The development of process innovation and organisational performance in Malaysian healthcare industry

Transcription

1 148 Int. J. Business Innovation and Research, Vol. 9, No. 2, 2015 The development of process innovation and organisational performance in Malaysian healthcare industry Nurul Fadly Habidin* Department of Management and Leadership, Faculty of Management and Economics, Universiti Pendidikan Sultan Idris, Tanjung Malim, Perak, Malaysia *Corresponding author Nur Afni Khaidir, Nurul Aifaa Shazali, Naimah Ali and Noor Hidayah Jamaludin Department of Accounting and Finance, Faculty of Management and Economics, Universiti Pendidikan Sultan Idris, Tanjung Malim, Perak, Malaysia Abstract: Recently, healthcare industry aims to fulfil expectations from customers by providing excellent services to their customer. Organisations should use the improvement method such as innovation in order to meet this requirement. Previous studies concerning innovation in healthcare industry is relatively extensive and varied but it is hard to find the investigation of relationship between process innovation and organisational performance. In relation to that, the purpose of this study is to review structural analysis of process innovation and organisational performance in Malaysian healthcare industries. A conceptual model using structural equation modelling (SEM) has been proposed and will be used to test the relationship between process innovation and organisational performance. Research hypothesis are developed based on the previous study that have been reviewed and also based on proposed research model. Keywords: process innovation; organisational performance; healthcare; service; balance scorecard; process improvement; performance measurement. Reference to this paper should be made as follows: Habidin, N.F., Khaidir, N.A., Shazali, N.A., Ali, N. and Jamaludin, N.H. (2015) The development of process innovation and organisational performance in Malaysian healthcare industry, Int. J. Business Innovation and Research, Vol. 9, No. 2, pp Copyright 2015 Inderscience Enterprises Ltd.

2 The development of process innovation and organizational performance 149 Biographical notes: Nurul Fadly Habidin is a Lecturer at Department of Management and Leadership, Faculty of Management and Economic at Universiti Pendidikan Sultan Idris. He holds a Doctorate in Engineering (Engineering Business Management). His research interests include business engineering, Six Sigma, and continuous process improvement. He has involved in a number of funded research projects. Nur Afni Khaidir is a full Master s student of Management Accounting at Universiti Pendidikan Sultan Idris. Her research interests are related to Six Sigma practices, process innovation and organisational performance. Naimah Ali is a full Master s student of Management Accounting at Universiti Pendidikan Sultan Idris. Her main research has focused on customer relationship managements, service quality improvement and organisational performance. Nurul Aifaa Shazali is a full Master s student of Management Accounting at Universiti Pendidikan Sultan Idris. Her main research has focused on lean healthcare practice, supply chain innovation and healthcare performance. Noor Hidayah Jamaludin is a full Master s student of Management Accounting at Universiti Pendidikan Sultan Idris. Her main research has focused on sustainable healthcare service, sustainable innovation and sustainable healthcare performance. 1 Introduction In Malaysia, the service industry contributes to the national growth and has improved yearly. This can be seen in 2008 until 2011, the contribution of services to gross domestic product (GDP) is RM million, RM 302, 045 million, RM million and RM million respectively (Economic Report 2012/2013). As we know, the healthcare industry is also one of the services besides finance and insurance, communication, government services and other services that contribute to GDP. Based on Bessant and Maher (2009), these services have received relatively little coverage in research on innovation management. Therefore, research on service industry particularly healthcare should be enhanced in order to increase the national income. Innovation is an effective way to improve the products, services or processes within the organisation itself. Based on Dershin (2010), innovation always been written about technique to stimulate and manage the process with vital interest to companies. Innovation has been implemented and a lot of research findings have been discussed across the globe and companies. For example, in the manufacturing industry (Boujelben and Fedhila, 2010), information and technology (Waychal et al., 2011; Rajala and Westerlund, 2008), small and medium enterprises (SMEs) (Piperopoulos and Scase, 2009), defence industry (Borjesson and Elmquist, 2012) and pharmaceutical (Chaturvedi and Chataway, 2006; Subramanian et al., 2011). This shows that innovations can assist organisations to defend and strengthen their organisations in the market. Besides, innovation is source of competitive advantage (Erekson et al., 2008; Bresciani, 2009). The implementation of innovation contribute for organisation to achieve competitive

