Modelling the factors affecting Indian medical tourism sector using interpretive structural modeling

Modelling the factors affecting Quality of Life among Indian police officers: a novel ISM and DEMATEL approach

Background

This study examines quality of life (QOL) of a sample of police officers in India. The concept of QOL includes well-being, social obligations, relationships of a person, and his association with environment. The study examines the factors on which QOL of police officers depend and their relationships with each other. The issues linked with QOL are important because they directly affect the individual's ability to maintain a healthy lifestyle and affect organizational performance in the long run. This study explores relevant factors that have an impact on the QOL of the employees of police department in India.

Method

In this paper, literatures review, ISM, MICMAC, and DEMATEL methodology have established eleven factors that impact the QOL of police officers in India. Mutual relations between factors have been established using the ISM approach to develop a model to represent these relationships. DEMATEL methodologies were used to analyze these factors.

Results

Results indicate that "fair compensation, work overload, workplace safety, and job stress" are the top-level factors that affect QOL of police officers.

Conclusion

The identification of factors and their mutual relationships that affect QOL are important for police officers and have to be dealt with according to their order of importance. The research model developed in this study shows how the factors of police officers' QOL are interrelated and presents the interrelationships among these factors. A comprehensive model depicting the relationships among these factors has been established, so that the QOL of police officers can be improved.

Modeling and analysing the barriers to the acceptance of energy-efficient appliances using an ISM-DEMATEL approach

Purpose

Electricity savings from energy-efficient appliances (EEAs) may have a significant impact on reducing global warming. There are several barriers confronted by EEAs, which have lowered their acceptance rate. The current study aims to identify and highlight key barriers to strengthening domestic sector adoption of EEAs in developing countries.

Design/methodology/approach

In the current study, 13 barriers were discovered by an in-depth literature review and the judgement of experts as well. Further, integrated “interpretive structural modeling” (ISM) and “decision-making trial and evaluation laboratory” (DEMATEL) approaches are used to evaluate barriers. The ISM technique is implemented to categorize barriers into distinct hierarchy levels and “cross-impact matrix multiplication applied to classification” (MICMAC) analysis to divide barriers among four clusters “independent, linkage, dependent and autonomous.” Moreover, the DEMATEL methodology is applied to classify the barriers among cause and effect clusters.

Findings

The integrated ISM and DEMATEL approach suggests that the topmost influencing barriers to the acceptance of EEAs are the lack of Government policies and initiatives, lack of attractive loan financing and subsidized energy prices.

Practical implications

This study would help researchers, regulators, producers, policymakers and consumers to comprehend the need for additional developments and understand that the adoption of EEAs is a current need. Overall, the results of this study expedite stakeholders with the key barriers that may assist to enhance the acceptance of EEAs within the domestic sector.

Originality/value

An extensive literature survey showed a dearth of studies for the identification, modeling and analysis of barriers collectively. Therefore, the current work used the ISM and DEMATEL approaches to fill the gap and to provide more comprehensive knowledge on barriers related to the acceptance of EEA.

Pharmacovigilance in emerging economies: modeling interaction among barriers

Purpose

The main purpose of this paper is to identify and rank various barriers to pharmacovigilance (PV) in context of emerging economies and examine their interrelationships using the interpretive structural modeling (ISM) approach. The result is a model that offers insights about how to achieve rational and safe use of medicines and ensure patient safety as realized through robust national PV systems.

Design/methodology/approach

The paper develops a model to analyze the interactions among PV barriers using the ISM approach. Based on input from clinical and medical product development experts, PV barriers in emerging economies were identified and reviewed. The hierarchical interrelationships among these PV barriers were analyzed in context of their driving/dependence powers.

Findings

Findings of the study identify key PV barriers—lack of resources/infrastructure, weak legislation, unfair burden of disease, lack of PV capacity, training, and enforcement authority—that drive, or strongly influence, other barriers and thwart implementation of robust national PV systems in emerging economies. Pharmaceutical industry factors were PV barriers that were identified as autonomous, implying their relative disconnection from other barriers, and patient PV practices barrier was strongly dependent on other barriers.

Research limitations/implications

The paper offers policy- and decision-makers alike with a framework to support further research into interdependencies among key PV barriers in emerging economies. It can serve as an impetus for further research with potential to broadening the understanding of how and why PV systems may be rendered ineffective. Future studies can be planned to apply the ISM approach to study PV barriers in the context of developed economies and draw lessons and implications for policy- and decision-makers by contrasting results from these studies.

Practical implications

This paper contributes to the understanding of the multifaceted nature of PV and its barriers. The proposed approach gives public health decision-makers a better comprehension of driver PV barriers that have most influence on others versus dependent PV barriers, which are most influenced by others. Also, knowledge, attitude and practices of patients and caregivers can also be critical PV barriers in emerging economies. This information can be instrumental for public health policymakers, government entities, and health/PV practitioners to identify the PV barriers that they should prioritize for improvement and how to manage trade-offs between these barriers.

