Using fuzzy set qualitative comparative analysis for evaluating the effectiveness of relationship marketing and innovation in 3D printing medical market

1 Introduction

Recently, three-dimensional (3D) printing is receiving much attention from academics and practitioners. In a highly competitive environment, 3D printing could prove critical for a firm to establish a dominant position and earn higher profits. Extensive literature confirms a keen interest in 3D printing in the competitive environment [e.g., 6, 14, 37, 40]. The Economist [37] reported that additive manufacturing by 3D printing is creating the third industrial revolution, additive manufacturing is one of several breakthroughs leading to the factory of the future, and conventional production equipment is becoming smarter and more flexible. 3D printing has been widely applied as a powerful technological tool for the consumer, industry, and medical markets. Gartner [14] predicted that 3D printing technology could become among the top 10 strategic technologies in the world, and Canalys [6] indicated that 3D printing would grow to $22.4 billion by 2020. The U.S. Postal Service Office of Inspector General [40] reported that the entire 3D printing industry, valued at approximately US$3 billion in 2013, is expected to grow to US$550 billion per year by 2025. Accordingly, managers must understand how to satisfy 3D printing customers to enhance the competitiveness of business activities.

Technology involving 3D printing has become one of the vital success technologies across the world. Canalys [6] noted that the medical industry has a high potential for applying 3D printing technology. Asia University and China Medical University (Taiwan) collaborate to set up a new medical team specializing in 3D printing which is China-Asian Associated University 3D Printing Medical Research Center (CAAU 3DP MRC). This center is to take advantage of unique opportunities of 3D printing for medical applications, such as Division of Neurosurgery, Division of Orthopedics, Division of Dentistry and Division of Rehabilitation Medicine [3].

This study attempts to explore the competitive advantages and effectiveness of relationship marketing and innovation for 3D printing medical applications at the CAAU 3DP MRC. This study attempts to explore the competitive advantages and effectiveness of relationship marketing and innovation for 3D printing medical applications at the CAAU 3DP MRC. The study is supported by both China Medical University, and Asia University. Specifically, the vision of CAAU 3DP MRC [11] is “Be a world’s premium organization to develop and deliver advanced and affordable 3D printed medical care to improve the quality of life of the general public.”

In academics and practitioners, classical economics or transaction cost theories assume that people always act based on their own interest [10]. Therefore, a consumer will only purchase products made by 3D printing if a firm’s marketing strategies can maximize his/her utility or satisfaction. Specifically, if purchasing or consuming activities can satisfy the customers, the customers will be inclined to purchase or consume more of the product. Managers thus must understand how to satisfy the customer and how to win the customers’ favor to enhance purchasing or consuming activities is the major issue for the business manager or decision maker. It also means that the business manager must be cautious in utilizing related strategies, such as marketing strategy or innovation strategy, in increasing the competitive advantages in the industry. Previous studies suggested that the purpose behind developing marketing or innovative strategies is to enhance a firm’s competitive advantage and performance [e.g., 5, 18, 33].

Relationship marketing strategies are necessary for firms to survive in the highly competitive marketplace [1]. Especially for the 3D printing market, relationship marketing could effectively maintain and grow the existing customer base, while developing new customer groups or markets. Many benefits come to firms that can achieve sustainable customer relationships. With the increasingly fierce commercial competition, relationship marketing strategy has become the primary method to adapt to the dynamic competitive environment. Academic researchers in the fields of marketing management and consumer behaviors are paying much attention to relationship marketing strategies and user satisfaction [e.g., 1, 9, 18, 33]. In addition to the relationship marketing strategy, innovation strategies can serve as another method for firms to survive in highly competitive markets. Firms that can achieve sustainable innovations realize many benefits, such as more opportunities to capture international markets [33]. In general, firms also can create higher profits through valuable innovations [9, 49]. Innovation can revitalize an organization by exploiting a firm’s competitive advantages. Both Cheng et al. [9] and Raymond and St-Pierre [35] suggested that innovation is a crucial success factor in adapting to a dynamic competitive environment. According to consumer behavior theory, user perceived value and risk appear to be another critical role in satisfaction. Exploring the impacts of perceived values and risks on user satisfaction is necessary to capture the nature of consumer behavior. Based on these issues, this study intends to investigate the influence of perceived value and risk of 3D printing on user satisfaction.

