Service quality benchmarking via a novel approach based on fuzzy ELECTRE III and IPA: an empirical case involving the Italian public healthcare context

Particulate air pollution and metabolic risk factors: Which are more prone to cardiac mortality

This study explored multiplex, country-level connections between a wide range of cardiac risk factors and associated mortality within the South Asian Association for Regional Cooperation (SAARC) countries. The grey relational analysis (GRA) methodology is used to evaluate data from 2001 to 2018 to compute scores and rank countries based on cardiac mortality. Subsequently, we used the conservative (Min-Max) technique to determine which South Asian country contributes the most to cardiac mortality. The Hurwicz criterion is further applied for optimization by highlighting the risk factors with the highest impact on cardiac mortality. Empirical findings revealed that India and Nepal are the leading drivers of cardiovascular disease (CVD) mortality among all SAARC nations based on the results of the GRA methodology. Moreover, the outcomes based on the Hurwicz criterion and the conservative criterion indicated that CVD mortality is considerably impacted by household air pollution from the combustion of solid fuel, with India as a potential contributor in the SAARC region. The outcomes of this research may enable international organizations and public health policymakers to make better decisions and investments within the SAARC region to minimize the burden of CVD while also strengthening environmentally sustainable healthcare practices.

Assessing port service quality: An application of the extension fuzzy AHP and importance-performance analysis

It is argued that ports are playing a crucial role in developing nations’ economy. Still, solutions to improving port service quality (PSQ) to boost ports’ competitive capacity is questionable. Hence, this study aims to investigate port service quality (PSQ) by using integration of the extension Fuzzy Analytic Hierarchy Process and Importance-Performance Analysis (IPA) from port users’ perspectives. From the relevant literature and expert interview, the hierarchical structure of PSQ embracing six dimensions with 29 criteria was first established. To test the research model, the Dong Nai port joint stock company (DNPC) and their port-service users were empirically investigated. It is found that: (1) the importance degree of dimensions is ranked as follow: empathy (21.07%), tangibles (20.15%), assurance (15.97%), reliability (15.54%), responsiveness (12.53%), diversity (14.74%); (2) for criteria of PSQ, top five criteria concerned by shipping companies and ocean freight forwarders comprise: "proactive provision of vessel schedules", "cargo handling facilities and equipment", "detailed schedule", "accuracy and consistency of schedules", and "geographical location"; (3) there are four service attributes (SAs) needing to prioritize for improvement, including "perfect transportation of cargos", "ability in dealing with cargo damage", "willingness in helping customers", "provision of special cargo-related services". The practical policy is that port authorities should transfer the limited resources from SAs in Quadrant IV to Quadrant II to enhance the PSQ.

Identification of quality gaps in healthcare services using the SERVQUAL instrument and importance-performance analysis in medical intensive care: a prospective study at a medical center in Taiwan

Background

Assessing patients’ expectations and perceptions of health service delivery is challenging. To understand the service quality in intensive care units (ICUs), we investigated the expected and perceived service quality of ICU care.

Methods

We conducted this study at an ICU of a university-affiliated medical center in Taiwan from April to September 2019. Admitted patients or their family members responded to a questionnaire survey adopted from the SERVQUAL instrument consisting of 22 items in five dimensions. The questionnaire was provided on ICU admission for expectation and before ICU discharge for perception. We analyzed the quality gaps between the surveys and applied important-performance analysis (IPA).

Results

A total of 117 patients were included (62.4% males, average age: 65.9 years, average length of stay: 10.1 days, and 76.9% survival to ICU discharge). The overall weighted mean scores for the surveys were similar (4.57 ± 0.81 and 4.58 ± 0.52, respectively). The ‘tangibles’ dimension had a higher perception than expectation (3.99 ± 0.55 and 4.31 ± 0.63 for expectation and perception, respectively, p < 0.001). IPA showed that most of the items in ‘reliability,’ ‘responsiveness’ and ‘assurance’ were located in the quadrant of high expectation and high perception, whereas most of the items in ‘tangibles’ and ‘empathy’ were located in the quadrant of low expectation and low perception. One item (item 1 for ‘tangibles’) was found in the quadrant of high expectation and low perception.

Conclusions

The SERVQUAL approach and IPA might provide useful information regarding the feedback by patients and their families for ICU service quality. In most aspects, the performance of the ICU satisfactorily matched the needs perceived by the patients and their families.

Prioritization of Medical Errors in Patient Safety Management: Framework Using Interval-Valued Intuitionistic Fuzzy Sets

Medical errors negatively affect patients, healthcare professionals, and healthcare establishments. Therefore, all healthcare service members should be attentive to medical errors. Research has revealed that most medical errors are caused by the system, rather than individuals. In this context, guaranteeing patient safety and preventing medical faults appear to be basic elements of quality in healthcare services. Healthcare institutions can create internal regulations and follow-up plans for patient safety. While this is beneficial for the dissemination of patient safety culture, it poses difficulties in terms of auditing. On the other hand, the lack of a standard patient safety management system, has led to great variation in the quality of the provided service among hospitals. Therefore, this study aims to create an index system to create a standard system for patient safety by classifying medical errors. Due to the complex nature of healthcare and its processes, interval-valued intuitionistic fuzzy logic is used in the proposed index system. Medical errors are prioritized, based on the index scores that are generated by the proposed model. Because of this systematic study, not only can the awareness of patient safety perception be increased in health institutions, but their present situation can also be displayed, on the basis of each indicator. It is expected that the outcomes of this study will motivate institutions to identify and prioritize their future improvements in the patient safety context.

Fuzzy Multicriteria Modelling of Decision Making in the Renewal of Healthcare Technologies

In the current literature, there are a clear lack of systems to assist in making decisions about the renewal of technology for healthcare equipment, which means that the limited capacity to invest in new equipment cannot usually be appropriately applied as determined by the care requirements of a community. This may have important repercussions for patients, such as the inability to offer treatment or diagnosis, having to delay treatment or diagnosis, increase the risk of patients and care staff of using obsolete equipment, and preventing early, accurate, and reliable diagnosis, all of which have effects on the quality of care to a community. This study therefore describes the first multicriteria model in a fuzzy environment to assist in decision making related to the renewal of healthcare equipment. The fuzzy analytic hierarchy process (FAHP), which allows for ambiguities, uncertainties, and doubts inherent in real-world decision processes to be taken into account, was used to do this. The model produces a plan with actions to be taken depending on the obtained results. The model includes a novel methodology that consists of modifying the top–down technique to allow for the levels of priority for renewing healthcare equipment to be determined from judgements given by three experts. The model was validated by applying it to a set of medical devices, and we show the results for a surgical C-arm, an X-ray CT room, a neonatal ventilator, a defibrillator, and a video-colonoscope. A program was also created using the NI Labview software to process the model so that it could be applied with a user interface that acts quickly, simply, and intuitively.