Social implications

PV barriers in emerging economies, as compared to developed economies, are inherently different and need to be examined in their specific context. The hierarchical ISM model suggests that resources and regulation initiatives by governments in emerging economies lead to through informed/enabled pharmaceutical supply chain players and eventually drive PV-specific knowledge, attitude, and practice outcomes improvements across their populace.

Originality/value

This paper highlights the deployment of ISM approach as a health policy decision support tool in the identifying and ranking barriers to effective PV systems in emerging economies, in terms of their contextual relationships, to achieve a better understanding as to how these interrelationships can affect national PV system outcomes.

Modelling the barriers of weather index insurance service adoption integrating expert mining and ISM Fuzzy-MICMAC

Purpose

The purpose of this study is to explore and prioritize the barriers that affect weather index-insurance (WII) adoption among customers by utilizing interpretive structural modelling (ISM) and fuzzy-MICMAC.

Design/methodology/approach

This paper utilized the combined approach in two phases. In first phase comprehensive literature study and expert mining method have been performed to identify and validate WII adoption barriers. In second phase, ISM has been utilized to examine the direct relationships among WII adoption barriers in order to develop a structural model. Further, fuzzy-MICMAC method has been utilized to analyse indirect relationships among barriers to explore dependence and driver power.

Findings

This study has identified 15 key barriers of WII adoption among customers and developed a structural model based on binary direct relationship using ISM. Later, the outcomes of ISM model have been utilized for analysing the dependence and driver power of each WII adoption barriers in cluster form using fuzzy-MICMAC. The customer awareness related WII adoption barrier are mainly at the top level, WII demand related barriers are in the centre and WII supply related barriers at the bottom level in ISM model.

Practical implications

The findings offered important insights for WII insurers to understand mutual relationships amongst WII adoption barriers and assists in developing strategy to eliminate dominant key barriers in order to enhance their customer base.

Originality/value

Based on best of author's knowledge this paper firstly integrates the ISM fuzzy-MICMAC method into identification and prioritization of barriers that affects WII adoption among customers.

Modeling and analysis of barriers in controlling TB: developing countries' perspective

Purpose

Tuberculosis (TB) continues to c-exist with humans despite many TB control programs and elimination strategies. This depicts that some barriers are not allowing achieving the desired results. The current study aims to focus on identification and ranking of such barriers to facilitate TB control programs in developing countries.

Design/methodology/approach

In the present study, 13 barriers that can influence success rate of TB elimination strategies have been recognized with an in-depth assessment of related literature and opinions of specialists from medical industry and academic world. The interpretive structural modeling (ISM) and decision-making trial and evaluation laboratory (DEMATEL) techniques have been employed for the ranking of barriers.

Findings

Based on driving power of barriers, the study coined that underinvestment is a major barrier followed by poor implementation of government policies and programs, poverty and poor primary health care infrastructure.

Research limitations/implications

The findings may guide healthcare service providers and researchers in analyzing the barriers and understanding the necessity of further advancements to decrease the count of already existing and incident cases.

Practical implications

Policy- and decision-makers may utilize the information on dependence and driving power of barriers for better planning and effective execution of TB control strategies.

Originality/value

Although a lot of literature is available on different barriers that are affecting success of TB strategies, the current study analyzes all the key barriers collectively for the prioritization of barriers.

An assessment of government measures in combatting COVID-19 using ISM and DEMATEL modelling

Purpose

The purpose of this paper is to evaluate the interplay of various measures used by different governments around the world in combatting COVID-19.

Design/methodology/approach

The research uses the interpretative structural modelling (ISM) for assessing the powerful measures amongst the recognized ones, whereas to establish the cause-and-effect relations amongst the variables, the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method is used. Both approaches utilized in the study aid in the comprehension of the relationship amongst the assessed measures.

Findings

According to the ISM model, international support measures have the most important role in reducing the risk of COVID-19. There has also been a suggestion of a relationship between economic and risk measures. Surprisingly, no linkage factor (unstable one) was reported in the research. The study indicates social welfare measures, R&D measures, centralized power and decentralized governance measures and universal healthcare measures as independent factors. The DEMATEL analysis reveals that the net causes are social welfare measures, centralized power and decentralized government, universal health coverage measure and R&D measures, while the net effects are economic measures, green recovery measures, risk measures and international support measures.

Originality/value

The study includes a list of numerous government measures deployed throughout the world to mitigate the risk of COVID-19, as well as the structural links amongst the identified government measures. The Matrice d'Impacts croises-multiplication applique and classment analysis can help the policymakers in understanding measures used in combatting COVID-19 based on their driving and dependence power. These insights may assist them in employing these measures for mitigating the risks associated with COVID-19 or any other similar pandemic situation in the future.

Does healthcare service quality affect outbound medical tourists’ satisfaction and loyalty? Experience from a developing country

Purpose

Poor quality of services in the health-care sector of the developing countries like Bangladesh forces affluent patients to seek advanced medical treatment from abroad. The purpose of this study is to explore the outbound medical tourists’ satisfaction and loyalty on the basis of the quality of the health-care service provided by foreign medical institutions.

