An Integrated Fuzzy Clustering Cooperative Game Data Envelopment Analysis Model with application in Hospital Efficiency

Hospitals are the main sub-section of health care systems and evaluation of hospitals is one of the most important issue for health policy makers. Data Envelopment Analysis (DEA) is a nonparametric method that has recently been used for measuring efficiency and productivity of Decision Making Units (DMUs) and commonly applied for comparison of hospitals. However, one of the important assumption in DEA is that DMUs must be homogenous. The crucial issue in hospital efficiency is that hospitals are providing different services and so may not be comparable. In this paper, we propose an integrated fuzzy clustering cooperative game DEA approach. In fact, due to the lack of homogeneity among DMUs, we first propose to use a fuzzy C-means technique to cluster the DMUs. Then we apply DEA combined with the game theory where each DMU is considered as a player, using Core and Shapley value approaches within each cluster. The procedure has successfully been applied for performances measurement of 288 hospitals in 31 provinces of Iran. Finally, since the classical DEA model is not capable to distinguish between efficient DMUs, efficient hospitals within each cluster, are ranked using combined DEA model and cooperative game approach. The results show that the Core and Shapley values are suitable for fully ranking of efficient hospitals in the healthcare systems

A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study

[EN] Performance evaluation is relevant for supporting managerial decisions related to the improvement of public emergency departments (EDs). As different criteria from ED context and several alternatives need to be considered, selecting a suitable Multicriteria Decision-Making (MCDM) approach has become a crucial step for ED performance evaluation. Although some methodologies have been proposed to address this challenge, a more complete approach is still lacking. This paper bridges this gap by integrating three potent MCDM methods. First, the Fuzzy Analytic Hierarchy Process (FAHP) is used to determine the criteria and sub-criteria weights under uncertainty, followed by the interdependence evaluation via fuzzy Decision-Making Trial and Evaluation Laboratory(FDEMATEL). The fuzzy logic is merged with AHP and DEMATEL to illustrate vague judgments. Finally, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) is used for ranking EDs. This approach is validated in a real 3-ED cluster. The results revealed the critical role of Infrastructure (21.5%) in ED performance and the interactive nature of Patient safety (C+R =12.771). Furthermore, this paper evidences the weaknesses to be tackled for upgrading the performance of each ED.Ortiz-Barrios, M.; Alfaro Saiz, JJ. (2020). A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study. International Journal of Information Technology & Decision Making. 19(6):1485-1548. https://doi.org/10.1142/S0219622020500364S14851548196Lord, K., Parwani, V., Ulrich, A., Finn, E. B., Rothenberg, C., Emerson, B., … Venkatesh, A. K. (2018). Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. The American Journal of Emergency Medicine, 36(7), 1246-1248. doi:10.1016/j.ajem.2018.03.043Sørup, C. M., Jacobsen, P., & Forberg, J. L. (2013). 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K., Govindan, K., Antucheviciene, J., & Turskis, Z. (2016). Hybrid multiple criteria decision-making methods: a review of applications for sustainability issues. Economic Research-Ekonomska Istraživanja, 29(1), 857-887. doi:10.1080/1331677x.2016.1237302Lolli, F., Balugani, E., Ishizaka, A., Gamberini, R., Butturi, M. A., Marinello, S., & Rimini, B. (2019). On the elicitation of criteria weights in PROMETHEE-based ranking methods for a mobile application. Expert Systems with Applications, 120, 217-227. doi:10.1016/j.eswa.2018.11.030De Almeida Filho, A. T., Clemente, T. R. N., Morais, D. C., & de Almeida, A. T. (2018). Preference modeling experiments with surrogate weighting procedures for the PROMETHEE method. European Journal of Operational Research, 264(2), 453-461. doi:10.1016/j.ejor.2017.08.006Sun, G., Guan, X., Yi, X., & Zhou, Z. (2018). An innovative TOPSIS approach based on hesitant fuzzy correlation coefficient and its applications. Applied Soft Computing, 68, 249-267. doi:10.1016/j.asoc.2018.04.004Frazão, T. D. C., Camilo, D. G. G., Cabral, E. L. S., & Souza, R. P. (2018). Multicriteria decision analysis (MCDA) in health care: a systematic review of the