (https://business-planner.ru/articles/analitika/issledovanie-rynka-stomatologii-sankt-peterburga-v-2017-godu.html) and an article of the magazine "Business St. Petersburg" (https://www.dp.ru/a/2018/06/28/Zubnie_kliniki_razmnozhajut)

Data for the task "e" was collected by means of an in-depth interview with the expert in children's stomatology, which was analysed later. Besides, an online survey of 150 respondents from St. Petersburg was held for identification of features of demand for children's dental services (the task "f").

The results of the thesis are recommendations, that could be relevant for managers of dental clinics in Saint-Petersburg, who plan to enter the premium segment market of children's dentistry.

1.Theoretical foundation

marketing strategic healthcare

Marketing on the healthcare market.

The market of medical services is a very broad and complex field of business and each person becomes its consumer at least several times throughout the lifespan, as the human health is our foremost priority need. The need for medical services is caused by the fact that full and high-quality medical care allows people to fulfil themselves and to achieve some vital objectives in life, without their depending on the state of health. Providing these services on a paid basis is one of the indicators of medical business with its legal regulation, expenses and proper marketing approach. Nowadays hospitals and healthcare companies are facing the rising medical expenditure, therefore, to avoid high growth of medical costs efficient investment in marketing is the top priority [Qian, Wan, Du, Shi & Huang, 2018].

Marketing in healthcare system has a number of important differences and specific features, but it does not require creation of a new paradigm [Criй, Chebat, 2013]. Certainly, the main essence of marketing as human activity, which according to Kotler (2007) is directed to satisfaction of needs and requirements by means of exchange does not change also in a context of medicine. However, different articles on marketing of health services written during the last decade illustrate that the majority of researcher considers this phenomenon from innovative point of view, while applying different aspects of strategic marketing in medical field. There are several examples: Janet R. McColl-Kennedy provides a new health care Customer Value Cocreation Practice Styles (CVCPS) typology, thus expanding and modifying the firm-consumer collaborative marketing approach [McColl-Kennedy, 2012]. Sirgy M. J. studied, if there exists a consumer sovereignty in the healthcare market, developing a new theoretical model based on a context of major consumer segments [Sirgy, Lee & Grace, 2011]. Suhinin (2017) considers traditional Concept of the Marketing Mix in the article, transforming it for a medicine context and suggesting to allocate new components of marketing mix that will contribute to efficiency of marketing mix application in modern medicine - they are "Property" and "Planning". Analyzing these articles about marketing in healthcare we see that in the majority of cases researchers create new theoretical models or transform traditional methods and instruments of marketing to medicine context. Many authors of the articles on application of marketing in medicine agree that health-care organizations face unique challenges while trying to find relevant marketing principles [Criй, Chebat, 2013; Anderson, Rayburn, & Sierra, 2018; Thomas, 2008]. Researches consider various components of marketing strategy and reveal their features within business of the medical organizations.

Consumer.

First of all, differences between the consumer in medical business and other spheres of the market relations are emphasized. The nature of the demand for health services assumes that the majority of serious healthcare episodes occur almost always unpredictably and without a certain frequency, so, patient is not a regular consumer of services [Thomas, 2008]. However, as it has been already mentioned, unfortunately everyone faces the need of help from any medical professional at some time, therefore potential consumer in healthcare is everyone. Moreover, if the person becomes a consumer of healthcare services, an emotional component (fear, pride and vanity) before and during the direct contact with a doctor or a consultant is present in most cases, what is seldom observed in other consumer transactions [Thomas, 2008]. Unstable emotional state of patients can somewhat affect the objectivity of decision-making, sidelining economic motives [Thomas, 2008]. Criй and Chebat also consider in their article the emotional component, but from another side [Criй, Chebat, 2013]. According to them, an emotional irritant can also be the fact that medical treatment in many cases is an intimate process which often implies some awareness of the doctor and causes discomfort for some consumers. They "must paradoxically both safeguard their privacy and surrender part of their intimacy to health personnel" [Criй, Chebat, 2013, p.124]. Indeed, relationship between the doctor and the patient "erases" some boundaries and requires trust as they become based on collaborative interactions where consumers become more active participants of health-care service delivery process [McColl-Kennedy, 2012]. Patients are well-informed about treatment process, and treatment plans of some chronic diseases include some deeper aspects of the individual's life such as of habits, beliefs and lifestyle of the patient [Mechanic, Meyer, 2000].