Furthermore, several studies focus on the antecedents or consequences of innovation and provide valuable contributions to the knowledge of innovation [e.g., 9,10, 15, 18, 33, 45]. However, few studies have taken these two perspectives into account to explore the gap between these different perspectives in the 3D printing market. 3D printing suppliers may have more information about relationship marketing based on information asymmetry theory, and consumer behavior theory indicates that perceived values, perceived risks, or user satisfaction seem as covert consumer behaviors that cannot be directly observed by suppliers. The degrees of relationship marketing, innovation, perceived value, and perceived risk from 3D printing suppliers’ perspectives may differ from the customers’ perspectives. Therefore, the gaps between customers’ evaluation and suppliers’ perception are on the issues of perceived value, perceived risk, and user satisfaction of 3D printing may exist. Accordingly, this study develops an integrated conceptual framework to combine potential relevant antecedents, such as relationship marketing, innovation strategies, 3D printing perceived values, and 3D printing perceived risk, to explore the configurations for achieving user satisfaction from both the 3D printing suppliers’ and buyers’ perspectives by using fuzzy set qualitative comparative analysis software.

2 Literature review

Relationship marketing as a comprehensive business strategy, and several researchers have expressed a great interest in a trust and long-term win-win relationship [e.g., 39, 43, 44, 47]. Berry [4] first defined relationship marketing as businesses providing service to attract, maintain, and increase their relationships with the consumers. Yu and Tung [47] suggested that successful relationship marketing produces satisfied customers, creates favorable word-of-mouth, and lowers the costs of cultivating new customers when building long-term and mutually beneficial relationships. Relationship marketing aims to cultivate customer loyalty and acquire customer value by establishing long-term relationships. Relationship marketing as a long-term relationship between seller and buyer and believed that the maintenance of excellent relationship marketing was the primary task of managers. Tsaur et al. [39] indicated that relationship marketing includes mutual benefits, lifetime commitment to the customer, the fulfillment of the promises, use of knowledge about customers to help them satisfy their needs, and interaction and empathy with customers. Relationship marketing can be defined as establishing, developing, and maintaining fruitful relational exchanges. The benefits of building long-term strong and collaborative relationships between firms were the core of relationship marketing.

Relationship marketing was mainly to match customers’ needs and promises. Therefore, relationship marketing was a long-term win-win strategy for attracting, developing, and maintaining customer relationships. Based on these regards, this study defines relationship marketing as a long-term win-win strategy that 3D printing providers provide service to attract, maintain, and increase their relationships with the consumers. Since the additive manufacturing of 3D printing is creating the third industrial revolution, 3D printing managers must understand interrelationships among business strategy, perceived value, and user satisfaction. Relationship marketing as a type of index for customer value or satisfaction and customers will enhance their satisfaction based on excellent relationship marketing between the firm and customer. The ultimate value of relationship marketing is to continue to provide customers with high overall satisfaction effectively [1, 50]. In other words, relationship marketing can be seen as the primary source of 3D printing user’s satisfaction.

Human resource managers and researchers are becoming more interested in innovation. Kusiak [26] suggested that innovation, as an iterative process, aims to create new products or processes by using new or even existing knowledge. Innovations in products, processes, organizational and markets were all the domains of innovation, and product innovation and process innovation are more prevalent in researches [e.g., 10, 18, 32, 33, 35]. Therefore, this study focuses on product and process innovations. In terms of innovation, several studies proposed that innovation as the antecedent of customer behavior may well become a significant factor in the customer decision because customers should be comfortable purchasing a product when they perceive higher attractiveness or overall evaluation from the new offers [2, 35]. Innovation not only has an impact on productivity but they also generally play a key role in creating competitive advantages or market share for firms. Since innovation is the primary source that can create the firm’s competitive advantage or market share in the long run, the managers must understand how to use the innovation strategy to satisfy customers.