main characteristics and methodological steps. BMC Medical Informatics and Decision Making, 18(1). doi:10.1186/s12911-018-0663-1Ortiz-Barrios, M. A., Herrera-Fontalvo, Z., Rúa-Muñoz, J., Ojeda-Gutiérrez, S., De Felice, F., & Petrillo, A. (2018). An integrated approach to evaluate the risk of adverse events in hospital sector. Management Decision, 56(10), 2187-2224. doi:10.1108/md-09-2017-0917Al Salem, A. A., & Awasthi, A. (2018). Investigating rank reversal in reciprocal fuzzy preference relation based on additive consistency: Causes and solutions. Computers & Industrial Engineering, 115, 573-581. doi:10.1016/j.cie.2017.11.027Aires, R. F. de F., & Ferreira, L. (2019). A new approach to avoid rank reversal cases in the TOPSIS method. 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A new multi-criteria decision making approach for sustainable material selection problem: A critical study on rank reversal problem. Journal of Cleaner Production, 182, 466-484. doi:10.1016/j.jclepro.2018.02.062Chen, Z., Ming, X., Zhang, X., Yin, D., & Sun, Z. (2019). A rough-fuzzy DEMATEL-ANP method for evaluating sustainable value requirement of product service system. Journal of Cleaner Production, 228, 485-508. doi:10.1016/j.jclepro.2019.04.145Jumaah, F. M., Zadain, A. A., Zaidan, B. B., Hamzah, A. K., & Bahbibi, R. (2018). Decision-making solution based multi-measurement design parameter for optimization of GPS receiver tracking channels in static and dynamic real-time positioning multipath environment. Measurement, 118, 83-95. doi:10.1016/j.measurement.2018.01.011Singh, A., & Prasher, A. (2017). Measuring healthcare service quality from patients’ perspective: using Fuzzy AHP application. 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Multi-criteria decision analysis for supporting the selection of medical devices under uncertainty. European Journal of Operational Research, 247(1), 216-228. doi:10.1016/j.ejor.2015.05.075Kovacs, E., Strobl, R., Phillips, A., Stephan, A.-J., Müller, M., Gensichen, J., & Grill, E. (2018). Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care. Journal of General Internal Medicine, 33(7), 1142-1154. doi:10.1007/s11606-018-4435-5Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS ONE, 13(8), e0203316. doi:10.1371/journal.pone.0203316Hermann, R. M., Long, E., & Trotta, R. L. (2019). Improving Patients’ Experiences Communicating With Nurses and Providers in the Emergency Department. Journal of Emergency Nursing, 45(5), 523-530. doi:10.1016/j.jen.2018.12.001Hawley, K. 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The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review. Journal of Nursing Scholarship, 46(2), 106-115. doi:10.1111/jnu.12055Ebben, R. H. A., Siqeca, F., Madsen, U. R., Vloet, L. C. M., & van Achterberg, T. (2018). Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review. BMJ Open, 8(11), e017572. doi:10.1136/bmjopen-2017-017572Innes, G. D., Sivilotti, M. L. A., Ovens, H., McLelland, K., Dukelow, A., Kwok, E., … Chochinov, A. (2018). Emergency overcrowding and access block: A smaller problem than we think. CJEM, 21(2), 177-185. doi:10.1017/cem.2018.446Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2014). Overcrowding in emergency department: an international issue. Internal and Emergency Medicine, 10(2), 171-175. doi:10.1007/s11739-014-1154-8Uthman, O. 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Assessing the queuing process using data envelopment analysis:an application in health centres

Queuing is one of the very important criteria for assessing the performance and efficiency of any service industry, including healthcare. Data Envelopment Analysis (DEA) is one of the most widely-used techniques for performance measurement in healthcare. However, no queue management application has been reported in the health-related DEA literature. Most of the studies regarding patient flow systems had the objective of improving an already existing Appointment System. The current study presents a novel application of DEA for assessing the queuing process at an Outpatients’ department of a large public hospital in a developing country where appointment systems do not exist. The main aim of the current study is to demonstrate the usefulness of DEA modelling in the evaluation of a queue system. The patient flow pathway considered for this study consists of two stages; consultation with a doctor and pharmacy. The DEA results indicated that waiting times and other related queuing variables included need considerable minimisation at both stages