Product.

Secondly, distinctive features of the product of medical organization which it offers to the consumers have to be considered while developing marketing process [Murunova, 2009; Suhinin, 2017; Thomas, 2008]. In this context the product is a medical service. First of all, a medical service is an intangible product what imposes some restrictions on realization of marketing strategy. Because of such intangibility of medical service, the patient cannot precisely assume the result of next doctor's appointment and visualize the expectations [Suhinin, 2017]. Besides, there is no packaging for majority of medicine organizations services, so it is hard for patients to quantify the product they bought and to compare it with the price for the received service. So, there are no standard evaluation techniques and every consumer evaluates and assesses it differently, being guided by his subjective impressions and feelings [Thomas, 2008]. In spite of the fact that patients become more well-informed about the treatment process, some elements of treatment "are complicated and difficult to explain to a layperson" [Thomas, 2008, p.7], therefore, the consumer either relies on authority of the attending physician, or conducts an independent research (for example, in the Internet) that can distort his understanding of the problem and influence the treatment process negatively. Also, medical service is a product which is not intended for sale or use after a certain period of time [Suhinin, 2017], what in case of expensive treatment creates feeling of risk with the consumer, as the influence of a product on well-being of the patient comes immediately at the time of rendering the service.

Promotion.

To establish communication and stable relations with the consumer the company needs qualitative and effective marketing communications which are reflected in the following component of marketing mix - promotion. Communication messages have to convey to the consumer information about the product and its benefits and features. Many authors integrate the principles of promotion under a medicine context, mark out main features and a number of challenges which the organization faces when choosing promotional strategy.

First of all, before choosing marketing messages for promotion of medical services it is necessary to consider that the end-user may not be the target for the marketing campaign (книга Health Services Marketing). The person who in the result is a consumer of medical service is not the one who makes the decision and chooses between producers in many cases. It is caused by many factors, such as lack of information an ordinary patient has, inability of the patient to make the decision because of physical incapacity and so on. In this case the decision is made by the attending physician, the family member or the trustee, therefore, arises the question: where to place the promotional emphasis? [Thomas, 2008]

The next characteristic feature of medical services consumption is that almost all medical services are not restricted by a single visit of the patient. It also influences chosen marketing communications that, for example, can help the physician remind his current patient of the next annual or weekly check-up. As for attraction of new consumers, promotion in medicine allows to overcome the problems of intangibility. By using clear messages, emphasizing the attributes of their services and results, organizations can influence feelings, associations and emotions of the potential patient and create a picture of the healing process [Purcarea, Gheorghe, I. & Gheorghe, C, 2015]. However, they notice that in case of medicine it is necessary to approach communication messages carefully, as in various countries there is a set of strong social norms of advertising in health fields. It is worthwhile paying special attention to this key moment of the medical services promotion.

These rules and standards can be controlled both by the law, and ethical norm and mentality of people. For example, let's consider a situation in the USA: while the group of direct-to-consumer prescription drug is legally regulated by the Federal Drug Administration, rest advertisements for health care services are under ethically regulation (meaning that in case of non-compliance with norms companies can loss the license) of the Federal Trade Commission. As for Russia, the basic principles of legal regulation are stated in the Federal law "About Advertising" of 13.03.2006 N 38-FZ. Various aspects of advertising of medical services are regulated in this law, including: the requirements to reliability of advertising, types of goods and services that are forbidden to advertise, general requirements to different ways of advertising etc. Violations of the law on advertising are punished in the Russian Federation in the form of an administrative penalty [Петречук, 2014]. This could lead to the conclusion that because of strict regulations and dynamic changes in the legislation it is very easy for medical organizations to violate the law in desire to promote their medical goods or service effectively. Therefore, the majority of the companies carefully treat advertising process of the services and try to avoid risks and in these cases demand on medical services can rarely be created through advertising [Criй, Chebat, 2013].