According to innovation-related researches, this study focuses on the product and process innovations to evaluate the innovation strategy. Innovations as technology-related innovations can enhance customer overall satisfaction. Innovations offer the customer or user better value for the money that can improve the product quality and reduce costs [33]. Cheng et al. [10] focused on product innovation and argued that product innovation enhanced product assortment attractiveness. They further claim that firms that make new products would enjoy a premium price. Scholars have suggested that technology-related innovations were associated with outcome or overall satisfaction of users. Horst et al. [19] proposed that introducing a new product or new service may involve benefits to the user. New products, services, or ideas are critical to product innovation [2, 18], process innovation can increase production efficiency and reduce monetary or time costs. [e.g., 2, 10, 18, 32, 35]. Akgün et al. [2] suggested that process innovations typically improve the efficiency of creating or establishing the products or services. Cheng et al. [10] proposed that process innovation may be positively affected by proximity, which may be seen as a form of fixed cost consolidation. Based on these regards, innovation not only has a major impact on productivity or competitive advantage but also generally plays a key role in creating user’s satisfaction. In other words, this study considers that innovation from 3D printing as the other causal condition to determine user’s satisfaction.

In addition to relationship marketing and innovation, perceived value and perceived risk are also growing interests to managers and researchers, and several researchers focused on investigating the interrelationships among perceived values, perceived risks and user satisfaction [e.g., 8, 19, 21, 24, 27, 28, 31, 36, 48, 50]. Chen and Chen [8] defined perceived value as “the consumer’s overall assessment of the utility of product or service based on perceptions of what is received and what is given.” Besides, a customer’s perceived value can be seen as a function of the total sum of benefits received divided by the total sum of sacrifices made by the customer to receive the benefits. However, several studies supported that multiple dimensions of perceived values may better than a single dimension of perceived value [e.g., 27, 31]. Lee et al. [27] proposed that multiple dimensions, such as forms of emotional value, functional value, and overall value, could be applied to measuring customer’s perceived value for a product. Among the various dimensions of perceived value, those most commonly utilized found in recent literature for understanding customers’ perceived values are hedonic value and utilitarian value. Miao et al. [31] suggested that perceived values can be referred to as the customer’s perceived value or customer value, and regarded as the consumer’s overall assessment of the utility of a product based on perceptions of what is received and what is given. The main components of a customer’s perceived value obtained from product or service consist of utilitarian and hedonic value. Lee et al. [27] applied a structural equation model to investigate the effect of perceived value on user satisfaction. They proposed that perceived value not only affected customer choice behavior at the pre-purchase stage but also influences user satisfaction. Chen and Chen [8] suggested that perceptions of quality and value affect user satisfaction. They further report that perceived value has a positive influence on a customer’s overall satisfaction. Accordingly, this study defines perceived value as an antecedent of user’s satisfaction that is evaluative function regarding hedonic and utilitarian values from 3D printing providers.

Risky situations can be those where the probabilities of outcomes are not known, or the outcome is known or unknown [22]. The perceived uncertainty in a purchase or consume situation can indicate the perceived risk and affects personal emotional conditions [e.g., 19, 22, 24, 28, 48]. Horst et al. [19] purposed that perceived risks were a combination of uncertainty plus the seriousness of the outcome involved. Yüksel and Yüksel [48] employed structural equation modeling to explore whether risk perceptions during shopping affect customers’ emotions and overall satisfaction. Buyers may perceive two general types of risks, such as financial risks and trust barriers when dealing with transactions. Kim et al. [24] identified perceived risk as a consumer’s belief about the potential uncertain adverse outcomes from the transaction that include financial risk, product risk, and information risk. Lee et al. [28] further suggested that perceived risk measures beliefs of the uncertainty regarding possible negative consequences. In general speak, perceived risk can influence on user’s satisfaction [19, 50]. Accordingly, perceived risk can seem like the source of user’s satisfaction, and this study defines perceived risk as evaluation regarding the potential uncertain adverse outcomes from 3D printing providers.