3 150 N.F. Habidin et al. advantage which allow generating greater sales and retaining more customers than its competitors. In the healthcare industry, organisation faces multiple challenges such as medical error, multiple medical records, incorrect doses, and so on (Thakur et al., 2012). The healthcare industries mostly involve the person s life and every process must be emphasised. In addition, Shazali et al. (2013) noted that customer s expectation to gain quality in healthcare is increasing. Coinciding with this, innovation in healthcare is one of the best ways to overcome this challenge. Implementing innovation in organisation have been proven by previous studies (Lopez-Nicholaz and Merono-Cerdan 2011; Akgun et al., 2009) to make the better performance to their organisation. On top of that, healthcare practitioners also had views of innovation. Thakur et al. (2012) defined innovation in healthcare as changes that help healthcare practitioners improve their work to be better, smarter, faster, and cost effective. As continuation to that, Porzsolt et al. (2009) refer to innovation in healthcare as the changing or replacement of the previous method with a new one that is more sustainable and give competitive benefit. In the healthcare industry, there has significant improvement but inefficiency still exists (Prada, 2008). Based on that, the authors want to explore more in-depth the process innovation as an improvement method. The main objective of this paper is to review structural analysis between process innovation and organisational performance in Malaysian healthcare industry. This study attempts to explore the degree level of newness in process innovation consisting of radical process innovation; incremental process innovation; and service process innovation. In organisational performance, there are four indicators and these are financial performance; customer performance; internal business process performance; and innovation and learning growth performance. The organisation of the paper is as follows: Section 2 presents a review of the relevant literature consisting of process innovation, organisational performance and development of the propose hypothesis. Section 3 presents a description of the methodology. Section 4 presents the proposed researched model and finally conclusion and future research are discussed. 2 Literature review 2.1 Process innovation The input that is owned by organisations such as raw material, labour and so on need to processed before it becomes output (products or services). Process is defined as an interrelated set of activities designed to transform input into output which is offered to the end customer (O Sullivan and Dooley, 2009). Process innovation can be viewed as implementation of new or improved production or delivery method that includes changes in techniques, equipment and software (Omachonu and Einspruch, 2010). As to other studies, Bergfors and Larsson (2009) defined process innovation as development driven by internal production objectives. Besides, process innovation also can refer to improving the efficiency or effectiveness of the way the organisation operates (Harrington Institute Inc.). Hence, process innovation is the newest or improvement method in internal process to achieve the greatest performance and goals of the organisation.

4 The development of process innovation and organizational performance 151 Customers are no longer concerned with the price of products or services but emphasise on quality. To address the problem, every organisation should take efforts to enhance the quality of their available goods or services. Akgun et al. (2009) stated that process innovation assist organisation to improve the efficiency of creating or establishing the quality of products or services. Organisations need to continuously monitor the process innovation that has been implemented, so that the quality can be improved. Quality is an important key to the business and to assist organisations to retain and attract more customers. On top of that, customer information and feedback support organisation to improve products or services quality and increase productivity. In addition, Reichstein and Salter (2006) stipulated that process innovation is an important source to increase productivity, and enable firms to enhance competitive advantage and is also an important element in government innovation policy. When an organisation achieves the competitive advantages, the organisation s position becomes more powerful and influential than its competitors. For example, process innovation allowed Japanese industry gain competitive advantage where they had dominated global markets of cars and electronic products in 1970s until 1980s (O Sullivan and Dooley, 2009). These authors also highlight that the well-known organisations such as Dell and Zara gain competitive advantage by providing higher-quality products, delivered faster and more efficiently to the market compared to their competitors. The organisation will avoid the high cost of producing a product or service and aims to reduce costs as much as possible. Habidin et al. (2012) mentioned that organisations in the healthcare industry are preparing for the lower cost of material and to eliminate waste and defects in many aspects. Therefore, implementing process innovation continuously can give the positive impact to the organisation. Chenavaz (2012) interpreted that when the process innovation increase continuously, it can reduce production cost then the price of output will decrease while also improving output quality. Besides, Lager (2002) described that process innovation might reduce the production costs, increase the return, and increase production volumes. In conclusion, the implementation of process innovation in service industries like healthcare might lead to reducing the organisational costs, increasing sales, improving processes and make better quality service to customers. Organisations in either manufacturing or service industry have implemented major or minor innovation in their process. Dewar and Dutton (1986), Reichstein and Salter (2006) and Kim et al. (2012) identified process innovation through the degree of newness in process innovation which is radical process innovation and incremental process innovation. Meanwhile, Chen and Tsou (2012) proposed the innovation through service process innovation. The authors proposed process innovation in three ways, which are radical process innovation, incremental process innovation and service process innovation Radical process innovation Radical innovation refers to making major changes in something established (Dewar and Dutton, 1986; O Sullivan and Dooley, 2009; Kohler et al., 2009). Meanwhile, radical process innovation also defined as a process developed by organisation and also new to industry (Reichstein and Salter, 2006). Henceforth, the radical process innovation consists of the level of change whether the new changes or major improvement on