Price.

It is possible to have a direct impact on the demand for both medical, and other services, thanks to manipulations with the following component of marketing mix - price. Healthcare organizations pay special attention to pricing process to ensure motivated and timely price reaction to changes in medical business with the maximum sales volume and profitability. General approaches to an optimal prices combination proccess are formed in the pricing policy [Бутова, Бойков 2014]. The price of medical service is a money equivalent of the economic relations which arise in the course of the practical actions for preservation and strengthening of human health [Шилова, 2018]. It is also an important qualitative parameter which defines its economic and social essence in the country where this service is provided [Михайлова, 2013]. In this part several features of the prices and pricing on medical services of the private medical organizations in the Russian Federation will be considered.

Many authors agreed that at the moment neither in the Russian Federation nor abroad the optimum techniques of pricing on medical services are accepted at the legislative level yet, [Смайловская, 2006; Шилова, 2018]. Special characteristics of medical activity of the private organization largely determine specifics of the pricing of medical services, and in some aspects complicate it, making more difficult for regulation and less clear for the patient. For example, AS it was already mentioned earlier, it is hard for the patients to quantify the product they bought and to compare it with the price for the received service as there is no packaging. [Thomas, 2008]. However, Nugumanova also notes another feature which complicates patient's understanding of actual cost of the rendered service [Нугуманова, 20013].

The fact is that the structure of costs of paid medical services in many clinics is complicated and consists of some blocks: - direct costs of the establishment; - expenses of paraclinical services; - consultations of experts; - costs of operations; - overhead costs. - costs of drug treatment according to MES [Михайлова, Муслимов, 2013]

Medico-economic standard (MES) is the quality standard of rendering medical service which regulates and "specifies the kinds and quantities of diagnostic and treatment services a patient with a particular health condition should receive". [Kamenshchikova, 2018, p.117]

It is often also difficult to define and prove the expenses when rendering services because of the strong interaction of the market of paid medical services with the market of medical technologies, medical equipment, pharmacological products and preventive orientation products [Михайлова, Муслимов, 2013]. This interaction (with suppliers of medical equipment and medication) directly influences the actual costs of rendering this or that service which in turn influences its price. Moreover, in many cases of providing of specific medical services the calculations of the price are carried out not for a single medical service but for the whole complex of related services, for example medical and hotel care of patients in medical organizations. As a result, the price of this complex turns out for the patient higher, than the price for a single medical service because of higher costs [Нугуманова, 2013].

All cumulative costs of the organization and rendering medical services are included in the contract price which is used in most medical institutions of a private health care segment. It represents market equilibrium price and is defined by a supply - demand ratioin on the market of medical services [Нугуманова, 2013]. However, Smaylovskaya claims that pricing in the commercial sector is more connected not with the expenses but with influence of the external marketing environment [Смайловская, 2006]. Shilova also concludes that nowadays it is more relevant for the private medical organization to determine the price according the level of the existing prices of the competitors on the market [Шилова, 2018].

Place.

Dynamic expansion of the commercial healthcare sector in Russia increases the competition among private clinics that seek to choose the proper location which contributes to effective patient acquisition and retention. If earlier special attention was not paid to the location of the clinic (because of underdevelopment of private medicine every medical care was provided in hospitals) [Thomas, 2008], now rapid development of the market increasingly defines importance of "place" in the marketing mix of the medical organization. Place is the way how care and other services are distributed, including treatment choices, assortment, location or the hours a clinic can be accessed.

Traditionally, any company which is located on the "front page" is assumed to attract more clients, however, because of the features of medical services and needs of patients, this statement is not relevant for clinics and other private medical organizations. While some medical institutions are guided by the principle that the contemporary consumer demands convenient locations other clinics pay more attention to features of patients and their needs, thereby increasing the profit [Thomas, 2008].