Based on the theories of information asymmetry and consumer behavior, the evaluations of relationship marketing, innovation, perceived value, perceived risk, and user satisfaction of 3D printing suppliers may differ from their customers or users. Both relationship marketing and innovation strategies are business strategies that were adopted by firms to increase the competitive advantages in the industry. According to Adjei et al. [1], Tsaur et al. [39], and Watkins and Hill [43], 3D printing providers may focus on employing relationship marketing, such as trust, commitment, and stability, while relationship marketing attracts, maintains and improves their relationships with the consumers. However, 3D printing buyers or customers may have less information about relationship marketing strategies of 3D printing suppliers, and can only estimate the degree of relationship marketing. Similarly, 3D printing users may be challenging to understand the specialized know-how information of innovation related to 3D printing technology. However, it is also difficult for 3D printing suppliers to evaluate covert consumer behavior, including perceived values, perceived risks, and user satisfaction. Accordingly, the gaps between customers’ evaluation and 3D printing suppliers’ perception may exist. In other words, the causal configurations to be sufficient for high user’s satisfaction for the perspectives of 3D printing suppliers may differ from the user.

3 Empirical research

Fuzzy or fuzzy set has been popularly applied for testing theories [16, 42]. Ghanbari [16] focused on the modified method of fuzzy complex linear system. Kacprzyk et al. [23] described the new asymmetric measure of matching fuzzy sets. In the logic-based approach, set-theoretic connections are asymmetrical rather than symmetrical. Mendel and Korjani [29, 30] indicated that it is a good practice to employ fuzzy set qualitative comparative analysis (fsQCA) from asymmetric thinking in data analysis not only for the desired outcome but also for the complement of that outcome. fsQCA has been widely performed as a powerful technological tool of data analysis to explore the combinations of relevant antecedents or causal recipes for achieving high outcome [7, 34]. Accordingly, fsQCA has been receiving much attention from academics and practitioners [e.g., 7, 12, 13, 25, 29, 30, 34, 43]. Based on these regards, this study attempts to combine relationship marketing, innovation, perceived 3D printing value, and perceived 3D printing risk as causal conditions to explore the configurations for achieving high 3D printing user’s satisfaction from both perspectives of 3D printing providers and their users by employing fsQCA that available at the website fsQCA.com.

There are four major steps in fsQCA process, including data calibration, creating truth table, conducting analysis, and interpretation. Figure 1 indicates the steps of fsQCA based on Chang and Cheng [7], Cheng et al. [9], and Ragin [34]. The values of fuzzy-set membership range from 0 to 1 that threshold for full membership (i.e., fuzzy score equal to 0.95), the cross-over point (i.e., fuzzy score equal to 0.5), and the threshold for full non-membership (i.e., fuzzy score equal to 0.05). In order to transform antecedents (i.e., relationship marketing, innovation, perceived 3D printing value, and perceived 3D printing risk) and user satisfaction from seven-point Likert scales into fuzzy variables, it is necessary to calibrate them. The process of transforming variables into sets requires the specification of full membership, cross-over anchors, and full non-membership, and this study set the original values of 7.0, 4.0, and 1.0 from seven-point Likert scales to correspond to these memberships based on Cheng et al. [9], and Ragin [34], respectively. The next step is to recognize configurations that are sufficient to the outcome from those that are not by specifying the consistent cutoff value as 0.75 and the number-of-cases threshold as 1 to edit truth table based on Chang and Cheng [7], Cheng et al. [9], and Ragin [34]. There are two possibilities analysis for each fsQCA, including standard analysis and specify analysis. This study uses standard analysis that has be recommend by most researches [e.g., 9,13,34] of fsQCA for conducting analysis in third step. Finally, complex solution with no logical remainders used, intermediate solution with partial logical remainders are incorporated into the solution, and parsimonious solution with all logical remainders may be used are three solutions produced for each analysis. Since intermediate solutions will not allow removal of necessary conditions, intermediate solutions are superior to both the complex and parsimonious solutions. Accordingly, this study provides the intermediate solutions to interpret how causal conditions, including relationship marketing, innovation, perceived 3D printing value, and perceived 3D printing risk, combine to contribute to high 3D printing user’s satisfaction from both perspectives of 3D printing providers and their users.