5 152 N.F. Habidin et al. organisation s elements of internal process is related to industry itself. Kim et al. (2012) stated that the level change in radical process innovation is major changes of technological directions, approaches or linkage among core components. Achieving the success in implementing the radical process innovation gives great positive impact on the organisation but otherwise would occur when they face failure. This is supported by O Sullivan and Dooley (2009) that stated radical innovation can create change in growth but have to face high level of risk and cost of failure. Besides, radical process innovation aims to accomplishing lower costs and higher product quality with changing the process by implementing new or significantly improved elements into the organisations (Kim et al., 2012; Gatignon et al., 2002). In order to avoid failure, organisations must aim and make sure that every process to implement innovation gives positive effect to organisations. Un (2010) examined how firms manage employees to explore new knowledge for radical innovation and improved knowledge for incremental innovation to 202 innovation projects in 42 firms. This author found the system of organisation-level management practices and the systems of team-level practices have a positive relationship with radical innovations. Besides that, looking in depth at radical process innovation that was implemented by organisations, Kim et al. (2012) investigated the association among different quality management practices directly related to radical process innovation. The finding showed that quality management practices (quality data and reporting) are significant and directly related to radical process innovation Incremental process innovation Incremental innovation refers to small change or refine to their existing products, processes, and services (Dewar and Dutton, 1986; O Sullivan and Dooley, 2009; Kohler et al., 2009). On top of that, incremental process innovation is also defined as a new process for organisation but not for industry (Reichstein and Salter, 2006). In other words, incremental process innovation is identified as minor improvement or changes in organisation s elements of internal process but has no effect to industry. The level change in incremental process innovation is minor changes of existing components, design, price, function, quantity or time (Kim et al., 2012) In contrast with radical process innovation, success in implementing the incremental process innovation gives effect to organisation only and in case of failure, organisations are able to bear it because the loss only involve a small amount and organisations are dealing with low risk. Although incremental innovation has an advantage in dealing with low risk, organisation s slowness to reach growth targets lead to loss of competitive advantage (O Sullivan and Dooley, 2009). This is because incremental process innovation aims to achieve lower costs and higher product quality with incrementally improved elements into an organisation (Kim et al., 2012). Hence, incremental process innovation is more focused in organisation itself, and does not only stress to achieve competitive advantage in industry. In addition, a study by Un (2010) found that the system of organisation level management practices and system of team level practices have a positive relationship with incremental innovations. Another empirical study of incremental process innovation by Kim et al. (2012) discovered that quality data and reporting positively are associated with incremental process innovation.