For example, many care centers are located near potential patients (in case of children's stomatology - near the schools or family neighborhood, in case o premium class private clinics - in more elite areas) [Thomas, 2008], thereby paying more attention to targeted advertising and increasing its efficiency. Others being guided by the fact that mostly, except for some emergency situations, people choose to receive medical care purposefully either from a certain doctor, or for a certain price having analyzed all the possible opportunities [Горячев, Н., Горячев Д., Варламов, 2017]. Thus, these clinics pay bigger attention not to the location, but to their medical personnel and price list. However, the most effective factor of medical services consumer attraction is not only their price and quality, but also a variety. Full treatment plan of the patient is formed directly after examination by the doctor in clinic. For example, according to N.A. Goryachev the patients of dentistry at the time of primary visit receive no more than 10% of the possible volume of the necessary help. Therefore, the wider is the range of related services which the clinic can provide, the more attractive to the patient it will be [Горячев, Н., Горячев Д., Варламов, 2017].

The next important aspect of "place" is the way and the channel of distribution, which allows medical service to reach the patient [Thomas, 2008]. Smaylovskaya M. in detail considered possible distribution channels, and came to a conclusion that in the sphere of paid medicine the distribution has its specific features [Smaylovskaya,2006]. First of all, subject to sale is a service what makes involvement of wholesale intermediaries impossible. Besides, multilevel sales channels of paid medical services demand special expenses that can lead to increase in prices for services and it is extremely undesirable for average private medical institutions in the Russian Federation. For this reason, the main is direct distribution channel at which the medical organization carries out its marketing policy on involvement of patients by itself. Common practice are also one-level schemes of distribution where the marketing company or the consulting physician act as intermediaries, are engaged in attraction of new patients and increase marketing efficiency of the clinic. Marketing company provides qualified services and guarantees on involvement of new consumers; however, its use is relevant only for large MPIs because of high cost. The consulting physician in turn is considered by potential patients as a reliable source of information on treatment which they trust.

1 Research design

This part of the work explains the chosen design of study and the research tools. Moreover, it describes the data collection process.

The main research part comes after the literature review, when following topics have already been discussed: basics of marketing and marketing research, marketing on the healthcare market (its features and features of the market itself) and Russian healthcare system (key legislation features and trends).

The research strategy can be described as a single case study, since only one clinic in Saint- Petersburg is examined. However, one of the steps of the plan is to analyze performance of the competitors of the company, so, the best and the worst practices will be also described (on the third stage). So, the empirical investigation of developing marketing strategy for healthcare organization will be conducted within real life context of the dental clinic in Saint- Petersburg.

The step by step plan of the study has five stages with different data collection and analysis methods.

The first step is company overview. It's a summary of the most important points about the clinic: the short story of the company is provided, company's activities and provided services are described, the licenses are examined. The data is collected from the web-site of the clinic (Dental Palace, UPD: http://www.dentalpalace.ru/), from face-to-face interviews with administration who sustain relationships with stakeholders and have direct contact with patients.

The second step is to analyze the internal environment of the organization in order to indicate its Strengths, Weaknesses, Opportunities and threats using SWOT analysis. This stage implies organizational strategy illustration, analysis organizational culture, current internal and external marketing strategies, Customer Relationship Management analysis (loyalty of the patients, switching costs, customer acquisition and retention). The main data collection method here is analysis of company's documents, both openly accessible (current price list) and provided personally by the administration (guide for administrator of “Dental Palace”: “How to communicate with patients”). Moreover, review of social media is provided, using Instagram accounts of the most famous dentists of the company (e.g. Instagram account of Mazepov Dmitriy: https://www.instagram.com/mazepov_smiledesign/?hl=ru) and the VK account of the clinic itself (https://vk.com/club170623619). Based on the findings SWOT analysis of the clinic is conducted.

The third step is external analysis of the external micro-environment of the clinic, considering every stakeholder of the company, all the suppliers are named and customer portrait is created on this stage. Moreover, competitive analysis of the external environment is conducted using Porter's Five Forces model.