Sustainable Assessment in Supply Chain and Infrastructure Management

In the competitive business environment or public domain, the sustainability assessment in supply chain and infrastructure management are important for any organization. Organizations are currently striving to improve their sustainable strategies through preparedness, response, and recovery because of increasing competitiveness, community, and regulatory pressure. Thus, it is necessary to develop a meaningful and more focused understanding of sustainability in supply chain management and infrastructure management practices. In the context of a supply chain, sustainability implies that companies identify, assess, and manage impacts and risks in all the echelons of the supply chain, considering downstream and upstream activities. Similarly, the sustainable infrastructure management indicates the ability of infrastructure to meet the requirements of the present without sacrificing the ability of future generations to address their needs. The complexities regarding sustainable supply chain and infrastructure management have driven managers and professionals to seek different solutions. This Special Issue aims to provide readers with the most recent research results on the aforementioned subjects. In addition, it offers some solutions and also raises some questions for further research and development toward sustainable supply chain and infrastructure management

Redesigning the Barranquilla's public emergency care network to improve the patient waiting time

Tesis por compendio[ES] La oportunidad en la atención es uno de los críticos de mayor relevancia en la satisfacción de los pacientes que acuden a los servicios de Urgencias. Por tal motivo, las instituciones prestadoras de servicio y las organizaciones gubernamentales deben propender conjuntamente por una atención cada vez más oportuna a costos operacionales razonables. En el caso de la Red Pública en Servicios de Urgencias de Barrannquilla, compuesta por 8 puntos de atención y 2 hospitales, la tendencia marca un continuo crecimiento de la oportunidad en la atención con una tasa de 3,08 minutos/semestre y una probabilidad del 93,13% de atender a los pacientes después de una espera mayor a 30 minutos. Lo anterior se constituye en un síntoma inequívoco de la incapacidad de la Red para satisfacer los estándares de oportunidad establecidos por el Ministerio de Salud, hecho que podría desencadenar el desarrollo de sintomatologías de mayor complejidad, el incremento de la probabilidad de mortalidad, el requerimiento de servicios clínicos más complejos (hospitalización y cuidados intensivos) y el aumento de los costos asociados al servicio. En consecuencia, la presente tesis doctoral presenta el rediseño de la Red Pública en Servicios de Urgencias anteriormente mencionada a fin de otorgar a la población diana un servicio eficiente y altamente oportuno donde tanto las instituciones prestadoras del servicio como los organismos gubernamentales converjan efectivamente. Para ello, fue necesaria la ejecución de 4 grandes fases a través de las cuales se consolidó una propuesta orientada al desarrollo efectivo y sostenible de las operaciones de la Red. Primero, se caracterizó la Red Pública de Servicios de Urgencias en Salud considerando su comportamiento actual en términos de demanda y oportunidad de la atención. Luego, a través de una revisión sistemática de la literatura, se identificaron los enfoques metodológicos que se han implementado para la mejora de la oportunidad y otros indicadores de rendimiento asociados al servicio de Urgencias. Posteriormente, se diseñó una metodología para la creación de redes de Urgencias eficientes y sostenibles la cual luego se validó en la Red Pública sudamericana a fin de disminuir la oportunidad de atención promedio en Urgencias y garantizar la distribución equitativa de los beneficios financieros derivados de la colaboración. Finalmente, se construyó un modelo multicriterio que permitió evaluar el rendimiento de los departamentos de Urgencia e impulsó la creación de estrategias de mejora focalizadas en incrementar su respuesta ante la demanda cambiante, los críticos de satisfacción y las condiciones de operación estipuladas en la ley. Los resultados de esta aplicación evidenciaron que los pacientes que acceden a la Red tienden a esperar en promedio 201,6 min con desviación de estándar de 81,6 min antes de ser atendidos por urgencia. Por otro lado, de acuerdo con la revisión de literatura, la combinación de técnicas de investigación de operaciones, ingeniería de la calidad y analítica de datos es ampliamente recomendada para abordar este problema. En ese sentido, una metodología basada en modelos colaterales de pago, simulación de procesos y lean seis sigma fue propuesta y validada generando un rediseño de Red cuya oportunidad de atención promedio podría disminuir entre 6,71 min y 9,08 min con beneficios financieros promedio de US$29,980/nodo. En último lugar, un modelo compuesto por 8 criterios y 35 sub-criterios fue