6 The development of process innovation and organizational performance Service process innovation For organisations that provide services, they need to make improvements in order to keep the good image and improve their customer satisfaction. Coinciding with that, service innovation is one of the improvement methods that assist organisations to achieve their goals. Service innovation is referred to as making changes to intangible products that effect high degree of customer interaction and demand (O Sullivan and Dooley, 2009). IfM and IBM (2008) explained by implementing service innovation, it s giving the advantages to organisations by improving the experience of finding, obtaining, installing, maintaining, upgrading and disposing of products; deliver better self-services; and eliminating waiting time by using modern devices. On top of that, there are previous studies that examine the implementation of service innovation in service industry such as banking sector (Jham, 2010) and higher institution (Sparrow et al., 2006). The health industry is seen more directed on providing services to their customer rather than product like hospital area. Thus, service innovation is appropriate to implement in the healthcare industry in order to provide greater service to customer and enhance their performance. When an organisation identified the requirement from customer, new or improvement service process is needed (Chen and Tsou, 2012). Thus, in order to manage and meet the customer demand, the organisation needs to implement service process innovation to provide better quality of service. The important thing in service process innovation is assisting organisation to enhance their capabilities and resources; enhance the focus to design or improve customer service strategies and tactics; and enhanced competitiveness; and improved firm performance (Chen and Tsou, 2012). Besides that, Grawe et al. (2009) in an empirical study discovered that service innovation capability directly lead to higher levels of market performance. Therefore, service process innovation does not only assist organisation to improve the quality of services but also increase overall organisational performance. 2.2 Organisational performance Recently, there are many organisations that have measured their organisational performance through balance scorecard strategy (BSC). BSC was developed by Kaplan and Norton in early 1990 as strategic management system and also as a performance measurement system that is used extensively in organisations (Kaplan and Norton, 2008). The BSC focuses on organisation s goals and performance measures with continuous efforts to achieve their goals (Karra and Papadopoulos, 2005). On the other hand, Greiling (2010) stipulated BSC is often used as a measurement tool and not as a management system. So, one of the effective ways to measures organisational performance is through BSC. The BSC has been implemented in many organisations whether in manufacturing industry (Aravamudhan and Kamalanabhan, 2007; Farooq and Hussain, 2011; Habidin, 2012) or service industry such as healthcare, academic, banking and so on (Karra and Papadopoulos 2005; Gurd and Gao, 2007; Aravamudhan and Kamalanabhan, 2007; McPhail et al., 2008; Aidemark, 2010; Zangoueinezhad and Moshabaki, 2011; Farooq and Hussain, 2011; Wu, 2012) to measure organisational performance. Based on previous studies, the service industry, especially healthcare industry, get the most attention in implementing BSC to measure performance.

7 154 N.F. Habidin et al. Performance measurement refers to a process of measuring the efficiency and effectiveness of actions (Neely et al., 1996). Performance can be measured either in terms of financial or non-financial; or both. To measure organisational performance, organisation looked for the four perspectives in BSC which are financial performance, customer performance, internal business process performance and innovation and learning growth performance (Niven, 2002; Habidin, 2012). Meanwhile, previous studies in healthcare industry, Aidemark (2010) explored the four perspectives of BSC, which are financial perspective; inhabitant or patient perspective; direction perspective; and health perspective to measure performance. Meanwhile, Ali et al. (2013) proposed two indicators of organisational performance in the healthcare industry, which are patient satisfaction and employee satisfaction. In this study, authors explored organisational performance that consists of the financial performance; customer performance; internal business process performance; and innovation and growth learning performance which is based on BSC perspective Financial performance Organisations always measure their performance based on their financial health in monetary terms. Kaplan and Norton (1996) noted that financial perspective refers to the long-term goal of organisations to obtain the returns from the capital that had been invested. Based on Urrutia and Eriksen (2005), financial perspective identifies how value was created in the past. Traditionally, financial performance is measured by analysing the profitability, sales growth, and revenue per sales visit (Farooq and Hussain, 2011). In financial perspective, the goals of organisations are different based on the types of organisation; these are the profit seeking organisation and the non-profit organisation. The goal of profit seeking innovation is to improve the financial results (Niven, 2003) while for non-profit organisation is to minimise the cost efficiency (Urrutia and Eriksen, 2005). Although the perspective of financial performance between the two types of organisations is different, ut it shows the financial performance measurement is very important to be measured to show the financial position of the organisation. There are a lot of studies related to financial performance. Wang and Wang (2012) explored the relationship between innovation and financial performance which was empirically tested using data collected from 89 high technology firms in Jiangsu Province of China. This author discovered that firm s innovation (innovation speed and innovation quality) appears to enhance a firm s financial performance. In addition, in healthcare industry, Raju and Lonial (2002) examined the impacts of service quality and marketing on financial performance in the US hospital industry. These empirical findings showed that quality and marketing functions have a major impact on the financial performance of organisations. Thus, financial performance is accurate to be one of performance measurements in this study Customer performance Organisations need to create the strategic objective before measuring customer performance. Based on Grigoroudis et al. (2012), the strategic performance measurement in healthcare organisations proposed the strategic objective for customer perspective consisting of the quality improvement of provided services; coverage of area demand for