As the topic of the study is developing marketing strategy for a new service, future implementation of children's dentistry services is considered on the next step. Children's dentistry is the certain dental area and its services are planned to be offered to the patients of the clinic within few months. It requires specific doctors, a new target audience, licenses, technical equipment and so on. So, the overview of new service is conducted in this part, using benchmarking, legal requirements, analysis of the demand for this service and developing new relevant customer acquisition program. There are two main data collection methods used on this stage. The first method helps to analyze the demand by conducting an online-survey with 150 respondents, which was conducted within the period from 1^th to 20^th of Mai. All questions that were asked can be found in Appendix 1.

The second method of data collection is conducting an in-depth face-to-face interview to analyze the experience of the expert in children's dentistry, when the service is considered using the modified 7p methodology.

The interview can be divided into several blocks. Each of the sections illustrates a separate component of marketing mix.

The first block of questions is devoted to general information on the company in which the respondent works, to his medical and administrative experience (Questions 1-7).

The following block reflects main features of children's dentistry services (Questions 8, 9)

In the third block the most profitable location of the clinic is considered, which provides the maximum availability of a product to the target market. (Question 10)

Further it is analyzed how to create a policy of promotion of the company in the most effective way. (11-13)

Next, some features of the pricing process in children's and family dental clinics are analyzed. (14-16)

The following section highlights the necessary requirements to the personnel working in private children's dental or family clinic. (17-18)

The seventh section is devoted to the characteristics of the concrete place where children's reception is carried out. (19-21)

In the last block process of interaction between the target consumer and the company is described, it is also considered how to make the use of services the most comfortable for the end user. (Question 20)

The fifth step is to provide recommendations based on the findings. The recommendations on improvement of the company's different marketing aspects with respect to implementation of the children's dentistry, so, the findings and recommendations are applied to the specific situation.

The research is cross-sectional, because a particular phenomenon is studied at a particular time. Namely, it is analysis of marketing tools used by a company at the time of 2019 and developing of the new strategy for the implementation of the new particular service.

2. Overview of the company

The "Dental Palace" clinic was founded in 1995 and focuses on a premium segment of patients, using high-quality materials, expensive equipment and author's methods of treatment.

The company is located at the Petropavlovskaya St. 4, St. Petersburg, metro station Petrogradskaya. Working hours of the clinic: from Monday to Friday from 9:00 till 21:00, on Saturday from 9:00 till 18:00.

According to the All-Russia Classifier of Types of Economic Activity (OCVED) [URL: https://код-оквэд.рф/ N.D.] which was approved and enacted by the Order of Rosstandart of 31.01.2014 N14-St since February 1, 2014, the primary activity of this company is dental practice, however there are several additional types of activity: production of the devices used in medical purposes, based on use x-ray, alpha, beta and gamma radiations, consultation on issues of commercial activity and management and also other activity in the field of medicine, not included in the groups.

The dental center provides for more than 20 years both medical, and preventive help to the patients. Special attention in the clinic is paid to the issues of prevention, there is a regular preventive programme which is directed to prophylactics of the most widespread diseases of teeth and oral cavity.

The small number of the dentists specializing in various areas is engaged in the medical help. The main areas are: Therapy, Periodontics, Orthopedics, Orthodontics, Surgery.

The full range of the provided services according to each area is given below:

Therapy: consultation of the dentist, professional teeth cleaning, treatments of dental caries, treatment of a diastema (gap between two teeth), treatment of tooth channels, a pulpitis or periodontitis, teeth whitening.

Periodontics: treatment of gums

Orthopedics: installation of veneers on teeth, prosthesis on the implants, prosthetics of teeth by fixed and removable prosthetics.

Orthodontics: correction of a bite of teeth by means of orthodontic devices

Surgery: extractions and treatment of a granuloma at tooth root, implantation of teeth by various designs of tooth implants.

The clinic possesses all the necessary documents and licenses, which are available on the main website (Dental Palace, UPD: http://www.dentalpalace.ru/). There is a unified and indefinite "License for medical activity" of May 16,2016 granted by the Health Committee of St. Petersburg. All types of dental services except children's dentistry are specified there. The management of the clinic wants to implement this service by the fall of 2019.