diseñado para evaluar el rendimiento general de los departamentos de Urgencias. Los resultados del modelo evidenciaron el rol crítico de la infraestructura (Peso global = 21,5i garantir la distribució equitativa dels beneficis financers derivats de la col´laboració. Finalment, es va construir un model multicriteri que va permetre avaluar el rendiment dels departaments d'Urgència i va impulsar la creació d'estratègies de millora focalitzades en incrementar la seva resposta davant la demanda canviant, els crítics de satisfacció i les condicions d'operació estipulades en la llei. Els resultats d'aquesta aplicació van evidenciar que els pacients que accedeixen a la Xarxa tendeixen a esperar de mitjana 201,6 min amb desviació d'estàndard de 81,6 min abans de ser atesos per urgència. D'altra banda, d'acord amb la revisió de literatura, la combinació de tècniques d'investigació d'operacions, enginyeria de la qualitat i analítica de dades és àmpliament recomanada per abordar aquest problema. En aquest sentit, una metodologia basada en models col´laterals de pagament, simulació de processos i llegeixin 6 sigma va ser proposada i validada generant un redisseny de Xarxa la oportunitat d'atenció mitjana podria disminuir entre 6,71 min i 9,08 min amb beneficis financers mitjana d'US$ 29,980 / node. En darrer lloc, un model compost per 8 criteris i 35 sub-criteris va ser dissenyat per avaluar el rendiment general dels departaments d'Urgències. Els resultats de el model evidenciar el paper crític de la infraestructura (Pes global = 21,5%) en el rendiment dels departaments d'Urgència i la naturalesa interactiva de la Seguretat de l'Pacient (C + R = 12,771).[EN] Waiting time is one of the most critical measures in the satisfaction of patients admitted within emergency departments. Therefore, hospitals and governmental organizations should jointly aim to provide timely attention at reasonable costs. In the case of Barranquilla's Pubic Emergency Service Network, composed by 8 Points of care (POCs) and 2 hospitals, the trend evidences a continuous growing of the waiting time with a rate of 3,08 min/semester and a 93,13% likelihood of serving patients after waiting for more than 30 minutes. This is an unmistakable symptom of the network inability for satisfying the standards established by the Ministry of Health, which may trigger the development of more complex symptoms, increase in the death rate, requirement for more complex clinical services (hospitalization and intensive care unit) and increased service costs. This doctoral dissertation then illustrates the redesign of the aforementioned Public Emergency Service Network aiming at providing the target population with an efficient and highly timely service where both hospitals and governmental institutions effectively converge. It was then necessary to implement a 4-phase methodology consolidating a proposal oriented to the effective and sustainable development of network operations. First, the Public Emergency Service Network was characterized considering its current behavior in terms of demand and waiting time. A systematic literature review was then undertaken for identifying the methodological approaches that have been implementing for improving the waiting time and other performance indicators associated with the emergency care service. Following this, a methodology for the creation of efficient and sustainable emergency care networks was designed and later validated in the Southamerican Public network for lessening the average waiting time and ensuring the equitable distribution of profits derived from the collaboration. Ultimately, a multicriteria decision-making model was created for assessing the performance of the emergency departments and propelling the design of improvement strategies focused on bettering the response against the changing demand conditions, critical to satisfaction and operational conditions. The results evidenced that the patients accessing to the network tend to wait 201,6 min on average with a standard deviation of 81,6 min before being served by the emergency care unit. On the other hand, based on the reported literature, it is highly suggested to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for addressing this problem. In this sense, a methodology based on collateral payment models, Discrete-event simulation, and Lean Six Sigma was proposed and validated resulting in a redesigned network whose average waiting time may diminish between 6,71 min and 9,08 min with an average profit US$29,980/node. Lately, a model comprising of 8 criteria and 35 sub-criteria was designed for evaluating the overall performance of emergency departments. The model outcomes revealed the critical role of Infrastructure (Global weight = 21,5%) in ED performance and the interactive nature of Patient Safety (C + R = 12,771).Ortíz Barrios, MÁ. (2020). Redesigning the Barranquilla's public emergency care network to improve the patient waiting time [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/156215TESISCompendi