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Fig. 1

Steps of fsQCA.

In terms of measurements, relationship marketing measurement contains ten items to evaluate the level of 3D printing center developing and maintaining and valuable customers or consumers to the long-term mutually beneficial relationships invested in integrated marketing activities based on Adjei et al. [1] and Tsaur et al. [39]. Previous research relating to the construct of innovation [e.g., 2, 10, 18, 26, 33] were reviewed to develop our empirical measures. Accordingly, innovation measurement contains ten items. Building on previous research relating to the perceived values [e.g., 8, 27, 31], six items in the literature were used for assessing the extent to which hedonic value and utilitarian value of 3D printing. According to previous research relating to the constructs of perceived risk [e.g., 19, 22, 24, 28], six items were adopted to evaluate the potential uncertain negative outcomes of 3D printing. Previous research relating to the construct of user satisfaction [e.g., 8, 27, 50] were reviewed to develop our empirical measures. Accordingly, user satisfaction measurement contains five items regarding the customer’s overall judgment.

For evaluating the applicability of the proposed conceptual model, this study employed questionnaire surveys and collected primary data from 3D printing suppliers and their customers. Specifically, this study raises the empirical data for exploring the competitive advantage and effectiveness of marketing strategies or innovation strategies of 3D printing medical applications at the China-Asian Associated University 3D Printing Medical Research Center (CAAU 3DP MRC). The primary empirical setting for this study is the CAAU 3DP MRC, one of the best medical research centers in Taiwan. Therefore, this study constructs practical sample from 3D printing suppliers’ perspectives based on the members of CAAU 3DP MRC, doctors or nurses of both Asia University Hospital and China Medical University Hospital and the sample of 3D printing buyers’ perspectives are collected from patients of both hospitals attempting to use for 3D printing medical applications, such as Division of Neurosurgery, Division of Orthopedics, Division of Dentistry, and Division of Rehabilitation Medicine. Eventually, this research obtained a final valid sample of 10 respondents from 3D printing suppliers and 189 respondents of 3D printing medical.

In the respondents of 3D printing suppliers, 60% of the respondents were male, 70% of the respondents were married, 60% of the respondents were 31 to 40 years old, and 80% of the respondents had a college education. In the respondents of customers, more than 63% of the respondents were female, about 60% of the respondents were not married, more than 68% of the respondents were 21 to 40 years old, and more than 67% of the respondents had a college education.

For verifying the dimensionality and reliability of the research constructs, purification processes, including factor analysis and internal consistency analysis (Cronbach’s alpha) were conducted in this study. The reliabilities and validities for the constructs are shown in Table 1. The reliability of the measurement items was verified by using Cronbach’s alpha coefficients. The alpha values for all research constructs are higher than 0.75. Following Hair et al., these high alpha values suggest that the research constructs all have high internal consistency among the research items. Furthermore, the validity of the construct was measured by using the explained variance of each factor from factor analysis. The cumulative percentage of total variance extracted by factors all follow the requirements suggested by Hair et al. [17], indicating that the reliabilities and validities of these constructs are acceptable. Therefore, tests of hypotheses were undertaken while using factors of these constructs in assessing the interrelationships among the research variables.