In view of lack of children's dentistry, the clinic loses a big segment of patients and does not get the greatest possible profit. Entry into the market of children's dental services is considered by the management as potential new development of the clinic, and, because of the increasing demand for these services a new project was initiated.

3.Analysis of the internal environment of the company

During the analysis of each aspect of company's activities it is necessary to consider that this is a small enterprise, which in general has about 20 workers, among which: the doctors who are carrying out medical practice, administration of the clinic, the heads, paramedical personnel, experts working in economic department of clinic, etc.

3.1 Organizational structure

The scheme of organizational structure of the “Dental Palace” clinic is illustrated in the Figure 1.

One can see on the scheme that in case of “Dental Palace” clinic division of work happens depending on functions of this or that department (therefore the structure is functional), and heads of all departments report to one head - the chief medical officer. There are 6 departments in total: clinic-expert department, human resources department, medical department, economic department, accounts department, department of economic work.

The Deputy Chief Physician of medical department supervises two additional departments: the department of administration consisting of the chief manager and his assistant and the treatment department where experts of 8 directions of dentistry are presented. The department of economy also supervises the customer service department.

Figure 1. Organizational structure of “Dental Palace”

Because of a small number of workers in the clinic and the long period of work, one can observe the spirit of association and friendly relations in the collective. Besides, according to the claim of the management, most of the doctors work in the clinic since the moment of its basis, therefore, much attention is paid to corporate culture. On the other hand, internal integration of new members of collective is also developed in the clinic.

3.2 Organizational culture

Basic elements of the organizational culture of the "Dental Palace" which define the atmosphere and social climate in the organization and also dominating in the organization the system of values and styles of behavior are listed below.

a) Behavioural stereotypes: the common professional language used by all doctors (specializing in different areas) and administration, knowledge of medical terminology, mistrust to folk customs and traditional medicine, focus only on medical knowledge and professional experience by treatment the patients.

b) Group norms: the standards unique to the group regulating behavior of all members. In case of a dental clinic it is more about dentists as a "group" which has to adhere a strict dress code rules, has to pay huge attention to personal hygiene and a certain professional behavior, which inspires trust and calm to the patient.

c) The values: the principles and values, announced publicly for which realization the company seeks: "We all are betrayed to high quality of treatment and service. For this reason a priority for us is high-quality service of each patient only on premium standards, but not an increase in number of patients due to reduction in cost of our materials and works".

d) Philosophy of the organization: the ideological principles of the clinic state: "We introduce only those methods of treatment which were reliably proved, are safe for health of our Patients (among whom there is also staff of our clinic and their relatives). We trust only the positive long-term results."

e) Rules of conduct during the work in the organization: unconditional adherence to the principles and rules adopted by Dental Association of Russia in the Ethical Code of Experts of the Dental Profile, being guided by the principles of humanity, mercy and ethical norms.

f) Organizational climate: next characteristic feature of interaction of members of the company with each other is a friendly climate and also trust to professional experience of the colleagues (in case of need the consultation of dentists of other specialties does not cause any difficulties and misunderstanding).

g) The existing practical experience: there are some methods and techniques used by doctors for achievement of definite purposes and transferred only inside the clinic: "In our dental laboratory work the technicians of elite classes making crowns and veneers by an author's technique".

3.3 Production and external marketing.

The next important aspect of the internal environment of the company is production. As it was already mentioned, all types of dental services are provided to adult patients in the clinic, what makes complex service possible. The management of the "Dental Palace" considers the main competitive advantage existence of dental laboratory which is a basis of orthopedic department of the clinic and allows to make dentures inside the clinic and also gives the chance to technicians to take part in the treatment process since the first consultation. Thus, the relationship "patient-doctor-technician" is controlled at all stages, the conflict situations connected with misunderstanding or non-compliance with the agreed production deadlines are minimized.

Despite such a developed internal marketing in the company, fever resources and efforts are spent on the strategy of external marketing. Operating on the market for more than 20 years, the clinic invariably occupies a certain share of the market. However, "with development of the competition and new technologies, profit from constant base of patients begins not to be enough for purchase of new expensive materials and equipment" - claims the administration of the clinic.

