Authors: António Rocha; Ana Sara Costa; José Rui Figueira; Diogo Cunha Ferreira; Rui Cunha Marques

Abstract:The Portuguese National Health Service (SNS) was created to provide universal, equal, and tendentiously free care. There are different levels of care (primary, secondary, continued, and palliative) and all of them should deliver quality care services. Quality in healthcare is assessed according to several criteria, such as patient safety, care appropriateness or access. However, over the last years political and economic events have had an impact on the SNS. Hence, structural reforms have occurred, and new healthcare policies have been implemented, mostly focused on improving efficiency and reducing costs. It associated to divestment can increment barriers to access, compromise infrastructures and equipment, and, above all, the service’s quality. This work aims to assess quality of the Portuguese public hospitals (secondary care providers) in this line. To this aim, we adopt a multiple criteria decision aiding approach, applying the Electre Tri-nC method to build a decision model with intervention of an expert, who acts as the decision maker. Hospitals are assessed and assigned to predefined categories, taking into account the hospitals’ performances on various criteria. Each criterion is characterized by different subcriteria, resulting in a complex criteria tree. Thus, to construct a multidimensional scale for each criterion, we propose an innovative approach using an Electre Tri-based method. The results are analyzed and the robustness of the model is tested. This work’s findings may have potential application to healthcare policy and hospital funding in the SNS, in which financial sustainability is a permanent challenge.

Keywords: Quality; Hospitals; National Health Service; Electre Tri-nC; Multiple criteria Decision Analysis; Multidimensional scales

[Bibliographic reference] Rocha, A.; Costa, A. S.; Figueira, J. R.; Ferreira, D. C.; and Marques, R. C. (2021). Quality assessment of the Portuguese public hospitals: A multiple criteria approach. Omega. https://doi.org/10.1016/j.omega.2021.102505

About the journal: Omega reports on developments in management, including the latest research results and applications. Original contributions and review articles describe the state of the art in specific fields or functions of management, while there are shorter critical assessments of particular management techniques. Other features of the journal are the “Memoranda” section for short communications and “Feedback”, a correspondence column. Omega is both stimulating reading and an important source for practising managers, specialists in management services, operational research workers and management scientists, management consultants, academics, students and research personnel throughout the world. The material published is of high quality and relevance, written in a manner which makes it accessible to all of this wide-ranging readership. Preference will be given to papers with implications to the practice of management. Submissions of purely theoretical papers are discouraged. The review of material for publication in the journal reflects this aim.

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Authors: Juan Carlos Leyva López; Jesús Jaime Solano Noriega; José Rui Figueira; Jun Liu; Diego Alonso Gastélum Chavira

Abstract: Electre III is a well-known multiple criteria decision aiding method based on pairwise comparisons. However, it cannot be applied to ranking problems involving many alternatives, because the number of pairwise comparisons can then be rather large. In this paper, we present an evolution-based approach for exploiting large fuzzy outranking relations and deriving a crisp outranking relation with desirable properties. Therefore, the utilization of a fuzzy outranking relation is modeled as a three-objective optimization problem, which is solved by an evolutionary algorithm. The proposed ranking algorithm is a hybrid of the elitist non-dominated sorting genetic algorithm-II (NSGA-II) and a reference point method with the repeated use of a choice mechanism. In addition, a method that portrays the obtained ranking in a Hasse diagram is used for recommendation purposes. We designate the new method RP²-NSGA-II+H. In our experiments, the proposed ranking procedure demonstrates a better performance in terms of ranking error rates than other ranking procedures based on multi-objective evolutionary algorithms. Our experimental results also demonstrate that, with the new procedure, this method can be scaled for hundreds of alternatives.

Keywords:  Multiple criteria analysisFuzzy outranking relationsMulti-objective evolutionary algorithmsRanking proceduresElectre III

[Bibliographic reference] Leyva-López, J.C.; Solano-Noriega, J.J.; Figueira, J.R.; Liu, J.; and Gastélum-Chavira, D.A. (2021) Non-dominated sorting genetic-based algorithm for exploiting a large-sized fuzzy outranking relation. European Journal of Operational Research. [in press]. https://doi.org/10.1016/j.ejor.2020.12.026

About the journal: The European Journal of Operational Research (EJOR) publishes high quality, original papers that contribute to the methodology of operational research (OR) and to the practice of decision making. EJOR contains the following types of papers:

• Invited Reviews, explaining to the general OR audience the developments in an OR topic over the recent years;
• Innovative Applications of OR, describing novel ways to solve real problems;
• Theory and Methodology Papers, presenting original research results contributing to the methodology of OR and to its theoretical foundations;
• Short Communications, if they correct important deficiencies of papers previously published in EJOR.