8 The development of process innovation and organizational performance 155 medical services; increase the reliability of medical services; and increase the effectiveness of medical services. On top of that, Revere et al. (2007) proposed the customer performance measures which are short lead-times; on-time delivery; and/or innovative products and services; that are important to customers. This is because, customer performance measure based on the level of customer satisfaction or elements in customer expectations that were successfully met by the organisation. Rollins et al. (2012) investigated the different ways of using customer information (action-oriented and knowledge-enhancing information) affecting a firm s performance in business-to-business markets. The results of this study discovered that action-oriented customer information usage has a strong positive effect on customer performance. It concludes that customer performance is developing based on customer perspective and it is the significant key to measure the overall organisational performance because the business cannot succeed without the role of customer Internal business process performance The organisation should play a role in developing and mastering internal business processes in order to achieve excellent organisational performance. The organisation must add value to customers (Niven, 2003) by focusing on the components in internal business process that is important to make customers satisfied (Farooq and Hussain, 2011). By measuring internal business process performance, the organisation knows the advantages and disadvantages of their process and the present value of their performance. The organisation makes the improvement or changes in their process if internal business process performance does not achieve the level as desired (Farooq and Hussain, 2011). Considering that, the organisation need to measure internal business process performance to attract and retain customer and also satisfy shareholder expectations of financial return (Revere et al., 2007). The evidence in using internal business process as performance measurement has been found in previous studies. Chen and Liang (2011) examine whether different knowledge evolution strategies (knowledge mutation and knowledge crossover) would affect internal process performance. Their result showed that knowledge evolution strategies increase the internal process performance. Meanwhile, Prasad et al. (2010) found positive relationships between information technology (IT) related capabilities (top management commitment; IT steering committee and shared organisational knowledge; and flexible IT infrastructure) with internal process-level performance. Hence, the implementation of the right and systematic internal process affects the positive internal business process performance and vice versa Innovation and learning growth Learning growth is more focused on the intangible assets owned by the organisation. The learning and growth perspective are leading indicators that drives the value in the future (Urrutia and Eriksen, 2005). For example, Revere et al. (2007) stated that people, system and organisation procedures are the sources for learning growth perspective. In addition, recent study by Farooq and Hussain (2012) noted that learning and growth perspective consist of employee satisfaction, alignment of employee skills with jobs, number of

9 156 N.F. Habidin et al. employee suggestions implemented, and hours of employee training. Next, Grigoroudis et al. (2012) proposed the strategic objectives for learning and growth perspective consists of the development of third party collaboration; technological growth and human resources development. In line with this, innovation and learning growth performance measures the employee perspective and the development of innovation to bring great success to their organisational performance. Cuihua et al. (2010) examined how a service-oriented enterprise acquires innovation resource (tangible innovation and intangible innovation) and their effect on innovation performance in rapidly changing environment. This study discovered that innovation resource is closely related to innovation performance. In addition, the empirical study concerning learning growth performance has been explored by Chen and Liang (2011), whereby they found that knowledge mutation increases learning growth performance in different industries. 2.3 Process innovation and organisational performance There are many empirical studies that investigated the relationship between combination of innovation such as product innovation, process innovation or managerial innovation with organisational performance. Jimenez-Jimenez and Sanz-Valle (2011) explored the relationship between innovation and performance using structural equation modelling (SEM) with data from 451 Spanish firms. The researchers discover innovation (product innovation; process innovation; administrative innovation) relates positively to organisational performance (open/internal model; rational model; human relation model). In addition, Gronum et al. (2012) investigated the relationship between innovation (product/service innovation; operational process innovation; organisational/managerial process innovation; and marketing method innovation) and firm performance (profit, productivity, sales, and range of product growth) in SMEs. Based on investigation on 1,435 SMEs, this finding found that innovation supports the firm performances. However, there are a few empirical studies that focus more directly on relationship between process innovation and organisational performance. Based on Prajogo (2006) which explored the relationship between process innovation and business performance (sales growth, market share and profitability), the researcher found process innovation shows a relatively stronger relationship with business performance in manufacturing industries. In the healthcare industry, the information or previous studies concerning the process innovation in healthcare industry is still lacking (Omachonu and Einspruch, 2010). Coinciding with this, this paper reviews the structural analysis of process innovation and organisational performance in the Malaysian healthcare industry. To understand the relationship between process innovation and organisational performance in the Malaysian healthcare industry, the following proposed hypothesis will be tested. H 1 There is a positive and direct significant relationship between process innovation implementation and organisational performance in Malaysian healthcare industry.