Indeed, at the moment there is no regular budget allocated for marketing plans and activities. The management of the clinic suspended all types of sales promotion and services promotion campaigns what spread even to work of the main website of the company: for about a year a third-party marketing firm has the rights for the website of the clinic what, certainly, complicates the process of attracting new patients and informing them. In view of recent changes in organizational structure of the clinic, the information on the website is irrelevant, and the old platform and the complicated web-design do not allow the visitor to interact with the clinic effectively.

As for the Social Media Marketing of the company, it is mainly directed to promote brand of the specific doctor, but not of the clinic in general. Most of all is involved in SMM of his own brand is the head of the clinic, the doctor of higher category, the prosthetist Dmitry Mazepov who several times a week posts in his Instagram account photos showing the results of the work for the 15th thousand audience of subscribers.

According to the claim of the head of the clinic, Dmitry Mazepov is an independent brand and one of the first dentists in Russia who in 1995 began to install porcelain veneer. Thanks to such a long professional experience and active promotion on social networks, Dmitry has both a big base of the patients who independently visit the clinic and bring others and also new patients who became interested thanks to positive the comments on the Instagram account. Besides, Dmitry has an opportunity to use for his own advertizing the authority of many media persons who visited clinic and were satisfied with the service and quality of the performed work.

The clinic does not use other types of advertizing what, certainly, is huge disadvantage of its marketing strategy of promotion of dental services.

4 SWOT analysis

Thus, after the analysis of the internal environment of the company and the existing marketing strategy, it is possible to draw conclusions on unfair advantage which competitors of the clinic will not be able to copy or buy.

Strengths

a) The small number of workers creates spirit of partnership and friendly relations in the collective. Much attention is paid to corporate culture and common values of members of the company, individual approach is applied to each of members of the team.

b) High qualification of the doctors (on average, professional experience is about 20 years).

c) The constant base of clients attached to specific doctors and also bringing new patients.

d) The long-term results (the clinic operated on the market for more than 20 years what causes trust for patients).

e) Several doctors of the clinic are an independent brand what attracts new patients. For example, Dmitry Mazepov, who started as one of the first Russia's dentists the installation of porcelain veneer works in “Dental Palace”. Many movie stars and public figures are regular patients of the clinic that, certainly, is a great advantage in issues of promotion and brand recognition among potential patients.

f) A possibility of complex service as all types of dental services are provided in the clinic

g) There is dental laboratory in “Dental Palace” that is a big advantage thanks to an opportunity to regulate deadlines of works and to adjust already available works directly in day of reception of the patient.

h) In the dental laboratory work the technicians, who make crowns and veneer by an author's technique.

Weaknesses

a) The clinic provides every type of dental services except children's dentistry. The lack of the license for children's dental services seriously reduces the potential profit of the company as demand for these services is very high in St. Petersburg.

b) The high rent caused by the location in Petrogradsky district.

c) Weak organization of a marketing information system in the clinic.

d) Lack of experience of market researches.

e) Slow reaction to innovations and implementation of new technologies in view of the insufficient budget

Opportunities

a) The clinic is located in one of the optimal areas for doing dental business - Petrogradsky district. Increase in number of business centers in this area is a favorable factor of the external environment which can influence business growth in the future.

b) Increase in working age population (potential consumers).

c) Increasing popularity of a cult of a healthy lifestyle leads to increase in demand for medical services.

Threats

a) Increase in prices for supplies increases cost of providing services that considerably lowers profit.

b) Rather intense competitive rivalry between operating dental clinics of a premium segment in Petrogradsky district is observed.

c) Possible increase in a refinancing rate

5. Conclusions on the basis of the SWOT analysis

On the basis of the SWOT analysis it is possible to draw several conclusions and recommendations on how the dental clinic "Dental Palace" can increase profit and expand number of regular patients.

First of all, there are two areas in which the management of the clinic does not make special efforts, and the company has no experience. Among them - children's dentistry (despite a tendency to increase in a share of children's dentistry and demand for these services) and also external marketing activity.

