A Fuzzy Decision-Making Model for the Key Performance Indicators of Hospital Service Quality Evaluation

Introduction

One of the major concerns of the healthcare industry all over the world is to provide better hospital service quality (Yucesan and Gul, 2020 Chang, 2014; Akdag et al. 2014; Taşkin et al. 2015). Management and delivery of hospital services are achieved in a competitive environment in Turkey. For this reason, to make better decisions, the services provided by the public and private hospitals should be assessed in terms of key performance indicators. According to the recent official figures, a number of healthcare facilities and infrastructures has been improved by the end of 2017. In the year 2017, the number of hospitals under the auspices of the ministry of health has increased compared to the previous year. Similarly, the number qualified beds have an increase of 14% by the year 2017 compared to 2016. Moreover, statistics for the indicators such as total number of intensive care unit beds, number of neonatal intensive care unit beds, number of hemodialysis centers, number of MRI, CT and Ultrasound devices in inpatient health care facilities, number of primary health care facilities, number of family health center medical examination rooms and number of ambulances have been improved at the year 2017 compared to the previous years. On the other hand, the utilization of healthcare services in Turkey has been made better (Republic of Turkey Ministry of Health, 2018). Despite the continuous increase in the number of patients admitted and the number of hospitals in Turkey, it does not have enough attempts about service quality evaluation according to hospital types. On the other hand, many people continue to receive health services from public hospitals, although private hospitals are increasingly located in the Turkish health care system. Therefore, a causal and effect decision-making model is needed in order to evaluate both public and private hospital service quality key performance indicators.

In this study, therefore, a multi-criteria decision-making (MCDM) model in evaluating hospital service quality criteria is presented. MCDM is an important field of management science, which clearly reflects multiple criteria in decision-making environments. It includes several kinds of methodologies for decision-makers and practitioners. MCDM based methods heavily include human participation and judgments (Kubler et al. 2016). It deals with evaluating, prioritizing or selecting alternatives under conflicting criteria with respect to decision-maker(s) preferences (Gul et al. 2016). The main mechanisms of an MCDM method are itemized as alternatives, criteria against evaluated alternatives, scores of alternatives on the criteria, and criteria weights reflecting the relative importance of each criterion as compared with others (Gul et al. 2016). DEMATEL is one of the MCDM methods applied to various fields, from manufacturing to the service sector. In healthcare service quality evaluation literature, researchers apply DEMATEL mostly to determine the importance weights of service quality criteria (Behdioğlu et al. 2019; Roy et al. 2018; Gul et al. 2014; Shieh et al. 2010). Since the decision-making process involves the vagueness of human judgments, a combination of fuzzy sets theory and the DEMATEL method is used in this study.