Assessment of Relative Technical Efficiency of Small Mental Health Areas in Bizkaia (Basque Country, Spain)

Mental disorders cause an enormous burden to society. Considering the current economic context, an efficient use of scarce inputs, with an appropriate outcome production, is crucial. This situation defines a classical Relative Technical Efficiency (RTE) problem. A well-known methodology to assess RTE is the Data Envelopment Analysis, although it presents some limitations. These may be overcome through a hybrid strategy that integrates Monte-Carlo simulation and artificial intelligence. This study aims to (1) design of a Decision Support System for the assessment of RTE of Small Mental Health Areas based on DEA; and (2) analyse 19 mental health areas of the Bizkaian Healthcare System (Spain) to classify them and to identify potential management improvements. The results have showed higher global RTE in the output-oriented orientation than in the input-oriented one. This suggests that a decision strategy based on improving the input management, within the ranges of the expert-driven model of community healthcare, could be appropriate. A future research line will focus our attention on the validation process through the analysis of micromanagement interventions and their potential impacts in the real system

TEA-IS: A hybrid DEA-TOPSIS approach for assessing performance and synergy in Chinese health care

YesThis paper presents an assessment of the Chinese healthcare system in 31 provinces for a 10-year period in light of relevant physical and human resource variables. First, a novel TEA-IS (Trigonometric Envelopment Analysis for Ideal Solutions) model is developed to assess healthcare efficiency at the province level. Machine learning methods are also employed to predict high-low performance and the synergistic Chinese healthcare province in terms of contextual variables. The results indicate that synergy has played a pivotal role in the Chinese healthcare systems, not only by triggering higher performance levels due to the progressive adoption of best practices over the course of time, but also by being closely related to different socioeconomic and demographic variables, such as the illiteracy rate. It is possible to claim that healthcare performance has remained stable in China over the past two decades, performance and synergy at the province level are still heterogeneous

HSE management system and efficiency evaluation of construction projects

The strategy of Belt and Road Initiative actively advocates the establishment of economic partnerships with countries along the belt and road, and makes infrastructure construction a field for preferential development. It provides good development opportunities for domestic and foreign engineering contracting enterprises. The "Strategic Implementation Guidance Document" mentions that infrastructure construction and operation should be green and efficient. However, most state owned engineering contracting enterprises do not attach importance to HSE management, which obviously affects the engineering efficiency and hinders the sustainable development of enterprises. However, China's engineering contracting enterprises pay less attention to HSE management, which obviously affects project efficiency and hinders the sustainable develop ment of enterprises. This study takes a typical large project contracting enterprise (Enterprise A) in China as the research object, adopts the SWOT analysis method, analyzes the weakness of project management at the organization level, and consummates th e organization level project HSE management system of the enterprise at the organization layer and the project layer. Through the enterprise interview, questionnaire design and investigation, this study puts forward the suitable indicators and methods of H SE management performance evaluation, and verifies the effectiveness of the methods through the empirical analysis of eight projects. Then, this study proposes incorporating the project HSE management performance into the comprehensive evaluation methods o f project efficiency. The empirical analysis shows that the HSE management system proposed in this study at the organization layer and at the project layer can improve the HSE management performance of the project. Project HSE management performance has a positive impact on project efficiency, that is, the more enterprises attach importance to project HSE management, the higher the degree of completion of project objectives. The above research results are helpful to improve project management system at the organizational level and enhance the competitiveness of project contracting enterprises.A estratégia da "Belt and Road Initiative" defende ativamente o estabelecimento de parcerias económicas com os países ao longo de uma determinada faixa e faz da construção de infraestruturas um campo preferencial para desenvolvimento. Este campo fornece boas oportunidades de desenvolvimento para as empresas de engenharia nacionais e estrangeiras. O "Documento de Orientação de Implementação Estratégica" menciona que a construção e operação de infraestruturas deve ser eficiente e sustentável. No entanto, a grande maioria das empresas públicas contratadas não atribuem a devida importância aos sistemas de gestão de saúde e segurança (HSE) o que, obviamente, afecta a eficiência da engenharia e dificulta o desenvolvimento sustentável das empresas. As empresas privadas chinesas de engenharia ignoram a gestão HSE o que, obviamente, afecta, também, a eficiência dos projetos de sustentabilidade das empresas. Neste trabalho foi considerada uma grande empresa Chinesa de contratação (Empresa A) na China como referência de pesquisa, que adota a análise swot, analisa as fraquezas na gestão de projetos ao nível da organização e consuma a gestão de projetos em HSE ao nível da organização e do projeto em si. Através de entrevistas, questionários e investigação, este projeto apresenta os indicadores e métodos a dequados de avaliação de desempenho e verifica a efetividade dos métodos através da análise empírica de oito projetos. Em suma, este projeto propõe incorporar métodos de avaliação da eficiência através dos indicadores de gestão do HSE. A análise empírica demonstrou que o sistema proposto de gestão HSE, ao nível da organização e de projeto, pode aumentar efetivamente a gestão de performance do HSE em projeto. A gestão da performance do projeto HSE teve um impacto positivo na eficiência do projeto, ou seja, quanto mais as empresas atribuirem importância à gestão de projetos HSE maior será o nível de conclusão dos objetivos sustentáveis do projeto. Os resultados deste projeto são úteis para melhorar o sistema de gestão de projetos ao nível organizacional e aum entar a competitividade das empresas na contratação de projectos