Design/methodology/approach

The medical tourists from Bangladesh who have got medical services from Indian medical institutions were taken as a sample by applying a purposive sampling technique. For the measurement of outbound medical tourists’ satisfaction, the dimensions of the HEALTHQUAL model were adopted. A self-administrated questionnaire was the major tool for collecting data from the respondents. Using partial least square-structural equation model multivariate statistical technique and with the aid of SmartPLS software, primary data collected from 218 final respondents were analyzed.

Findings

The findings of this study reveal that four dimensions of the HEALTHQUAL model, namely, empathy, tangibility, efficiency, and safety have a significant positive impact on building medical tourists’ overall satisfaction, and then the overall satisfaction also has a positive level of significance on building loyalty towards foreign medical service providers.

Practical implications

The findings of this study can be a helpful instrument for the developing countries to rethink and reshuffle their own existing health-care system for providing quality medical services and at the same time, the medical tourists importing countries to sharpen their existing service quality as well as to attract more medical tourists in the future.

Originality/value

A handful of research has been carried out, especially focused on health-care service quality measurement and the relationship of health-care service quality with satisfaction and loyalty from the perspective of developing countries outbound medical tourists. Thus, this research work will give a flavor to think of health-care service quality in a different dimension.

Barriers to Medical Tourism Development in the United Arab Emirates (UAE)

Medical tourism is a thriving industry. Many destinations now seek to attract more medical tourists. The United Arab Emirates (UAE) is no exception. As one of the most important pillars of the UAE’s economy, tourism is considered a high priority. However, medical tourism in the UAE is still developing. This paper addresses the main challenges for medical tourism in the UAE and proposes methods to enhance its development. This research utilized qualitative analysis. Twelve professionals in medical tourism were interviewed to provide data. The data were then analyzed using NVivo 12 software. Our results indicate that the key barriers to medical tourism development in the UAE are high costs of medical tourism services, lack of marketing activities, lack of collaboration between medical and tourism service providers, and so forth. Although initiatives from the UAE government are very encouraging, more efficient medical care supply networks, tourism suppliers and intermediaries should be established to ensure its growth. This research could influence national tourism policies in the UAE as well as regional alliances in all Gulf Cooperation Council (GCC) and the Middle East and North Africa (MENA) countries.

A study on the influence of factors associated with organizational readiness for change in healthcare organizations using TISM

Purpose

The purpose of this paper is to identify, analyze and develop a model to measure the interactions among different factors of organizational readiness for change in service sector specific to healthcare organization. The total interpretive structural modeling (TISM)-based readiness for change is to build a theoretical framework to understand the mutual interactions among the factors and to identify the driving and dependence power of these factors.

Design/methodology/approach

TISM is used to identify factors that contribute to analyze the readiness state before starting a change implementation process in healthcare. Matrice d’Impacts croises-multiplication applique´ a classement analysis is used to find the driving and dependent factors of change in healthcare.

Findings

This paper identified 12 factors of readiness for change from literature review followed by expert interview to understand the inner connection of factors and study inner relationships. The result says that state of affairs, recent trends in healthcare sector, technology advancement and interdependence among departments are key factors for readiness of change.

Research limitations/implications

This research mainly focused on readiness factors for change in the healthcare sector.

Practical implications

This study will be useful for researcher and practitioners to understand the readiness factors for change.

Originality/value

In this research work, TISM-based readiness for the change framework structural model has been proposed for healthcare organizations which is a new effort in the area of organizational change management in this sector.

Modeling the factors affecting the quality of life in diabetic patients in India using total interpretive structural modeling

Purpose

Diabetes mellitus has become a major world health problem that has unenviable impacts on health of the people including quality of life (QOL) also and in which person’s physical and psychological state, social commitments and relationships and his interaction with the environment is affected. This shows that there is an urgent need for behavior change and considerable educational strategies for proper management and rehabilitation (Reddy, 2000). This research has identified and ranked the significant factors which affect the QOL in diabetic patients in India. The paper aims to discuss these issues.

Design/methodology/approach

In this paper, nine factors which affect the QOL in diabetic patients in India have been identified through review of the literature and evaluated by total interpretive structural modeling (TISM) approach, i.e. an extended version of ISM. In this approach, interpretations of the interrelationship among factors have been discussed. Therefore, TISM approach has been used to develop the model and the mutual interactions among these factors.

Findings

The results of the model and MICMAC analysis indicate that diet restriction, body pain and satisfaction with treatment are the top-level factors.

Practical implications

Identification of the factors that have a remarkable effect on the QOL in diabetic patients is very important so that the doctors and other healthcare professionals may handle these factors efficiently and proper rehabilitation can be provided to such patients.

Originality/value

This paper has used an application of the TISM approach to interpret the mutual relationship by using the tool of interpretive matrix and has developed a framework to calculate the drive and the dependence power of factors using MICMAC analysis. The issues related to QOL are extremely important, as they can strongly anticipate a person’s capability to govern his lifestyle with disease like diabetes mellitus and maintain good health in the long run. This shows the urgent requirement of an optimized model which can predict and interpret the relationships among these factors. In this research, the interrelationships among these factors have been developed and interpretations of these interactions have been given to develop a comprehensive model so that QOL of diabetic patients may be improved.