It is necessary to monitor the areas in which the company is insufficiently strong, to improve them, and develop special programs for minimization of risks of influence of weaknesses on efficiency of the company.

Thus, it is recommended to study the market of children's dentistry and, in case of favorable conditions, to obtain the license for these services thereby seriously increasing the number of potential patients.

As for marketing activity of the company, it is necessary to pay bigger attention not only to promotion and recognition of a brand of the certain expert on social networks and thanks to media persons who are constant patients, but also to advertising campaign and other types of promotions of the services of the clinic and its brand.

5. Analysis of the external environment of the company

In the following section the external environment of the company is going to be examined. This includes the factors that can directly affect the clinic's activities. It implies the stakeholders like potential customers of dental services, suppliers of medical equipment and supplies. Furthermore, the analysis was conducted by applying the strategic model of Porter's Five Forces Analysis.

5.1 Consumer Profile

According to the experience of an acting administrator of the clinic who is in touch with all the patients, the following consumer profile was composed.

As the clinic only targets adults, the consumer age always exceeds 18. However, the majority of them are people over the age of 30 that have some permanent income and devote special attention to their health and appearance (e.g. going to the gym, discarding unhealthy habits).

The regular consumer of services by “Dental Palace” dental clinic is a patient with a good income who trusts a time-tested clinic and requires a particular attention to their problem and individual approach on the side of employees. They are not willing to remember what to do and when to come next time and are used to a situation when they are always explained the following steps and given respective directions. In their turn, they fully trust the professionalism of the doctors and other staff as they are likely to be referred to them by friends or relatives. The clinic aims at families: the client brings here their relatives, friends, colleagues and other acquittances.

As the clinic considers the esthetic dentistry to be the priority sector, most requests have to do with denture and implantation. Nevertheless, they are usually preceded by a therapeutic preparation. Because the clinic has doctors specialized in multiple areas, the patient may obtain all the services needed within the same company.

5.2 Resources Providers

When selecting the best suppliers of medical equipment and supplies, a dental clinic may either work with producers who deal with immediate production of the supplies or distributers who resell the goods obtained from large producers. A question guide was developed in the beginning in order to prepare for an interview with the manager of the economic planning department dealing with planning, control and procurement in the clinic. The goal of the questions was to investigate the general criteria of supplies quality, quality of communication with the supplier, logistics quality, the ways to reveal the most loss-making partnership etc. However, in the course of conversation with the assistant dean of the clinic for economic affairs, it became clear that the partnership framework is relatively primitive and not worked over in detail: the majority of orders by the economic department are fulfilled upon request, looking for the best possible price offered by various licensed suppliers. Therefore, they can switch to a company providing better conditions depending on the assortment, prices and special offers. Long-term contracts are barely concluded but some supply agreements on delivery, maintenance of dental equipment and purchase of consumables with the firms “Raudentall” and “Coral” could be seen as examples of the best possible partnership as the clinic has been working with them for over 15 years.

“Raudental” offers complex solutions for equipping the clinics of different specializations with a high-quality medical equipment, toolkit and consumables. The enterprise provides and maintains such dental equipment as for example, a multi-functional device for maxillofacial visualization, an innovational intra-oral sensor etc.

The distribution and technology center “Coral” partners with the clinic in the following areas: sale of the dental equipment and consumables, spare parts for the existing equipment, repair and maintenance of the dental equipment.

5.3 Porter's Five Forces Analysis

The influence of the external environment on “Dental Palace” is analyzed in the form of Porter's Five Forces in case of entry into the market of family dentistry. The results are illustrated in the Figure 2.

Figure 2. Porter's Five Forces Analysis in the dental industry of Saint-Petersburg

a) Threat of New Entrants - MEDIUM

Appearance of new companies on the market threatens the current players with reducing their market share due to the probability of adding more production capacities to the area. The greater the entry restrictions are on the market, the lower the threat. Therefore, it is necessary to estimate the level and extent of restrictions on entry of the new companies into the market of children's dental services:

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