The intermediate solutions for the perspectives of innovative suppliers and customers produced by the fsQCA technique are summarized in Table 2. Consistency values of configurations and solutions exceed 0.93 based on both perspectives of 3D printing suppliers and customers. The consistency indices are similar significance metrics, and high consistency indicates a subset relation exists, which in turn supports an argument of sufficiency. These results indicate that these configurations are sufficient conditions causing high user satisfaction. There is one causal configuration (i.e., 1A) found to be sufficient for high user satisfaction for the perspectives of 3D printing suppliers and three configurations (i.e., 1B, 2B, and 3B) for the perspectives of 3D printing customers. Path 1A indicates that the combination of relationship marketing, innovation, and perceived 3D printing value results in a high level of user satisfaction based on perspectives of 3D printing suppliers. In the perspective of 3D printing customers, path 1B represents that customer can achieve high satisfaction when high relationship marketing with high innovation. Path 2B shows that a high level of innovation with a low level of 3D printing perceived risk can achieve a high level of high user satisfaction. Path 3B indicates that a high level of relationship marketing and 3D printing perceived value with a low level of 3D printing perceived risk can achieve a high level of high user satisfaction. Comparing path 1B and 2B, high level of relationship marketing and low level of perceived risk are treatable as substitutes. Similarly, path 2B and 3B represent that innovation and combination of relationship marketing and perceived value are also treatable as substitutes.

To develop an integrated framework for evaluating the effectiveness of relationship marketing, innovation, perceived 3D printing value, and perceived 3D printing risk on user satisfaction, empirical research based on the customer’s perspective and 3D printing supplier’s perspective are adopted in this study simultaneously. For exploring the gap between customers’ evaluation and 3D printing suppliers’ perception, this study further adopts fsQCA. This study extends the knowledge of relationship marketing, innovation, perceived 3D printing value and perceived 3D printing risk to develop the conceptual model measurement of user satisfaction. Accordingly, empirical analyses to derive several contributions. First, this study considers asymmetric thinking in data analysis by using fsQCA rather than symmetric thinking in data analysis. Although symmetric thinking can explore the symmetric relationship among independent variables and dependent variable, net effects estimation approach to research may result in high values of causal statements are both necessary and sufficient for high values of the dependent variable to occur and that low values of dependent variable occur with low values of causal statement in symmetric relationship. Therefore, this study focus on exploring the combination of relationship marketing, innovation, 3D printing perceived value, and 3D printing perceived risk results in a high level of user satisfaction based on perspectives of 3D printing suppliers and customers.

According to the information asymmetry theory and consumer behavior theory, we also find that there are gaps between customers’ evaluation and 3D printing suppliers’ perceptions. In the perspectives of 3D printing suppliers, the combination of relationship marketing, innovation, and 3D printing perceived value is sufficient conditions causing high user satisfaction. However, there are three causal configurations (i.e., 1B, 2B, and 3B) found to be sufficient for high user satisfaction for the perspectives of 3D printing customers, and low 3D printing perceived risk is more impartment causal condition. Through the comparison of the causal configurations, different ways could be found to achieve high user satisfaction based on the perspectives of innovative suppliers and customers.

6 Limitation and future research

This study develops an integrated conceptual framework to explore the configurations for achieving user satisfaction from both the 3D printing suppliers’ and buyers’ perspectives by using fuzzy set qualitative comparative analysis software. Accordingly, there are limitations including the research structure, research methods, and research time in this study. There are also some recommended directions for future research. First of all, this study focuses on combining potential relevant antecedents, such as relationship marketing, innovation strategies, 3D printing perceived values, and 3D printing perceived risk in 3D printing medical market. Therefore, it is suggested that future research can focus on other market of add in other research constructs, such as experiential marketing, perceived ease of use or perceived usefulness. Second, this study adopted a questionnaire survey and collected primary data from patients of both hospitals attempting to use for 3D printing medical applications. The statistical techniques we employed included descriptive statistics, factor analysis, and fuzzy set qualitative comparative analysis; it is suggested that future research can add in other data collection methods or employs other statistical techniques, such as reliability analysis or structural equation modeling. Furthermore, this study had limited manpower and time. Therefore, it’s difficult to adopt an overall sampling method. Hopefully, future researchers would engage in stratified sampling in order to reduce the error value of research results.