10 The development of process innovation and organizational performance Research methodology Basically, innovation is well known to be applied to the product rather than the process or service. However, innovation on the process in the organisation itself has been proven to have an impact on organisational performance. The previous studies by Gronum et al. (2012) and Prajogo (2006) have shown that there is positive relationship between process innovations on organisational performance. Continuing that, the aim of this study is to review structural analysis the process innovation and organisational performance in the Malaysian healthcare industry. Healthcare industries were chosen because the requirement for improvement method and performance measurement in this sector is very important. Besides, the previous study concerning the relationship between process innovation and organisational performance is hard to found (Omachonu and Einspruch, 2010). In order to achieve the aims of this study, the Malaysian healthcare industry was proposed as the population. Meanwhile, private hospitals will be the samples of the study. The authors will use the structured questionnaire to ensure most issues concerning process innovation and organisational performance will be answered. The questionnaire will be distributed to the managers of Malaysian hospitals. The SEM technique was adopted to analyse the data gathered from the survey. Exploratory factor analysis, reliability analysis and confirmatory factor analysis were performed to test the construct validity, reliability, and measurements loading. Having analysed the measurement model, the structural model was then tested and confirmed. To analyse the preliminary data and provide the descriptive analyses such as means, standard deviations, and frequencies, the Statistical Package for the Social Sciences (SPSS) version 17 was used. SEM using AMOS 6.0 will be used to test the measurement model later. 4 Proposed research model Based on literature review before, there are many previous studies investigating innovation in healthcare industry but there are a few empirical studies that focus directly on the relationship between process innovation and organisational performance in the healthcare industry. Kim and Suh (2011) stated that there is still a lack of studies to evaluate the relative efficiency of technologically innovative activities which includes process innovation in service organisations. Generally, healthcare organisation is one of the sectors in the service industry. In addressing the problems, the authors propose to analyse the relationship between process innovation and organisational performance in Malaysian healthcare industry. Process innovation consists of radical process innovation, incremental process innovation and service process innovation. Meanwhile, measurement of organisational performance is through BSC which includes financial performance; customer performance; internal business process performance; and innovation and learning growth performance. Figure 1 presents the proposed research model.

11 158 N.F. Habidin et al. Figure 1 Proposed model of the study e1 e2 e3 Radical process innovation Incremental process innovation Service process innovation Process innovation H 1 Organizational performance Financial performance Customer performance Internal business process performance Innovation and learning growth performance e4 e5 e6 e7 5 Conclusions This paper provides the research review of process innovation and organisational performance. Healthcare becomes an important issue around the world because the national development is influenced by healthy community. The customers nowadays are very concerned with the quality of their healthcare. To meet this need, the healthcare industry should move forward to improve their existing product or service by implementing innovation in their processes. To date, it is very difficult to find previous studies that examine the relationship between process innovation and organisational performance in the healthcare industry. Thus, the empirical research on process innovation is seen as very important and useful to improve organisational performance. In order to do that, the purpose of this study is to carry out structural analysis on process innovation (radical process innovation; incremental process innovation; and service process innovation) and organisational performance (financial performance; customer performance; internal business process performance and; innovation and learning growth performance) in the Malaysian healthcare industry. This study is expected to help researchers and practitioners in the healthcare industry to improve the understanding and identify opportunities for improvements in the processes of implementing process innovation in order to enhance organisational performance. As have been mentioned before, based on the previous studies, the process innovation assists organisation to increase organisation s productivity and quality. When the output s quality was improved, customers will be satisfied and will use it again and thus increase productivity. In addition, the cost will be reduced and finally get the chance to achieve competitive advantage. It has been proven effective especially to the manufacturing industry and this study attempted to employ it in the healthcare industry particularly in Malaysia. From previous studies and the proposed research model, research hypothesis are being developed. This study also has been conducted based on the proposed conceptual model. This study focuses on the relationship between process innovation and organisational performance through BSC. Thus, it gives the benefits, opportunities and recommendations for future researchers to subsequently explore in more detail the process innovation and organisational performance particularly for the healthcare industry. For future agenda, in order to get the empirical result of the relationship

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